Month: July 2015

In summer heat, athletic trainers call for safety measures (Reuters)

(Reuters Health) – A thousand-dollar expenditure for an automated external defibrillator (AED) could mean the difference between life and death for some young athletes, a cost that one Little Rock, Arkansas high school knows too well.

A heart abnormality caused 16-year-old Antony Hobbs to collapse during his Parkview High basketball game in 2008. Hobbs was unaware of his condition, likely present since birth. Though an ambulance responded, he died about an hour after an otherwise ordinary game tip-off.

The outcome differed starkly two years later when another Parkview player, Chris Winston, collapsed on court with the same condition. A new state law, named for Hobbs, had required that AEDs be placed in schools, and AED use led to Winston’s survival.

While Arkansas’ policy followed tragedy, the National Athletic Trainers’ Association (NATA) and the American Medical Society for Sports Medicine are asking schools to proactively take measures to protect kids before summer training for fall sports.

“We’ve mostly been reactionary in terms of our preparations,” said Jonathan Drezner, a University of Washington sports medicine physician and co-author of an editorial in the Journal of Athletic Training that calls for emergency practice implementation in schools. “It shouldn’t be that a kid has to die for the school to be prepared,” he said.

In 2014, 11 high school football players died during practice or competition, according to the National Center for Catastrophic Sports Injury Research. Five deaths were a result of brain injury or cervical fracture. Six were the result of heart conditions, heat stroke or water intoxication.

“AEDs are a relatively inexpensive way of saving a life,” said Doug Casa, CEO of the University of Connecticut’s Korey Stringer Institute, which works to prevent sudden deaths in sports. Casa authored NATA’s “best practice” guidelines in 2012 for school sporting events (available online here:

In addition to calling for AEDs onsite, the guidelines advise schools to develop heat acclimatization programs, with phase-ins of equipment, along with gradual increases in intensity and duration of exercise. Football practice in early August is the most dangerous time for heat strokes in young athletes, according to the organization.

The recommendations also call for schools to coordinate their emergency plans with local emergency services.

Nationwide adoption of the guidelines has proven slow, however. Only 14 of 50 states, for example, meet NATA “best-practices” regarding heat.

And according to the Sudden Cardiac Arrest Foundation, only 19 states have laws mandating AEDs in at least some schools.

Jason Cates, an athletic trainer for Cabot Public Schools in Cabot, Arkansas, was among those who worked for changes after Hobbs’ death to ensure the safety of Arkansas’ student-athletes. For districts with limited budgets, he suggests enlisting support from local booster clubs and parent-teacher organizations, and holding fundraisers during games.

To schools that install new turf or expensive video screens instead of safety measures, Cates says, “If you can afford to do that stuff, you can afford athletic health care.”

Source: Reuters

Exertional Hyponatremia

Exertional Hyponatremia

By Rachel Katch, Assistant Director of Research  

Exertional hyponatremia (EH) is a rare, yet potentially fatal condition that is associated with a serum sodium concentration less than 130mEq/L. There are two common causes for this lack of sodium in the blood, which are: (1) an individual ingests fluid replacement beverages well beyond sweat losses, and (2) an individual’s sodium losses through sweat are not replaced adequately. There are many risk factors for developing this condition, but a few key factors are overhydration, participating in events that last longer than four hours, and gender. Many individuals think that the more fluid they ingest, the better for their body it is during exercise. This is not always the case. By over hydrating, you are setting yourself up for EH due to sodium depletion. Secondly, by competing in exercise greater than four hours, an individual tends to drink more fluid due to the increased time, which would again set them up for sodium depletion both from sweating and overhydrating. And lastly, gender does play a role. EH is more commonly found in females due to their generally small stature. The theory is the smaller the body mass index, the more effect overhydrating will have on the body due to having a smaller mass to dilute.

The signs and symptoms, as well as treatment, of EH are outlined in Table 1. Mild symptoms generally occur with a serum sodium concentration between 135-130mEq/L. Moderate to severe symptoms start to occur when serum sodium concentrations start falling below 130mEq/L. The lower the sodium concentration, the faster an individual will decline in health, and if they are not treated appropriately EH possibly will result in death due to encephalopathy.

