Month: October 2015

ADs Face Barriers To Hiring Athletic Trainers (Athletic Business)

Source: NATA 


DALLAS, October 27, 2015 – As the country continues to address several recent reports of youth sports injuries and catastrophic outcomes, a new study sheds light on the barriers some athletic directors (ADs) face in hiring athletic trainers (ATs), whose job it is to help prevent injuries and manage them should they occur. Nearly two-thirds of high schools lack a full-time athletic trainer and almost 30 percent don’t have any AT services, according to the National Athletic Trainers’ Association (NATA).

Athletic Directors’ Barriers to Hiring Athletic Trainers in High Schools will appear in the October issue of the Journal of Athletic Training, NATA’s scientific publication and is now online first:

“Three major themes emerged from the data,” said lead author Stephanie Mazerolle, PhD, ATC, assistant professor, director of the Athletic Training Professional Bachelor’s Program, University of Connecticut, and Medical and Science Advisory Board member of the Korey Stringer Institute (KSI). “The athletic directors who participated in the study clearly identified lack of power, budget concerns and non-budget concerns – including rural locations, misconceptions about the role of the athletic trainer and community interference – as major factors limiting their ability to hire athletic trainers in their school settings.”

More than 7 million high school students currently participate in organized sports; 1.4 million high school sport-related injuries occur each year; whereas most athletic injuries are relatively minor, potentially limb-threatening or life-threatening injuries can occur.

“Most deaths that occur in sport are preventable and result from a failure to have proper prevention strategies in place, immediately recognize the condition, and/or implement appropriate care,” added Douglas J. Casa, PhD, ATC, FNATA, chief executive officer of KSI and director of Graduate Athletic Training Education, Department of Kinesiology, at the University of Connecticut. “Prompt management of these injuries is critical to the patient’s positive outcome and should be carried out by trained health care personnel, such as the athletic trainer, to minimize risk.”

As reported in the study, in 2013, the Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs urged all high schools to have an AT on staff to take care of emergency situations and provide care for student athletes. Some schools rely on coaches, ADs or bystanders who are not trained in discerning the similar signs and symptoms of potentially fatal conditions.

Study Protocol

To facilitate organizational changes within secondary school athletics, researchers sought to assess the current environment and potential resistance to change. Schools that had previously participated in the

CATCH-ON (Collaboration for Athletic Training Coverage in High Schools, more recently referenced as the “Benchmark Study”), initiated by KSI and NATA, served as the initial recruitment pool.

Of the total 568 schools, the authors selected a random sample of those schools that did not have the medical services of an AT. Twenty full-time public high school ADs (17 men, three women), from four geographic regions of the U.S. (North, South, Midwest and West) participated. Data were collected by telephone interviews using a guided questionnaire. 

Study Results

Lack of Power:

  • Public school ADs perceived they lacked the power to make hiring and budget decisions and that there was little to no chance of persuading schools or departments to allow them to do so, despite prior efforts. Responses included “zero chance” and “no way.” Reasons included priority of teacher hires and the challenge of shifting monies from other departments and budget cuts. The ADs said that a lack of support from supervisors in the school hierarchy existed and they did not believe it could be overcome.

Budget Concerns:

  • The funds allocated to a specific department or projects within a school can be a leading factor in the services and programs that a school can provide for its student athletes. All but one AD in the study attributed not employing an AT to a lack of funding. Eighteen of 20 discussed budget concerns as a major barrier to hiring. “It was financial, period, financial” said one AD. Another said “we would love to but … this is just not going to happen.” A third said “the school just runs a sports program under what’s called the bare minimum amount of money we can come up with.” Limited resources and budgetary concerns were primary factors in prohibiting hires.

Non-Budget Concerns:

  • Rural Area/Location: Resources in these areas can be substantially limited and location can be problematic; schools may be several miles from cities. Many rural ADs rely on the local emergency medical system (EMS), physician assistants or traveling physicians in the absence of hiring an AT. “We do have one small school that is about 110 miles away and they have a volunteer athletic trainer. It’s just that I don’t know how we’d get someone to come out here,” said one AD.
  • Misconceptions About the Role of the Athletic Trainer: Although most ADs understood the role of the AT, others thought the coaches had sufficient knowledge and training to address the medical needs of the athletes without an AT. All 20 participants stated that their coaches received training in first aid, CPR and concussion recognition and were expected to apply this knowledge during practices and games. This misconception extended to the belief that other health care providers, including emergency medical technicians (EMT) or physical therapists, could be appropriate substitutes for ATs.

