An athlete lies motionless on the field and the coach is ill prepared to handle the situation. Six million athletes compete yearly and nearly one million will sustain injuries including 36 fatalities. Coaches must be knowledgeable to respond. This study investigated basic knowledge of injury management of high school coaches using American Red Cross Sport Safety Training test (SSTT). Experts subdivided each question into three categories: non-life threatening (NLT), neutral (N), or life threatening (LT). 40 coaches participated, 57% were males and 43% were females. Test scores were similar for males (84%) and females (83%). Females performed higher (86%) on the LT questions compared to males (82%) and males scored higher (84%) than females (82%) on NLT questions. SSTT scores were consistent among coaches with similar levels of education, regardless of years of experience. Coaches without a college education (NCE) scored poorly. NCE’s with 0-5 years of experience and more than 10 years of experience scored a 72% on the test. NCE’s with 6-10 years of experience had the lowest mean score (58%). Females with more than10 years of experience, regardless of education, achieved a score of 92% compared to their male counterparts (80%). These males scored 83% for NLT questions, 78% for N questions, and 78% for LT questions. 57% of the male coaches and 38% of the female coaches were walk-ons (WO). The WO coaches scored the lowest on the test with a 79%, with a mean score of 77% for the NLT questions and 80% for the LT questions. Only 68% of the WO’S received a passing score, compared to credentialed teachers with no physical education (CTNPE) who scored 88% and coaches with physical education credentials (PE) who scored 91%. CTNPE’s scored 86% on the LT questions, PE scored 92% for LT questions. Interestingly, the mean score for coaches of contact sports (CS) was the lowest in all categories. The scores for the CS group raise serious concerns when considering the rate of injury that occurs in contact sports. Continued efforts need to be made to assure that coaches have knowledge to make medical decisions. Care needs to be taken by school districts to assure that coaches have this knowledge in accordance with state law or be provided remedial instruction in medical emergency care prior to the start of their respective sport seasons.Keyword(s): coaching, high school issues, medical/medical care