Blog Post

CamelBak Elite Athlete Testing

Gabe Giersch, MS

Associate Director of Education and Assistant Director of Athlete Performance and Safety

KSI had the awesome, unique opportunity to test two CamelBak sponsored pro-athletes over

the course of two days! The athletes were Lea Davison, a two-time Olympian Mountain Biker (2012 & 2016), and Gediminas Grinius a decorated Lithuanian trail runner. Some very fit, athletically decorated media personnel underwent testing as well. The athletes were able to undergo heat and sweat testing, where they exercised for 60-minutes total. Because it was a hot environment, the athletes were asked to collect their sweat in a specially prepared towel,and atthe end of their hour, we didwhole-body wash downs to collect samples to assess their sweat electrolyte concentrations. Whole-body wash downs are the gold standard for assessing whole-body sweat electrolyte concentration and very few labs across the country still use this technique. Many have moved over to local collection in sweat pouches, which is a great method of assessing local sweat, but not necessarily valid for whole-body calculations.

The athletes were also able to complete an anaerobic threshold test or a VO2max test where we tested their ability to ward-off an accumulation of lactate (a by-product of anaerobic metabolism) where we could extrapolate their anaerobic threshold based on continual readings, or their maximal oxygen uptake by exercising until volitional fatigue, respectively. This was a great opportunity for KSI and allowed us to use our expertise to interact with some incredible athletes.

Back in Falmouth– 2017

Yuri Hosokawa, PhD, ATC

Vice President of Communication, Vice President of Education

Ryan Curtis, MS, ATC, CSCS

Associate Director of Athlete Performance and Safety

 

Our summer is not complete without going to Falmouth, MA, to work at the New Balance Falmouth Road Race medical tent and continue our research and educational initiatives. We have been very fortunate to have the support from the race board members to have KSI presence at the pre-race medical symposium, health & fitness expo, and at the race as medical volunteers and research staff.

 

NB Falmouth Road Race Medical Symposium

With a host of medical volunteers and invited guests in attendance, this year’s NB Falmouth Road Race Medical Symposium featured presentations on a range of relevant topics including recognition and treatment of running-related orthopedic injuries, physiological concerns when developing strategies to optimize performance in the heat, and wearable technologies that can assist in optimizing performance.

 

Veteran NB FRR orthopedic medical provider, Dr. Don O’Malley, drew upon his experneces to give a thorough review of his top 10 running related orthopedic injuries. Dr. William Adams, a member of KSI’s medical and science advisory board and current assistant professor at the University of North Carolina at Greensboro, presented on physiological concerns and strategies when optimizing performance in the heat. The third invited speaker was Ryan Curtis, MS, ATC, CSCS, Associate Director of Athlete Performance and Safety, who discussed integration of wearable technology to optimize performance in the heat.  The symposium was concluded with our Chief Medical Officer, Dr. John Jardine, who also serves as the Co-Medical Director of the NB Falmouth Road Race. He briefed attendees on the logistics and chain of command that will be followed on the day of the race. Overall, the 2017 NB FRR Medical Symposium featured not only relevant topics in medicine but additionally offered a glance into the future of health and performance optimization.

 

Health & Fitness Expo

This year was our first time to participate in the Health & Fitness Expo as an exhibitor. The increased recognition of the KSI among the Falmouth runners was evident. We had many runners come stop by, and it was such a rewarding experience to have some of them share their personal stories about how they or their family members and friends were saved from exertional heat stroke by the NB Falmouth Road Race medical volunteers.

 

 

At the expo, we also met with this year’s study participants who already participated in a series of laboratory tests at the University of Connecticut in mid-July to early August. These runners were provided with an ingestible thermistor pill, which allow researchers to readily measure their internal body temperature on the day of the race.

 

 

Race Day

Race day for both medical and research volunteers started before dawn on Falmouth Sunday. The research crew set up the morning data collection booth at Lawrence School, which was where all runners met to get on shuttle buses to the starting line in Woods Hole. The research data collection included measurements such as participants’ gastrointestinal temperature, sweat rate, and pre- and post-race blood and urine collection.