High school interscholastic leagues often mandate medical personnel only for football games. High schools that do not employ ATs may rely on their coaching staffs or others to act in emergency situations. Seventeen ADs reported that they had football teams and did not employ ATs. One AD said that because there was a hospital nearby, they didn’t have an AT on staff and that the hospital might bring someone by the field from time to time. “If minor injuries occur, you know, we handle that on-site ourselves,” said another. “Well, the hospital obviously has a person … I don’t know if it’s like a pure AT and it is probably more of a physical therapist type,” adds a third.

  • Community Interference: This category encompassed local schools’ resources and, in some cases, medical coverage provided free of charge. Interference was based on the notion that other medical care providers who were community members or local to a school supplied sufficient on-site coverage for games – including volunteer medical coverage from local EMS. Some are teachers, principals or others with EMT training. “We have a local guy (EMT) who will donate his services for us,” commented one AD.

Recommendations Moving Forward

While continued research is needed, the authors hope that identifying these barriers will lead to the development of strategies to overcome them. Recommendations include:

  • Athletic directors should continue to advocate for the hiring of athletic trainers despite budget concerns and educate parents, school boards and superintendents about the benefits that an athletic trainer can bring to the student athlete’s well-being and medical care.
  • Encourage state legislatures to pass more structured guidelines for athletic health care that follow the recommendations of NATA and other organizations about appropriate medical care in secondary schools.
  • Promote states that have model programs as well as the positive effects of community support – especially through the collective voice and power of parents.
  • Address the misconception that basic first aid/CPR/concussion recognition training for coaches is an acceptable substitution for athletic training services.
  • Budget creatively: sponsor pilot programs with support and/or grants from local hospitals and clinics; hire graduate assistant athletic trainers to provide care in rural areas or appeal to newly credentialed athletic trainers who are excited about their careers who may be a good fit for those environments.
  • Consider community outreach programs with clinics, hospitals and universities as a way to fund or acquire athletic trainer services.

“It is our goal that these findings are catalyst for change,” says Mazerolle. “We hope that all high school student athletes will someday have full-time athletic trainers and receive the gold standard of care they deserve.”

Additional Resources:

NATA High School Benchmark Study

Best Practices For Sports Medicine in High School and Colleges (consensus statement)

Preventing Sudden Death in Secondary School Athletics (consensus statement)

About NATA: National Athletic Trainers’ Association (NATA) – Health Care for Life & Sport

Athletic trainers are health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and sport-related illnesses. They prevent and treat chronic musculoskeletal injuries from sports, physical and occupational activity, and provide immediate care for acute injuries. Athletic trainers offer a continuum of care that is unparalleled in health care. The National Athletic Trainers’ Association represents and supports 43,000 members of the athletic training profession. Visit


Source: Athletic Business

New study highlights difficulty schools face in hiring athletic trainers, scope of shortfall (USA Today)

Much has been made about the lack of certified athletic trainers on the sidelines of a large percentage of American high school athletic programs, and for good reason; not having an athletic trainer is akin to driving down the street without wearing a seatbelt and just hoping for the best. Now a new study from the National Athletic Trainers’ Association (NATA) highlights just how bad that lack of trainers has become, as well as some of the critical issues that make it hard for athletic directors to hire them.

According to the study titled Athletic Directors’ Barriers to Hiring Athletic Trainers in High Schools, roughly two-thirds of American high schools do not employ a full-time athletic trainer, with 30 percent of American schools lacking any athletic trainer at all. That lack of trainers has a profound impact on the health of young athletes; 1.4 million American student athletes are injured each year during scholastic competition, with some of those injuries proving fatal. Notably, seven teenagers have died during the 2015 football seasonalone either during or after football games or practices.

While these deaths have led to a “crusade” for information and coordination among different groups trying to help, it should also highlight the glaring lack of athletic trainers available to many American schools.

The study will appear in the October issue of the Journal of Athletic Training.

“Most deaths that occur in sport are preventable and result from a failure to have proper prevention strategies in place, immediately recognize the condition, and/or implement appropriate care,” Douglas Casa, PhD, the chief executive officer of the Korey Stringer Institute at the University of Connecticut said in a NATA release. “Prompt management of these injuries is critical to the patient’s positive outcome and should be carried out by trained health care personnel, such as the athletic trainer, to minimize risk.”

