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.

16-year-old killed when log falls on him during football drill (ESPN)

FARMINGVILLE, N.Y. — A high school football player lifting a large log with teammates as part of a Navy SEALs-style drill was hit in the head by the log and died Thursday, raising questions about adapting such military training to young athletes.

Joshua Mileto, a 16-year-old Sachem East High School junior, and about five of his teammates were carrying the log overhead when the accident happened at a preseason exercise camp supervised by a half-dozen coaches, Suffolk County police said.

The 5-foot-6, 134-pound wide receiver and defensive back was declared dead later at a hospital.

Sachem East graduate Carlin Schledorn, who played football as a junior, said carrying the log — about 12 feet (3.7 meters) long and the diameter of a utility pole — was a “team building” exercise.

“It’s very big. It’s like a tree, and it’s a challenge for people who weightlift,” he said. “Five or six people do it at once. I feel horrific for the team and coaches because I know them, and they are all great men.”

School officials, including the head coach, did not comment on the exercise.

A person at Mileto’s home declined to speak with reporters.

Classmate Olivia Cassereli said Mileto “cared about everyone else.”

“He put others before himself, and everyone loved him and was friends with him,” said Cassereli, who called him her best friend.

Some colleges and other high schools around the country have incorporated log-carrying drills and other military-inspired exercises into their football preparations in recent years, sometimes bringing in SEALs to teach and motivate.

Players at Indiana’s New Albany High School teamed up last month to tote 6-foot-long, 200-pound logs two miles from a local amphitheater to the school.

SEALs and Green Berets trained the players first on how to lift the logs and carry them on their shoulders, coach Steve Cooley said. Accompanied by coaches and a police escort, the groups paused for water and put the logs down every one or two blocks, and each six-person squad had an extra man who could sub in if someone got tired.

“The purpose was not to try to see how tough they are … the purpose was to accomplish a goal,” Cooley said. “It was very rewarding for all of us.”

But after Mileto’s death on Thursday, sports safety expert Douglas Casa questioned the wisdom of having teenagers perform an exercise that involves carrying a heavy object and that was developed for Navy SEALs, who are “potentially a very different clientele.”

“There’s so much potential for things to go wrong that I would really want people to think twice before doing something like that,” said Casa, executive director of the University of Connecticut’s Korey Stringer Institute, which works to improve safety for athletes.

Football, at all levels, has become more safety-conscious in recent years amid scrutiny of head injuries in the sport. In college football, for instance, the NCAA this year barred the two-a-day contact practices that coaches once used to toughen up their teams in the preseason, though many teams had ended them already.

For high schools in Suffolk County, offseason practices are permitted as long as they are not mandated and are open to everyone, said Tom Combs, executive director of the athletic organization that oversees high school sports in the county.

“What exercises that are conducted are the privy of the school district and individuals running the workouts,” he said.

In an unrelated incident, another player fell and hit his head Wednesday at the school during training, police said. His injuries were not life-threatening.

Sachem Superintendent Dr. Kenneth Graham extended condolences to Mileto’s family and friends and said support services will be offered “for as long as needed.”

The team’s training officially starts Monday, and the football season starts in September.

Source: ESPN

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.

UConn Study Finds High School Athletes At Risk; Connecticut Ranks 38th Nationally (Hartford Courant)

By: Mike Anthony

Connecticut ranks in the bottom third nationally in implementation of requirements at the state level to keep high school athletes safe from some life-threatening conditions, a new nationwide assessment of safety guidelines shows.

In fact, most states are failing to properly protect athletes against heatstroke, sudden cardiac arrest and other conditions, according to the study by UConn’s Korey Stringer Institute. The results were made public Tuesday morning at NFL Headquarters on Park Avenue.

Connecticut ranked No. 38 of 51 (each state and the District of Columbia) in graded assessments of the implementation of policies pertaining to the four leading causes of death among secondary school athletes — sudden cardiac arrest, traumatic head injury, exertional heat stroke and exertional sickling, which is a medical emergency that can occur in athletes carrying the sickle cell trait.

“What Connecticut has in place that is really a model program right now is the heat acclimatization policy,” said Douglas Casa, CEO of the Korey Stringer Institute. “That’s the phasing in of activity across time during the first couple of weeks of football practices. Connecticut has every single point you can attain on our rubric related to the first five days of not having two-a-days, not having successive days of two-a-days, phasing in the amount of equipment.

