csss value of the at 2017 · 2014 fall 2014 spring 2015 fall 2015 spring 2016 ... key takeaways •...

TheValueoftheAthleticTrainer:theDollars,theLives,theDifference

RobertHugginsPhD,ATCVicePresidentofResearch

VicePresidentofAthletePerformance&Safety

YuriHosokawaPhD,ATCVicePresidentofEducation

VicePresidentofCommunication

“Whatisthemostcriticalthingthatweneedtokeepyouth

athletessafe?”

ProgressingTheValueofTheATTimeline

Spring 2014

Fall 2014

Spring 2015

Fall 2015

Spring 2016

Fall 2016

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KSI & NFL Meet

KSI and NFL meet. Question is asked“How do we as a nation improvehealth and safety in sport and getAthletic Trainers into schools?”

Insurance Data ObtainedCompanies provide KSIwith claims and injurydata

Value of ATs: Insurance PerspectiveDo ATs help reduce excessliability and medical costs?

NFL Hosts Optimization of Services MeetingAdditional companiesprovide data to KSI

Presence of AT ResultsATs not present during62% of deaths in thesecondary school setting

Value of ATs: Presence of the ATWhat medical coverage ispresent at the time ofsudden death?

NATA Financial SupportBuy in from NATA tosupport insurance project

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School districts with Fulltime Ats have 4x lessclaims and 2.5x less $

Preliminary Insurance Results

TheLivesIsthereanydatathatwecanobtainthatwouldhelptoshowthatAthleticTrainersinHighSchoolssavelives?

PresenceofAthleticTrainers,EmergencyActionPlans,andEmergencyTrainingattheTimeofSuddenDeathinSecondarySchoolAthletics

• Background:• Currentbestpracticesforthepreventionofsuddendeath(SD)duringsecondaryschoolathleticssuggest:• appropriateon-sitemedicalservices(e.g.athletictrainer)• venue-specificemergencyactionplans(vEAP)• basicemergencytrainingforcoaches

• NocomprehensiveretrospectiveanalysisofSDcasesinthissettinghasinvestigatedifappropriateon-sitemedicalserviceswereprovided,ifvEAPwerepresentandfollowed,orifcoachesutilizedtheiremergencytraining.

Purpose&Methods• Purpose:ToexaminecasesofSDduringsportatthesecondaryschoollevelanddescribeappropriatemedicalservices,emergencyplanning,andemergencytrainingatthetimeofthedeath.

• PatientorOtherParticipants:• Secondaryschoolswhoexperiencedasport-relatedSDduringatrainingorcompetitionsession

• NationalCenterforCatastrophicSportInjuryResearchdatabasefrom8/1/2000-7/31/2013.

• Representativesemployedatthetimeofdeathorwithextensiveknowledgeofthedeathwereaskedtoparticipate.

SecondarySchoolsfromNCCSIRDatabasefrom2000-2013

(n=279)

SecondarySchoolsResponding(n=134)

RefusaltoParticipate(n=16,12%)

Noknowledgeoftheevent(n=42,31%)

SecondarySchoolsIncluded(n=76,57%)

AthleticDirectors(n=67)

Principals(n=3)

Coaches(n=3)

AthleticTrainers(n=2)

Secretary(n=1)

ParticipationBreakdown

AppropriateMedicalPersonnelAreNotPresentAtAMajorityOfSuddenDeaths

• 62%(n=42)ofthesuddendeathsatthesecondaryschoolsdidNOThaveathletictrainingservices.

• Nomedicalservicesofanykindwerepresentat42% (n=32) ofthedeaths.

• ATswereemployedin61%(n=46)oftheschools,butnotpresentfor27%(n=17)ofthedeaths.

VenueSpecificEAPs(vEAPs)• OverallvEAP Presence

• 66%(n=50)ofschoolshadvEAPs inplace• 44%(n=26)ofschoolsdidNOThavevEAPs inplace

• OfschoolswithAthleticTrainingservices(n=46)• vEAPs werepresentin74%(n=34)oftheschools• vEAPs werenotpresentin26%(n=12)oftheschools

• WhenvenuespecificEAPswereinplace,itwasfollowed100%ofthetime!• ThosewithoutvEAPs inplace(n=26),38%(10/26)remaintodaywithoutavEAP!