Meanwhile, the October study highlighted five significant obstacles to the efforts of athletic directors to hire certified athletic trainers. While some, such as budgetary issues, may seem obvious, others such as a generalized misconception about the role and expertise of athletic trainers, are more nuanced. You can read more about the five obstacles in the study here, but in short here are the areas that must be addressed to improve the number of athletic trainers at American schools, according to NATA:

  • Lack of Power: The AD does not have significant authority to hire a trainer or increase the budget to do so
  • Budgetary Limitations: The AD does not have the funding to hire an athletic trainer, or any obvious mechanism to address that financial shortfall
  • Rural Locations: Many schools are not in an area with enough medical professionals to make a high school-based or accessible athletic trainer possible
  • Misconceptions About the Role of Athletic Trainers: Some athletic directors apparently believe that the first aid training provided to coaches is sufficient to deal with in-game injuries and medical incidents
  • Community Interference: Essentially, this is the sense that volunteer medical services provided on site at many sites is sufficient and more cost effective

All of these issues provide difficulties for the needed spread of athletic trainers across America. And that, in turn, leaves young athletes at risk. There is hope that the new study will increase awareness and spark a renewed push to increase the number of athletic trainers at American schools. If it does, it can’t come soon enough.


Source: USA Today

Why High School Football Is Just As Deadly Now As It Was 35 Years Ago (Huffington Post)

Hardly a week has passed since the beginning of the 2015 high school football season without the tragic news that a young player has died.

Six have died already this fall. Tyrell Cameron broke his neck on a punt return. Roddrick Williams collapsed at practice. Ben Hamm and Kenny Bui both died from head trauma, and Evan Murray suffered a lacerated spleen. The latest to die, Cam’ron Matthews, told teammates he felt dizzy, then suffered a seizure.

These stories have drawn horror and headlines, but they are not out of the ordinary. In fact, 2015 is on track to meet the usual numbers of high school football-related deaths: There were 11 in 2014, and 18 in 2013. More than 100 kids have died from high school football-related injuries in the last decade, according to data from the University of North Carolina’s National Center for Catastrophic Sport Injury Research.

Those numbers used to be even higher. In the 1970s, a combination of rule changes that prohibited leading with the head on blocks and tackles, helmet safety standards and medical advances made football fields dramatically safer. More than 150 high school football players died from head, neck and spine injuries alone between 1965 and 1974. That number dropped by nearly half over the following decade.

And then, progress stopped.

Since 1980, both the average number and average rate of annual high school football-related deaths have remained relatively constant. During that time, roughly four kids have died each year due to head, neck and spine injuries the NCCSIR consider “directly” related to football. An average of seven more died from “indirect” causes — heat stroke, underlying illnesses like asthma or sickle cell complications, or cardiac arrest, the most common killer of young athletes. In the last decade, the annual averages have actually increased to five direct and 10 to 12 indirect deaths, said NCCSIR director Dr. Kristen Kucera, though that could be because increased awareness has driven up the number of media reports, on which NCCSIR relies.

Which raises the question: Why haven’t things gotten better?

There are a host of potential answers, including that high school football has come to mimic its collegiate counterpart in size and intensity, said Dr. Douglas Casa, the CEO of the University of Connecticut’s Korey Stringer Institute. The institute, named after the NFL player who died from heat stroke in 2001, promotes initiatives and research to prevent catastrophic deaths in sports.

But one reason stands out above the others: States and schools, he said, aren’t putting the right policies in place to fully protect their athletes.

“The best practices are not being followed,” Casa said. “I’m kind of mystified, but people are just not implementing evidence-based medicine and policies at the high school level. I’m not saying they’re not interested in it, but they’re just not doing it.”

The changes implemented in the 1970s primarily addressed deaths related to head and spine injuries. The number of head-, neck- and spine-related deaths reached their lowest point ever over the last decade, but they remain concerning at their current level.

Indirect fatalities, however, have continued to increase, Casa said. That is worrisome because incidents of heat stroke, heart attacks and complications with illnesses like sickle cell are “almost 100 percent survivable if they’re treated properly,” he said.

Doctors and athletic trainers who study catastrophic injuries in high school sports have a decent idea of how to prevent the vast majority of those indirect deaths. Both KSI and the National Athletic Trainers Association recommend enacting emergency action plans so that people on the ground know how to respond to life-threatening injuries. They also recommend having defibrillators on site to treat sudden cardiac arrests, immersion pools to manage heat exhaustion before it becomes fatal, and other basic medical procedures and practices in place.

Too many schools, though, don’t have those devices on hand or strategies and procedures in place, likely because too many states don’t require them to.