 

 

At the medical tent, medical volunteers gathered to review the triage protocol and proper methods for treating exertional heat stroke. Chris Troyanos, Medical Coordinator of the NB Falmouth Road Race, Dr. Jardine and Dr. Robert Davis, the co-medical directors, and Dr. Douglas Casa from KSI lead the group of veteran and novice medical volunteers so that the medical tent was ready for runners who would be finishing the 7.1-mile course in the forecasted warm and humid conditions.

 

 

Findings from the NB Falmouth Road Race study will be analyzed over the course of the next several months and will be prepared for scientific presentations at the National Athletic Trainers’ Association and American College of Sports Medicine annual meetings in 2018.

 

 

 #RunFalmouth #Strive2Protect #RaceMedicine

2017 Summer Intern KSI Fellowship Experience

Miwako Suzuki, KSI Intern Fellow

My name is Miwako Suzuki, and I am an Athletic Training student at Indiana State University. Gratefully, I was chosen to receive the opportunity to intern at the Korey Stringer Institute in the Summer Fellowship Program. I am originally from Japan, and I studied Athletic Training there as well. While receiving my education in Japan, I found it necessary to learn more about prevention and management of emergency conditions, and this sense of mission brought me to the United States. I became aware of the KSI four years ago when I was still in Japan through Dr. Yuri Hosokawa, Vice President of Education and Communication at the KSI, and I have been attracted to the KSI since then. The past two months and ten days that I spent with the KSI members were full of great experiences and learning.

Among the several projects that I worked on during the summer, the main focus was placed on the Athletic Training Locations and Services (ATLAS) Project. The aim of the ATLAS Project is to determine the extent of current athletic training services provided in the secondary school setting, and it was launched in January 2016 with these goals:

  • Create a real-time database of athletic training services in secondary schools
  • Create a directory for each state’s athletic training association and high school athletics association
  • Assist states in moving toward full-time athletic training services
  • Provide useful data to each state’s athletic training association and high school athletic association
  • Identify common factors associated with increased athletic training services across the country
  • Provide data to assist with legislative efforts to improve healthcare for high school athletes

 

At the beginning of the summer, the ATLAS Project was at the stage of figuring out the extent of athletic training services in the last 10% of high schools that we had been unable to reach. To reach those schools, I have tried multiple methods such as making phone calls, writing emails to athletic directors, and searching their website for athletic trainer’s information. Even though I made some progress with these strategies, the most effective method was reaching out to athletic trainers of the neighboring high schools of the unknown schools for help. From this experience, I have learned firsthand that ATLAS is not only a great database but also a very useful communication tool. While interacting with high school athletic trainers throughout the nation, many of them showed their appreciation and support for this study. I am very grateful to be one of the members to propel this important project forward. I would like to thank Dr. Robert Huggins for including me in this project and always guiding me. I also would like to thank Sarah Attanasio, ATC, for teaching me and providing help whenever I asked.

Testing for the Falmouth Road Race study began in mid July. We conducted a modified heat tolerance test on recreational runners of a wide range of ages who are participating in the New Balance Falmouth Road Race on August 20th, 2017. Although the study will not be completed until the race day, collecting data on individuals’ physiological responses to exercise in the heat was a great learning opportunity for me. I believe that the wide distribution of demographics of this study allowed me to encounter various responses among the subjects. With regard to conducting a laboratory test, I observed the effort of the KSI members to make the study robust. I was very fortunate to learn from such experienced and passionate colleagues. I would like to express my deepest gratitude to Dr. Yuri Hosokawa and Kelsey Rynkiewicz, ATC, for their effort to involve me in this study.

 

On August 20th, which will be my last day as a KSI fellow, I will be at the New BalanceFalmouth Road Race and will serve as a medical volunteer with the KSI staff. The Falmouth Road Race has been recognized for its high incidence rate of exertional heat illnesses because of the environmental conditions and its short duration (7.1 miles), which allows runners to maintain relatively high intensity throughout the entire duration of the course. According to a previous study from the KSI, this race has saved multiple exertional heat stroke patients each year. Since I have never encountered a real exertional heat stroke case, I would like to take this opportunity as a great hands-on learning experience.