EmergencyTraining

• Insuddendeathcases78%(n=59)ofcoachesreceivedemergencytraining

• Thistrainingwasappliedin58%(n=34)ofdeaths

KeyTakeaways• 62%ofthedeathsdidnothaveappropriateon-siteathletictrainingservicespresent.• Medicalserviceswerenotpresentin42%ofSDcases.• WhenvEAP wereinplace,theywerefollowed.• AlthoughmedicalpersonnelandvEAP werepresentin~60%ofcases,thedeathwasnotprevented.• Detailedcase-specificinformationtoidentifyunderlyingmedicalcauseofdeathandopportunitiesforimprovingpreventionandcareproceduresareneeded.

TheDifferenceWhatpercentageofschoolshaveATs?HowareAthleticTrainingservicesimprovingthroughoutthecountry?Wherecanwemakeadifference?

November2016 March2017

Purpose(s):

1. Createareal-timedatabaseofathletictrainingservicesinsecondaryschools

2. Createadirectoryforeachstate’sathletictrainingassociationandhighschoolathleticsassociation

3. Assiststatesinmovingtowardfull-timeathletictrainingservices4. Provideusefuldatatoeachstate’sathletictrainingassociationandhigh

schoolathleticassociation5. Identifycommonfactorsassociatedwithincreasedathletictraining

servicesacrossthecountry.6. Improvethedeliveryofhealthcareservicesviaimprovedcommunication

betweensecondaryschools

DataAcquisitionProcess

ATLASMasterDatabase

1.NATABenchmark StudyDatabase

• Originaldatabase• Called 24,000schoolspublic&private• ~50%responseratenationwide• Upto4yrs old

2.NationalCenterforEducationStatisticsDatabase

• FederalReporting• Title1,students,teacher:student ratio• Locale:urban,suburban

3.IndividualStateData• ProvidedbySSCChair• StatefilesarerefinedwithhelpfromSSCmembers

• Mergedwithmasterdata

4. ATLASSurvey• Marketing• Twitter,Facebook,NATAROM,NATANews

• WordofMouth• DistrictMeetings• PhoneCallswithStateLeaders• ProgramDirectors• EmailstoAT StatePresidents

Mergedwith

PastProcess

CurrentProcess

Mergedwith

ATLASProjectWebofConnectivity

NATASSC•StrategicInitiatives

•ATValueModel•SafeSportSchools

StateATAssoc.

•Legislative•Healthcare•Communication

StateHighSchoolAthAssoc.

• SafetyPolicies• Improvemedservices

NATA&NFL

InsuranceProject•ATServices

AnalysisStatePolicyJustification

AssistotherAssociations• AMSSM• StateHSAssoc• NFHS

AT ServicesInNeedBasedAreas• Title1Schools

MarketingCompanies• Gatorade• J&J

ATLASProvides:1. ComprehensiveListofAT

Services2. Evidencetosupportbest

practiceimplementation(EAPs)

3. Sportscovered4. Physiciansupervision5. Physiciancredentials6. ATcredentials/licensure7. AThiringtrends(overtime)8. ThresholdsforFTandPT9. ComparisonsbetweenFT&

PT10. DirectoryforATs

SummaryPoints(30,000ft view)

• 2016-2017PrimaryGoals• Removeallunknownschools(blackdots)ineachstateontheATLASmaps• Getto8,000surveysbyJune2017

• ATLAS“Mapping”isshowinggreatprogress:• June=14,888àDec=11,752àMar=15,973• Overall%Mapped:June=44%à Dec=53%àMar=71%

• ATLASSurveycontinuestoshowgreatprogress:• June2016(5Ksurveys)àDec2016(6,600Ksurveys)àMarch2017(7,000surveys)

• ThesuccessofATLASProjecthingesupon:• completionofthesurveys• assistancewithmappingbykeyleadersatthestateanddistrictlevel

• KSIhasreachedouttoeachstate’sSSCmemberforassistance

ATLASResultsAsOf6:45amToday• 71%ofthenation’shighschoolsaremapped(n=15,973/22,589)

• 43%ofschoolswithATserviceshavecompletedthein-depthATLASsurvey(n=4,828/11,282)

• 50%ofschoolshaveathletictrainingservices(n=11,282/22,589)

Overall:• 27%ofschoolshaveFullTimeservices(n=6,022/22,982)• 23%ofschoolshavePartTimeservices(n=5,260/22,982)• 21%ofschoolshaveathleticswithNOATservices(n=4,770/22,982)• 29%ofschoolremainunknown(n=6,509/22,589)

HowareAthleticTrainershiredNationally?

