Blog Post

Preventing Sudden Death in Sport– CoxHealth Sports Safety Conference

Brad Endres, ATC, CSCS

Assistant Director of Sports Safety Policies

The prevention of sudden death in sports begins well before a catastrophic injury occurs.

It may be true that heroes are made in how they respond when they are needed most. Many stories throughout the country give testament to the life-saving nature of an appropriate and timely response to medical emergencies in sport. While these stories are indeed uplifting, they are often the result of a great amount of effort dedicated to being prepared in the event of an emergency. During their 2017 Sports Medicine Conference, the Sports Medicine team at CoxHealth exemplified the old adage that “practice makes perfect”, and it was truly a sight to behold. This team, led by Dr. Shannon Woods, was a shining example of how to collaborate with multiple health care providers in order to create, implement, and practice “best-practice” policies and procedures intended to promote athlete safety. KSI was invited to travel to Springfield, MO to take part in the Conference, and it was inspiring to witness the rubber meet the road in regards to the practical application of research.

Throughout the two days of the conference, KSI staff led evidence-based educational sessions on exertional heat illnesses. KSI Vice-President of Communication and Education Dr. Yuri Hosokawa started off the conference on Friday morning with an evidence-based presentation about the prevention, recognition, and treatment of exertional heat illnesses. After the presentation, she led the participants through a practical lab session on the “best-practices” of responding to an individual suffering from exertional heat stroke (EHS).  The participants attending the Friday session of the conference included athletic trainers, coaches, sports medicine physicians, EMS personnel, and school administrators from local area high schools, given that these practical skills would be vital for treating one of their athletes in the event they developed EHS while participating in sports. On Friday afternoon, CoxHealth staff led mock emergency scenarios where participants  were able to gain hands-on practice of what they had learned in the morning. The participants took the scenarios seriously, which led to great discussions during the scenario debriefings. Additionally, the local Springfield news station recorded a news segment about the Conference in order to spread the word about emergency preparedness and athlete safety.

On the final day of the conference, the participants included physical therapists, physicians from other specialties, parents of young athletes, and other interested members of the community. Yuri and I geared our presentations to a slightly different audience, but the message was largely the same: evidence-based policies and procedures can indeed save lives.

Yuri and I were thankful to be invited to the 2017 CoxHealth Sports Medicine Conference, and proud to represent KSI at such an impressive collaborative event. Being in compliance with “best practice” emergency response policies is not always the easiest thing to do, but networks like CoxHealth Sports Medicine are proving that it can be done. Because of their efforts, the athletes they serve will undoubtedly be safe and well cared for.

2017 ACSM Annual Meeting Recap

Yasuki Sekiguchi, MS, CSCS, Assistant Director of Athlete Performance

 

The American College of Sports Medicine (ACSM) Annual Meeting was held in Denver, CO from May 30-June 3. Most of the KSI staff attended this outstanding conference and they were honored with the opportunities to present their research. We had great discussion with the audiences and received critical feedback for future work via these presentations.

  • Douglas J. Casa, PhD, ATC, FACSM- Catastrophic Heat and Exertional-Related Conditions among Athletes
  • Robert A. Huggins, PhD, ATC- Biomarkers of Endocrine, Muscle, and Inflammatory Health Track Training Loads of a Collegiate Soccer Season

  • William M. Adams, PhD, ATC- Monitoring Cardiovascular, Hepatic, Renal, and Hematological Markers of Health in Collegiate Soccer Players
  • Yuri Hosokawa, PhD, ATC- Outcomes from a Modified Heat Tolerance Test to Track Thermal Strain

  • Samantha E. Scarneo, MS, ATC- Assessing the Reliability and Validity of an Objective Method of Measuring Postural Stability: Preliminary Data

  • Luke N. Belval, MS, ATC, CSCS- Comparison of Rectal Temperature Prediction Models Utilizing Machine Learning

  • Ryan M. Curtis, MS, ATC, CSCS- Starters and Non-starters Require Separate Load Monitoring and Analyses Throughout a Collegiate Soccer Season
  • Rachel K. Katch, MS, ATC- Weighted Heat Stress Score as a Predictor of Rectal Temperature in a Warm Weather Race

  • Courteney L. Benjamin, MS, CSCS- Monitoring Markers of Nutrition Status Throughout a Collegiate Soccer Season

  • Gabrielle EW. Giersch, MS- The Effect of the Cypla2 -163 c>A Polymorphism on the Metabolism of Caffeine and Effect on Performance

  • Yasuki Sekiguchi, MS, CSCS- Thirst Modulates Cycling Performance in the Heat in Dehydrated Males
  • Andrea R. Fortunati, MS, ATC- Monitoring Markers of Oxygen Transport Throughout a Collegiate Soccer Season
  • Brad D. Endres, BS, ATC- Epidemiology of Sudden Death in American Youth Sports.