“An example where we need improvement is something related to environmental monitoring. A state like Georgia, for instance, has a great program where if it’s a really hot day, they measure the environmental conditions and make modifications [to practices] based on the conditions. Because we know that almost all heatstroke deaths happen when it’s hotter than usual for where you live.”

States were given a score reflecting how well they have implemented policy aimed toward preventing and managing life-threatening conditions, related mostly to exertion, with scores (the best being 20) assigned in five categories.

Connecticut received a score of 40.001 out of 100, with scores of seven in exertional heatstroke, six in traumatic head injuries, six in sudden cardiac arrest, 15 in appropriate health care coverage and 6.001 in emergency preparedness.

The study did not take into account practices, many of them common and consistent, that take place through policy set by school districts.

“We’re disappointed that the survey is communicated in such a way that seems to be reflective of an entire state’s efforts when in fact it’s really only a very generalized approach to certain categories, and it’s only about state association policy,” CIAC executive director Karissa Niehoff said. “Our state has some of the most stringent requirements for coaching certification and education. We’re required to educate all parents and student-athletes about concussions and cardiac arrest, and we do that. We’re not an association that imposes requirements such as trainers at every single event, or requires certain [weather] measurement systems, because frankly we think that districts are best able to decide what’s appropriate for them and, truthfully, what they can afford.”

North Carolina was found to have the most comprehensive policies and received a top score of 79, followed by Kentucky (71.13) and Massachusetts (67.4). The states with the lowest grades were Colorado (23), California (26) and Iowa (26). The median state score was 47.

The KSI study recommended a course of action for all states to implement the following policies:

• Automatic external defibrillators and certified athletic trainers on site at all athletic events.

• Phasing in summer practices and taking other steps to protect athletes from heat stroke.

• Training coaches on concussion symptoms.

• Detailed emergency action plans for all life-threatening emergencies.

• Mandated screening of athletes for sickle cell trait.

The report notes that there have been 735 deaths and 626 catastrophic injuries among high school athletes between 1982-2015. More than 7.8 million secondary school athletes participate in sanctioned sports annually, the study states.

Korey Stringer was an All-America football player at Ohio State and first-round draft pick of the Minnesota Vikings in 1995. He died at age 27 in 2001 after suffering heatstroke during Vikings training camp in 2001.

The Korey Stringer Institute, founded at UConn in 2010, is a nonprofit organization dedicated to promoting the prevention of sudden death in athletes and active individuals. It has a staff of 20, and 60 volunteers.

Each state’s governing body for high school sports was notified of the study’s results and given 30 days to respond with questions, clarifications, disputes or confirmations. Scores will continue to be updated as new information is provided and policies change.

“We offer the strongest encouragement for best practices, we offer guidelines,” Niehoff said. “We were disappointed that the emphasis was on a ranking as opposed to a really comprehensive and authentic look at everything that’s being done in a state. … Whether or not it feels good to look at study results, it does spark conversation and it’s always good to revisit with urgency whether your health and safety policies are as relevant and supportive as they can be.

“Quite frankly, we appreciate that the legislature does not get involved too deeply in statutory language around implementation around athletic programs because to change legislation is quite an involved process that takes time. When our association develops policy, we can be nimble and respond quickly if there’s new research or something that needs to change in a rapid way.”

The NFL allowed Tuesday’s announcement to take place at its headquarters because it sponsors the Korey Stringer Institute, though the NFL did not sponsor the study.

“While we focus a lot of treating injuries and illnesses, Our role in prevention is just as important,” said another speaker, Morgan Busko Anderson, an internal medicine physician specializing in primary care sports medicine and a sports medicine fellow at Wake Forest University. “Prevention of injuries, prevention of illnesses, prevention of deaths. The evidence shows that prevention practices and policies can prevent these deaths. So why do we have this gap now, between what we know is evidence-based, best-practice medicine, and what some of our high school athletes are receiving?”

Casa said many of the fixes are simple.

“We believe you can get to 85 points out of 100 for less than $5,000 a year,” Casa said. “We’re trying to institute policy and do whatever we can before [young athletes] die, to not have to wait for your particular state to have an emergency or tragedy to implement policy, to maybe learn from a tragedy that happens across a state line. A lot of the states did react in a very positive way after having a tragedy, and we’re trying to prevent them from happening in the future.”