 

I appreciate every aspect of the activities that I had the opportunity to take part in at the KSI. The KSI was an even greater place than I expected. All the members are making a great effort for their projects with the strong passion and commitment for the KSI’s mission. I believe that this is the reason why the KSI has been successfully leading our profession. Lastly, I would like to thank Dr. Douglas Casa for providing such a great opportunity. I fully enjoyed summer 2017 with such great colleagues.

Health and Safety Policy Ranking for High School Athletics

Samantha Scarneo, MS, ATC

Director of Sport Safety

On Tuesday, August 8th, the Korey Stringer Institute held a press conference for the release of the Health and Safety Policy Ranking for High School Athletics. The goal of this project was to review publically available information from high school associations and state legislation to determine how states are mandating safety standards for their athletes. A positive finding from this study is every state, including the District of Columbia, has some type of health and safety policy requirement for their high schools to follow. However, not a single state meets all of the minimum best practice requirements for the areas focused on in this project; which happen to be the top causes of sudden death in sport, accounting for over 90% of sport-related deaths.

 

North Carolina is leading the way scoring a 79%, followed by Kentucky (71.13%) and Massachusetts (67.4%). KSI was honored to have Mr. Bob Gfeller, Mr. David Csillan, and Dr. Morgan Anderson as well as Dr. Douglas Casa and Dr. William Adams, speak at the press conference. Dr. Adams began the press conference stating the methods used for this project, which included accessing publically available information from state high school associations and legislation. Dr. Casa followed up with information pertaining to the results of the study. Csillan, athletic trainer from New Jersey, provided comments about his continued advocacy for New Jersey to implement best practice standards statewide. Mr. Gfeller spoke on the importance of implementing policies to ensure that no parents need to go through the tragic loss of a child. Dr. Morgan Anderson echoed these comments by stating “We have tragic examples from the past that motivates us daily to make a change.”

The Orthopedic Journal of Sports Medicine will publish the study with these findings in the September issue. The accepted version of the PDF can be found here.

Change is difficult. There may be states who are not thrilled with these published findings, too. However, these data are the reality of current health and safety policies in high school athletics. This report is dedicated to the parents who have lost, or those parents who have their sons and daughters participating in sport, and it can be the conduit in making sure that your children’s safety are accounted for by the governing organizations. I urge you all to contact your state high school association leaders and legislators to find out if they are 1) aware of where they stand in the ranking and 2) their plans forward for improvement.

Seamless triage saves a life of an athlete

Yuri Hosokawa, PhD, ATC

Vice President of Communication, Vice President of Education

 

 

Earlier this summer, when everyone was relieved to have completed the spring sport season, we were invited to give a lecture and hands-on training for exertional heat stroke emergency at CoxHealth Sports Medical Conference in Springfield, MO. This was their second annual gathering to review and practice updated policy and procedures for athlete health and safety. Physicians, athletic trainers, emergency medical technicians, athletic directors and coaches of local high schools attended this meeting. During the hands-on training, multiple scenarios were practiced. For example, what do you do when the first responder was an individual who was not medically licensed? What is the chain of command when an athletic trainer is present and not present? What cooling modalities are acceptable? What precautions must be taken during cooling? This lab also reiterated the importance of cool first, transport second. I am happy to say that their updated policy specifically states to cool first and then transport after the patient’s rectal temperature is down to 102 degrees Fahrenheit and that no other measures of body temperature assessment is acceptable. Throughout the meeting, I was very impressed to see their collaboration and understanding of each other’s role and I know their athletes are in good hands.

A month and half after the meeting, I received an email from CoxHealth stating that their emergency preparedness was put to a test– where an athlete was successfully recognized and treated for exertional heat stroke.

