When it comes to promoting the health and safety of student-athletes, Dr. Brian Hainline is optimistic that great strides can continue to be made across all levels of sports medicine.
“Currently, there is a great spirit of collaboration among organizations,” said Hainline, who is the NCAA Chief Medical Officer. “The way we’re coming together now is truly magical.”

That spirit of collaboration was on full display at the 2016 Collaborative Solutions for Safety in Sport (CSSS) National Meeting last month in Indianapolis. The two-day meeting, organized by the National Athletic Trainers Association (NATA) and the American Medical Society for Sports Medicine (AMSSM) and hosted by the NCAA, brought together representatives from every NFHS member state association to discuss best practices in the risk minimization and medical care of student-athletes.

One goal of the meeting was to spur action throughout states on several initiatives, including sudden cardiac arrest, emergency action plans, performance-enhancing drugs and mental health.
The Korey Stringer Institute’s Dr. Douglas Casa helped host the conference and spoke at an opening press conference about the success from the effective implementation of a risk minimization policy, specifically, the NCAA’s heat acclimatization policy. Casa said that prior to 2003, on average, two NCAA student-athletes died each year from heat illness. In 2003, the NCAA mandated heat guidelines, which include an acclimatization period and practice limits. Since that time, the NCAA has experienced one heat-related death.

“One policy change that cost no money saved 30 college athletes’ lives,” Casa said.

At the high school level, Denise Alosa, an athletic trainer at the University of Vermont, used last year’s CSSS Meeting to help the Vermont Principals’ Association enact heat and cold policies, as well as sudden cardiac arrest education, to all schools in the state.

“As a result of the 2015 CSSS meeting, we rolled out a heat plan last summer and had no instances of heat illness,” Alosa said.

Vermont’s example is exactly how the NFHS hopes to address various health and risk minimization issues, according to Dr. Bill Heinz, chair of the NFHS Sports Medicine Advisory Committee. Heinz said being a federation prohibits the NFHS from mandating policies like the NCAA.

“[For example], we would love to have a full-time athletic trainer in all high schools,” Heinz said. “However, we walk that fine line in not making policies that are onerous on state associations.”

 

Heinz said the NFHS instead provides guidelines and position statements so state associations can determine the best solutions for their respective state.

Another major topic of discussion on the first day involved athletic training services in secondary schools. Robert Huggins, of the Korey Stringer Institute, presented the ATLAS project, which maps athletic trainer services across the country. ATLAS, which stands for Athletic Training Location and Services, has surveyed more than 3,000 athletic trainers nationwide and allows users to view what schools are covered by athletic training services, how they are hired and what services they provide. The ATLAS Project is available on the Korey Stringer Institute website, ksi.uconn.edu.

Dr. Hainline, who was one of several presenters from the sports medicine field, urged states to consider the mental health of student-athletes as important and integral as their physical health.

“Suicide is the third-leading cause of death in student-athletes,” Hainline said. “Mental health is not apart from, but rather a part of athlete health…and should not be neglected.”

Dr. Cindy Chang, of the University of California, San Francisco and the chair of the California Interscholastic Federation Sports Medicine Advisory Committee, spoke about the dangers of eating disorders and the importance of energy balance among busy student-athletes. She also shared how a drive for perfection can be beneficial in athletics, but detrimental to young people susceptible to eating disorders.

Fairfax County (Virginia) schools have been very active in educating their students and faculty on the importance of mental health awareness. John Reynolds, an athletic trainer from Fairfax County, presented on how fostering resiliency can help students’ mental wellness.

“School athletics can provide great opportunities to foster resiliency and mental wellness in student-athletes,” Reynolds said.

Education-based athletics was one of six “assets” Reynolds identified that students could use to avoid risky behavior and mental health issues. The others included participating in community service, having teachers who recognize good work, personal integrity, a community of adults to ask for help and involved parents to talk to. Reynolds said the more assets available to a student, the less likely he or she would choose risky behavior or become depressed.

The final panelist on mental health was Dr. Francis O’Connor, of the Uniformed Services University, who spoke about the dangers of performance-enhancing drugs and supplements. O’Connor has been successful in removing dangerous supplements from military bases, here and abroad, and warned that there is still very little known about the effects many performance-enhancers have on the body. Similar to Dr. Chang, O’Connor mentioned that the determination of many student-athletes to gain the slightest perceived edge is enough for them to try a supplement, and a significant hurdle to overcome in preventing their abuse.

“Do they work? Yes, they work. We use them strategically [in the military],” said O’Connor.

But, O’Connor emphasized education about the possible dangers and side effects of supplements, noting his personal belief that they can be linked to heart failure.

Another keynote speech came from Martha Lopez-Anderson from Parent Health Watch. Lopez-Anderson lost her 10-year-old son to sudden cardiac arrest and shared her desire to make AEDs more available to all schools, not just high schools. It’s a cause that Dr. Chang champions.

“AEDs should be ubiquitous, like fire extinguishers,” Chang said. “Sudden cardiac arrest is unpredictable but survivable.”

The NFHS was a sponsor of the meeting and Bob Colgate, liaison to the NFHS Sports Medicine Advisory Committee, was pleased to see the member state associations convene to discuss these important topics.

“Having all of our member state associations represented and in one room listening to sports medicine experts share their thoughts and best practices can hopefully help them develop their own policies to serve student-athletes better.”

