Sep 30, 2015
Catching Up with Jon Almquist

As part of our 25th anniversary celebration, we check in with Jon Almquist, who co-authored a controversial article for T&C regarding athletic training students back in the 1990s and has become an expert on treating concussions since his retirement from the high school ranks.

The following article appears in the October 2015 issue of Training & Conditioning.

Never one to shy away from controversy, Jon Almquist, ATC, VATL, stirred things up in 1999 when he wrote the first of his many articles for Training & Conditioning. In “Passing the Torch,” he and co-author Bart Peterson, MS, ATC, argued that high school athletic trainers had made a mistake in their use of student athletic trainers (as they were then called). At that time, the students were often used as primary health care providers, and the article pointed out the problems with such a setup–insight that is now accepted throughout the profession.

Almquist certainly had the experience to speak from. Hired as the first certified athletic trainer at George C. Marshall High School in Falls Church, Va., in 1983, he quickly rose through the ranks to become the head of the Fairfax County (Va.) Public Schools Athletic Training Program. By the time he retired from the position in 2013, he was overseeing 50 athletic trainers who were caring for more than 25,000 athletes.

Now a Concussion Specialist at the Fairfax (Va.) Family Practice Comprehensive Concussion Center, Almquist has long been a vocal advocate for athletic trainers in the high school setting. He served on the NATA’s Secondary School Athletic Trainers’ Committee for 14 years, with multiple stints as its chair, and headed the group that developed the Appropriate Medical Care for Secondary School-Age Athletes guidelines. His long list of NATA honors include the Athletic Trainer Service Award in 1997, Most Distinguished Athletic Trainer Award in 2006, and induction into the Hall of Fame in 2014. In the pages of T&C, he offered advice on implementing minimum weight guidelines in wrestling, preventing heat illness, evaluating your staff, and more.

As T&C celebrates its 25th anniversary, we caught up with Almquist to get his reflections on that first article he penned for us, the biggest challenges of his career, and the shortcomings of today’s athletic training education programs. He also relays the most up-to-date ideas on treating concussions.

Do you remember the article you wrote for our September 1999 issue on the proper role of students in athletic training at the high school level?

I don’t remember the specifics of the piece, but I do remember the many discussions I had with people regarding this issue. At that time, we were eager to provide greater educational opportunities for high school students interested in athletic training, and we figured a good way to do that was by giving them more opportunities to practice skills. The problem, we eventually realized, was that by doing so we were also unintentionally undermining the perception of athletic trainers as professionals.

We started to hear administrators say they didn’t need to hire more certified athletic trainers–they just needed a couple more student trainers. That was eye-opening and made us take a step back. We wanted to teach the students about athletic training, but that didn’t mean they were qualified to take on professional-level responsibility. So we advocated limiting their duties, and also came up with the term “athletic training student aide” instead of student athletic trainer to further distinguish their role.

To this day, we’re still debating what to teach students and what to allow them to do. There’s no reason to restrict teaching, but giving anyone the impression that a high school student could substitute for a certified athletic trainer is a bad idea.

What was the response to the article?

Initially, a lot of people were frustrated by it, especially in the Northwest where there were very strong health occupation training clubs in many of the schools. They put a lot of stock in having students perform athletic training tasks and even had competitions to see how quickly students could tape an ankle or how well they could evaluate a knee injury.

We were fine with showing high school students how to do a Lachman test, for example, but we wanted to draw the line at allowing them to perform it. We didn’t want them to do a Lachman test on their own, only to turn a partial tear into a complete tear by mistake. Our message was not well-received at first, but as we explained it further, more and more people started to realize that leaving the actual medical care up to athletic trainers was in everyone’s best interests.

Is there anything that stands out about any of the other articles you wrote for T&C?

I remember writing about proper record keeping, and, although we’ve come a long way, I think this is an area where there is still room for improvement. Twenty years ago, as we were striving for acceptance as a health care profession, everyone agreed that we needed to demonstrate a high level of care. But we were reluctant as a group to embrace being accountable for what we do. That was amazing to me.

