CSSS

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.

2nd Collaborative Solutions for Safety in Sport

By Alicia Pike, Assistant Director of Youth Sport Safety 

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National Athletic Trainers’ Association (NATA) President, Scott Sailor, kicked off the 2nd Collaborative Solutions for Safety in Sport (CSSS) Meeting with a powerful statement. “Nearly all deaths and serious injuries can be avoided when proper steps are taken.” A continuation of last year’s inaugural meeting in New York City, the NATA and American Medical Society for Sports Medicine (AMSSM), with assistance from the Korey Stringer Institute, brought together each state’s High School Athletic Association Executive Director and Sports Medicine Advisory Committee Chair for the second year in a row to discuss proactive policy changes and states’ progress on various health and safety initiatives at the secondary school level.

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On March 22, 2016, Dr. Brian Hainline, Chief Medical Officer of the NCAA, opened the meeting with the keynote address, speaking on the challenges of change. A session followed titled, “Where are we now?” facilitated by Douglas Casa, Robert Huggins, Larry Cooper and Thomas Dompier. This session focused on progress made in policy change, athletic training coverage across the nation, proper injury prevention strategies specific to Heads-Up Football, and an overview of data from the Datalys Center for Sports Injury Research and Prevention. The meeting portion of day one concluded with small group breakout sessions, quite valuable for those in attendance, as they spoke candidly with one another about successes and barriers pertaining to sport safety policy implementation.

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Day two began with a keynote address from Martha Lopez-Anderson, Chair of the Board of Directors for Parent Heart Watch. Turning tragedy into triumph, Martha shared her heartbreaking personal story that led to her involvement in this organization, and advocated for the implementation of prevention strategies for sudden cardiac arrest in the youth population, including placing AED’s in all locations, cardiac screening, and getting appropriate personnel trained in CPR/AED use. Following her keynote, a session dedicated to mental health issues in student-athletes ensued. Although not directly in the spotlight, mental health is a true problem. Dr. Brian Hainline stressed the importance of having an emergency action plan in place for mental health issues, similar to the ones implemented to manage various incidents such as cervical spine or head injuries. Alongside Dr. Hainline, John Reynolds, Dr. Cindy Chang, and Dr. Francis O’Connor also facilitated this session. From sharing success stories on the promotion of mental wellness in a school district, to discussions on the prevalence and consequences of disordered eating and performance-enhancing drug use, attendees were informed of proper strategies to take in limiting and managing mental health issues in student-athletes.

Taking a different approach this year, attendees were allowed to choose from three different breakout sessions, providing opportunities to promote discussion in small groups about personal experiences, struggles, and successes with cardiac and heat policy implementation, and employing athletic trainers in secondary schools. This created an environment of close collaboration, with states getting feedback for themselves while simultaneously helping each other. NATA President, Scott Sailor, said it best. “With your [attendees] collaborative support we will make a difference. We will save lives, reduce injuries, and create a playing environment that ensures health and safety first.” It was another incredibly successful CSSS Meeting, and we anticipate the next to result in even greater strides towards improving sport safety in the secondary school setting.

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Medical Experts Look Beyond Law to Make Youth Sports Safer (ABC News/AP)

To toughen safety standards in youth sports, medical experts are turning away from lawmakers and toward high school sports associations to implement policies and procedures to prevent deaths and serious injuries.

The National Athletic Trainers’ Association and the American Medical Society for Sports Medicine completed two days of meetings and programs with representatives from all 50 state high school athletic associations Friday at the NFL offices in Manhattan. The goal was to have decision-makers return to their states and push high schools to put into place recommendations on how best to handle potentially catastrophic medical conditions such as heat stroke, sudden cardiac arrest and head and neck injuries.

Some states, such as Arkansas, have passed laws requiring schools to meet certain standards, but Doug Casa, director of athletic training education at the University of Connecticut, said high school associations should be first to act because they have more flexibility to move quickly.

“Trying to get a state law passed, one, can take a long time but two, sometimes a lot of things get attached to the laws that weren’t the original intention. Also, they’re written by people who don’t truly understand the nuances of a football practice or how sports work into the system of a school year. Those are nuances that the state high school association totally gets,” Casa said.

In 2013, best practice recommendations were published in the Journal of Athletic Training, but many states are still lagging in implementation of those guidelines. They include having a full-time athletic trainer on staff, having automated external defibrillators in every school and accessible to all staff members, and having an emergency action plan for managing serious and potentially life threatening injuries. Funding is often cited as the reason schools, many of which are already struggling to make ends, meet fail to implement these recommendations.

According to the NATA and AMSSM, only 37 percent of high schools in the United States have full-time athletic trainers. Only 22 percent of states meet the recommendation that every school or organization that sponsors athletics develop an emergency action plan. Only 50 percent of states have met recommendations that all athletic trainers, coaches, administrators, school nurses and other staffers have access to an automated external defibrillator.