 

 

Furthermore, the ACSM annual meeting provided great opportunities to meet with former colleagues. The University of Connecticut Alumni Association Reception was held on Thursday night (6/1). A lot of attendees spent time with old friends and shared current work with them. This kind of reunion always enables us to recall great memories and have energy for future work. We are grateful for all of the people who helped coordinate this event.

 

 

This conference also allows attendees to make new relationships with other professionals through attending various sessions and meetings. These opportunities lead KSI staff to obtain further knowledge, skills and new ideas. They certainly help to develop KSI and execute our mission “to provide research, education, advocacy and consultation to maximize performance, optimize safety and prevent sudden death for the athlete, soldier and laborer.” The KSI staff members are thankful to all of the presenters and attendees for their contributions to this field as well as helping make this conference one where individuals who are passionate about similar topics can meet, collaborate, and enjoy one another. We look forward to seeing everyone again soon!!!

 

Sleep and Wellness Summit Recap

William M Adams, PhD, LAT, ATC

Vice President of Sport Safety

Sleep is an essential aspect of one’s health and normal physiologic function. It has been well documented within scientific literature that sleep restriction or sleep loss is associated with increased risks of cardiovascular disease, diabetes mellitus II, obesity and other comorbidities. Additionally, in the context of sport or physical activity, alteration of one’s sleep has been shown to impair physical and cognitive performance, which could be the difference of a win or loss on the athletic playing field, loss of productivity or increased accidents on the job site or catastrophic outcome in military operations.

Narrowing down the issue of sleep and performance to a specific population, the collegiate student-athlete, is at the most risk of sleep loss or restriction. The collegiate student-athlete’s schedule may be one of the most demanding schedules of individuals in the 18 to 22-year-old age bracket; these student-athletes not only have the demands of training and competing in their sport, but are also responsible for managing a full work load as a student and fulfilling any open time to the social aspect of being a college student. It is not uncommon for some of these athletes to be putting in 40-80 hours of week of work centered on their sport and academic work.

To address the issue of student-athlete sleep and overall wellness at the collegiate level, the NCAA Sport Science Institute convened an inter-association task force to discuss this topic. Forty individuals including representatives from all three NCAA athletics divisions, student-athlete representatives across all divisions, representatives from leading medical organizations in this area, and researchers whose expertise focuses on the effects of sleep on various aspects of physiological function (e.g., performance, cognition, diet and metabolism, recovery and risk of injury). I was one of the guest speakers who had the opportunity to present some preliminary data examining sleep on risk of injury and recovery during a competitive soccer season. The topics that were presented aided in stimulating the follow up discussions centered on developing an overall consensus and recommendations to carry forward in the development of evidence-based best practice recommendations to enhance the wellness of collegiate student athletes.

In the coming months, the attendees from this meeting will be working hard to develop these evidence-based recommendations to delivery to the NCAA and to submit for peer-reviewed publication.  This is exciting news and the NCAA is highly commended for their efforts in striving to further enhance the health and safety of our collegiate student-athletes.

KSI 6th Annual Fundraising Gala

Gabrielle Giersch, Associate Director of Education and Assistant Director of Athlete Performance and Safety

On May 11th KSI hosted our 6th annual fundraising gala at the NFL headquarters in New York City. Our staff traveled down and were humbled and honored by the incredible turnout and support from those that attended. The efforts of KSI to prevent sudden death and maximize safety and performance were major topics of remarks made throughout the night.

We were honored by the presence of several of our corporate partners who help immensely to making the mission of KSI a reality. It was truly a night for people to come together in joyous support of the work of KSI and their role in it. We were especially excited to welcome heartsmart.com since it was their first KSI event as a corporate partner!