Maps on KSI’s website track which states meet the institute’s basic standards for safety in sports. When it comes to concussion managementemergency action plans and defibrillators, not a single state meets its minimum best practices requirements. KSI recommends two separate policies to prevent heat stroke. Just three states meet best practice recommendations for the first — modifications to practices and games during periods of excessive heat — while only 13 pass the test on heat acclimatization policies that call for phasing in practice activity to get the body used to hot temperatures.

The most frustrating part for football safety advocates is that they know these policies can work. The NCAA drafted heat acclimatization guidelines in 2003. The number of heat stroke deaths in August — the most dangerous month — dropped from and average of two per month to just one in 12 years, Casa said. States that have similar standards, he added, have also seen reductions.

Another glaring problem is the lack of certified athletic trainers on site at practices and games. Just 37 percent of high schools employ a full-time athletic trainer, according to a NATA survey released this year. More than half have a part-time trainer, and three-quarters have access to a trainer at games.

In too many instances, a coach who is untrained as a medical professional is on the front line of decision-making about an injured player’s health. When it comes to determining threat levels that different injuries pose — from concussions and spinal problems to heat- and heart-related issues — athletic trainers are almost indispensable.

“These are areas where the care that athletes receive in the first few minutes of recognizing they are in distress dictates, for the most part, the outcome of that athlete’s injury,” said Dr. Scott Sailor, the president of NATA.

The structure of high school sports, which are governed largely on a state-by-state basis, creates a major barrier for implementing uniform safety standards.

There are, however, signs that everyone is taking the problem more seriously. Most of the state-level changes that have taken place have come in the last five years, Casa said. In March, NATA and the American Medical Society for Sports Medicine held a conference at NFL headquarters in New York that brought together medical experts and high school athletic association officials from all 50 states. They discussed best practices to prevent catastrophic injuries, and the two organizations plan to reconvene the group next year at the NCAA’s headquarters in Indianapolis.

The National Federation of State High School Associations has recommended further changes to tackling rules in an effort to limit head injuries, NFHS executive director Bob Gardner said, and even Congress has hinted at trying to take action that could require schools to implement concussion management protocol. Newly formed advocacy groups have organized other conferences and symposiums to address the dangers of high school sports, which are hardly limited to football.

“We have the evidence now in a lot of these areas,” Casa said. “It’s just, how can we get this whole thing moving faster without having to wait for kids to die?”

Source: Huffington Post

Assessing Traumatic Brain Injuries (UConn Today)

UConn researchers are working with college athletes to test a new device that can quickly assess concussions and other traumatic brain injuries.

The device, developed by Bethesda, Md.-based medical neuro-technology company BrainScope Co. Inc., is a handheld instrument that can help clinicians identify traumatic brain injury (TBI) at the time and place of injury.

“BrainScope approached the Korey Stringer Institute because of our extensive background in conducting research studies,” says UConn graduate student Samantha Scarneo, director of youth sports safety at the Korey Stringer Institute. The concussion study “aligns with KSI’s overall mission to prevent sudden death in sports and overall safety in all levels of sport,” she adds.

The device, which is not yet available commercially, is about the size of a smartphone. Placed on a patient’s head, it measures a patient’s electroencephalograph (EEG), or brainwaves, to gauge brain function after head injury.

The non-radiation-emitting instrument was developed for military use in war zones, and is being adapted for athletes who sustain a TBI while playing contact sports. Within 10 minutes, the device can help medical personnel determine whether it’s safe for a player who’s had a head injury to return to the athletic field.

TBIs include structural injuries such as a bruise or bleeding in the brain and what experts call a “milder form” of TBI, concussions, caused by a bump or jolt to the head. These injuries can alter brain function yet be difficult to detect, as they don’t always cause immediate symptoms.

UConn, one of nine universities participating in the nationwide study, offers an added benefit in the form of state-of-the-art MRI equipment at the University’s new Brain Imaging Research Center, and scientific staff to analyze and make sense of the diagnostic and medical imaging data generated by the study.

Peter Molfese, assistant research professor and director of operations at UConn’s Brain Imaging Research Center, notes that MRI works by manipulating magnetic fields of hydrogen molecules in the body to identify the structure and function of different brain tissues.

After a concussion or other traumatic brain injury, Molfese says, there is a reduction in both gray and white matter in the brain. “Less brain means that functions that were otherwise handled by particular areas need to be remapped to other areas. However, the brain’s ability to remap function is not perfect, and various levels of head injury can leave people with permanent brain damage that can hinder their abilities later on.”