Sarah Bankhead (ATC, athletic trainer at CoxHealth), who treated the athlete, recalls the day as follows: When our athletes were putting away the blocking bags after practice, a coach noticed one of the athletes closing his eyes and beginning to fall over in the shed. The coach caught him and immediately called for help. The first coach to reach him checked his pulse and noticed shallow rapid breathing­­. The head coach called 911 and the other two coaches started putting ice in the groin, neck, and armpit areas. I, the athletic trainer, soon came over with a rectal thermometer, inserted it, and got an initial temperature of 108 degrees Fahrenheit. After confirmation of exertional heat stroke, a tarp was immediately place underneath the athlete and began to be filled with ice and water to start the cooling process before the emergency medical service arrived. We ensured that the athlete’s temperature was cooled to 102 degrees Fahrenheit, and then the athlete was transported via ambulance for follow up evaluation. The athlete has made a full recovery with no deficits thanks to the quick actions of those above, an effective policy in place, and the Sports Safety Summit which prepared my coaches to respond

Many teams have now begun their fall pre-season training. Do you know the chain of command and procedures when a heat emergency occurs on your practice field? It is never too late to review and build a consensus among the stakeholders of your sports medicine team. Take a “time out” and go over your emergency action plan. #Strive2Protect

 

NSCA 40th Annual National Conference

Courteney Benjamin MS, CSCS

Associate Director of Communication and Assistant Director of Athlete Performance and Safety

Members of KSI had the opportunity to travel to Las Vegas, Nevada for the 40th annual National Strength and Conditioning Conference
where strength and conditioning coaches, personal trainers, sport scientists, sport nutritionists, and health enthusiasts gathered to present, network, and honor certain outstanding members.

 

We were fortunate to attend a lecture given by this year’s Sport Scientists of the Year, Shawn M, Arent, and Dave DiFabio from Polar, whom we had the opportunity to work with in the past. They discussed the use of wearable technology and how coaches and sport scientists should start thinking about applying the knowledge we gather from this data to practice.

Ryan Curtis, Yasuki Sekiguchi, and I presented some of the recent research findings from the KSI. I presented a poster titled, “Analysis of Women’s Cross Country Lab Tests Results and Training Over the Course of a Competitive Fall Season” on Thursday (7/13/17). I examined the change in lactate testing, VO2 max and training of the UCONN Women’s Cross Country team during their fall season. The major finding of this study was the vOBLA (velocity at onset of blood lactate) was significantly higher during the middle of the season while VO2 max did not change throughout the season. During my presentation, I was very excited to reconnect with two of my former colleagues from Florida State University. Daniel Shaefer was the former director of strength and conditioning at FSU and is now working on is PhD at the University of Wisconsin-Madison. Jon Jost was the former FSU director of strength and conditioning and recently accepted a position with Gatorade. I am hopeful that we will get an opportunity to collaborate on future research. I also had the fortune to meet Kristen Holmes-Winn, from WHOOP, who funded the research Ryan and I presented at this conference.

 

Yasuki Sekiguchi presented a poster titled “Heartrate Variability between Starters and Nonstarters throughout a Collegiate Soccer Season.” During this study, HRV and training load metrics were monitored over the course of D1
college soccer season. The relationship between these variables were examined for all players, starters, and nonstarters. The major finding of this research was that acute:chronic training load ratio might be used to explain the changes in HRV over the course of a Division 1 male soccer team

Ryan Curtis did an oral presentation on Saturday (7/15/17) titled “Relationship between Sleep, Training Load and Fitness in Collegiate Soccer.” Overall this study illustrated that sleep quality may be more sensitive to increased training load than sleep quantity. Collegiate athletes with increased training loads have increased light sleep but not REM sleep or overall sleep duration.

Outside of the conference, we had a fantastic time exploring the Las Vegas strip and the beautiful hotel hosting us and the conference, Paris Las Vegas. I am extremely thankful to the NSCA and KSI for the opportunity to collaborate and learn from others in the field while making memories that will last a lifetime. I look forward to attending this event next year and present the results from our upcoming projects.