We were able to honor three incredible people with our KSI awards. The 2017 KSI Lifesaving Research Award was presented to R. Dawn Comstock, PhD from the Colorado School of Public Health at the University of Colorado, the 2017 KSI Lifesaving Service Award was presented to James L. Thornton, ATC from Clarion University, and the 2017 KSI Lifesaving Education Award was presented to Brain Hainline, MD, CMO of the National Collegiate Athletic Association. Big congratulations to all award winners!!

As a follow-up from the announcements from the last year’s fundraising gala, it was announced that all proceeds from the 6th annual fundraising gala were going toward the heat lab equipment fund. After some unforeseen circumstances that increased the cost, we have decided to raise additional funds for the lab equipment, instead of compromising the quality of the facility. University of Connecticut generously pledged to offer the account up to $200,000, if KSI can raise $130,000. Donations can be made from our website: https://uconn.givecorps.com/causes/1153-the-korey-stringer-institute-fund

We would like to give a special thanks to the UConn Foundation for assistance in helping the evening run so smoothly. We also cannot thank the attendees enough for traveling to attend the event, proudly showing your support for KSI and our mission, and always being so generous with your time and advocacy.

 

For the photos of the gala please visit the link below:

http://www.lepetitstudio.photos/Events/Korey-Stringer-Institute-6th-Annual-Gala-2017/?platform=hootsuite

 

121st Boston Marathon

William M. Adams, PhD, ATC Vice President of Sport Safety

Robert A. Huggins, PhD, ATC Vice President of Research and Vice President of Athlete Performance and Safety

April 17, 2017 was the 121st running of the Boston Marathon, a race considered by many as the world’s most elite marathon drawing over 30,000 participants in the 26.2-mile trek from Hopkinton, MA to Boylston Street in downtown Boston. This years’ race was warmer (70-75°F) than the average year, thus resulting in a greater number of runner’s seeking medical care during or following the completion of the race. In total, ~2,400 runners were treated in medical tents both at the finish and along the course throughout the day ranging from minor issues (muscle cramps, dehydration and musculoskeletal injuries) to more severe injuries such as exertional heat stroke and hyponatremia. As a result of the heat, 20-25 runners were treated for exertional heat stroke (EHS) both on the course and at the finish line. Why so many EHS’s you might ask? Well given the time of the year (April) and provided that many runners training throughout the winter months have limited heat exposure during training, there is a greater risk of exertional heat stroke when environmental conditions become warmer than average conditions, which was evident at this year’s race.

For KSI’s William Adams, PhD, ATC and Robert Huggins, PhD, ATC, it was their 6th time being part of the medical staff that volunteers their time on Marathon Monday to assist the runners in need of medical care. Below is a reflection from both Dr. Adams and Dr. Huggins on their experiences at this year’s race and from their previous years as medical volunteers

Dr. Adams’ Perspective

For the 2017 Boston Marathon, I was assigned to the finish line chute, which is located from behind the finish line to the medical tent in front of Boston Public Library. I was responsible for observing the finishers crossing the finish line and identifying those runners who were injured or suspected of having potential issues (e.g. exertional heat stroke). In previous years, I have worked in the medical tents located at finish line, so this year was a new experience for myself as a clinician as I transitioned from treating runners triaged to the medical tent to identifying runners in need of medical care upon finishing the race.

Overall, the Boston Marathon is an amazing experience and it has been a privilege to work alongside great clinicians over the past 6 years. It is a gratifying feeling having runners stop after finishing the race and thanking you for being there and making their race experience the best it can be. Marathon Monday also has special meaning for myself personally as I met my now wife 6 years ago at the race as we both volunteered to be a part of the medical staff in 2011.

For clinicians wanting to get a sense of what it is like to provide medical care at a mass participation event, I would strongly encourage anyone to sign up to volunteer for the Boston Marathon and get to experience what the world’s best marathon has to offer.