Source: Hartford Courant

Understanding environmental heat stress (Training and Conditioning)

By: Yuri Hosokawa, PhD, ATC, LAT, Korey Stringer Institute, University of Connecticut

As the brutal summer heat takes a toll across the country, high school athletes and youth sport leagues are ramping up their summer camps and pre-season workouts in preparation for the fall season. While the importance of hydration is often emphasized during summer workouts, the use of environmental-based activity modification guidelines is often overlooked. The two major roles of environmental monitoring and activity modification guidelines are: (1) to minimize prolonged exposure to dangerous heat stress and (2) to optimize the use of practice time in the heat without overstraining the athletes.

Two of the well-accepted environmental-based activity modification guidelines for exercise in the heat are published by the National Athletic Trainers’ Association and the American College of Sports Medicine. Each guideline provides specific wet bulb globe temperature (WBGT) ranges and recommended modifications, with different types of athletic activities and populations in mind. Understanding the differences between the two guidelines will help clinicians decide which guideline better fits their needs.

National Athletic Trainers’ Association’s Guidelines (2015)1

The most recent position statement from the National Athletic Trainers’ Association (NATA) provides example WBGT guidelines from the Georgia High School Athletics Association. The uniqueness of these guidelines is that it provides activity modification recommendations that best suits fall American football training. Epidemiological studies suggest that youth football athletes are one of the most vulnerable populations to exertional heat stroke given the time of the year they start the season and the unique physical demands in the heat that is amplified with wearing protective equipment. Therefore, having football specific modification guidelines required at the high school level across the country could direct not only the athletic trainers, but also the coaches and referees in what the appropriate modifications should be given the environmental temperatures.

It should be noted that the example provided by the NATA is adjusted for the regional environmental conditions normally observed in the state of Georgia during fall football training. Consequently, the temperature threshold may not be realistic for states in the northern part of the continental U.S. (i.e., the threshold temperatures are set too high to be practical). To address this potential regional discrepancy, Dr. Andrew Grundstein and his colleagues have proposed adjustment to the WBGT threshold by regions to account for the environmental differences observed (i.e. environmental conditions observed in Louisiana versus environmental conditions observed in Maine).

American College of Sports Medicine Guidelines (2007)2

Football is not the only form of physical activity that takes place during the summer months. While other team sports, such as soccer and lacrosse, may benefit from adapting the NATA guidelines, sports such as cross country may not find the guidelines as helpful due to the different nature of activity (i.e., intermittent vs. continuous activity). In such case, coaches and clinicians may be referred to the guidelines published by the American College of Sports Medicine (ACSM). Their activity modification recommendations are less specific to the type of sport, making it easier to implement as a global precaution for any type of physical activity in the heat. For that reason, the ACSM guidelines are also often implemented by various road race organizers in deciding if they should cancel, modify, or postpone mass participation events such as road running races.

It should also be noted that the same study by Dr. Grundstein and his colleagues have made the regional adjustments based on the ACSM guidelines to accommodate for the various climatology we observe in different part of the country.

Take Home Message

Environmental monitoring is a simple way for athletic trainers and coaches to reduce the risk of heat related injuries. It also ensures that the athletes are getting quality practice time during the summer days, where many athletes may be just getting ready to not only get used to the heat but also to exercise itself. For more information regarding the activity modification guidelines, please visit our website at ksi.uconn.edu or contact us here. #KnowYourCondition

 

References:

1. Casa DJ, DeMartini JK, Bergeron MF, et al. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. J Athl Train. 2015;50(9):986-1000. doi:10.4085/1062-6050-50.9.07.

2. Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, Roberts WO. American College of Sports Medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc. 2007;39(3):556-572. doi:10.1249/MSS.0b013e31802fa199.

3. Grundstein A, Williams C, Phan M, Cooper E. Regional heat safety thresholds for athletics in the contiguous United States. Appl Geogr. 2015;56:55-60. doi:10.1016/j.apgeog.2014.10.014.

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

 

Report credits Utah high school athlete concussion protocol, finds defibrillator policies lacking (Deseret News)

 Ben Lockhart

SALT LAKE CITY — Utah’s stringent approach to concussion protocol is protecting the well-being of high school athletes, according to a new national report.

