Background: When medical coverage does not exist at games and practices, coaches are often responsible for the management of acute conditions. The question that arises is whether they make proper medical decisions concerning the health and safety of their athletes. The purpose of this study was to assess high school head coaches' decision-making skills related to acute medical condition management through the use of case scenarios.
Methods: A cover letter/web link to the web-based survey was e-mailed to all 2008-2009 school year South Dakota high school head athletic coaches.
Results: Head coaches were found to be responsible for the immediate care of injured athletes at practice (87.2 percent) and home competitions (72.3 percent). Less than 75.0 percent of coaches reported feeling "prepared" or "somewhat prepared" to handle 11 of the 16 types of acute athletic injuries and medical conditions presented, with less than 75.0 percent of coaches giving "appropriate" or "overly cautious" responses to eight of the 17 cases. Little to no relationship was found between perceived level of preparedness for treating various conditions and appropriateness of responses. A significant difference was found in appropriateness of decisions based on level of athlete (68.9 percent starters, 79.3 percent non-starters) and event situation (66.5 percent important events, 76.6 percent non-important events).
Conclusions: In South Dakota, high school coaches are most often responsible for the initial management of acute injuries; yet, a large percentage of coaches did not feel "prepared" to manage various conditions and/or gave "inappropriate" responses to multiple cases. Furthermore, the level of athlete and the event situation may influence coaches' decisions. Further education may include the proper management of head and neck injuries, multiple concussions, dislocations, heat emergencies, eye injuries and internal organ injuries. Health care workers can be an integral part of training coaches in the care of acute conditions, as well as providing practice and event coverage.