Dr. Huggins’ Perspective

Every year on Partriot’s Day I wake up at 4:00 am and drive with some of my colleagues to Boston, MA to volunteer my services in the finish line medical tent at the Boston Marathon. Each year I am amazed at the sheer number of medical professionals who gather to be there for the runners. Hundreds of healthcare professionals, students, and volunteers work together to provide care to thousands of runners for approximately 6 hours. The entire team is under the direction of the BAA Medical Directors (Chris Tryanos, ATC, Pierre d’Hemecourt, MD, Aaron Baggish, MD, and Sophia Dyer, MD). Every year, myself and all of the other medical professionals show up at 6:00am, get our credentials, head to the medical meeting, assemble with our respective group leaders for our assignments (Lawrence Venus for the Athletic Trainers), get our lunch, and report to our sections. This year I had a little time to spare before reporting to the medical tent and took a moment to visit one of the bombing sites near the finish on Boylston Street. Attached to the tree nearest the site, (see image) there was a memorial on the tree to remind those of the tragedy that happened back in 2013. Although I was not present in the medical tent that year, I was so proud of how my fellow Athletic Trainers and the other medical professionals responded to that emergency. Each year we are reminded of that tragic event and certainly it is in the back of our minds, but each year since, we push on for if we dwell on that day and live in fear, “they” win and “they” WILL NEVER WIN! #BOSTONSTRONG

My first 3 years I worked in Medical Tent A, however for the past 3 I have had the honor of working in Medical Tent B on the heat team. Good ole’ section 19! This year was like the rest in that my primary responsibility was to assist in the administration of the cold-water immersion treatment for any runners whose core body temperatures exceeded 104°F.  Given the number of EHS patients is not nearly that experienced in Med Tent A, in addition to being on the heat team, my section also provided care in a similar fashion to the other sections of the tent. I had the honor of working with two fantastic nurses, two physical therapists, and a medical student in charge of documentation. Each year I meet new people and it is always a great experience. Although, the weather this year brought more dehydrated, slightly hyponatremic (low blood sodium), and muscle cramping athletes our way than years past, it was another successful day in Boston and I strongly encourage anyone who is interested in working the medical tent to volunteer and come see a side of the marathon that most don’t even know about. I promise it will be an experience that you will always remember!

2017 Collaborative Solutions for Safety in Sport

William M. Adams, PhD, LAT, ATC Vice President of Sport Safety

March 28-29, 2017 Kansas City, MO

The 3rd annual Collaborative Solutions for Safety in Sport meeting was held last week in Kansas City, MO that brought over 100 individuals representing all 50 states and the District of Columbia together to continue the task of enhancing the health and safety policies for high school athletics. This meeting, hosted by the National Athletic Trainers’ Association and the American Medical Society for Sports Medicine and supported by the Korey Stringer Institute and Gatorade, began out of an idea spawned by Drs. Douglas Casa, PhD, ATC, FACSM, FNATA, FNAK and Jonathan Drezner, MD to make high school sports safer for the participating athletes.

This years’ meeting was constructed so that the attendees decided on the topics to be discussed. Prior to the meeting, all of the attendees were sent a survey that asked them which topics they would either want to learn more about or have in depth discussions about. From the survey, 16 breakout sessions were formed where the attendees who wanted to learn more about one particular topic were able to come together in small groups to have further discussions.

 

Overall, these breakout sessions were immensely successful as they stimulated many fruitful discussions over the successes, barriers, and other strategies to help develop and implement health and safety policies across the US. It was great to see states that have been successful in implementing change in a certain area (i.e. heat acclimatization) providing feedback and suggestions to states that have not been successful in implementing such policies. These discussions provided great peer-to-peer feedback, which may have been better received for some individuals.

 

Having attended all of Collaborative Solutions for Safety in Sport meetings over the past three years, it has been amazing to see the efforts taken by leaders within state high school athletics associations and sports medicine advisory committees following the meeting to develop and implement health and safety policies. States like Vermont, Illinois, South Carolina, Utah, New Jersey and many others have taken advantage of these meetings to implement best-practice policies in their state with many crediting the Collaborative Solutions meeting as the event that was the impetus for change.

 

While many states have made great strides in improving the health and safety of their student athletes, others have remained resistant to change and often citing “We haven’t had anything happen in our state, so there is no reason to change.” We must remember that implementing evidence-based minimum best practice policies such as emergency action plans, heat acclimatization, access to AEDs, environmental-based activity modification guidelines and the management of sport related concussion, cost little to no money to implement and there should be no reason not to take the proactive steps to keeping our young student athletes safe.