But critical athlete safety precautions such as accessible defibrillators and detailed emergency action plans are not required in Utah, and that significantly hurts the state’s standing in protecting those same competitors, according to the report from the University of Connecticut’s Korey Stringer Institute.

In all, Utah earned 44 points out of a possible 100 after being graded on student safety criteria. All states were analyzed on the same criteria, according to the institute, which cited 735 high school athlete deaths between 1982 and 2015 as a reason the research was needed. Data comparing states’ results were not immediately available.

Concussion safety

Utah scored full points for its traumatic head injury protocol because schools are required to not allow student athletes to return to activity on the same day of a suspected concussion. Utah also requires any subsequent clearance to play to come from a sufficiently licensed medical professional, and students may not resume participating in athletics before returning to school.

“I think we’ve led the country when it comes to concussion policy,” said Rep. Paul Ray, R-Clearfield, who played high school football while living with a heart condition.

Ray sponsored the law passed in 2011 that’s responsible for much of the concussion protocol for high school athletes, including requirements on how to obtain medical clearance to return to competition, and mandating that parents of minors participating in amateur sports sign that organization’s head injury policy.

Rob Cuff, director of the Utah High School Activities Association, said he’s appreciative of that law, adding that it “was good for kids and it was good for parents to be educated, and that was the only way it was going to happen.”

It is helpful that member schools are required not only by UHSAA regulations but by law to treat concussions with caution, Cuff said.

“(It) is really binding,” he said. “Schools need to make sure they’re not only following our guidelines, but also state law.”

Utah’s overall score as it pertained to traumatic head injuries was pulled down 10 points because coaches are not required to participate in Heads Up concussion prevention training.

Cuff said that score is not reflective of the instruction Utah schools undergo in the regular course of their jobs and independent of that program.

“You have to pay for that,” he said, “and we feel like (concussion prevention) is an education piece that’s already been covered by the coaches and their training.”

It is the athletes and their parents who most often need the most persuasion to err on the side of caution following a concussion, said Ray, a former high school basketball coach.

“Really, the protocol was put into place for parents and students because they’re the ones who want to push the envelope on that,” he said.

Having a plan

UHSAA officials currently are focusing on shoring up schools’ emergency preparedness plans, an area in which Utah lost points in the report’s evaluation. Those efforts include ensuring that emergency transportation access for severely injured athletes from various venues is adequately thought out, Cuff said.

“It’s very simple,” he said. “It’s just the protocol of what happens in the case of emergency. It just depends on the community or the area.”

Emergency preparedness plans, as defined in the institute’s analysis, may address where to keep the necessary emergency equipment, how to identify health providers that would respond to athletic venues, and determining responsibilities for school personnel in a crisis.

Issues outlined in such a plan, Cuff said, also address other questions: Do medical personnel come to the games? Which sports so they attend?

“(Some) schools have them on call,” he said, while others have a vehicle on hand.

“The bottom line is: What is their plan and do they have a plan in place?” Cuff said.

Part of emergency preparedness means having athletic trainers on site, said Ray, who sponsored a bill earlier this year to require high schools with athletics programs to have a full-time athletic trainer on staff.

Ray’s athletic trainers bill was voted down in a legislative committee following opposition from groups worried about how feasible such a requirement would be for rural schools.

But Ray said high school sports programs are not worth the trouble if they can’t afford to provide that type of care, which he called essential, for the safety of their athletes.

“They just have to step up to the plate,” he said. “If they’re going to have a sports program that has the potential to put youth safety in jeopardy, they need to step up to the plate or they need to not have athletics. … It’s a matter of time before one of these schools get slapped with a multimillion-dollar lawsuit.”

Valerie Herzog, president of the Utah Athletic Trainers Association, agreed that students are left too vulnerable without such a professional employed with the school full time. Because of their inherent risk, sports programs just aren’t worth it without that safety guarantee, she said.

“If you’re going to drive a car, and you say, ‘I can’t afford a seat belt,’ then you shouldn’t buy a car,” Herzog said. “I wouldn’t buy my kid a bike if I couldn’t also afford to buy them a helmet.”

Cuff said he likes the idea of requiring athletic trainers in schools, but he can sympathize with those who believe it’s not doable.

