More than one-third of college athletic trainers say coaches influence the hiring and firing of their schools' sports-medicine staffs, a finding that counters an NCAA-recommended protocol urging medical staff to make decisions about athlete health independent of coaches and administrators.

Among the 1,796 athletic trainers who answered a recent survey, more than 48 percent said their school was not following the NCAA-directed guidance . Nearly one in five respondents said a coach had played an athlete who had been deemed medically ineligible to participate.

The National Athletic Trainers' Association sent survey questions to more than 9,200 athletic trainers who work in all divisions of NCAA, NAIA and two-year schools in an attempt to generate baseline data about how institutions are following NCAA guidelines. About 775 of the 1,796 respondents said they worked in Division I.

The crux of the guidelines call for coaches and administrators to be left out of the decision-making process when it comes to an athlete's health.

But those who answered the survey painted a picture that shows those guidelines are far from being met — and portrayed coaches as still having an influence on who runs the programs' medical staffs.

"When a coach comes to an institution and maybe gets rid of, fires, or replaces a sports medicine staff in place that's doing quality work, is that right thing to do?" said Kansas director of sports medicine Murphy Grant, who chaired the committee that conducted the survey. "The institution's role is to take care of the student-athlete. We want to look at the influence of why those things occur."

Nearly three in five of 537 athletic trainers who answered questions about whether they received pressure from non-medical personnel about medical decisions said they did. Of those, 28.8 percent said they received pressure at least twice a month and 2.56 percent said they received pressure daily.

Other findings:

—Nearly three in 10 said the autonomy of medical staff differed depending on sport.

—Just short of half the athletic trainers said there was no formal document describing their school's model regarding independence of the medical staff.

—More than 76 percent of respondents said they feel they have unchallengeable authority to determine medical management of athletes.

"It's concerning that 24 percent feel they do not," Grant said.

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Athlete health

Athletic trainers: Coaches still influence health decisions