 

Keeping the forward progress mindset and further cultivating relationships between sports medicine advisory committees, high school athletics associations and coaches with the mindset of having the most up-to-date evidence-based policies in place is needed to ensure that our young athletes are protected while playing the sports that they love.

Collaborative Solutions for Safety in Florida High School Sports

William Adams, PhD, LAT, ATC

 

On March 9-10, 2017, Drs. Douglas Casa, PhD, ATC, FACSM, FNATA, FNAK and William Adams, PhD, ATC along with KSI staff member Courteney Benjamin, MS, CSCS traveled to the University of Florida to attend their Collaborative Solutions for Safety in Florida High School Sports meeting. Organized by the University of Florida and the Florida Association of Sports Medicine, the aim of the meeting was to begin the steps of health and safety policies for the Florida’s high school student-athletes.

 

The meeting was attended by representatives from various regions within the state of Florida and included sports medicine physicians, athletic trainers, high school administrators, coaches and the Florida High School Athletics Association. Dr. Casa spoke on the importance of implementing evidence-based best practice policies focused on the leading causes of death in sport and provided numerous case examples as to how these policies have been effective at reducing the number of sport-related deaths. Dr. Adams followed by discussing the current standing of health and safety policies mandated for high school athletics in Florida.

 

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Following these initial talks, the rest of the meeting consisted of various break out sessions specifically designed to stimulate discussion amongst the group and discuss strategies for how to implement changes to current policies related to emergency action plans, environmental monitoring and activity modification guidelines, concussion, AEDs and coaching education. Discussing the current barriers for implementing the aforementioned policies and strategies to overcome these barriers with the attendees, who many are the state leaders in their respective professions, allowed everyone in the room to participate to assist in developing a plan going forward to present to the Florida High School Athletics Association to further protect their student-athletes.

 

Overall, this meeting was a tremendous success and we are truly thankful for the University of Florida and FASmed for organizing this meeting and for the University of Florida for hosting the meeting at their facilities.  Having a group of highly motivated individuals from across the state of Florida come together to discuss how they can improve high school student-athlete health and safety is a model example of ways other states can have similar successes. The coordinated efforts of sports medicine professionals, high school and state high school athletics association administrators and coaches is instrumental for preventing sudden death in our young athletes who have a full life to live in front of them.

 

IMG_0494

Wet Bulb Globe Temperature or Heat Index?

Yuri Hosokawa, PhD, ATC, Vice President of Education, Vice President of Communication

 

On February 27th, KSI’s Vice President of Education and Communication, Yuri Hosokawa, PhD, ATC was invited to give a presentation on wet bulb globe temperature (WBGT) based activity modification guidelines at the Athletic Trainers’ Society of New Jersey.

Screen Shot 2017-03-01 at 1.05.02 PM

In the CAATE Athletic Training Education Competencies [5th Edition] under the Prevention and Health Promotion section, it is stated that athletic trainers should be able to “explain the principles of environmental illness prevention programs to include acclimation and conditioning, fluid and electrolyte replacement requirements, proper practice and competition attire, hydration status, and environmental assessment (e.g., sling psychrometer, wet bulb globe temperatures [WBGT], heat index guidelines).” That being said, we, as Athletic Trainers and clinicians have all been exposed to the utilization of a sling psychrometer, WBGT, and heat index to monitor and assess environmental heat risk. But do you know the differences in how they work? Without the proper understanding of these indices, you may not be capturing the heat strain appropriately. For example, WBGT of 82°F and heat index of 82°F represent very different environmental conditions because of how these numbers are derived.

To calculate WBGT, you will need: wet bulb temperature (Tw), globe temperature (Tg), and dry bulb temperature (Td). Wet bulb temperature is a measurement of humidity, globe temperature is a measurement for amount of solar radiation, and dry bulb temperature is a measurement for air temperature. In addition, wet bulb temperature and globe temperature are influenced by wind speed. WBGT equation (see bellow) weighs heavily on the Tw (70%) because the air saturation dictates the capacity for the body heat dissipation through sweat evaporation. Since evaporative heat loss accounts for the majority heat dissipation during exercise, an environment that hinders this process will pose an extreme heat strain.