Casa said just 14 states meet the minimum best practices with regard to heat acclimatization, but the ones that have adopted them since 2011 have had no athlete deaths from heat stroke.

Casa cited Georgia, Arkansas, Texas, North Carolina and New Jersey as states that have been leaders in implementing the recommendations.

Jason Cates, a member of the executive committee of the Arkansas Athletic Trainers’ Association who led reforms in Arkansas after a high school basketball player died of sudden cardiac arrest in 2008, said that while legislation can be help to move programs forward, it can also create problems with legal liability.

“At what point in time are we going to legislate ourselves out of sports?” he said. “I think in some states, in some instances (legislation) is the way to go, but my hope is people just get it.

Casa acknowledged legislation is often necessary to fund programs.

With legislation comes politics and give and take. Kevin Guskiewicz, professor and co-director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina, said that doesn’t come easy for medical professionals.

“It’s hard for people like us that are medical people to compromise on anything because we think we should have it all,” he said. “So that’s where we’re beating our fists on the table at state capital buildings as we’re debating why we need it all. I did learn a lot about compromise.”

 

Source: ABC News/AP

Inaugural Collaborative Solutions for Safety in Sport Meeting

CSSS 2015
CSSS 2015

By Alicia Pike, Assistant Director of Youth Sport Safety 

On March 26th and 27th, the National Athletic Trainers’ Association (NATA) and American Medical Society for Sports Medicine (AMSSM) in conjunction with the Korey Stringer Institute (KSI) and the National Football League (NFL) hosted the very first “Collaborative Solutions for Safety in Sport” meeting at the NFL Headquarters in New York, NY. This meeting was made possible by the lead sponsors, NATA and AMSSM. Corporate sponsorship was provided by MISSION AthletecareJones & Bartlett LearningPRIVIT, and Camelback, and supported by KSI and NFL organizations.

We know from years of research that many of the deaths that occur in sport are preventable if best practices for prevention and management are in place. Therefore, the goal of this meeting was to bring together the state high school association leaders and sports medicine advisory committee members and the National Federation of State High School Associations to discuss development and implementation of best practice policies for safety in sport. We are excited to have had representation from all 50 states in one room for this meeting, and provided opportunities for key decision-makers to review and enhance safety policies currently in place in their respective states to reduce risk of sudden death in high school sports.

Chris Valletta, co-founder of MISSION Athletecare kicked off the meeting with the keynote. The remainder of this first day involved emphasis on best practices and policy implementation for heat-related illness and cardiac events. Dr. Douglas Casa, Chief Operating Officer of KSI, spoke about the importance of policies including heat acclimatization and wet-bulb globe temperature monitoring that should be in place at every high school, as well as proper recognition (via a rectal thermometer) and treatment (ice water immersion bath) of heat-related illnesses. Regarding cardiac events, Dr. Jonathan Drezner, team physician for the University of Washington and Seattle Seahawks, spoke about the absolute necessity of having AED’s readily available at all high schools and competition/practice locations, as well as the importance of regularly practicing emergency action plans and performing monthly checks of AED batteries and pads to ensure they are ready to use in case of an emergency cardiac situation.

The second day began with a keynote address from Dr. Brian Hainline, Chief Medical Officer of the NCAA. Following his speech, Ron Courson, Athletic Director of Sports Medicine at the University of Georgia spoke about emergency action plans and when properly implemented, practiced, and executed, can ultimately save the life of an athlete. To close out the meeting, Dr. Kevin Guskiewicz, Director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center in UNC Chapel Hill, spoke about head injuries, including concussions, and the policies that should be in place at every school to protect the health and safety of the student-athletes. Guskiewicz brought home the idea that “This is not an injury that can be managed by a clock, calendar, or cookbook.” Head injuries should be treated on an individual basis, and policies need to be implemented to ensure the athlete is not returning to sport before he/she is physically and cognitively ready.

The meeting was an absolute success for being the first time in history that the key people from each state were together in one room for the same initiative. Great questions, comments, success stories, as well as struggles were brought up from those in attendance. We each face challenges regarding policy development and implementation, but this could be achieved more quickly if we collaborate and work together. With this meeting, the NATA, AMSSM, KSI, and NFL hope to have instilled in the attendees the knowledge and materials the attendees need to return to their respective states and make change happen; change that will follow best practices, change that will ensure athletes are getting the absolute best medical care they deserve, and change that can save a life. “A 2 millimeter difference can make a mile change.” Are you prepared? Do more than care. Think. Act. Make a change. Save a life.