There are many ways to implement prevention strategies to mitigate the risk of suffering from EH, which include but are not limited to: (1) education on fluid intake before, during, and after competition, (2) maintaining a healthy diet that incorporates appropriate sodium intake, and (3) creating individualized fluid replacement protocols. Proper education on hydration is a key feature to preventing EH by letting individuals know what is appropriate so they do not overhydrate. Prior to exercise, an individual would want to be hydrated; but what does that mean? Proper pre-exercise hydration includes consuming 500-600mL of water or sports drink two to three hours before exercising, and then consuming 200-300mL 10-20 minutes before. Appropriate hydration during an event is crucial as well, and generally includes consuming 200-300mL every 10-20 minutes. And lastly, post-exercise hydration aims to correct any fluid loss during exercise by consuming fluid containing water, carbohydrates, and electrolytes within two hours of exercise completion.  

Table 1. Exertional Hyponatremia Signs & Symptoms with Treatment


Maintaining a healthy diet that incorporates correct sodium intake for your exercise is also important. Dietary sodium supports normal body maintenance of fluid balance and can help prevent muscle cramps, heat exhaustion, and EH. This is especially important for those individuals exercising in hot weather due to the excess sodium depletion through sweating. It is significant to note that sports drinks generally contain low levels of sodium relative to blood, and should not be the only source of sodium replenishment. Instead, eat salty foods such as soup or pretzels prior to exercise while using sports drink as a supplement the diet.

Lastly, creating individual fluid replacement protocols is the most effective way to prevent EH. An individualized fluid prescription incorporates, but is not limited to, factors such as: (1) sweat rate, (2) sport dynamics (rest breaks, access to fluid), (3) environmental factors, (4) acclimatization state, (5) exercise duration, (6) exercise intensity, (7) gastric emptying/intestinal absorption, and (8) individual preferences. Some individuals sweat more than others; have a slower gastric emptying rate; have different fitness/heat acclimatization status; etc. which all lead to different fluid replacement protocols. These protocols should always be individualized and not generalized to maximize performance and to mitigate the risk of suffering from EH.

Everyone is different, and their fluid replacement protocols should be no exception.    

KSI Fellowship


This summer, Korey Stringer Institute welcomed the first fellow, Kyle MacKinnon, BS, ATC. (Photo from left: Dr. Stearns, Sarah Attanasio, Rachel VanScoy, Luke Belval, William Adams, Dr. Huggins, Lesley Vandermark, Andrea Fortunati, Kyle MacKinnon)


By Kyle MacKinnon

Going to college at Ithaca College, I was fortunate enough to gain the mentorship of Kent Scriber. Kent was known for his stories from his early career. In 1985 he provided potentially life-saving treatment to a young track athlete suffering from exertional heat stroke. This athlete was Douglas Casa, the Chief Operating Officer of the Korey Stringer Institute. One day over our winter break, my program director emailed me with an opportunity-a summer position had been posted at KSI. After a period of emails, phone calls, and interviews I was fortunate enough to be selected as the inaugural KSI research fellow.

After graduating college in the spring, I had about two weeks of nothing. Quickly, this passed and I was off to Storrs, Connecticut. I started at KSI on June 1st. Although I am only here for 8 short weeks, I have been immersed in several on-going projects. From high school policy updates to a prolonged study on performance variables and soccer players, I have gained invaluable insight into the world of research and sports safety. Most recently I have been creating an informational video on heat acclimatization. Many of KSI’s research publications have been compiled into policies to optimize safety. The video project is designed to be an accessible resource for all those who may encounter heat stress.

My time here has given me a better awareness of what goes on in world of research. It is filled with tough work and even tougher people doing the work. The process behind a publication was almost a mystery to me before I came to KSI. After observing and having conversations with my colleagues I have a firmer understanding of the process. One thing that I have learned that is a constant is that something can always be better, whether that means getting new eyes on a paper or stepping back and trying a new perspective.

There is a constant need for more research. In an era of information, KSI is committed to producing only the best quality evidence and research. I am grateful to have had this opportunity to be at the front lines of research. The lessons taught to me here will follow me throughout my career and life.