Policies

2017 Collaborative Solutions for Safety in Sport

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

March 28-29, 2017 Kansas City, MO

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

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

 

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

 

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

 

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

 

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

Collaborative Solutions for Safety in Florida High School Sports

William Adams, PhD, LAT, ATC

 

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

 

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

 

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

 

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

 

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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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Texas House Advances Bill Mandating EKGs for High School Athletes (Education Week)

The Texas House of Representatives approved a bill last week that would require high school athletes to undergo an electrocardiogram, or an EKG, before participating on a sports team.

The bill, which passed the House on an 82-62 vote on April 14, would require all high school student-athletes at University Interscholastic League schools to have an EKG before the student’s first year of participation in sports, and again before his or her third year. If a parent or guardian submits a written request to waive the requirement, however, a student-athlete would not be required to undergo the EKG.

According to a 2011 study published in the journal Circulation, sudden cardiac arrest was the leading cause of death during exercise in NCAA student-athletes, and similar data has held true for younger athletes, too. State Rep. Sylvester Turner, one of the bill’s joint authors, believes mandating EKGs could help prevent some instances of sudden cardiac arrest by uncovering undiagnosed conditions.

“These deaths are preventable and we have the resources to inform Texas parents if their child is at risk,” said Turner in a statement. “The legislation does not require parents to take any medical action in response to an ECG. Regardless of the information the ECG provides, any medical decisions regarding the student athlete remain at the parent’s discretion.”

The legislation was inspired in part by Scott Stephens, who lost his son Cody to sudden cardiac arrest in May 2012. Since that time, Stephens started the Cody Stephens Go Big or Go Home Memorial Foundation, which helped screen over 15,000 athletes last year, according to The Dallas Morning News. Fifteen of those youth-athletes wound up needing heart surgery, and two were told to quit contact sports, the paper reported.

“We found 17 kids out of 15,000,” Stephens told the paper. “If there’s a million kids in the state of Texas getting a physical, that tells me—just by the math—that there’s 1,000 kids out there that are possible candidates for sudden cardiac arrest.”

If signed into law, the Texas bill would go into effect beginning with the 2016-17 school year. It has since been sent to the Senate for further discussion.

Sudden cardiac arrest has been a hot topic in youth-athlete safety for years. In 2011, a 16-year-old Michigan high school basketball player named Wes Leonard collapsed on the court after hitting a buzzer-beating shot due to an enlarged heart. After being rushed to the hospital and undergoing CPR, he was pronounced dead due to sudden cardiac arrest. His friends and family later createdThe Wes Leonard Heart Team to advocate for student-athlete-safety legislation, including a requirement that all public and private schools have enough automatic electronic defibrillators on site.

That same year, the National Athletic Trainers’ Association released a statement urging states to pass pending youth-athlete-safety legislation, despite any potential budgetary concerns. At its third annual Youth Sports Safety Summit in December 2011, association members discussed ways to prevent sudden death in youth sports.

“We believe that 90 to 95 percent of the deaths that happen in youth sports are preventable,” said Dr. Douglas Casa, the chief operating officer of the Korey Stringer Institute at the University of Connecticut, during that year’s summit.

In November 2011, a survey presented at the American Heart Association’s scientific sessions revealed that fewer than 6 percent of doctors in the state followed national sudden-cardiac-death screening guidelines to their fullest extent when examining high school athletes. Not a single athletic director said that his or her school required doctors to comply with all state guidelines at the time, either.

In the spring of 2012, meanwhile, then-Pa. Gov. Tom Corbett signed a law designed to protect student-athletes from heart failure. It required schools to issue an information sheet to parents of student-athletes about the warning signs and symptoms of sudden cardiac arrest, which they needed to sign and return to the school before their children were allowed to participate in athletics.

This past March, Dr. Brian Hainline, the NCAA’s first chief medical officer, divulged to The Wall Street Journal his plan to recommend “that athletes at higher risk of cardiac death, including male basketball players, be required to undergo an EKG test to search for cardiac defects,” according to the paper. However, “some 100 university team physicians” signed a petition “calling on him to change his mind,” the WSJ reported one month later, which he wound up doing.

“I have become convinced that the infrastructure and knowledge base will not support this effort at present,” Hainline announced at a conference in mid-April, per the paper.

The issue clearly remains contentious among medical experts, and the Texas House had its fair share of members opposed to the bill, too. We’ll see over the coming weeks whether Texas state senators express the same concerns.

 

Source: Education Week

Protecting High School Athletes From Preventable Deaths (WBUR)

Listen to Dr. Casa’s Interview with NPR here.

 

Doug Casa, chief operating officer of the Korey Stringer Institute, says the highest number of sports-related deaths in the U.S. are among the 7 million high school athletes.