Research efforts to accurately and quickly evaluate TBIs have intensified in the U.S. because of the toll they have had on the U.S. military (300,000 cases since 2000, according to the Department of Defense), and high-profile lawsuits brought against the National Football League by former players for its handling of concussions. In addition, a recent Centers for Disease Control and Prevention report found that 2.5 million emergency department visits, hospitalizations, or deaths were associated with TBIs.

The UConn researchers are now working with both UConn club sports teams and Eastern Connecticut State University varsity and club sports teams to enroll athletes for the study. They aim to complete data collection in December or by the end of the spring sports season in 2016, depending on the number of athletes who sustain concussions. The study will use the Brain Imaging Research Center’s fMRI machine for all of its MRIs, on both injured and non-injured participants.

The interdisciplinary team working on the study includes Douglas Casa, head of the Kinesiology Department’s Korey Stringer Institute, and Jeffrey Kinsella-Shaw, director of the physical therapy doctoral program, in addition to Scarneo and Molfese.


Source: UConn Today

Deadly month in high school football (CNN)

Roddrick “Rod” Williams was a popular offensive lineman and tuba player at Georgia’s Burke County High School. On the football field, the bespectacled 17-year-old was known for his hard play and lighthearted song and dance numbers that made teammates laugh.

Saturday, one day after the Burke County High School Bears took the field without their beloved No. 71, the Pride of Burke County symphonic band played his favorite songs as part of his funeral service. His tuba rested on the 50-yard line in the school stadium.

Williams’ death Monday night was the fifth of a U.S. high school football player since early September.

The 5-foot-11-inch, 300-pound junior collapsed September 22 shortly after football practice began, CNN affiliate WSB reported. The school trainer performed CPR until an ambulance arrived, according to the station.

His death was heart-related, Burke County Coroner Susan Salemi told CNN, declining to elaborate.

About 3 high football deaths a year

The number of young athletes whose deaths are related to high school football fluctuates from year to year.

In 2014, five high school players died of causes directly related to the sport, such as head and spine injuries, according to a survey by National Center for Catastrophic Sports Injury Research (NCCSIR) at the University of North Carolina.

Another six players died of indirect causes: Three were heart-related, one was from heat stroke and two were hypernatremia and water intoxication, the survey found.

“Certainly this is not going to be one of the low years,” said Robert Cantu, medical director for the NCCSIR and a professor at the Boston University School of Medicine.

The past decade has seen an average of three fatalities each year directly attributable to high school football, the survey said.

In 2013, there were eight deaths directly linked to high school football.

Between 2005 and 2014, the deaths of 92 other high school football players were indirectly related to the sport, according to the NCCSIR survey.

“These events are incredibly tragic,” said Dawn Comstock, an associate professor at the University of Colorado’s Colorado School of Public Health.

“I would love to never see another high school athlete die while they play their game but the positive benefits of playing sports in terms of lifelong health are greater.”

The benefits, however, will be of little solace to the families and friends of Williams and the other four high school football players who have died this season.

Kenney Bui

Kenney Bui, 17, a wide receiver and defensive back for Evergreen High School near Seattle, died Monday after suffering a traumatic brain injury during a game the previous Friday.

Video shows Bui taking a hard shot to the head and getting back up, CNN affiliate KIRO reported. He was taken away in an ambulance after taking another hit to the head later in the game.

Bui died from blunt force injuries to the head, according to the King County medical examiner’s office.

His father, Ngon, a janitor in Seattle’s public schools, told KIRO he learned of his son’s death via text message: “Your son is dead.”

Close to tears, Ngon Bui said, “I love my son. I don’t want nothing to happen to … kids. And a parent to have to worry.”

Bui’s father asked his son to quit the game after a previous injury, but the teen’s mother and Bui overruled him, the station reported.

Bui suffered a mild concussion in early September and the school referred him to a doctor, Highline School District spokeswoman Catherine Carbone Rogers told CNN on Friday. He was cleared to play after a few days and returned to the field two weeks later, she said.

Evan Murray

Evan Murray, a senior at Warren Hills Regional High School in northwest New Jersey, died September 25 after leaving the game with an injury, according to the school.

A GoFundMe page to assist Murray’s family said the quarterback and captain — a popular student who also played baseball and basketball — “felt woozy” after getting hit in the backfield.