For more resources and information that were shared at the meeting, please visit: www.SolutionsForAthleteCare.org

KSI Staff at CSSS 2015

Pressing Need for Full-Time Athletic Trainers in High Schools (UConn Today)

Last year, 15 high school athletes died playing or practicing sports and thousands more suffered injuries, some of them career-ending.  Many of those fatalities and long-term injuries could have been averted, say researchers with UConn’s Korey Stringer Institute, if more school systems hired full-time athletic trainers and adopted other important health safety protocols.

On Thursday (March 26), members of the Institute joined leaders from the National Athletic Trainers’ Association (NATA) and the American Medical Society for Sports Medicine (AMSSM) in a “call to action” to promote the need for more athletic trainers and other critical safety measures in high schools across the country.

The groups made their case at a news conference at National Football League headquarters in New York. The NFL is a core sponsor of UConn’s Korey Stringer Institute (KSI), which is dedicated to preventing sudden death in sport due to exertional heat stroke and other catastrophic conditions.

“It is vital for schools to have appropriate sports medicine care during games and practices to ensure the safety of high school student athletes,” says kinesiology professor Douglas Casa, chief operating officer of the KSI and director of athletic training education  at UConn. The Korey Stringer Institute is affiliated with the College of Agriculture, Health, and Natural Resources.

The joint news conference was a major milestone for the Korey Stringer Institute, which has been advocating for more full-time athletic trainers and better medical coverage for young athletes since it opened in Storrs in 2010. Casa and the KSI team have been conducting a nationwide education campaign to get states to adopt better health and safety protocols for athletes. Early in the process, Casa helped craft NATA’s landmark position statement on preventing sudden death in secondary school athletics that was endorsed by 16 organizations including AMSSM, which is the national governing body for team physicians, and the National Federation of State High School Associations.

Thursday’s event included a first-ever work session with key stakeholders in high school sports medicine from all 50 states. The group discussed strategies for strengthening medical coverage for student athletes. Casa said future sessions are already planned for 2016 and 2017.

“Adopting these measures and putting them into practice will potentially help save lives and reduce injury,” says Jim Thornton, NATA president. “These recommendations are vital and reinforce our commitment to safety today.”

Currently, only 12 percent of all states require that schools have a detailed emergency action plan in place for critical incidents involving athletes. Only 14 of the 50 states meet minimum best practices in regard to protecting athletes from heat stroke, such as limiting practices on extremely hot days and allowing athletes to gradually adjust to working out in the heat. Half of the states have automated external defibrillators at school-sanctioned athletic events.

The decisions made in the first 10 minutes after a catastrophic incident will often be the difference between life and death. — Doug Casa”

On the positive side, access to athletic trainers at high schools has doubled over the past two decades. Currently, about 70 percent of public high schools around the country have athletic training services, compared to about 35 percent in 1994.

“While the percentage of secondary schools with athletic trainer services has increased dramatically, school districts should begin or continue to hire athletic trainers to improve coverage for appropriate care,” says Casa, a competitive-long distance runner and international expert on exertional heat stroke. “The decisions made in the first 10 minutes after a catastrophic incident will often be the difference between life and death.”

Yet schools without athletic trainers continue to rely on coaches, administrators, athletic directors, and others to provide on-site medical care. Only about 37 percent of schools around the country have at least one athletic trainer on staff as a full-time employee, according to a recent study conducted by the KSI in conjunction with NATA.

Riana Pryor, director of research for the KSI, says a reliance on school faculty and other staff to recognize and treat sports injuries and related medical emergencies puts athletes’ lives at risk. Athletic trainers undergo years of training in such areas as athlete conditioning, injury prevention, emergency action planning, and injury treatment before becoming certified in the field, she says. In addition, athletic trainers are taught to identify the symptoms of potentially deadly conditions such as exertional heat stroke, cardiac conditions, and exertional sickling, which is a medical emergency involving reduced blood flow that occurs in athletes carrying the sickle cell trait.

Pryor and her research team at the KSI contacted all 14,951 public secondary schools in the United States as part of their athletic trainer survey. Many schools were contacted multiple times with about 8,500 providing data. The study, published in the February 2014 issue of the Journal of Athletic Training, found that schools with athletic trainer services used them at competitions more than practices. This gap in medical coverage exists despite the fact that many injuries happen during practices where athletes often perform grueling drills and exercise longer than during games.

With an estimated 7 million secondary school students participating in organized sports around the country each year and approximately 1.4 million high school sports injuries reported annually, having proper medical care and monitoring for those students is critical, says Pryor, a certified athletic trainer with a master’s degree in exercise and sports science, who served as the lead author of the study.

“The more athletic trainers we have in our high schools,” Pryor says, “the safer sports practices and games become.”