Casa, along with the National Athletic Trainers’ Association, is asking all 50 states to adopt safety procedures to safeguard athletes. Casa joined Bill Littlefield to discuss his efforts to make high school sports safer.

BL: Doug, how many athletes are we talking about in a given year?

DC: In a given year, if we just focus on high school, you usually see between 20 and 30 deaths. We’re also very focused on what we call “catastrophic injuries” that may not lead to death. And those will number in the hundreds.

BL: You focus your study on four causes of death: sudden cardiac arrest, head injuries, heat stroke and complications from the sickle cell trait. How did you narrow it down to just those four?

Testing High School Athletes For Steroids
Kids … find the tests pretty easy to beat,” says the founder of a group that aims to prevent steroid use.

DC: It’s a good question. I mean, the research has shown that those four causes of death actually are about 90 percent of all the deaths that we see in high school and college sports. So it’s not to say there aren’t other things that could be dangerous to an athlete, like lightning strikes or something called hyponatremia or asthma.

But those four that I mentioned, all four of these conditions can be prevented. And in the case of heat stroke, for instance, death is 100 percent preventable if treated properly. And in the case of cardiac conditions, if an AED [automated external defibrillator] is placed on within a minute, they’re 90 percent preventable.

BL: In 2013, I understand that along with the National Athletic Trainers’ Association, you recommended that all 50 states adopt guidelines to protect athletes from sudden death. But in 2015, only 22 percent of states have done that. Why is it so difficult to get everybody on the same page when it comes to something so basic as player safety?

I’ve been an expert witness on 35 cases where deaths have happened in sport … and in almost all the cases, the death was preventable with relatively simple, simple policies and procedures.

– Doug Casa, Korey Stringer Institute

DC: It depends on which particular policy we’re speaking of. I mean, some states have moved forward faster, for instance, like with some concussion policies as an example.But they’ve been a little slower, maybe, with heat acclimatization policies or AED policies. Because at the high school level, you have to change policies on a state-by-state level. It’s not like the NCAA, or the NFL, or professional governing bodies where one organization will influence everyone.

I really think the last three-to-five years have been just a total, monumental shift in the thought process, and we’ve seen a lot of substantial changes. As an example, with heat acclimatization, in 2011 we had zero states that met the minimum guidelines for heat acclimatization, which is kind of the key step to prevent heat stroke deaths. And now we’re at 14 states. And it might not seem like a lot, but of those 14 states, 10 of them are in the Southeast, and we still have not had a heat stroke death in any of those 14 states that have followed those policies. So that’s powerful ammunition for those other states to move forward and adapt some of these policies.

BL: I find it hard to understand how something so commonsensical as “Hey, let’s have some acclimatizing to heat conditions” could ever be controversial anywhere.

We don’t want to stop until we have 50 states, although my wife keeps convincing me we don’t need Alaska for heat acclimatization.

– Doug Casa, Korey Stringer Institute

DC: I wouldn’t say it’s controversial. Sometimes change takes a little bit of time because they have to change what they’ve done for the last 50 years. In high school football they like to start out and have their two-a-day practices, and a lot of times it’s a change of a mindset for them.

So I do agree with you, it’s very common sense, it’s very simple changes and the amazing thing is it costs so money at all. So when we usually get a chance to sit down and meet with them individually, most make progressive changes. Fourteen states meet the minimum standards, but, to give credit, another 20 have made substantial changes in the right direction.

BL: You know, Doug, I haven’t known you for very long but I can tell you are the ultimate “glass half-full” kind of guy if you’re talking about 14 states are on board, and you’re talking about progress. 

DC: Well, I guess my way of looking at it is 90 percent of all heat stroke deaths in America happen in concentrated states in the Southeast region of the country. So probably saving three or four kids lives every summer just by the states we’ve gotten on board — so that makes me feel pretty good for those families. But yeah, we don’t want to stop until we have 50 states, although my wife keeps convincing me we don’t need Alaska for heat acclimatization.

But I mean that’s just one example. There’s a lot of really simple things we can do to keep kids safe. I mean, AEDs is a great example. It’s only $1,000 for an athletic department to have one nearby. Cardiac’s the leading cause of death in sport in America and to have an AED there is almost a foolproof way of saving someone’s life. It’s really a pretty small cost when you think of the benefit.

BL: Especially when you’re thinking in terms of a $60 million high school football stadium.

DC: That, or when you think about the lawsuits that emanate when deaths do occur that are preventable. I’ve been an expert witness on 35 cases where deaths have happened in sport, especially at the high school level. And in almost all the cases, the death was preventable with relatively simple, simple policies and procedures that would have protected that kid that passed away.

 

Source: Only a Game