NATAAbstract2017EmploymentofAthleticTrainersInSecondarySchools:TheATLASProject

Objective:ToquantifycurrentemploymentprovidersofATservicesinthesecondaryschoolsettingnationwide.

Results:27%EmployedSchoolDistrictEmployee16%SchoolDistrictEmployeeTeacher51%Medical/UniversityEmployee6%IndependentlyContracted

• Background• Previousresearchofsecondaryschooladministratorshasdeterminedthat:

• 70%ofpublicschoolshaveaccesstoanAT• 58%ofprivateschoolsnationwidehaveaccesstoanathletictrainer.• 37%ofpublicreportedhavingfulltimeATservices• 28%ofprivateschooladministratorsreportedhavingfulltimeATservices.

• Howeverspecificinformationreportedfromathletictrainersregardingtheirspecificemployerhasnotbeendocumented.

Methods• Objective:ToquantifycurrentemploymentprovidersofATservicesinthesecondaryschoolsettingnationwide.• Design: Longitudinal,survey-basedquestionnaire.• Setting: Public,private,charter,magnet,specialeducationandalternativesecondaryschoolsintheUnitedStates.• Participants:Secondaryschool certified athletictrainers.• Interventions: SecondaryschoolATscompletedanonlinequestionnairefromJune2015toNovember2016.

FullTimevs.PartTime• Full-timeservicesweredefinedasallofthefollowing:

• ATservicesprovidedtoonly1school• ³5daysperweek• ³30hoursperweek• ³10monthsperyear.

• Part-timeservicesweredefinedasanythinglessthanFT.• Athletictraineremploymentstatuswascollectedandsplitintofourcategories:• schooldistrictemployees(SDE)• schooldistrictemployeeswithteachingresponsibilities(SDET)• medicaloruniversityfacilityemployees(MUE)• independentcontractors(IC).

Results• Athletictrainers(n=3836)from50statesandoneprovincerespondedtothesurvey.• 81%(n=3136/3836)workedinpublicschools• 16.69%(n=627/3836)inprivateschools• 1.9%(n=73/3836)incharter,magnet,specialeducationandalternativeschoolscombined.

Employer• 27%(n=1052/3836)ofathletictrainersareSDE• 16%(n=630/3896)areSDET• 51%(n=1965/3836)areMUE• 5%(n=189/3836)areIC.

Results• 43%employedbytheschooldistrict(SDE+SDET)• 57%whileamajorityofathletictrainerswerenotemployedbytheschooldistrict(MUE+IC)• 76%(n=2918/3836)ofathletictrainersreportedworkingFT.

• OftheFTathletictrainers,31%(n=908/2918)wereSDE,• 18%(n=515/2918)wereSDET• 48%(n=1389/2918)wereMUE• 3%(n=97/2918)wereIC.

• 24%oftheathletictrainersreportedworkingPT• 16%(n=144/917)wereSDE• 12%(n=115/917)wereSDET• 62%(n=576/917)wereMUE• 10%(n=92/917)wereIC

KeyFindings• AthletictrainersemployedbyamedicaloruniversityfacilitytoprovideATservicestothesecondaryschoolwasthemostcommon,followedbyemploymentthroughtheschooldistrictwithoutteaching,schooldistrictwithteachingresponsibility,andindependent.• Nationally,itismorecommonforanATtobehiredfromanoutsidesource(MUE+IC)thanbytheschooldistrict(SDE+SDET).• Thesedatawillenhanceknowledgeofandidentifycurrentemploymentmethodsforschooldistricts/organizationslookingtohigheranATinthehighschoolsetting.

TheDollarsWhatisthevalueoftheathletictrainerfromtheinsuranceperspective?