 

WBGT= 0.7Tw + 0.2Tg + 0.1Td

 

On the other hand, heat index is a number that shows “how hot it feels” when relative humidity is factored into the air temperature. It also assumes that the environment is under shade (i.e., not full sunshine) and that the person is walking at 3-mph, which is does not depict the heat stress of someone performing intense exercise in the heat. Therefore, it is apparent that activity modification guidelines that rely on heat index is not appropriate in an athletics context. Lastly, the measurement taken from the sling psychrometer is reflective of the Tw and Td. Typically, a sling psychrometer unit comes with a conversion scale, which allows the clinicians to use the Tw and Td values to calculate the heat index.

Athletic trainers, who are interested in checking or improving current activity modification guidelines, are encouraged to review Table 5 from the NATA Position Statement on Exertional Heat illness, which shows an example from the Georgia High School Athletics Association’s activity modification policy using WBGT.

2017 Youth Sport Safety Governing Bodies Meeting

Samantha Scarneo, MS, ATC, Director of Sport Safety

Screen Shot 2017-02-26 at 6.48.14 PMFour years ago, Dr. Casa had a vision to bring together the representatives responsible for safety initiatives for the leading national governing bodies (NGBs) of youth sports and educate them on how to make their sport safer. This past week, the four-year effort concluded with a meeting at the National Athletic Trainers Association (NATA) headquarters in Carrollton, TX. We have accomplished an astonishing amount over the past three years. In 2015, the 1st Youth Sport Safety Governing Bodies (YSSGB) Meeting was convened by the Korey Stringer Institute and hosted by the National Football League in New York, NY. The goal of this inaugural meeting was to educate the NGB attendees on the top causes of sudden death in sport and to learn what various NGBs have done up to this point to improve youth athlete safety. From this meeting, we were able to leave with a better understanding of the inner-workings of the NGBs; we also learned that it was extremely difficult for NGBs to provide any type of mandate or requirement because they do not have a structure to govern and oversee mandates outside of sport rules. From there, we knew we needed to create a document that outlines what the best practice recommendations should be for youth organizations.

Several position statements, consensus statements, inter-association task force documents, and research articles have been published by professional organizations. However, these documents have had a focus on the high school and older athlete, leaving paucity in the literature as to best practice recommendations for the youth athlete. The 2nd YSSGB meeting led by the Korey Stringer Institute and the National Athletic Trainers’ Association in 2016 focused on creation of a document and aimed to get feedback from the NGBs on what should be included in a best practice document. The outcome from this meeting includes a document to serve as the first of its kind to guide recommendations for improving sport safety for the youth athlete.

 

It was also in the 2016 meeting that the leaders in the NGBs requested to KSI and NATA that we convene to discuss how to continue efforts to make youth sport safer. Which led to our objective for the 2017 YSSGB meeting to discuss the potential tasks that should be addressed for future efforts and again lead by the NATA and KSI.

 

This year’s attendees included a mix of both new faces and veterans to the meeting:

 

US All Star Federation USA Lacrosse
USA Baseball US Soccer
USA Basketball USA Football
USA Track and Field USA Wrestling
USA Gymnastics USA Hockey
American Academy of Pediatrics American Medical Society for Sports Medicine
Korey Stringer Institute National Athletic Trainers Association
Safe Kids World Wide

 

At the meeting, we discussed strengths, areas for improvement, facilitators and barriers for promoting safety initiatives within their own organizations. We had veteran NGBs that discussed their successes and struggles in spearheading the youth sport safety initiatives, while other NGBs that are relatively new shared their recent achievement in mandating the background checks for their coaches, which is also an important topic to be addressed by the NGBs to ensure youth athlete safety. Every representative from the NGBs believed that they could continue to learn from this collaborative effort and were  hopeful for future meetings to continue their discussions in keeping their youth athletes safe.

 

I would be remiss if I did not conclude with a heart-felt thank you to the NATA for their extremely warm welcome to their facilities and for their sponsorship of the meeting. Specifically, to Katie Scott, MS, ATC, Athletic Trainer in Residence at the NATA, for all of her time and effort into the creation of this meeting during the past two years, and for her continued commitment, dedication, and passion for improving the profession of athletic training and sport safety for all athletes. I would also like to thank the NATA Foundation for hosting our dinner on Thursday night, and to Camelback and Jones and Bartlett for donating their products.

 

As I have concluded this blog post the past two years, If you want to go fast, go alone. If you want to go far, go together”—Unknown.