 

Source: UConn Today

Safety symposium finds optimism, room for improvement in state policies (USA Today)

NEW YORK – Awareness of health issues in youth and high school sports is quite high, and there is better access to life-saving materials, knowledge and planning than there has been, but young athletes continue to die in ways that would be preventable if treated more responsibly.

That message from a panel of medical experts on Thursday applies to a full range of potentially catastrophic health incidents in teens, including sudden cardiac arrest, heat stroke, and concussive events, inclusive of any incident that causes brain or neck injuries.

The one constant is proper medical oversight must be available and in far too many cases is not. That is a problem the panel hopes to address as part of two days of meetings here with representatives from the athletic bodies of all 50 states.

“You should cringe when you read that a kid died of heat stroke this summer, because it was a tub ice and an athletic trainer who kept that kid from having dinner with his family that night,” Douglas Casa, the COO of the Korey Stringer Institute at the University of Connecticut told a media briefing at the NFL offices. “Heat stroke is 100% survivable if treated properly, if you put an athlete in a cold water immersion tub on site immediately afterward. You have to cool first, transport second. … But diagnosis has to be done on site by an athletic trainer.”

According to the experts— including Casa; Jonathan Drezner, Seattle Seahawks team physician and director of the University of Washington Medicine Center for Sports Cardiology; Kevin Guskiewicz, University of North Carolina Matthew Gfeller Foundation Director; Jason Cates, head athletic trainer of Arkansas’ Cabot Public Schools, and Roman Oben a former NFL player who now serves as the league’s head of high school and youth football — one of the major problems plaguing the youth safety landscape is a lack of proper planning.

The statistics are not pretty. According to the Stringer Institute, only 22% of states meet the recommendation that every school or organization that sponsors athletics develop a plan for managing serious and or potentially life-threatening injuries. A mere 12% of states meet the recommendation that every school have a written plan that is distributed to all staff members, while only 10% fulfill the recommendation that the plan is specific to each venue and includes maps or specific directions to that venue.

When combined with an ongoing dearth of skilled medical professionals overseeing sports activities on campuses, it’s clear that even having all the right tools on campus can be insufficient in preventing death or serious injury due to sudden events.

“When you recognize sudden cardiac arrest, apply CPR and use an Automatic External Defibrillator that is on campus, the survival rate is above 80 percent,” Drezner said. “The survival rate of sudden cardiac arrest in the general public is 8 percent. When there is public access to defibrillators, survival rate is around 50 percent. Every school must have an emergency action plan that will accompany having all of the tools.

“An emergency action plan should be written and practiced at least annually, just as we practice fire drills. Sudden cardiac arrest is largely preventable if we are prepared.”

In fact, Cates could speak to those precise circumstances. In January 2008, Parkview High School basketball player Anthony Hobbs collapsed during a game at his school and died shortly thereafter. He had been transported to a local hospital but there was no AED at Parkview at the time. Two years later one of Hobbs’ teammates, Chris Winston, collapsed on the very same court that had claimed Hobbs’ life. This time the school was prepared. An AED installed just weeks before the incident was used before Winston was transported to a hospital.

Winston survived.

The panel focused on proper training and technique as opposed to the nature of sports themselves when discussing injuries. When asked about the recent retirement of San Francisco 49ers linebacker Chris Borland, all responded with an acknowledged respect for his decision but a wariness to use one man’s choice as a bellwether of reason, instead noting that, “every concussion is unique, like snowflake.” Borland cited concern over the long-term effect of concussions as the main reason he left after one season.

All five panelists either do, or said they would, allow their sons to play football.

The panel agree there is room for improvement, nationwide. Casa cited Georgia, Arkansas, Texas, North Carolina and New Jersey as states with policies that have proved quite effective and could serve as models for other states. Texas was lauded for passing the first bill that mandated AEDs be installed in all schools, while Washington passed a similar measure requiring a comprehensive approach to concussions and brain trauma.

Whether those practices can be spread to other willing states remains to be seen. In the meantime, there were passionate calls for improvements where they could be made quickly, in terms of both staffing and exerting reasoned rationality when dealing with youth sports.
“If a secondary school can afford to field a football, lacrosse or soccer team, there is no excuse for not being able to field a certified athletic trainer who can manage these emergency plans,” Guskiewicz said. “There are far too many schools that do not field certified trainers.”
Added Oben: “As a parent of two boys who play tackle football, an 11-year-old fifth grader and 13-year-old eighth grader, I’m the parent safety coach for my kids’ league. I’ve hosted parent safety education nights. It’s not so much about x’s and o’s, it’s about teaching the parents, particularly moms, about what we’re doing to ease their concerns and educate them about what we’re doing to keep their children safe. We all have to do our part. … We all have to make a collective impact. Coaches, athletic trainers, school administrators all have to do our part to make this work. And we have to continue to to hire appropriate medical experts.”​
Source: USA Today