In their work as athletic trainers and physical therapists, Michael Belanger ATC, PT, MSPT, and Jim Zachazewski, ATC, PT, DPT, both of the Sports Medicine Service in the Department of Orthopaedic Surgery at Brigham and Women’s/Mass General Health Care Center, Foxborough, can often be seen sprinting onto the field to assist an injured athlete, attending to players on the sidelines or collaborating with physicians to provide injury treatment and prevention programs.

Michael Belanger

Michael Belanger

During the pandemic, their role as liaisons between student athletes and their care providers has taken on added importance and, like many other health care professionals, expanded in scope to meet their community’s rapidly evolving needs.

Belanger and Zachazewski — two of the 10 staff supporting the Brigham’s Athletic Training team — are now not only evaluating injuries, providing immediate and rehabilitative care for injured high school athletes or taping ankles, but they are also educating local school system administrators, athletic directors, coaches, parents and student athletes on how to minimize the spread of COVID-19.  Additionally, they have played an integral role in creating national policies to prevent the spread of COVID-19 among student athletes across the U.S. for the National Athletic Trainers’ Association (NATA).

Infection control has always been part of athletic training policies, but it has mostly concerned the risk of bloodborne infections in injuries, such as those that might occur with a laceration or fracture. Respiratory illnesses historically haven’t been a major focus for the field.

Although Belanger and Zachazewski acknowledge that they are not infection control experts, as the pandemic emerged, they saw an unmet need — and an opportunity to adapt the expertly crafted, evidence-based policies in place at the Brigham for their community. In February 2020, they launched themselves into establishing COVID-19 protocols for student athletes when athletic trainers and facilities needed it most.

Jim Zachazewski

Jim Zachazewski

“There really were not any clinical research papers, policies or standards relative to the prevention and transmission of influenza or upper respiratory infection in athletic training facilities,” let alone any COVID-specific materials, Zachazewski said. “So we had to jump in, just like a lot of primary care providers and nurses when the pandemic started.”

After 10 days of drafting and tailoring the infection control policies put in place at the Brigham to fit athletic training facilities, Belanger and Zachazewski uploaded their finished work to the NATA’s online forum. It was downloaded more than 4,000 times. In recognition of their efforts, Belanger and Zachazewski were asked to join NATA’s taskforce for infection control. They worked with 18 other experts from across the country to produce professional standards for athletic training facilities nationwide.

The issues addressed in Belanger and Zachazewski’s policy to curtail infection spread included relocating common materials found inside a training facility, such as water coolers and gear, to minimize traffic; maintaining proper cleaning of hard surfaces, medical kits and equipment; and providing necessary personal protective equipment and proper disposal procedures.

Belanger and Zachazewski first noticed the need for COVID-19 protocols at a local level. With the Brigham, they provide an athletic training outreach program and team physician coverage to Carver High School, Foxborough High School, King Philip High School, Pembroke High School and Tri-County Regional Vocational Technical High School.

Belanger, who also cares for patients through Rehabilitation Services and serves as clinical supervisor of Athletic Training for Orthopaedic Surgery, said the schools’ athletic training facilities — which are typically small, shared spaces — needed to have the same standard of care as a physical therapy clinic or a physician’s office at the Brigham to limit the spread.

“One of the strengths of working at the Brigham is that there’s a wealth of information and a depth of knowledge, process, policy and procedure that is available to draw on. We realized that what we needed to do was adapt existing resources, rather than create new ones,” Zachazewski said.

An Evolving Field

Belanger and Zachazewski first learned about the athletic training profession as high school students. Belanger saw the athletic trainer at his high school as a role model and the profession as a way to participate in sports throughout his life as a contributor rather than solely as a fan. Zachazewski was a student athletic trainer for his high school and eventually his college.

“I’ve been taping ankles and taking care of injured student athletes since 1970,” Zachazewski said. “I feel strongly that we’ve got to bring the high-quality standards of health care into student athletics.”

Belanger said the pandemic has prompted the athletic training field to change for the better.

“Typically, as an athletic trainer, we tend to think about dealing with athletes from the standpoint of injury and occasionally illness. Now, illness has really been brought to the forefront,” Belanger said. “Infection can happen on the field and on the sidelines. At a game, there needs to be a certain standard for my surroundings to be able to prevent and control the spread of infection.”

Belanger and Zachazewski said building policy at a national level for other athletic trainers has been a very rewarding experience.

“This pandemic has shown that we all need to be able to manage what’s in the best interest of the student athlete,” Belanger said.