“He was always there for all of his teammates. Played hard, all the time. He’s going to be sorely missed by everybody,” baseball coach Michael Quinto told CNN affiliate News 12 New Jersey.

Ben Hamm

Ben Hamm, a junior linebacker and team captain at Wesleyan Christian School in Bartlesville, Oklahoma, died September 19 after suffering a head injury during a tackle in a game eight days earlier, CNN affiliate KOTV reported.

Hamm was in a coma after being rushed to the hospital with bleeding in his brain, according to the station.

His father, Steve, wrote of his son’s death of the team’s Facebook page: “Ben’s condition has deteriorated … because of a lack of oxygen in his blood and this morning I am saddened to let you know that the world has lost a spiritual warrior!”

Tyrell Cameron

Tyrell Cameron, 16, a student at Franklin Parish High School in Louisiana, died September 4 after a game injury, the Franklin Parish coroner’s office said. He died at Franklin Medical Center.

Cameron was hit during a punt return in the fourth quarter of the game against Sterlington High School, Franklin Parish head coach Barry Sebren told CNN affiliate KNOE.

Northeast Louisiana Ambulance Service was on the sidelines and rushed onto the field to help.

The cause of death is under investigation, but KNOE reported Cameron broke his neck.

Schools lack full-time trainers

The reason for the high number of high school football fatalities compared to college and the pros comes down to numbers.

There are about 1.1 million high school football players in the nation compared to about 100,000 in the NFL, college, junior college, Arena Football and semiprofessional level, the NCCSIR survey found.

High school football players suffer three times as many catastrophic injuries — deaths, permanent disability, neck fractures and head injuries — as college players, according to a 2007 study in the American Journal of Sports Medicine.

Kevin Guskiewicz, co-director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina, said the developing brains of high school athletes are more vulnerable to catastrophic head injuries.

In addition, the skill level of many younger athletes leaves them susceptible to serious injuries.

Making matters worse, nearly 70% of high school athletes with concussions played despite their symptoms, and 40% reported that their coaches didn’t know of the injury, according to a 2014 study in the American Journal of Sports Medicine.

The risk of serious injuries and death at the high school level is exacerbated by the shortage of full-time athletic trainers at practice and games — due largely to costs.

A study this year in the Journal of Athletic Training said only 37% of the nation’s public high schools have full-time athletic trainers.

“Nearly all of the causes of death in sport are influenced by the care in the first 5 to 7 minutes,” said one of the study’s authors, Douglas Casa, a professor of kinesiology at the University of Connecticut.

The five leading causes of death among high school athletes are cardiac conditions, heat stroke, sickling, and head and spinal cord injuries, according to Casa, who’s also the chief executive officer of UConn’s Korey Stringer Institute, which researches sudden death in sport.

“They are all impacted by the level of medical care. Sickling and heat stroke are 100% survivable with proper recognition and care and cardiac is over 90%.”

Exertional sickling is a medical emergency in those carrying the sickle cell trait, according to the institute. It occurs when red blood cells change shape, causing a buildup of the cells in blood vessels and leading to decreased blood flow.

‘High school sports safer than ever’

Comstock and other experts believe schools without full-time athletic trainers should disband their football teams.

Still, the past 10 years have seen significant changes intended to make the game safer for young athletes, according to experts.

Every state and the District of Columbia now has some type of sports concussion law, the National Federation of State High School Associations says. The laws cover issues like removing athletes with a suspected concussion from play and concussion education programs for coaches, though the laws vary significantly from state to state.

This year, the organization recommended limits on the number of days per week that football coaches hold full-contact drills.

“High school sports are probably safer than they’ve ever been,” Guskiewicz said.

Source: CNN

Why All Our Fancy Gadgets Still Can’t Beat Heatstroke (Outside)

A handful of smart wearables promise to detect heat-related illnesses before they become dangerous. Trouble is, they’re vastly over-promising on their abilities.

Over the past six years, a handful of companies have developed smart devices for athletes that they claim can detect heatstoke and other heat-related illnesses before they become dangerous.

Take the temple-thermometer sensor HotHead Technologies, launched in 2009, that was briefly available in some football helmets from Schutt. A similar technology is now used in a cap made by HotHead’s successor, Spree Wearables. VaporEze’s BodyTemp is a bandage-like strip with a built-in thermometer. And now a startup called SMRT Mouth is creating a sophisticated mouth guard, set to debut in 2016, that will monitor temperature, hydration, and exertion to warn competitors of impending heat illness.