“Well, certainly when you can get athletic trainers in your schools, you’re going to have the advantage of people who are already in the know,” he said. “Some of our rural districts just do not have access to an athletic trainer who’s willing to come live in the community. … So that’s really where the pushback (comes from).”

Defibrillators access

Cardiac arrest preparedness issues also knocked Utah down a peg in the Korey Stringer Institute report.

“That’s one thing that we’re improving on, and we were aware of that score,” Cuff said, “but I think we’re doing a much better job (than before).”

The state scored zero points out of a possible 16 on the report’s criteria that looked at policies mandating easy access to defibrillators at each athletic venue, training of athletics staff on how to properly use them, and sufficient maintenance of the devices.

But even though the report reflects that there aren’t policies formally requiring access to defibrillators, the state activities association has “made a big push” in recent years to get schools to buy them, Cuff said.

“What we do is tell them to apply for the grants” to be able to afford defibrillators, he said.

There are typically multiple defibrillators at sporting events between two schools, but “it’s at practice that we’re most concerned,” Cuff said. Simply having one is no substitute for knowing where it is and having the proper training to remove and use it, he said.

“We found that with the defibrillator, they may have one in the school, but it may be locked up in the principal’s office,” Cuff said. “They need to be placed somewhere (accessible), similar to a fire extinguisher.”

At next year’s legislative session, Ray said his bill to mandate athletic trainers in schools will also include language requiring easy access to defibrillators throughout athletic facilities.

Herzog agreed that there needs to be defibrillators at schools, and coaches need to know where they are and how to use them.

Such preparedness genuinely saves lives, the Utah Athletic Trainers Association president said.

“A lot of these are preventable deaths, (and) if it’s your kid, one’s too many,” she said. “This is real stuff. I mean, sports are dangerous. They push their bodies. … They push them as far as they can go.”

Utah also received mixed remarks for heat stroke prevention, earning credit for its regulations on high school sports practices but missing out on points associated with requirements on heat-related workout modifications.

The state received high marks for UHSAA providing catastrophic health care coverage to all member school athletes in the case of severe injury.

Source: Deseret News

Remembering Korey Stringer’s legacy (FanRag Sports)

John McMullen

It was easily the worst day I’ve ever had covering professional football.

The date was July 31, 2001, and the place was Mankato, Minn., on an oppressively hot and humid day in the Midwest during a different time.

When I tell younger reporters we weren’t allowed to bring water on the practice field back in those days, sometimes I get the feeling that they believe it’s an exaggeration like the stories of walking uphill both ways to school in the snow an older generation has turned into a cliche.

As silly as that sounds now, it was not hyperbole.

And that’s what stands out most about that day is vivid memories of just how difficult it was to get through a nearly three-hour practice, and I was just standing there. The Minnesota Vikings were expending energy in full pads and a lot of it.

By that time Korey Stringer had already developed into one of the best right tackles in the NFL. But the big man still had the reputation of being a little overweight and he wanted to please his position coach, a hard-nosed former player himself, Mike Tice. Stringer refused breaks to prove his toughness and water was an oasis for the weak even as the thermometer soared past 90.

Pride, stubbornness and football’s archaic culture quickly turned into a toxic cocktail.

Stringer never tapped out and made it through the entire session but collapsed after practice. He was rushed to the medical trailer where he eventually lost consciousness because of dehydration.

No one knew it at the time but the battle was already lost. When Stringer arrived at the hospital his body temperature had reached nearly 109 degrees and he died early morning the next day.

The Vikings were devastated and the entire NFL was shaken to its core. A 27-year-old man in the prime of a great career had succumbed to heatstroke.

Everyone who plays this game understands football is an extremely dangerous sport and it always will be as evidenced by the ongoing debates over CTE and repetitive head trauma. This was different, however, because it was just so senseless.

Common sense says anyone engaging in any strenuous activity in the summer heat should have plenty of water.

Just 16 years later hydration is dogma in sports and life itself. The league instituted mandatory water breaks and rest periods after the Stringer tragedy long before the 2011 CBA scaled back practices in a dramatic fashion.

As the days passed and the show went on, there was an empty feeling writing about how the Vikings planned to kick Chris Liwienski out to right tackle to replace Stringer.

Each year when I returned, the first stop was to visit the tree planted in Stringer’s memory and the plaque that honored him in front of the old Gage Residence Hall where the Vikings stayed.

