The Role of Athletic Trainers in the Public Safety Employment Setting

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April 3, 2019

By Lisa Limper, MS, CSCS, ATC

Athletic Trainers (ATs) have moved into the realm of public safety employment setting. A growing number of fire and police departments throughout the country are beginning to recognize the benefits of using ATs in their care plans for injured personnel.

Firefighters and police officers have a higher risk of incurring a work-related injury than most other occupations. According to the United States Department of Labor, the primary injuries to firefighters are back and shoulder pathology and police officers tend towards back and upper extremity injuries.1 Additionally, both departments have an increased risk of cardiac incidents. From 2008-2017, there were 473 firefighter line of duty deaths due to heart attacks from overexertion on the fireground.2These are largely preventable through lifestyle modifications. Due to this increased risk of injury, ATs provide value by assisting with prevention, assessment and rehabilitation programs.

In a 2009 National Athletic Trainers’ Association (NATA) survey of a variety of industrial companies that had an AT on-site and kept return on investment (ROI) data, more than 90 percent of respondents showed that missed days of work decreased by 25 percent or more, emergency room costs reduced by 50 percent or more, and over half reported a decrease in costs associated with workplace injuries.3

In her white paper, Reducing Law Enforcement Costs Utilizing the Sports Medicine Model, Nancy C. Burke, MS, ATC, VATL from the Fairfax County Police Department sets out the effectiveness in her department’s usage of ATs to rehabilitate injured police officers. She writes, “Utilizing an Athletic Trainer in an Academy setting has been proven to reduce overall medical costs by 49.5% and musculoskeletal medical costs by 86.3%. The Athletic Trainer treating sworn and civilian employees in a large county police force has shown reductions of overall medical costs by 22.05%, musculoskeletal medical costs by 21.2%.”4

San Antonio Fire Department (SAFD) has a similar program. The department website states, “The utilization of an Athletic Trainer within the department has decreased healthcare costs and returned personnel back to duty quickly and safely.”5 In a departmental study to determine the efficacy of an internal employee health program with in-house access to assessment and rehabilitation services provided by the Athletic Trainer, the researchers reported a greater than 50 percent decrease in lost work days. After the initial 9 months of the program in 2016, the SAFD documented $593,682.59 in cost savings; the initial capital outlay for equipment and annual salary at approximately $94,000 was recovered within the first quarter, which more than justified the creation of the full time AT position.6

Luis Rivera, PT, ATC took incorporating ATs into a fire department’s care plan a step further by incorporating them into a narrow concierge network. Rivera drew on his many years of experience with collegiate, professional and clinical athletic training and physical therapy programs to team up with the Milwaukee Fire Department. He formed Tactical Athlete Health Performance Institute (TAHPI) based on the model of care that collegiate athletes receive. Rivera’s teams in 6 cities, which includes ATs, physicians and physical therapists, have worked to reduce lost duty time and decrease costs of rehabilitating injured firefighters. Their results have been hugely successful. In 2017, the Milwaukee Fire Department saved $500,000 in emergency room visits alone by utilizing their full-time AT, and in their first year of operation in Memphis, their AT saved the MFD $1.3 million in overtime costs.7

In all of the programs mentioned, the availability of an AT to immediate assess injuries and begin treatment benefits firefighters and police officers. The number of emergency room visits decreases, little time is lost waiting for appointments, and therapy costs are decreased. When the AT feels that the patient is ready, they can administer performance testing to ensure that the patient is prepared to return to full duty. This reduction in medical costs and lost duty days reduces overall costs while simultaneously increasing the quality of care.

Beyond the rehabilitation aspect, there is much potential for ATs to partner with fire and police departments in the push towards including health and safety in the curriculum and training for public safety occupations. In a conversation with Gamaliel Baer, the Health and Wellness Coordinator, and Mike Goldsmith, the Department Specialist with the Howard County Fire and Rescue in Maryland, they described their new comprehensive health and wellness curriculum for their 26-week fire academy. Up until 2018, the department did not have a commitment to health and wellness, and normally included only about 2 hours of health topics. Their new program has 24-hours dedicated to health and wellness programming including training, sleep, nutrition and hydration. Since ATs have an extensive background in topics such as these, they may consider contacting their local police or fire departments or academies to arrange a similar partnership.8


1. US Department of Labor, Bureau of Statistics, Firefighter Factsheet, July 2013.

2. US Fire Administration, Firefighter Incident Report.

3. NATA Press Release. Nov. 4, 2014.

4. Reducing Law Enforcement Costs Utilizing the Sports Medicine Model, Nancy C. Burke, MS, ATC, VATL.

5. San Antonio Fire Department Official Website.

6. The Cost Efficiency of Athletic Trainers.

7. Personal interview with Luis Rivera, ATC (TAHPA) and Lt Erich Rhoden, (Milwaukee Fire Department, WI) Nov. 15, 2018

8. Personal interview with Gamaliel Baer, Health and Wellness Coordinator, and Mike Goldsmith, Department Specialist (Howard County Fire and Rescue, MD). Oct. 29, 2018.


About the Author


Lisa Limper, MS, CSCS, ATC has worked in professional, collegiate and high school athletics throughout her career, and has been a personal trainer at the YMCA of Middle TN for 19 years. She coached high school football for 7 years and has served on committees for the National Strength and Conditioning Association and American Football Coaches Association

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