This sort of technology has the potential to save lives. Every year, about 2,800 people are hospitalized for heat illness, according to a Centers for Disease Control and Prevention study. And while the elderly are the most vulnerable, athletes are at risk, too: a 2013 study analyzing summer running events in Israel found that participants were 10 times as likely to suffer heatstoke (the most serious heat-related illness) as any cardiac event—although risk for either was still low. Every year, some 9,000 student-athletes suffer some type of exercise-related heat illness, with the highest rates in football. Heatstroke causes organ failure and is life threatening if not treated quickly. In the Israeli study, two of the 21 heatstroke cases were fatal, and a 2014 paper by the University of North Carolina’s National Center for Catastrophic Sport Injury Research noted that there’s an average of 2.6 football player deaths per year due to exertional heat stroke. In some severe but non-fatal incidents, there can be lifelong changes to organ function.

But here’s the catch: none of the tools on the market work, at least not yet, says Douglas Casa, one of the U.S.’s foremost experts on exertional heat illness and the director of the University of Connecticut’s Korey Stringer Institute. The only way to accurately identify heat stroke early, he says, is to measure core temperature, which none of these devices are capable of doing.

Our bodies cool through the skin, via conductive (when heat radiates away from the skin) and convective (when sweat carries heat to the surface and then evaporates) means. But as soon as air temperatures rise past 98 degrees, we lose our conductive ability and rely entirely on evaporating sweat to cool down. Heatstroke occurs when our bodies are no longer able to shed heat. “Despite the fact that we define heat stroke as when your temperature goes past 104 degrees, this is not solely a temperature event,” says Dr. Lisa Leon, a research physiologist with the U.S. Army’s Research Institute for Environmental Medicine. “It’s a cardiovascular event.” What ultimately causes collapse and the most serious heat injury is too much strain on the cardiovascular system.

It’s normal for body temperature to rise during exercise, says Casa. Our normal resting core temperature of 98.6 degrees increases when we work out, particularly when we’re outside in warm weather. Conditioned and acclimatized athletes can typically handle periods of exercise-induced hyperthermia—where body temperature greatly exceeds normal. “This morning, I went for a run at 10 a.m. and I went hard for an hour and a half. My core temp when I finished was 104.3,” he says. “When we worked with soccer players in the World Cup, it was pretty normal for them to get to 103.5 or 104.5 during practice or games.”

The problem is when core temperatures rise above 104 degrees and stay elevated for longer than 30 minutes. “The great thing about the human body is that you have about a 30-minute window to be over that critical threshold with no long-term complications. A highly trained athlete who goes hyperthermic in a half-marathon, they know that if they have a half-mile left, they can get hot for those last minutes as long as they can immediately cool down afterward.”

So, 104 or less, for less than a half hour. Simple, right?

Not really, say Casa and Leon. The only way to accurately tell if you’re pushing the 105-degree mark is to measure core temperature. The accepted standards are rectal and esophageal, both of which are impractical for athletes to monitor during practice or games. Ingestible thermometers that transmit wirelessly, called thermistors, can be accurate, but only once they’ve passed into the intestine, says Casa. Otherwise, cold fluids can interfere with the reading. And that’s where most of the devices mentioned above fall short.

No skin- or mouth-temperature readings have been found to consistently correlate to core temperature, says Casa, and he cautions against relying on them to monitor heat stress. “We’ve found nothing else that works,” besides directly measuring core temp, he says. Leon says that USARIEM has in some situations been able to use heart rate changes to predict core temperature, but she reiterates her point that heat stroke, particularly in relation to exercise, is a more complex issue than that one metric can show.

That’s the second reason avoiding heat injury isn’t as simple as tracking core temp. Especially when dealing with exertional heat stroke “there are so many factors that go into your susceptibility,” Leon says. Are you acclimatized to heat? Are you fit or do you have extra weight that makes it harder to cool yourself? Do you have a pre-existing heart condition that limits your cardiovascular system’s ability to shunt heat from the core to the skin? “Multiple individuals at exactly the same core temperature experience heat injury to different degrees of severity,” she says. “One person may be fine at 104 degrees and another is collapsing at not much over 100.”

Of the various devices listed above, SMRT Mouth seems the most promising, partly because it won’t rely exclusively on temperature monitoring. Cofounder Dana Hawes says that the device will measure pulse rate, exertion based on exhalation force, and hydration, using fluid osmolality of saliva. The data will be sent to a proprietary application on a tablet using low-power wireless transmission. “The triangulation of those data points help paint a clearer picture for what is happening with the athlete,” he says. The idea is to let coaches and trainers monitor athletes and “provide a predictive tool” that helps prevent heat injury.