Entity State&SchoolDistrict Parent InsuranceProviderAssociatedCosts

• CatastrophicPremium(StateCost)

• LiabilityPremium(SchoolDistrict)

• ExcessMedicalPremium(SchoolDistrict)

• Co-pays• %ofmedicalcarecostfor

specialist• %ofmedicationcost

• %ofclaims(Dependingonplan)

• Operating/processingclaimscost

Goals&Expectations

• Reducepremiumcost• Decreasespending• Minimizeliability• Improvesafety• Reducecostto

parent/community

• Reduceout-of-pocketspending.• Haveschooltopayif

liable• SafeEnvironmentfor

children

• Providecoveragebasedonexpectedmedicalcosts/risk

• Reducenumberofclaimspaidout

• Claimsnottoexceedpremium/limitsofcoverage

PositiveBenefitsofanAthleticTrainer

• Reducepremiumcostfor• LiabilityInsurance?• ExcessMedical?• Catastrophic?

• Decreasedschoolliability• Improvedsafety&athlete

care• Compliancewithleague

recommendations• Decreasedcosttoparent

• Decreasedunnecessarycostsfor:

• VisitstoER• Emergencytransport• Rehabilitativecostsfor:

• PreandPostsurgery

• Decreasednumberofunnecessaryclaimsfor:Excessmedical,catastrophic,liability?

• Decreasedlevelofriskatschool=lesslikelytohavepreventablecatastrophicclaim?

Goals

SchoolDistrict

Reducepremiumcost

Decreasespending

Minimizeliability

Improvesafety

Reducecost toparentandcommunity

Parent

Reduceout-of-pocketspending

Haveschoolpaythecost,ifliable

Safeenvironmentforchildren

InsuranceProvider

Providecoveragebasedonexpectedmedicalcostandrisk

Reducenumberofclaimspaidout

Claimsnottoexceedpremiumorlimitsofcoverage

Hypothesis

• Preventable(unnecessary)numberofsecondaryinsuranceclaimsareobservedinschoolswithnoathletictrainingservice.• Anydifferencebetweenfulltimevs.parttimevs.noservice?

Methods

• Datafromtwosecondaryathleticsinsurancecompanies• Claimsdatawithdetailsonthemedicalserviceprovided• CompanyA:August,2010- July,2015(i.e.,4academicyears)• CompanyB:August,2012- July,2014(i.e.,2academicyears)

• AthletictrainingservicedatafromATLAS• DatafromwhatwasreportedbyJanuary,2017

Sampling• Datafrom476insurancepolicyholders• 22states

• 32%ofthedataarefromPennsylvania• 26%ofthedataarefromNewJersey

• CompanyA• Fulltime:233• Parttime:83• None:111

• CompanyB(alldatafromPennsylvania)• Fulltime:44• Parttime:6

Table1.SampleDemographics

FullTime PartTime NoneAR 5 1 8CT 13 36 2DE 5 2 0FL 1 0 4GA 2 3 5IN 1 0 0KS 1 0 0KY 3 2 14LA 2 10 1MA 4 2 8MO 0 0 1MS 0 1 11NC 0 2 3NJ 109 2 12NY 0 0 1OH 0 0 2PA 112 18 21SC 14 7 13TN 0 1 1TX 4 2 1VA 0 0 2WV 0 0 1Total 276 89 111

