Most U.S. High Schools Have No Full-Time Athletic Trainer on Staff

Only 37% of U.S. public high schools employ a full-time certified athletic trainer, and roughly one-third of secondary schools have no access to an athletic trainer at all. Approximately 5.9 million high school student-athletes may lack immediate access to a healthcare professional when they are injured during practice or competition. This matters because athletic trainers are the first responders for sports injuries, from concussions to heat stroke to sudden cardiac arrest. Without one present, a coach or parent must make triage decisions they are not trained for. When a concussion goes unrecognized, as studies show up to 50% do without an AT present, the athlete returns to play too early, risking second-impact syndrome, which can cause permanent brain damage or death. When a cardiac arrest happens and no AT is there to activate an emergency action plan and use an AED, survival rates drop dramatically: from 83% with an AT on-site to under 50% without. The downstream consequences compound. Schools without ATs see higher injury rates, longer recovery times, and more athletes who quit sports entirely due to mismanaged injuries. Parents in these districts face unexpected medical bills because injuries that could have been prevented or treated on-site instead become emergency room visits. Rural and low-income communities are disproportionately affected: almost 8 in 10 schools with low AT availability are in rural or inner-city areas. This problem persists because no U.S. state mandates that high schools employ an athletic trainer. Of the 48 states surveyed in 2024, 37 (77%) had no sideline medical coverage mandate of any kind. School boards view athletic trainers as a budget line item rather than a safety requirement, and athletics budgets prioritize coaching salaries, equipment, and facilities over healthcare staffing. The structural root cause is that high school sports governance treats medical coverage as optional rather than as a prerequisite for fielding a team.