Student athletes need access to health care professionals, better-trained coaches and up-to-date equipment, a coalition of groups recommended Wednesday in a call to action aimed at protecting the almost 8 million students participating in high school sports each year.
The Youth Sports Safety Alliance of more than 100 organizations released the proposed rules, which call for health providers such as athletic trainers or doctors available for every school, warnings about performance-enhancing substances for athletes and the creation of a national registry to track student athlete deaths. The rules also would require schools to have clean and well-maintained facilities, and require students to have a pre-season physical exam, including testing for some of the 400,000 concussions students suffer annually.
Many of the proposed requirements are already standard practice, state athletic officials said. The biggest hurdle, however, is medical care.
Only 42 percent of high schools have access to an athletic trainer and 47 percent of schools even come up short on the federally recommended nurse-to-student ratio.
"You get into schools with less than 30 kids in the schools, they're not going to have the money," New Hampshire Interscholastic Athletic Association executive director Patrick Corbin said. "They're lucky if they can find a physician in those places."
In his state, for instance, schools are required to have medical care for students during games and practice. But that can range from an on-site physician in the densely populated southern part of his state to a cellphone to call an ambulance in the rural north.
Additionally, a student athlete in New Hampshire can use a freshman-year physical exam for all four years of competition.
"In some of these places, good luck affording and finding a physician to do one," he said.
Organizers called their "Secondary School Student Athletes' Bill of Rights" the first comprehensive and national plan aimed at protecting students who participate on their schools' teams. The group is urging each state athletic association to adopt their blueprint.
While state athletic officials agreed with the premise of protecting students, logistical and financial challenges were clearly visible. Every state is on its own to put in place rules for its student athletes and athletic trainers aren't always a priority amid tight school and state budgets; the U.S. Bureau of Labor Statistics reports a $41,600 median salary for athletic trainers.
In Ohio, students already are meeting many of the requirements, said Deborah Moore, associate commissioner of the Ohio High School Athletic Association.
"It's not a requirement but most high schools have access to athletic training services," she said, noting the larger schools have athletic trainers on staff and smaller ones have contracts with local hospitals or rehabilitation facilities.
It's the same in Colorado, said Bert Borgmann, an assistant commissioner with the Colorado High School Activities Association.
In some cases, coaches step in.
"Coaches pick up the important aspects of athletic training because they know their responsibility is the kids on the floor and the kids on the field," Borgmann said. "You rarely, if ever, find a coach who is in this who is in this to hurt kids."
Texas, the state with the largest number of student athletes, already is following most of the advocates' requirement. Each school district is required to have a concussion-prevention program led by at least one medical professional but does not require schools to have an on-staff athletic trainer.
California, the state with the second largest number of student athletes, comes up short on the advocates' demand for on-site athletic trainers but officials there have considered it amid the state's budget crisis.
That's not enough for advocates.
"You wouldn't put a football team out on the field if you don't have enough money to buy helmets," said Dawn Comstock, an expert on school sports who teaches at the Colorado School of Public Health. "Why are you putting a football team on the field if you don't have enough money to hire a fulltime certified athletic trainer?"
Others objected to coaches setting the rules for the more than 7.6 million students who played high school sports last year and scores more who played on club or private-league teams.
At least 34 student athletes died that year, the alliance said.
"In most states, the state high school athletic associations control all the health and safety policies for our student athletes," said Douglas Casa, an expert on sudden deaths in sports and a professor at the University of Connecticut who helped write the proposed rules. "That should scare a lot of people in this room. If you had a family member with cancer, would you seek out a coach for advice? Their opinion on health and safety issues is not relevant."
Some 400,000 concussions occurred in high school sports during the 2008-09 school year. More than 7.5 million students played that year, the National Federation of State High School Associations reported.
Thirty-nine student athletes died in 2011 and 49 in 2010.
The decline is in part because 43 states have passed laws that require a doctor's note before an athlete returns to play after a concussion injury.
But while the total number of injuries has fallen, the rate of concussions has risen, leading to long-term health risks for these athletes.
"Think about this: You get an injury in the NFL, you have two guys at your side right away," said Christopher Nowinski, the co-director of the Center for the Study of Traumatic Encephalopathy at Boston University's School of Medicine.
That is seldom the case in high school fields, where more students die than in college or professional competitions.
"We do not provide a single professional medical person to half of high schools," the former Harvard football player and WWE professional wrestler added.