AthleticTrainingServiceNumberofPolicyHolders

AnalysisbyService:Overview• Ambulance

• Anesthesia

• Dentalinjury

• Diagnostic/image/labtests

• Emergencyroom

• Equipment/supplies

• Injection

• Prescription

• Outpatient

• Physician

• Rehabilitation/treatment

• Specialistconsultation

• Surgery

AverageNumberofServiceClaimsSubmittedperPolicyHolder

AverageCostPaidperPolicyHolder

FullTime 498.42 $78,027.06PartTime 532.28 $72,090.55None 629.24 $104,403.69

AverageNumberofServiceClaimsSubmittedperPolicyHolder

AverageCostPaidperPolicyHolder

FullTime 54.32 $39,063.13PartTime 161.667 $38,829.45

CompanyB:2academicyearscumulative

CompanyA:4academicyearscumulative

AnalysisbyService:CompanyA• Ambulance

• Anesthesia

• Dentalinjury


• Emergencyroom


• Injection

• Prescription

• Outpatient

• Physician



• Surgery

• Ambulance

• Emergencyroom



• Anesthesia

• Injection

• Surgery

• Dentalinjury


• Prescription

• Outpatient

• Physician


ACUTECARE

SURGICALPROCEDURE

DIAGNOSISANDMANAGEMENT

PHYSICIANANDSPECIALISTVISIT

AnalysisbyService:AcuteCare

Ambulance,1.8

Ambulance,1.8

Ambulance,1.7

EmergencyRoom,8.34

EmergencyRoom,6.29

EmergencyRoom,10.11

0 5 10 15

None

PartTime

FullTime

AverageNumberofAcuteCareClaimsSubmittedperPolicyHolder

FULLTIME:233PARTTIME:83NONE:111

AnalysisbyService:AcuteCare

Ambulance$142.08

Ambulance$186.68

Ambulance$235.88

EmergencyRoom$118.86

EmergencyRoom$84.31

EmergencyRoom$100.00

$0.00

$50.00

$100.00

$150.00

$200.00

$250.00

FullTime PartTime None

MedianClaimCost


AnalysisbyService:SurgicalProcedure

Anesthesia 10.83

Anesthesia 10.17

Anesthesia 7.85

Injection 3.06

Injection 3.46

Injection 2.38

Surgery 45.31

Surgery 41.88

Surgery 32.3

0 10 20 30 40 50 60

None

PartTime

FullTime

AverageNumberofSurgicalProcedureClaimsSubmittedperPolicyHolder


AnalysisbyService:SurgicalProcedure

Anesthesia$131.76 Anesthesia

$115.74

Anesthesia$135.52

Injection$17.77 Injection

$7.32

Injection$21.97

Surgery$205.00

Surgery$167.00

Surgery$176.99

$0.00

$50.00

$100.00

$150.00

$200.00

$250.00


MedianClaimCost


AnalysisbyService:DiagnosisandManagement

Diagnosis,Image,LabTests,81.85



RehabilitationandTreatment,280.4



0 50 100 150 200 250 300 350

None

PartTime

FullTime

AverageNumberofDiagnosisandManagementClaimsSubmittedperPolicyHolder


AnalysisbyService:DiagnosisandManagement

Diagnosis,Image,LabTests,$36.00 Diagnosis,Image,LabTests,

$33.98Diagnosis,Image,LabTests,

$34.39

RehabilitationandTreatment,$31.03



$0.00

$10.00

$20.00

$30.00

$40.00

$50.00


MedianClaimCost


AnalysisbyService:PhysicianandSpecialistVisit

DentalInjury4.02

DentalInjury4.59

DentalInjury3.78

EquipmentandSupplies,28.77



Prescription5.79

Prescription3.53

Prescription3.08

Outpatient,27.5

Outpatient,25.49

Outpatient,30.57

Physician,125.48

Physician,123.98

Physician,110.2

SpecialistConsultation0.95



0 50 100 150 200

None

PartTime

FullTime

AverageNumberofPhysicianandSpecialistVisitClaimsSubmittedperPolicyHolder


AnalysisbyService:PhysicianandSpecialistVisit

DentalInjury$93.50

DentalInjury$92.00

DentalInjury$75.04

EquipmentandSupplies$45.23 EquipmentandSupplies

$40.00

EquipmentandSupplies$41.37

Prescription$10.00

Prescription$10.00

Prescription$14.99

Outpatient$120.00

Outpatient$220.61

Outpatient$217.55

Physician$44.00

Physician$40.00

Physician$43.25

SpecialistConsultation$101.97



$0.00

$50.00

$100.00

$150.00

$200.00

$250.00


MedianClaimCost


Limitations

• Notalltypesofinjurieshappenatconstantrateforallschools• Ouranalysisistheaverageoffouracademicyears

• Noinformationonprimaryinsuranceclaims• Analysisperpolicyholder(schooldistrict)notbyindividualschool

Conclusions• Four-yeardataoninsurancedatademonstratedthatthenumberofclaimsandaveragecostwerehighestinschoolswithnoathletictrainer.

• Frequenciesofaverageserviceclaimswerelowestinfulltimewhentheserviceswererelatedto(1)surgicalprocedure,(2)diagnosisandmanagement,(3) physicianandspecialistvisit.

• Highestnumberwasobservedinfulltimeforacutecarerelatedserviceclaims,probablyduetotheenhancedrecognitionofinjuriesthatwarrantfurthercare.