 

NATA Clinical Symposia & Expo

Alexandra Finn

Assistant Director of Education

Athletic trainers from around the country gathered in Houston, Texas for the 2017 Annual NATA Clinical Symposia & AT Expo. The four day Clinical Symposia provided athletic trainers with the ability to explore new areas and benefit from the latest research. KSI was well represented by fifteen presenters who continued the mission of educating athletic trainers about our latest research. The warm weather of Texas was a constant reminder of the significance of heat in our southern states, but the strong interest showed by attendees from across the country demonstrated that athletic trainers are gaining an understanding that exertional heat illnesses are an issue of national concern. The selection of so many KSI members provided a unique opportunity for KSI to further its educational mission to maximize performance, optimize safety and prevent sudden death in sport.

Presentations kicked off early Tuesday morning when Andres Almeraya presented in the Master’s Oral Student Finalist session. His research about “Implementation of Automated Defibrillator Policies in Secondary School Athletics” demonstrated the strong need for additional state legislation to mandate that all secondary schools follow best practices. Andres entered the day as a finalist and was selected overall the best oral presentation in this section. Congratulations and well done, Andres! Dr. William Adams presented his work on the “Implementation of Heat Acclimatization Policies in Secondary School Athletics” during the Treat the Heat Session.

This year four KSI staff members: Luke Belval, Alexandra Finn, Rachel Katch and Brad Endres were selected to present a Free Communication Poster Presentation on Tuesday morning. Luke Belval presented on “Sex-based Comparison of Exertional Heat Stroke Incidence in a Warm-Weather Road Race.” Alexandra Finn presented on the “Implementation of Wet Bulb Globe Temperature Policies in Secondary School Athletics.” This research revealed that currently there are only three states that meet all the best practice recommendations in this area. Rachel Katch presented data titled “Cold Water Immersion in the Treatment of Exertional Heat Stroke Remains the Gold Standard at the Falmouth Road Race,” which demonstrated the significance of a road race having immediate cold water immersion available to treat exertional heat stroke. Finally, Brad Endres presented on the “Epidemiology of Sudden Cardiac Death in American Youth Sports.” Congratulations to both Alexandra Finn and Brad Endres who were selected as Master’s Poster Presentation Finalists. Brad’s poster proved to be the judges’ favorite taking home top honors for KSI in this category. Well done Brad and his research team!

Dr. Rebecca Stearns presented research during the session “When Exercise Gets Hot.” Her study focused on “Repeated Exertional Heat Stroke Incidence in a Warm-Weather Road Race.” Following Dr. Stearns presentation, two KSI members; Kelly Coleman and Alicia Pike spoke during the Diversity and Inclusion Considerations in Athletic Training session. Kelly Coleman presented data about the “Perceptions of Race and Ethnic Diversity on Athletic Training Clinical Practice” while Alicia Pike spoke about “Providing Medical Care to Male Sports Teams: Attractors to Employment for Female Athletic Trainers.

To finish the day, Dr. Robert Huggins provided an update on “An Overview of Secondary Schools ATLAS Project: Where Are We Now?” demonstrating the progress in mapping secondary schools across the nation.

The second day started off strong with three KSI members presenting. First, Sarah Attanasio provided insightful information about the ATLAS project. In a well-attended session, Dr. Douglas Casa discussed “Catastrophic Heat and Exertional-Related Condition Among Athletes.” Lastly, Samantha Scarneo presented data about “Implementation of Emergency Action Plan Policies in Secondary School Athletics.” Her study focused on the importance of every high school having an athletic trainer prepare an emergency care plan.

