Athletic Trainer

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.

 

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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.

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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.

Athletic Director Meeting on Secondary School Health and Safety

Alicia Pike, Associate Director of Research, KSI

 

In collaboration with the National Athletic Trainers’ Association (NATA), the Korey Stringer Institute (KSI) is conducting a study assessing perceptions of medical care provided at the secondary school level from various key stakeholder groups. These stakeholders are in a position to influence the level of medical care provided to secondary school athletes and include athletic directors, principals, superintendents, parents, coaches, and legislators.

 

As part of this initiative, participants are asked if they would like to take part in a focus group session. The purpose of the focus group, similar to a group discussion, is to gain a more in depth understanding of the participants’ perceptions, and allow them to interact with each other through open dialogue in a non-threatening environment. As the study kicks off, the KSI staff couldn’t think of a better place to hold our first focus group than in Nashville, TN!

 

The National Interscholastic Athletic Administrators Association (NIAAA) was holding their National Athletic Director Conference at the Gaylord Opryland Resort and Convention Center in Nashville from December 9th to the 13th. With a meeting made possible by the NATA, we recruited athletic directors for a focus group in support of this research initiative. On December 9th, Christy Eason, a University of Connecticut alum and now Assistant Professor of Athletic Training at Lasell College, and myself, conducted our very first focus group. The meeting was a success and resulted in rich dialogue between athletic directors with diverse backgrounds on various health and safety standards.

 

Dr. Douglas Casa, CEO of KSI, and Dr. Rebecca Stearns, COO of KSI, also made the trip to Nashville and were instrumental in ensuring the success of this meeting. After the focus group session, Rachael Oates, Assistant Executive Director of the NATA, and Amanda Muscatell, NATA External Marketing Manager, spoke about the history of the NATA and its growth over the years, as well as their major marketing initiative, AT Your Own Risk. To finish off the meeting, Dr. Casa presented on best practice standards for preventing sudden death in sport, focusing in on the top safety standards that athletic directors in Tennessee should have in place.

 

This meeting not only provided great insight on athletic directors’ perceptions, but also provided an opportunity to network with a unique group of people. This was only the start, but being a part of this meeting has opened my eyes to the true potential of this research initiative. I am extremely excited to see where it goes from here.

 

Gaylord Opryland Resort & Convention Center

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Marine Corps Marathon Weekend

By Gabrielle Giersch, MS, Assistant Director of Education, Assistant Director of Athlete Performance and Safety

 

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KSI in the White House

 

Thursday October 27th through Sunday October 30th a group of KSI staff traveled to Washington D.C. to present at the American Medical Athletic Association’s 25th Annual Sports Medicine Symposium and worked in the medical tent at the 42nd Marine Corps Marathon (MCM). While in D.C., the KSI staff got to explore the city, tour the White House, enjoy some of the museums on Constitution Avenue, visit Arlington National Cemetery and view the changing of the guards.

 

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Tomb of the Unknown Soldiers

 

We had a great showing at the American Medical Athletic Association 25th Annual Sports Medicine Symposium at the Marine Corps Marathon at Georgetown University Friday October 28th. Brendon McDermott Ph.D., ATC, alumnus of University Connecticut and also one of KSI’s medical and science advisory board member, and his colleague, Cory Butts M.S., traveled from University of Arkansas and presented Muscle Damage and Renal Function in Athletes with Physiological and Environmental Stress. From KSI, Luke Belval, M.S., ATC, CSCS, presented Changing Guidelines on Exertional Heat Stroke Care: Point of Care to Transport to the ER, and Douglas Casa Ph.D. presented Policy Changes Save Lives in all Levels of Sport: New Evidence and Successes. All three of these presentations helped to illustrate the important role of athletic trainers and medical staff at races, and show successes that KSI has had in treating exrtional heat strokes and changing policies to reduce the prevalence of sudden death in sport.

On Saturday, the staff had a “play day” in D.C. that consisted of visiting museums and playing Escape the Room D.C. Both KSI teams escaped (photo below) with the better team just beating the losing team by a few minutes!

 

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On Sunday the real fun began. The staff was up bright and early to make it to Aid Station #9 at mile marker 21 of the MCM! We evaluated and treated several athletes who were experiencing exercise associated muscle cramps and dehydration. Our Medical Advisor, Dr. John Jardine also played a critical role in treating exertional heat stroke patients.

 

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MCM KSI Medical Tent

 

The annual trip to D.C./MCM is a great way for the staff to learn, use their expertise, and bond.

Colby Concussion Summit and Beach to Beacon Road Race

By William Adams, PhD, ATC, Vice President of Sport Safety

This past weekend, KSI’s Vice President of Sport Safety William Adams, PhD, ATC and Director of Communication and Education Yuri Hosokawa, MAT, ATC were in attendance at the first annual concussion summit held at Colby College, hosted by the Concussion Institute at Colby College. They joined representatives from the National Athletic Trainers’ Association, as well as faculty members from the University of New Hampshire, University of Pittsburgh, Colby College and others.

