The ability to diagnose and treat injuries has improved for college and professional athletes - something that cannot be said for high school athletes. Yet, high school athletes comprise the largest group of athletes, with about 1 million playing football in the US.  Injury rates among high school football players ranges between 21% to 50%.  Another interesting statistic is that between 27% and 82% of high schools do not have a physician at high school football games - the differences in these estimates based partially on whether one is studying high schools in wealthy or impoverished communities. 

This study evaluated available medical coverage at home football games in 77 schools of the Chicago Public School system, by asking (mail, fax and telephone) about the presence of health professionals and of staff knowledgeable in First Aid and cardiopulmonary resuscitation. 

Eighty percent of schools had a football team, and of these 11% had a physician cover home varsity games.  This amounted to 5 physicians (4 family physicians and 1 orthopedic surgeon).  Eight percent of schools had an athletic trainer present, and 90% had paramedics at the games.   No school arranged for an ambulance to be on site during games, but some had ambulances ‘on call’.  89% of coaches were certified in CPR and First Aid.  In 46 of 47 schools, coaches were the only ones available on site for medical problems. 

The authors point out that physicians who attend these games often have high liability insurance costs associated with this practice - and they are difficult to afford.  Additionally, many physicians are not given adequate musculoskeletal injury education and do not feel comfortable covering games. 

(Tonino PM, Bollier MJ.  Physician and Sports Medicine 2004; 32(2):37-40). 

Comment:  There was no mention of school nurses anywhere in this article.  It is possible that school nurses were simply forgotten as potential health professionals attending games and/or practices (it wouldn’t be the first time), or perhaps the survey simply reflected that in Chicago Public Schools, school nurses are not performing this function.  I would be interested in knowing whether the presence of a physician made any difference to these very worrisome injury statistics or the outcomes of these injuries.  - H.T.