Geographic Remoteness, Socioeconomic Status, and Healthcare Access: Emergency Preparedness of South Dakota Secondary Schools.

Context: Athletic emergency preparedness remains critical to ensure athlete safety. Objective: To assess the influence of geographic remoteness, socioeconomic status, and healthcare access on athletic emergency preparedness of South Dakota secondary schools. Design: A cross-sectional study. Setting: Secondary schools. Patients or Other Participants: A total of 63 athletic directors (age = 44.09 ± 12.39 years, years as AD = 6.96 ± 7.47). Main Outcome Measure(s): A survey assessing athletic training (AT) and emergency medical services (EMSs), emergency action plans (EAPs), and CPR and AED, concussion, and heat illness policies and guidelines. Descriptive statistics were reported. An independent t test was performed to determine association between median household income (MHI) and access to ATs. Contingency tables and logistic regression were used to determine if access to an AT, hospital distance, and/or MHI were correlated with question responses. Results: Most respondents (73.03%) reported AT access; access was associated with MHI. Over 20% of schools were farther than 20 miles from nearest hospital. Schools without ATs in low MHI counties were less likely to have written EAPs (p=0.03, n = 48); schools without ATs were less likely to have EAPs for every venue (p=0.027, n = 32), CI (-10.7, -0.79). Most respondents (66.7%) reported no CPR certification and AED training requirement for coaches. Schools with ATs reporting farther hospital distance were less likely to have written heat illness guidelines (p=0.02, n = 36, and CI = -0.17-0.017). Schools in low MHI counties were less likely to possess these same guidelines (p=0.04 and n = 47) and were less likely to take environmental measurements to inform activity modifications (p=0.03 and n = 48). Conclusions: Limited AT access, geographic remoteness, and MHI can negatively impact athletic emergency preparedness. Schools may benefit from educational opportunities and emergency preparedness training of coaches and administrators.