 

The purpose of the meeting was to discuss the diagnosis and management of concussion and to establish the next steps that are needed from a research perspective to enhance clinician’s objective assessment of concussion in athletes.  The meeting concluded with an action plan to examine specific areas of concussion diagnosis and management to continue to add to the body of scientific literature surrounding the validity and reliability of tools that clinicians can use in their toolbox for concussion management.

Colby Concussion Summit 16

 

Following the concussion summit, KSI traveled south to Portland, Maine for the Beach to Beacon Road Race. The race weekend began with the medical symposium, where both William Adams and Yuri Hosokawa were two of the invited speakers. Adams spoke on hydration in today’s athletes while Hosokawa presented a case series examining the treatment and management of two exertional cases recently published by Stearns et al. in Current Sports Medicine Reports. The symposium was a huge hit and was extremely well received by all of the attendees.

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The road race occurred on Saturday in Cape Elizabeth, Maine. For those unfamiliar, Beach to Beacon is a 10-kilometer (6.1 mile) road race finishing at the picturesque Portland Headlight Lighthouse in Fort Williams. KSI staff members William Adams, Yuri Hosokawa and Samm Scarneo had the opportunity to volunteer as medical staff during the race. The day finished off with roughly 6,500 runners finishing the race and the medical volunteers providing excellent care to those needing it, including four individuals who had suffered exertional heat stroke. The best part of the race weekend were the new friendships that were made with the other physicians, nurses and athletic trainers who were also volunteering in the medical tent.

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The ATLAS Project: The Start of Something Big

By Robert Huggins, PhD, ATC, VP of Research, VP of Athlete Health and Safety

ATLAS UPDATE

There are countless new and innovative ideas that we have at KSI every day, but every once in a while there is that truly life changing idea. Even as daunting as that idea may seem, there is something deep within your gut, I mean really deep down, that you know can make and impact and is worth doing. The ATLAS Project was one of those ideas for us here at KSI and in true KSI fashion this idea would not be possible without the collaboration of the NATA Secondary School Committee and the members of the NATA.

 

The Athletic Training Locations And Services Project was developed by KSI from the “Athletic Training Services in Public Secondary Schools: A Benchmark Study” with the main goals to:

 

  • 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

Since its official launch in January, over 4,500 surveys have been taken by Secondary School Athletic Trainers all across the country. The Eastern Athletic Trainers’ Association has the largest percentage of high school athletic trainers who have taken the ATLAS Survey closely followed by Mid-America Mid-Atlantic and Southwest Athletic Training Associations as depicted below. In terms of raw number of surveys California leads with 220 surveys taken and Pennsylvania is in close second with 203 surveys. However, if we look at percentage of surveys taken, District of Columbia, New Mexico, and Utah are in the lead with 80%, 71%, and 55% respectively.

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Currently KSI uses Zeemapsä by Zeesource to map each states’ Athletic Training services and we are proud to say that Vermont and Maine were the first two states to be 100% mapped. Delaware, District of Columbia, Rhode Island and Wyoming are all within 40 schools of being 100% mapped and additional efforts in those states by KSI and their athletic training associations are being made as we speak.
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Recently Robert Huggins PhD, LAT, ATC and Larry Cooper, NATA Secondary School Committee Chair, presented the ATLAS project data at the Collaborative Solutions For Safety In Sport Meeting held at the NCAA headquarters in Indianapolis and will also be discussing this with Athletic Trainers at the NATA Symposium next week in Baltimore where they hope the project will continue to gain more momentum so be sure to stop by booth #2057 at the NATA Expo to map your high school!

Athletic Trainers in the Secondary School Setting

By Rachel VanScoy, Assistant Director of Sports Safety Policies

#AT4ALL Value Model

Athletic Trainers are health care professionals who work under the direction of a licensed physician and who specialize in the prevention, recognition, emergency care, treatment, and rehabilitation of sports related injuries. A recent study reported that only 37% of high schools in the United States provide full-time athletic training services.1 Seventy of the public secondary schools acknowledge the importance of athletic training services and provide some level of medical coverage.1 With the increasing number of sports participation and sports related injuries in the high school setting, it is essential that appropriate medical coverage is available. It is important to understand what services and coverage athletic trainers’ provide.

Athletic trainers do not just provide “coverage” during sporting events but provide quality health care to active individuals on and off the field. During emergencies, athletic trainers are onsite to provide immediate care to potentially life-threatening conditions and are trained to provide prompt treatment to help prevent sudden death (i.e., sudden cardiac arrest, exertional heat stroke). Furthermore, athletic trainers provide a link of communication between physicians, coaches, parents, and school nurses. Care of an athlete not only includes physical care but also psychosocial care. A safe environment is created which can result in an athlete confiding in the athletic trainer. Athlete trainers are trained to recognize potential problems (i.e., eating disorders) and can refer to the appropriate medical or professional services.

