When reached Thursday morning, Canton High athletic trainer Kristen Aguiar was preparing to monitor 11 sporting events that evening. She was also cleaning up from the previous night.
Later was the football walkthrough, and junior varsity and varsity games in field hockey, girls’ volleyball, and boys’ soccer. Plus freshman volleyball, cross-country, cheerleading, and golf practices.
But right then, Aguiar was coordinating with the school nurse and teachers the care of an athlete arriving on crutches, and checking in on a few other students who were in various stages of recovering from concussions.
Oh, and someone had driven into her parked Jeep, so she had to line up a trip to the auto body shop.
The school bell would chime at 2:28 p.m., starting the daily flood into her office. Aguiar typically sees 30-40 athletes in the 45-minute pre-practice surge. Some ask to be taped, others for clearance to return to play. Others have deeper concerns.
She’s built relationships with these athletes, as well as their families, coaches, doctors, and nurses. She knows who got banged up last week, who has a wonky ankle or a skin condition or a long-term knee issue. She knows who is trying to fight through something they shouldn’t.
“When things might fall through the cracks, we’re there,” said Aguiar, who has spent the last 11 years of a 23-year career at Canton.
Full-time athletic trainers are the glue of any school’s sports program, a valuable resource that keeps it all together.
If only they were deemed worthy of greater investment.
It may surprise you to learn that in a state that claims to have the best health care in the nation, neither state governance nor the organization that governs 382 secondary schools requires an athletic trainer working full time at each school.
MIAA rules call for one to be present in all competitions in football, wrestling, and rugby, plus varsity hockey games. Other sports can — and do — go uncovered.
Approximately 67 percent of MIAA schools have access to a full-time athletic trainer, according to Christianne Eason, president of sport safety and education at UConn’s Korey Stringer Institute. That’s behind 16 other states in their data, including Connecticut (79 percent) in New England.
It leaves thousands of Bay State scholar athletes with part-time (or less) support.
Money is the root of it, said Bob Colandreo, who teaches at Bridgewater State and chairs the Athletic Trainers of Massachusetts’ government affairs committee. “The MIAA refuses to push an unfunded mandate on its member schools,” he said. State officials generally consider it an MIAA issue.
A previous effort to convince the MIAA to require full-time athletic trainers fell flat. A rule change proposal for the 2027-29 cycle is again in the works and was voted on by one of the association’s sport committees, football, on Wednesday. None of the 17 committee members supported it.
“It’s going to be impossible,” Franklin County Tech athletic director Joe Gamache said at the meeting. “It’s not going to happen. I think it’s a great idea, but there’s a lack of trainers.”
Colandreo disagrees. Massachusetts has 1,582 active licenses for athletic trainers. But, he added, they are health care professionals with master’s degrees. They want full-time jobs, not the stipend positions most schools are offering, particularly in rural areas.
Colandreo noted that Massachusetts, in the last decade, has added major revenue streams by legalizing recreational cannabis and sports gambling and adding the “millionaires’ tax.” Could no one offer up some cash from those pools to schools in need?
His proposal would give schools without full-time trainers until 2028 to work it into their budgets.
“In my opinion, if the MIAA said: ‘OK, every school has to have an athletic trainer,’ schools would find a way to do it,” said John Jardine, vice chair of the MIAA sports medicine committee and chief medical officer at the Korey Stringer Institute.
“There’s money involved, and sometimes you’re losing something else to gain that. I get all that. But when you look at it from a health and safety perspective … it’s difficult to justify, until something happens.”
Ipswich parents need no reminder: Uproar over injuries to boys’ lacrosse players this spring resulted in the school’s part-time trainer quitting after 11 years in the role. Sharon hired a full-time trainer after a catastrophic football head injury that might have been prevented if someone had been checking in more often.
To cover the gaps, some schools rely on parents who are nurses or EMTs to stand guard at JV games — even if those parents are off the clock. School officials expect coaches, teachers, and nurses to handle injuries as best they can. And things will keep falling through the cracks.
Aguiar noted that school districts hire nurses at the recommended ratio — one for every 250 to 500 students, per the Massachusetts Department of Secondary Education — “for students when they’re sitting in class.”
“But when they go outside to play sports, and they’re running and moving and hitting each other, there’s nobody there.”
Hiring a full-time professional is no simple task for a school district, but how many more kids have to get hurt before we figure this out?
In the long run, what will cost more?
Matt Porter can be reached at matthew.porter@globe.com. Follow him on BlueSky at mattyports.bsky.social.