On the final day of presentations KSI members Kelsey Rynkiewicz, Dr. Robert Huggins, Dr. Yuri Hosokawa, Dr. William Adams and Alicia Pike all had an opportunity to present their data. Kelsey Rynkiewicz presented data on the “Implementation of Concussion Policies in Secondary School Athletics.” Dr. Robert Huggins presented on three different topics on Thursday. The first presentation looked at the “Presence of Athletic Trainers, Emergency Action Plans, and Emergency Training at the Time of Sudden Death in Secondary Athletics.” His second presentation provided data to support why all athletic trainers should be staffed and the importance of an athletic trainer in the ability to reduce risk and save lives. His last presentation was titled “State High School Athletic Policy Change Successes and Barriers: Results from Collaborative Solutions for Safety in Sports Meeting.” Dr. Yuri Hosokawa presented information on “Optimizing the Direction of Care: A Secondary Insurance Claim Analysis.” Dr. William Adams presented information on the “Current Status of Evidence-Based Best Practice Recommendations in Secondary School Athletics.”  Lastly, Alicia Pike looked at “Examining Sport Safety Policies in Secondary Schools: An Analysis of States’ Progress Toward and Barriers to Policy Implementation.”

It was a privilege for so many KSI members to have the opportunity to provide much needed information about subject matters such as the prevention and care of exertional heat illnesses to athletic trainers who are heading to summer sport training camps or planning for preseason training for fall sports. When not presenting, KSI staff members took advantage of the tremendous opportunity to learn from colleagues from other institutions. The annual conference, which will be moving to New Orleans, LA next year, is well worth the investment to attend!

University of Wisconsin Medical School Seminar

Rachel Katch, MS, ATC

Associate Director of Military and Occupational Safety

One of the dedicated missions of the Korey Stringer Institute (KSI) is to provide the most evidence-based information and education on preventing sudden death in sport and physical activity, and on June 24th, 2017, KSI had the opportunity to work on that mission. After traveling to Wisconsin, Dr. William Adams and I disseminated an eight-hour seminar with the specific focus of preventing sudden death in sport and physical activity. Our hosts were affiliates of the University of Wisconsin Medical School, and many individuals attending the seminar were local high school and collegiate athletic trainers. There were four individual presentations followed by a lab portion, in which participants received hands-on training and practice regarding the gold standard method of recognizing and treating exertional heat stroke (i.e., rectal temperature, cold water immersion). For many individuals, this was the first time practicing the skills needed to save a life from exertional heat stroke. The presentations given, including one evidence based practice session, included the following:

  • Preventing Sudden Death in Sport: Overview of Current Epidemiology and Prevention Strategies
  • Development and Implementation of Health and Safety Policies in Youth Student Athletes
  •  Optimizing Safety and Performance During Exercise: The Role of Hydration and Fluid Regulation
  •  Evidence Medicine in the Realm of Heat Stroke and Sudden Death: The Long Journey from Evidence to Policy

One of the more interactive portions of the seminar was the exertional heat stroke lab. After receiving a presentation on the best-practice recommendations, the participants were able to translate their knowledge into practice; some, if not all, for the first time. With the gold standard recognition and care of exertional heat stroke being well documented for decades, being able to practice these skills and break down the negative stigma around rectal thermometry and cold-water immersion is imperative to positive patient outcomes.

KSI is humbled to be able to not only provide the evidence-based research and literature, but also the means of translating that research into practice, and we are grateful to our hosts for providing us the opportunity to get our message out to fellow medical professionals.

American Society for Safety Engineers Heat Stress Panel Discussion

Gabrielle Giersch, MS

Associate Director of Education & Assistant Director of Athlete Performance and Safety

On Tuesday June 20th, I had the pleasure of representing KSI and sitting on a panel for the American Society of Safety Engineers entitled “An athletic approach to heat stress – beyond water, rest, and shade.” On this panel, we discussed the importance of keeping laborers safe, and using the knowledge we’ve garnered on athletes to do so. We discussed the causes of heat related illnesses, contributing factors, and how to best prevent heat illnesses from occurring in a working population. This panel could definitely be considered a conversation with a very active audience who was very interested in the topic and asked a lot of great questions! While the panel was only an hour long, some great information was put forth and hopefully with collaborations and putting the knowledge that we all have together, we can reduce the amount of heat related illnesses and deaths among laborers!