Source: NFHS

With all the attention on national rules to prevent and properly treat injuries to professional and college athletes, it may surprise you to learn that there are no nationwide guidelines to protect high school athletes from crippling or fatal injuries.

Instead, it is up to individual states and the schools within them to adopt policies and practices that help to assure the safety of children who play organized school or league sports. But most states and schools have yet to enact needed safety measures, according to data from the National Athletic Trainers’ Association.

“Each state has its own high school athletic association, and each policy has to be individually approved,” said Douglas Casa, an athletic trainer and chief executive of the University of Connecticut’s Korey Stringer Institute, named for the former National Football League player who died from complications related to heatstroke in 2001.

“It’s a burdensome, grueling process,” Dr. Casa said, that he and others hope will yield to the efforts of a new program, the Collaborative Solutions for Safety in Sport created by the athletic trainers’ association and theAmerican Medical Society for Sports Medicine.

The program held its second meeting last month, attended by two high school representatives from each state, to provide them with road maps to establish safety rules and policies or laws for high school athletics.

Last year alone, about 50 high school athletes died, according to the association, and thousands suffered long-term complications from sports-related injuries, most of which could have been avoided had well-established safety practices been in place and observed.

The leading causes of sports-related deaths among high school students are sudden cardiac arrest, head and neck injuries, and exertion-induced heatstroke or sickling, which occurs in athletes who carry the sickle cell trait. Fatalities occur primarily because most schools lack four critical ingredients to assure sports safety: emergency action plans, policies for proper conditioning and safe exercise in high heat and humidity, the presence of trained health professionals at all practices and games, and immediate availability of automated external defibrillators, or A.E.D.s, to reset a stilled or erratically beating heart.

In July 2004, Laura Friend of Fort Worth, lost her 12-year-old daughter Sarah during a junior lifeguarding class because nobody recognized the child was in cardiac arrest and no one initiated CPR or used the A.E.D. on the premises. Not until after Sarah died was it known that she had been born with an enlarged heart.

Ms. Friend, who now coordinates a Texas cardiac emergency project, created a nonprofit foundation in her daughter’s memory that has donated 59 A.E.D.s and provided CPR and A.E.D. training for hundreds of youth and adults in Texas.

However, despite a 2007 law requiring an A.E.D. in every school in Texas, “many are locked up in an office and not accessible, or only the school nurse knows how to use it,” Ms. Friend said.

Knowing that sudden cardiac arrest is by far the leading cause of death among student- athletes, Dr. Casa owns an A.E.D. and takes it to every practice and game of soccer, lacrosse and swimming involving his three school-age children.

The Mallon family of Del Mar, Calif., knows all too well the importance of having a medically trained professional on hand during practices and games. Tommy Mallon owes his life and well-being to an athletic trainer and a quick-thinking teammate who refused to help him up when he landed hard after colliding with another lacrosse player when he was 17. Instead, a trainer was summoned who, noticing subtle neurological signs that suggested a catastrophic, potentially fatal injury, called immediately for an ambulance.

Tommy, 23, now a global risk analyst in Austin, Tex., had sustained a fractured vertebra in his neck and torn artery to the brain. Had he been moved incorrectly, he could have died or been paralyzed.

In the years since, Tommy’s mother, Beth Mallon, has been a relentless advocate for teaching athletes how to recognize basic signs and symptoms of trouble on the field or court. Some 5,000 students have already been through the program she developed, Athletes Saving Athletes, taught by athletic trainers.

“In just two hours, the kids learn all they need to know: This could be serious, when and how to get help,” Ms. Mallon said. “We’ve had three success stories so far: one involving a heatstroke, one with cardiac arrest and a third with a neck injury and concussion.”

“High schools spend tons of money on referees, but almost nothing on safety,” she said. “I’d like to see every high school in the country adopt a sports safety curriculum. You never think a catastrophic injury will happen to your kid, but if it does, you’d be so grateful that someone is there who knows what to do.”

Dr. Jonathan Drezner, director of the Center for Sports Cardiologyat the University of Washington, outlined the key practices the collaborative project is trying to get every high school that sponsors athletic activities to adopt:

■ An athletic trainer at every practice and game;

■ An emergency action plan to respond appropriately to an athlete in distress;

■ A publicly accessible A.E.D. and school-based program in its use;

■ Climatization policies to prevent heat injury and heatstroke.

Although having a medically trained person readily available can be too costly for many schools, an A.E.D. costs only about $1,000 and can be used to save anyone — coaches, refs and spectators as well as athletes.

“I can’t believe we don’t have universal access to A.E.D.s in schools; they should be like fire extinguishers,” Dr. Drezner said. “There are 7.5 million high school athletes in this country. During the academic school year 2014-2015, there were 55 cases of cardiac arrest among them, and 57 percent died.”

Parents whose children want to play school sports often focus more on uniforms than on measures to protect them from serious or fatal injuries. Experts say that a pre-participation medical exam is critical and should include an EKG if there is any family history of heart trouble.

Coaches should know CPR, the location and use of an A.E.D., the signs of a possible concussion, and when to keep a player on the sidelines. Coaches should also monitor climate conditions and know when to postpone or suspend a practice or competitive event to avoid heat injuries. During hot weather and high humidity, a cooling tub should always be available. If school money is tight, parents might hold a fund-raiser to assure that an athletic trainer or sports medicine doctor attends every practice and game.

Source: The New York Times

Taking Action, Saving Lives