But the device is still very much in prototype stage and Hawes admits that SMRT Mouth needs to go through extensive testing to show that it can accurately measure what it claims to measure and that the links to heat illness are consistent and clear.

As director of the Stringer Institute, Casa has spoken with a number of companies in SMRT Mouth’s position and is skeptical of their broader claims. “I do think this has potential to help with hydration,” he says, “but the leap to body temperature is less relevant. I don’t know that a mouthpiece can give you an accurate indication of core body temp when someone just chugged a liter of 52-degree Gatorade.” He also points out that hydration is only partly related to heat illness. “A one percent loss in body mass due to dehydration will increase your core body temperature by about half a degree,” he says. But dehydration isn’t a prerequisite. “You can have heatstroke without being dehydrated,” he says, noting that he’s seen runners with heatstroke at the New York marathon in temperatures as low as 65 degrees. In fact, the 2014 football fatality report from the National Center for Catastrophic Sport Injury Research found that two athletes died from over-hydrating to prevent heat illness. That’s where SMRT Mouth’s multiple data points may help the most.

Brett Ely, a Graduate Teaching Fellow at the University of Oregon and former researcher at USARIEM, has co-authored several studies on using saliva osmolality to track hydration and says that, as long as you recognize the limits of the method, it’s a viable metric. “But it doesn’t work in terms of absolute thresholds,” she says. Even a sip of water can throw off short-term measurements. The key is to get lots of data by tracking over time—within the workout and over many workouts. She also points out that even if it isn’t directly related to heat injury, tracking hydration alone can be a valuable tool. To an observer, “the symptoms of dehydration and over-hydration look about the same,” she says. “The saliva osmolality could give you an indication of which it is so you know how to respond.” Ely added that one of the biggest benefits might be simply the mental shift that accompanies tracking data. “It’s similar to heart-rate monitors, where the awareness that you’re monitoring can be a reminder to take your easy day. This might serve as a reminder to take more breaks.”

Leon adds that she’s cautiously optimistic about tracking devices, if only for the reason that they can increase awareness. “We have specific guidelines we give to soldiers, and the basics are to know your environmental conditions, and the work you’re performing, and most of all, know your physical ability.”

While Casa and Leon say no wearable can currently monitor heat stress accurately, both are hopeful that will change soon. “I love the potential,” says Casa. “Someone is going to solve this problem in the next five years.”

We’re just not there yet.

Your best bet at preventing heat illness? Avoiding it in the first place. Prevention comes down to these five basic rules:


“Most heat illnesses happen in the first two to four days of exercise in the heat. Ramp up your exposure over a two-week period: the body is capable of some pretty amazing physiological changes to adapt,” says Casa.


Drink lots of fluids and not just water—you need electrolytes, too. “We see functional changes in how the body performs with dehydration around two percent loss of body mass,” says Ely, adding that you can reach that in as little as an hour of hard exercise. Dehydration is progressive, so if you’re only exercising an hour, you won’t notice the effects, but if your workout is longer and you’re not replacing fluids, the changes get increasingly severe.

Cool Yourself

Go for any tools you can use to lower your core temperature—shade, cold, wet towels during breaks, misting fans, and post-workout cold-immersion tubs.

Modify the Workout

“You can do the same intensity for a shorter period, or with more rest breaks, or you can do less intensity,” says Casa. This is key with structured workouts in team sports where athletes are asked to do a certain workout over a certain time. A 220-pound guy with almost no fat and a 320-pound lineman doing shuttle runs for 30 seconds at full speed are working at vastly different intensities. Take frequent breaks when it’s hot, and employ those cooling options.

Be Aware

Leon calls it paying attention to “skin in/skin out” conditions. Skin in consists of knowing your fitness and capabilities. Skin out is everything from what you’re wearing (like football pads or black clothing that absorbs heat) to the environmental conditions. In team sports, awareness needs to be collective, as teammates and staff look out for each other. The standard for assessing weather that poses a heat injury risk is a wet bulb globe thermometer, which is a relatively expensive piece of equipment but likely a good investment for any decent-sized organized exercise program like a high school athletics department or even large running club. Casa is dismissive of old-school coaching techniques where athletes are assigned to run laps or do other hard conditioning work as punishment. Coaches need to move past the workout-as-punishment mindset, he says, which can also make athletes less likely to speak out about being in discomfort.

Source: Outside