Additionally, athletic trainers work towards the prevention of injuries and sudden death. Before participation, athletes are screened using medical questionaries’ and preparticipation physical examinations. Athletic trainers are trained to identify potential risk factors and can make appropriate referrals for further screening. The preparticipation screening also allows athletic trainers to identify at risk individuals (i.e., Sickle cell trait, asthma, diabetes). Risk mitigation can be accomplished though educating parents, coaches, athletes, and administrators, as well as, through injury prevention programs. Off the field athletic trainers develop, practice and implement Emergency Action Plans (EAPS) and Policy, and Procedure manuals. A few examples of the policies that athletic trainers develop are heat acclimatization, concussion, lightning, hydration, and environmental (i.e., cold and hot weather) policies. Athletic trainers are responsible for ensuring policies are implemented and followed.

Athletic trainers provide on and off field services to continually maintain health and safety in sports. Described above are just a few of the many services athletic trainers provide at the high school level. For more information, visit the National Athletic Trainers’ Association (NATA) webpage for the Secondary School Setting.

 

References

  1. Pryor RR, Casa DJ, Vandermark LW, et al. Athletic Training Services in Public Secondary Schools: A Benchmark Study. Journal of Athletic Training. 2015;50(2):156-162. doi:10.4085/1062-6050-50.2.03.

 

ATLAS Update: Vermont Taking Initiative

By Sarah Attanasio, Assistant Director of Sport Safety Policies

ATLAS VT

Happy National Athletic Training Month! As the word is spreading, more information is being collected about the extent of athletic training services through out the country. KSI and the NATA secondary schools committee continue to work together to encourage athletic trainers employed in the high school setting nationwide, to complete the ATLAS (Athletic Training Locations and Services) survey.

The ATLAS team has been working very closely with Denise Alosa, the District 1 secondary school representative from Vermont the past months. Thanks to her hard work in the state of Vermont, they are one of the first states to have responded and collect information whether an athletic trainer is present and the extent of coverage at every school in the state of Vermont. “The information in the survey is amazing, it can provide contact information within their own state or if you are looking to higher an AT for your school or improve a situation; the maps can be useful,” Alosa said.

As of March 2016, more than 3,400 athletic trainers nation wide have responded to the ATLAS survey. Alosa working hard with the ATLAS initiative comments, “Being in the profession for a long time, I have seen it evolve, you have to get involved to keep things moving forward”. The use of these maps can be helpful for present athletic trainers in the work force as well as new athletic trainers seeking positions as the vocation continues to grow and evolve.

With the influx of completed surveys the last few months, it is becoming more apparent what the survey can provide. Denise Alosa added, “Eventually we will be able to obtain insurance information, policy information and best practices within each state. It is good to start somewhere now, where it is doable. Any grass roots have to start somewhere.” The ATLAS Project has grown immensely since it was created years ago, with the dedication of an extensive work force of volunteers, undergraduate students, graduate students, post-doctorates, professors and athletic trainers nationwide.

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ATLAS Project- Gaining Momentum

By Robert Huggins, PhD, ATC, Vice President of Research and Elite Athlete Health and Performance

ATLAS SocialMedia

As we prepare for Athletic Training month to hit in March, secondary school athletic trainers from around the country are helping KSI and the NATA secondary schools committee get a better grasp on the extent of athletic training services that our profession provides. “The KSI team has been working diligently to market the ATLAS Project in various media outlets and get the word out there to secondary school ATs” said Sarah Attanasio assistant director of sports safety policies. “Thanks to the help of Rachael Oats and all of her colleagues at the NATA offices, the ATLAS project was sent out via e-blast in the NATA Range of Motion and has been posted on the NATA website The ATLAS Project ” said Huggins, VP of Research at KSI. One week earlier, secondary school chair Larry Cooper allocated some time during the NATA board of directors meeting in Dallas, Texas for KSI to speak with the members of the Secondary School Committee. Each district representative was provided with content related to the project for distribution to their members and for easy website viewing. As a sign of their excitement and eagerness to start, some regional athletic training associations such as The Far West Athletic Trainers’ Association and state associations such as Michigan Athletic Trainers Society and Louisiana Athletic Trainers Association are linking directly to the ATLAS Project and it appears to be making rapid progress.

“The momentum of the ATLAS project has really shown a positive trend after the official national launch of the ATLAS Project in January,” said Huggins, “we have seen an exponential increase in the number of ATLAS surveys taken.  At one point we were averaging almost 100 surveys per day. In the last week or so it has leveled off to 40 per day which is still fantastic.” In response to the increased demand, KSI has brought on five additional workers per week bringing the total workers to 10 (8 undergraduate, 1 graduate and 1 post doctoral fellow). “We all to help sort the data, work directly with secondary school committee chairs in each state, and make each map as accurate as possible” said Rachel Morris, KSI undergraduate research assistant.

The ATLAS Project is rapidly approaching 3,000 surveys and KSI hopes that their goal of 8,000 surveys by June will come to fruition. “As the word continues to spread within each state, our results will become more accurate and we will be able to not only quantify the extent of AT services, but gather valuable information about where ATs are hired, in what capacity they are hired, and the commonalities from state to state” said Huggins. With this project KSI hopes that AT associations will utilize the maps as a directory to improve the continuity of healthcare within their state, promote legislative efforts to hiring full-time athletic trainers, and potentially reduce medical and insurance costs. “The possibilities are endless” said Larry Cooper, NATA secondary school chair “and we are so excited about where this project will go in the future!”