When we adopted a computerized record-keeping system in Fairfax County, there were a couple of athletic trainers who told me they couldn’t get on board with it. They said they wanted to be with the kids, not in front of a computer, and they decided not to continue in our district. Although these individuals had great passion for caring for people, they weren’t willing to continue to learn and expand their skill set, which is important in our profession.

Everybody hates record keeping, but you still need to do it. I have found it to be incredibly valuable because it improves athlete care and quantifies our value. It’s one thing to tell your boss you were really busy last week, but it’s another to report that you saw 42 new athletes and did 104 rehab treatments. Having the hard numbers enabled us to hire more athletic trainers in Fairfax County despite overall budget cuts in our district.

What did you find to be the biggest challenge of working at the high school level?

The most difficult aspect was having to start new with a fresh group of students and parents every year, many of whom were convinced their kid was headed to the pros. And there were constant changes among principals and athletic directors so my fellow athletic trainers and I had to prove ourselves time after time after time.

Another challenge was administrators who felt they had to be the most knowledgeable person in the room on everything–it’s hard to work in that kind of environment. But I was really fortunate to spend much of my career working with a district athletic director, Bruce Patrick, who didn’t want to be an expert on athletic training. He was an accomplished coach and a great leader. If what I explained to him made sense, then he accepted and trusted my expertise.

Based on your experience hiring young athletic trainers at Fairfax County schools for many years, do you feel the changes in athletic training education have been beneficial?

We’re definitely producing more intelligent athletic trainers now, but I’m not sure their people skills and ability to deal with the ups and downs of the profession are being taught as well as they used to be. Over the 30 years I was at Fairfax, there were only a handful of times an athletic trainer made a mistake from a clinical standpoint. But we received a lot of complaints resulting from a lack of communication. I don’t know exactly how to change that, but it’s something we need to address. We need to teach athletic trainers how to interact well with others, whether it’s parents, coaches, administrators, peers, or student-athletes.

I’m also worried about the perception that athletic trainers should only use evidence-based practice techniques. If we limit ourselves to evidence-based practices, we will never do anything new, and we will always be five years behind the times because that’s how long it takes for new ideas to get into the journals. We’ve always been a bit of a fly-by-the-seat-of-our-pants profession, and we’ve always considered things that are outside the box. Some work, while others don’t. Now, I’m afraid we’re in danger of losing that.

Why did you decide to leave Fairfax County Schools in 2013?

The district’s retirement system is so darn good that once you’ve been there 30 years, it’s not cost effective to keep working. So I retired and planned to work on personal projects I had been putting off–I have five vintage cars waiting to be restored. But I quickly realized I wasn’t ready to stop working. I love learning new things, and fortunately some folks at a local family practice group asked me to start a concussion clinic for them, which I thought was both interesting and important. We opened it in the fall of 2013 with a group of physicians, nurses, and athletic trainers, and it’s been growing like crazy ever since.

What have you learned about concussions now that they are your main focus?

I’d say the most important thing is that every concussion is different. They all have similarities, but when it comes to treatment, there is no easy blueprint to follow, and we have to care for every patient as an individual. I don’t treat athletes only–we’ve had patients from two months old to 70-plus. What each person brings to the table–such as anxiety or depression, their motivation level, or just their overall health–is another big part of the treatment process.

What treatment and management protocols have you implemented?

We are using programs for vestibular and ocular rehabilitation that have been very successful. We also have an online portal where patients can update their symptoms checklist at various times of the day, which has been helpful in seeing patterns we may not otherwise be aware of. Another big step has been getting teachers involved with our school-age patients. We’re seeing a huge connection between declines in the cognitive and academic abilities following a concussion.

Teachers should be able to make adjustments to accommodate a student’s disrupted learning following a concussion, whether it’s for three days or three weeks or three months. It’s not much different than screening a student for special education programs. But it needs to be done right away following a concussion. It can’t wait for a committee to meet.

The same holds true in the workplace. Adults may be working with multiple computer monitors or in a bullpen setting with a lot of noise and activity going on around them, and that can be difficult to handle after a concussion. So we’re trying to help employers figure out how to best handle these immediate but temporary concerns.

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