By 2013, Minnesota State was undergoing upgrades, Gage was demolished and the tree replanted outside Highland Center on campus. It will remain there as a remembrance even though the Vikings are leaving Mankato this August for the final time after training there for 52 consecutive years.

I’d like to believe Stringer died doing what he loved but I’m satisfied knowing he changed the game for the better and sacrificed himself to save countless lives through education. The Korey Stringer Institute has even helped improve working conditions in the heat outside of sports for members of the military as well as laborers.

That was never Stringer’s goal but it is his legacy and everyone in the NFL owes him a debt of gratitude.

Source: FanRag Sports

Senator Diegnan believes “life-saving” device can minimize risk of heat stroke in student-athletes (myCentralJersey.com)

By: Greg Tufaro

Sen. Patrick J. Diegnan Jr. held a press conference at Metuchen High School on Wednesday to educate others about the risks of exertional heat stroke and heat exhaustion for student-athletes, but it was the state legislator himself who learned some paramount information about a potentially life-saving device.

Christina Emrich, a veteran athletic trainer at Red Bank Regional High School and president of the Athletic Trainers’ Society of New Jersey, introduced Diegnan during the press conference to a Wet Bulb Globe Temperature (WBGT) monitor, which experts believe is a better gauge than the heat index in determining potentially hazardous environmental conditions for exercise.

The device is currently used at the professional and collegiate levels, but is not mandatory for NJSIAA member schools, which Diegnan would like to change.

“We’re talking less than $200,000 for the entire state,” Diegnan said of making at least one WBGT monitor, which costs approximately $400, available to New Jersey’s 500 school districts. “To me, it is the definition of a no-brainer. Is it worth $200,000 to save kids’ lives? Absolutely.”

Diegnan said he plans to introduce legislation in the coming months that would require school districts to obtain and use WBGT monitors beginning next year.

“Hopefully we can get it done in the fall and have it signed into law,” Diegnan said. “Let’s get them in the districts by next August.”

Dr. Jack Kripsak, Director of Sports Medicine at Somerset Medical Center who sits on the NJSIAA’s medical advisory board and also serves as the team physician for Bridgewater-Raritan High School, said he knows of at least three school districts in Somerset County who currently use the WBGT monitor.

“The (device) is a wise investment and it should be utilized,” Kripsak said. “It’s a life-saving piece of equipment investment-wise for school districts.”

A WBGT monitor measures ambient temperature, relative humidity, wind and solar radiation from the sun to determine environmental conditions during exercise. The user relies on WBGT guidelines to determine if modifications need to be made for activity such as the removal of equipment, increased hydration breaks, the adjustment of work/rest ratios and shortening the length of or possibly even canceling practice altogether.

Emrich demonstrated the WBGT during Wednesday’s late-morning press conference, at which time she recorded a reading of 85.7 on Metuchen High School’s turf field (artificial surfaces can be at least 10 degrees hotter than grass). The measurement, according to a WBGT grid containing guidelines, indicated that a coach or athletic trainer would “consider rescheduling practice if this (reading) actually happened during the day,” Emrich said.

According to the Kory Stringer institute, established at the University of Connecticut following the death of Stringer, a former Minnesota Vikings football star who died from exertional heat stroke in August 2011, a direct correlation exists between increased temperature and humidity levels and risk of mortality as a result of exertional heat stroke.

Exertional heat stroke is an elevated core body temperature above 103 degrees associated with signs of organ system failure due to hyperthermia. Central nervous system neurologic changes are often the first indication of exertional heat stroke.

Citing National Center for Catastrophic Sports Injury research data that heat-related illness claimed the lives of 35 high school football players nationally from 1995 through 2010, Diegnan conducted Wednesday’s press conference to alert student-athletes, parents, coaches, athletic trainers and school administrators about the warning signs and prevention of heat stroke.

“Heat stroke in student-athletes is completely preventable and while New Jersey is at the forefront of athletic training for our high school athletes, we must continue to refine our best practices to ensure we avoid future tragedies while allowing our children the simple joy of competition in sports,” said Diegnan, whose press conference on the topic came less than a week before NJSIAA schools are officially permitted to begin fall sports practices, some of which are conducted during extreme heat in the month of August.