AnalysisbyService:Ambulance

Exertionalillness30%

Concussion22%

Dehydration22%

Fracture11%

Anaphylaxis3%

Asthma3%

Dentalinjury3%

Headtrauma3% Laceration

3%

FULLTIME

359/395casesunknowndiagnosis

Concussion43%

Dehydration29%

Dentalinjury9%


Other5%

PARTTIME



Concussion28%

Fracture29%

NONE


AnalysisbyService:Anesthesia

Fracture48%

ACLtear21%

Dentalinjury11%

Pain

5%

FULLTIME


Dentalinjury27%

ACLtear20%

Fracture20%

Dislocation13%

Concussion6%

Fracuture7%

Subluxation7%

PARTTIME


Fracture34%

ACLtear13%Dentalinjury

13%

Dislocation13%


Concussion7% Meniscus

tear7%

NONE


Fracture30%

Concussion28%

ACLtear15%

Dentalinjury6%

PARTTIME

Concussion37%

Fracture21%

Dentalinjury12%

Sprain/strain9%

Exertionalillness8%

NONE

AnalysisbyService:Diagnostic/Image/LabTests

Fracture35%

Concussion32%

Sprain/strain5%

FULLTIME

13807/14174casesunknowndiagnosis 5632/5769casesunknowndiagnosis 8969/9085casesunknowndiagnosis

AnalysisbyService:EmergencyRoom

Dentalinjury29%

Concussion27%

Laceration16%

Fracture12%

Exertionalillness8%

FULLTIME


Dentalinjury34%

Concussion24%


Fracture12%

Dehydration9%

PARTTIME


Concussion40%

Dentalinjury29%

Laceration12%

Fracture10%

Exertionalillness7%

NONE


AnalysisbyService:Equipment/Supplies

Fracture47%

ACLtear18%

Sprain/strain10%

Dislocation8%

Concussion6%

FULLTIME


Fracture46%

Concussion28%

ACLtear16%

PARTTIME


Fracture65%

Sprain/strain18%

Concussion5%

NONE


AnalysisbyService:Injection

Dentalinjury40%

ACLtear20%

Concussion20%

Dislocation20%

FULLTIME


Menisuctear78%

Fracuture11%

Subluxation11%

PARTTIME



Meniscustear50%

NONE


AnalysisbyService:Prescription

Concussion29%

Paralysis25%

Dentalinjury18%

Infection12%

Fracture10%

ACLtear6%

FULLTIME


Dentalinjury62%

ACLtear15%

Internalbleeding15%

Concussion8%

PARTTIME


Fracture38%

Dentalinjury31%

Infection25%

Exertionalillness6%

NONE


AnalysisbyService:Outpatient

Concussion38%

Fracture22%

Dentalinjury7%

Laceration6%

Exertionalillness6%

Sprain/strain5%

FULLTIME


Concussion32%

Dentalinjury17%Exertional

illness10%

Fracture10%

Laceration9%

Sprain/strain8%

PARTTIME


Concussion32%

Dentalinjury14%

Laceration13%

Fracture10%

Exertionalillness7%

ACLtear5%

Overuse5%

Dehydration5%

NONE


AnalysisbyService:Physician

Concussion64%

Fracture10%

ACLtear5%

FULLTIME


Concussion59%

Fracture10%

ACLtear8%

Dentalinjury7%

PARTTIME


Concussion59%

Fracture7%

Sprain/strain7%

Dentalinjury6%

NONE


AnalysisbyService:Rehabilitation/Treatment

ACLtear31%

Sprain/strain21%

Concussion20%

Fracture9%

FULLTIME


Fracture25%

ACLtear21%

Concussion16%

Sprain/strain9%

Tendonitis7%

Separation7%

Dislocation5%

Meniscustear5%

PARTTIME


Concussion22%

Overuse21%

Fracture18%

Sprain/strain12%

Pain

6%

Dentalinjury6%

ACLtear5%

NONE


AnalysisbyService:SpecialistConsultation

Concussion63%

Fracture11%

Laceration11%

Dentalinjury5%

Dislocation5%

Sprain/strain5%

FULLTIME


Concussion100%

PARTTIME


Concussion100%

NONE


AnalysisbyService:Surgery

Fracture45%

ACLtear13%

Dentalinjury11%

Sprain/strain9%

Laceration7%

Dislocation5%

FULLTIME


Fracture38%

ACLtear16%

Dentalinjury15%

Meniscustear9%

Concussion6%

Dislocation6%

Fracuture5%

PARTTIME


Fracture36%

Dentalinjury20%

Overuse19%

Laceration10%

NONE


csss value of the at 2017 · 2014 fall 2014 spring 2015 fall 2015 spring 2016 ... key takeaways •...

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