Heightened awareness about the importance of hydration, the increased use of cold-water immersion tubs, the presence of certified athletics trainers at practice (Emrich said approximately 90 percent of NJSIAA member schools have an athletic trainer on site) and the adoption of an “acclimatization period” by football conferences in 11 statewide athletic associations nationwide — including New Jersey — appear to have contributed to reducing the incidence of heat-related illness and death.

Still, exertional heat stroke results in thousands of emergency room visits and hospitalizations throughout the nation each year, Diegnan said.

The NJSIAA was among the first statewide athletic associations in the nation to adopt acclimatization guidelines for football, which state teams cannot wear full pads during the first three days of training camp. In addition, practices cannot exceed five hours and a five-hour practice day may not be followed by a practice day greater than three hours. Warmup, stretching, conditioning, weight training and cool down periods are all considered practice.

Emrich noted that student-athletes in other sports, such as field hockey goaltenders who wear cumbersome equipment, must also consider the risks of practicing in extreme heat.

Some statewide athletics associations encourage, but do not mandate, that practice be canceled when the heat index soars above 100 and that practice time be limited if the heat index rises above 95. The WBGT and its guidelines could replace the heat index in New Jersey, should Diegnan’s bill become law. A reading above 92.1 on the WBGT would indicate practice should be deferred until later in the day.

Dr. Ken Herman, Chief of Emergency Services at J.F.K. Medical Center in Edison, said signs and symptoms of heat-related illness are recognizable and that “the tragedy (of the deaths that have occurred) is that it’s preventable.”

Herman said each August J.F.K. Emergency Services is called upon to treat an athlete who has been subject to excessive heat stress while practicing for high school athletics under conditions of high heat and humidity.

“Coaches, trainers, parents and athletes should look for signs of heat illness such as muscle cramping, excessive sweating, fatigue, dizziness, pale skin, weak pulse, fainting, and confusion,” Herman said. “Athletes themselves should be educated to hydrate before, during, and after training sessions, and athletes should be trained to maintain the color of their urine as light yellow to clear as a measure of hydration status. Treatment includes immediate transfer to a cooler environment, wetting the skin, and creating air flow to facilitate evaporation. Should symptoms persist, or be more serious, transport to a Hospital Emergency Department for definitive treatment would be appropriate.”

According to the Centers for Disease Control and Prevention, signs of heat exhaustion include heavy sweating, weakness, cold, pale and clammy skin, fast, weak pulse, nausea or vomiting and fainting. Those experiencing symptoms should move to a cooler location, lie down and loosen clothing, apply cool, wet cloths to as much of the body as possible, sip water and seek medical attention immediately if he or she has vomited.

Signs of heat stroke include a body temperature above 103 degrees, hot, red, dry or moist skin, a rapid and strong pulse and possible unconsciousness. The CDC qualifies those symptoms as an emergency requiring immediate medical attention. Individuals suffering from heat stroke should be moved to a cooler environment, be placed under cool cloths or even in a cool bath to reduce his or her body temperature and should not be given fluids.

“Exertional heat stroke is non-discriminatory,” said David Csillan, Athletic Trainer, Ewing High School and Co-Author, NATA Preseason Heat Acclimatization Guidelines for Secondary School Athletics. “It can occur across different sports, to both boys and girls, from the varsity to freshman teams, and as people may not know between in-door and outdoor sports.”

Diegnan encouraged parents of student-athletes to review the NJSIAA’s Heat Acclimatization Plan and Guidelines and to talk with their child’s coaches regarding their school’s heat illness emergency action plan.

Source: myCentralJersey.com

Korey Stringer’s death lingers on a final trip to Mankato (ESPN)

MANKATO, Minn. — Echoes. They’re everywhere.

This is where Korey Stringer took his final steps.

This is where he slept his last night and ate his final meal.

This is the road the ambulance followed as it delivered him to the hospital where he died.

As the Minnesota Vikings train at Minnesota State University, Mankato, for the last time this summer, team officials and fans alike are awash in sentimental thoughts. Memories surface from the meals they ate at institutions such as Jake’s Pizza, with its framed photographs of players and coaches dating back six decades. They range from the bizarre — Remember Dimitrius Underwood, a first-round draft choice who reported to camp in military fatigues and went missing the next day? — to the tragic.

For those who were here on Aug. 1, 2001, it is impossible to experience Mankato without staggering at the memory of Stringer’s death. Even 16 years to the day later, we see the physical and emotional triggers, and it is no less shocking that a healthy 27-year-old star died because he got overheated during a humid football practice.

I hope that Stringer’s memory, and the frightening lessons of his demise, will not fade when the Vikings shift their camp to their new year-round facility next summer. His death spurred overdue changes in the way professional sports teams train in summer heat, and efforts that culminated in the creation of the Korey Stringer Institute (KSI) have improved conditions for members of the military and outdoor laborers as well.

But on the anniversary of Stringer’s death and during the Vikings’ final trip to Mankato, it’s important to understand how much work remains. Tragically, the number of documented cases of heat stroke deaths at the high school and college football levels has risen since 2001, as the accompanying chart shows. KSI has developed a heat acclimation plan targeted at state-level high school sports associations, but fewer than half of the states have adopted it.

“The big thing is that we know death from heat stroke is 100 percent preventable,” said Douglas Casa, the CEO of KSI and a professor of kinesiology at the University of Connecticut. “Globally, we’ve made a lot of progress in saving people’s lives. There has not been a single death in cases of heat stroke where our guidelines were followed. But there are still these hard-core situations, mostly at the high school level in July when kids are working out without supervision, where they’re not doing the things they could, and it sometimes ends in tragedy.”

Founded in 2010 at UConn with contributions from the NFL, Gatorade and other corporations, KSI has worked to set a medically based standard for exertion in heat. Its recommendations include a number of protocols that could have saved Stringer’s life.

I was covering camp on July 31, 2001, the Vikings’ second day of practices that summer. The heat index approached 90 degrees by mid-morning, and it was so humid that my laptop screen fogged over when I opened it for the first time. Stringer practiced for nearly three hours in full pads, refusing breaks, and collapsed shortly after the practice’s conclusion.

He was led into a medical trailer, and as medical staffers observed what they believed to be dehydration, Stringer lost consciousness. He was taken by ambulance to a regional hospital, where his core body temperature was recorded at 108.8 when he arrived. He died early the next morning.

The KSI heat acclimatization plan calls for limiting practices to one per day for the first five days of activity and waiting until the sixth day to wear full pads. It warns high school-level parents that kids who spend much of their summer inside — most of them, in other words — will need a more gradual heat acclimatization timetable. And it suggests having manual cooling methods, including ice tubs and cold towels, on hand to use immediately if needed.

“It is so important to start bringing down that body temperature right away,” Cass said. “We don’t want it to wait until people go to the hospital.”

This week, KSI announced the results of an eight-month study performed in conjunction with WHOOP, a company that produces a device known as the Strap 2.0 to measure athletic performance, sleep quality and other health-related data. (WHOOP also partnered recently with the NFL Players Association to help professional-level players monitor their own exertion.) Among the biggest conclusions, according to WHOOP CEO Will Ahmed, is that quality and quantity of sleep correlated to performance and health in hot conditions.

WHOOP devices measure the stages and length of sleep to use in a “recovery score” that gives the user a sense of the body’s condition relative to its baseline.

“A lot of what we’re measuring has preventative capabilities,” Ahmed said.

These protocols and research results generate benefits beyond the world of sports. Members of the KSI staff spent time recently at Lackland Air Force Base in Texas, working on strategies to help airmen perform better and more safely at boot camp. Among the implemented changes was hiring athletic trainers to supervise recruits’ conditioning work. KSI also has worked with government agencies such as OSHA to standardize conditions for outdoor laborers.

Without a doubt, awareness and treatment of heat stroke have improved dramatically in the years since Stringer’s death. I still remember walking onto the field to cover my first NFL training camp in 2000 with a bottle of water in my hand on a hot day.

A security guard quickly pounced.

“No water on the field,” he said.

I asked why. His response stunned me: Players weren’t allowed to get water whenever they wanted to, so no one else on the field could, either.

Needless to say, that barbaric policy soon faded away. Now every NFL training camp is equipped with the tools it needs to prevent and treat heat stroke. But the fatality statistics at the college and high school levels remind us that heat stroke remains a threat.

Yes, a healthy but unprepared person really can die by overheating while exercising. We saw it happen 16 years ago. The echoes are everywhere. It’s impossible to forget.

Source: ESPN