Month: November 2015

Athletic Trainers Needed to Prevent HS Tragedies (Athletic Business)

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Post & Courier (Charleston, SC)


Eight high school football players across the country have died this season, and these tragedies appear to be occurring more frequently. Now more than ever, every high school needs to hire a full-time athletic trainer.

There are so many critical functions an athletic trainer performs for student-athletes. Treating and rehabilitating injured players and helping to determine return to play are only part of their duties. No role impacts the lives of the athletes more than recognition and initial treatment of life-threatening emergencies.

As an example, let s imagine a 17-year-old football player who suffers heat stroke during a summer practice. Without an athletic trainer present, it could take five or 10 minutes before a coach notices the player confused. The coach might not recognize the cause of his symptoms. Not knowing the initial management of heat stroke, he might call EMS.

It could take at least 15 minutes for the ambulance to arrive. Add more precious minutes for the paramedics to assess the player and load him in an ambulance. Factor in another five to 15 minutes in travel time to a hospital and 10 minutes or more for the emergency room doctor to assess and begin treating the patient. That s 30 to 45 minutes minimum before treatments to lower the athlete s core body temperature begin.

Most cases of heat stroke involve the athlete having a core body temperature between 106 and 110 degrees. There s a critical threshold for cellular damage around 105.5. If the athlete stays above that temperature for 60 minutes or more, he will almost certainly die or have long-term medical complications. If his temperature exceeds that level for 30 to 60 minutes, he usually lives but often has lasting complications. If his temperature drops below that level within the first 30 minutes, he survives and returns to a healthy life.

An athletic trainer can recognize an athlete in distress sooner, and he or she can start treatment right away. The athletic trainer can remove the uniform and helmet, take a rectal temperature and place the player in cold-water immersion. When his core body temperature drops to around 102 or 103, the paramedics can transport him.

Dr. Douglas J. Casa, director of Athletic Training Education at the University of Connecticut, told me that heat stroke is 100 percent survivable if you get the athlete s core body temperature below 104 degrees within 30 minutes of collapse. He has studied over 2,000 cases of heat stroke. No athlete has died when athletic trainers and medical providers succeeded in decreasing his body temperature to below 104 within 30 minutes.

Athletic trainers can save the lives of high school athletes.

Sadly a large percentage of high schools in this country don t have athletic trainers. Currently 70 percent of public high schools have athletic trainers at games or practices, and one third of the schools have full-time athletic trainers.

In a recent study performed at the University of Connecticut, researchers surveyed 20 high school athletic directors across the country to determine some of the challenges with schools hiring them. Some common themes emerged.

From AB: Study: HS ADs Face Barriers to Hiring Athletic Trainers

Many athletic directors cited difficulties convincing school boards to hire athletic trainers. Budgetary concerns were common. Schools in rural areas often noted challenges convincing athletic trainers to work there.

Many athletic directors denied a need for a certified athletic trainer, claiming that their coaches had taken basic first aid and CPR and even courses on concussions. While those steps are certainly worthwhile for all coaches, they are inadequate for the athletes. A weekend course or online tutorial doesn t come close to the knowledge and experience of an athletic trainer who completes at least two years of education and hands-on training. Plus conflicts of interest don t exist with athletic trainers like they could with a coach trying to determine if a star player should come out of the game.

Nurses, chiropractors and physical therapists offering to cover games is admirable and better than no medical coverage, but they cannot perform most of the duties of an athletic trainer. And having an ambulance and paramedics at sporting events is definitely a good idea, but it can be difficult to guarantee with local EMS often responsible for responding to emergencies throughout the town.

How can we overcome these barriers and have all high schools employ athletic trainers?

One approach would be for state legislatures to mandate that schools hire them. Currently Hawaii is the only state to require employment of athletic trainers. Many medical organizations like the American Medical Association and American Academy of Pediatrics have publicly supported high schools hiring athletic trainers. Some advocates have gone so far as to push for barring schools without athletic trainers from competing in contact and collision sports.

Parents could also push for athletic trainer coverage at their children s schools. Voicing their concerns and even offering funding ideas might help athletic directors find a way to hire full-time athletic trainers.

Athletic trainers play a huge role in keeping young athletes safe. We must find a way to get them into schools where they can make a real difference.

Dr. David Geier is an orthopaedic surgeon in Charleston.

For more information about other sports medicine topics, go to


November 13, 2015
Source: Athletic Business

Congressmen Push For Study Of High School Football Deaths (Huffington Post)

WASHINGTON — The recent spate of deaths in high school football has caught the attention of three members of Congress who want the federal government to study the problem.

The High School Football Safety Study Act, introduced Thursday by Reps. Cedric Richmond (D-La.), Ralph Abraham (R-La.) and Bobby Rush (D-Ill.), would require the Centers for Disease Control and Prevention to examine the causes of football-related deaths and produce recommendations for how to prevent them.

Luke Schemm, a 17-year-old Kansas student, on Wednesday became at least the eighth high school football player to die on the field or in practice since the 2015 season began.

“It is our responsibility to ensure that we leave no stone unturned to make the game as safe as possible for young people and prevent these tragedies from happening in the future,” Richmond said in a release announcing the legislation. “Moving forward, I hope this legislation will start that process and begin a national conversation about how to better protect youth in football.”

Though football-related deaths in high schools have received more media attention in recent years, the number has remained relatively constant over the past 35 years, as The Huffington Post reported in October. The most common causes of death include heat stroke, cardiac arrest, and head, neck and spinal injuries.

Athletic trainers and others who have observed safety issues in high school sports have said states and school districts simply aren’t doing enough to protect athletes. Just 37 percent of high schools, for instance, employ a full-time certified athletic trainer, though nearly three-fourths at least have access to one at most games.

“The best practices are not being followed,” Dr. Douglas Casa, CEO of the Korey Stringer Institute at the University of Connecticut, told HuffPost last month. “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 legislation introduced Thursday would ask the CDC director, the secretary of Health and Human Services, the secretary of Education, and the President’s Council on Fitness, Sports, and Nutrition to seek input from athletic trainers, health professionals, parents and coaches about the deaths.

“My district felt the terrible effects of one of these tragedies just this year,” said Abraham, referring to Franklin Parish, where 16-year-old Tyrell Cameron died after suffering injuries in a football game this fall.

“This bill will seek the root causes of such incidents so that we can better protect our children while preserving the game we love,” he said.

Source: Huffington Post

59th MDW evaluates, improves heat illness procedures (US Air Force)

JOINT BASE SAN ANTONIO-LACKLAND, Texas — The 59th Medical Wing is implementing new capabilities to provide potentially life-saving treatments for Air Force trainees engaging in high-intensity physical training in the hot and humid conditions of San Antonio.

To ensure basic military training and technical school students receive this rapid care, health officials are working with the Korey Stringer Institute to review and update 59th MDW and 37th Training Wing policies for responding to suspected exertional heat illness, including exertional heat stroke. Exertional heat stroke is a life-threatening medical emergency that results from prolonged exertion in the heat, resulting in failure of the body’s mechanisms for self-cooling.

The training works hand-in-hand with an upcoming Exertional Heat Illness Response Policy Letter from the 59th MDW and guidance from the Air Force Medical Operations Agency.

“With rapid response and proper treatment, heat stroke is 100 percent survivable with no lasting effects,” said KSI’s chief operating officer Dr. Douglas Casa, who lead the training team here.

“We need to respond quickly once someone goes down or shows signs of heat stroke; the clock for cooling them doesn’t start when they go down, it starts when (body temperature) rises above 105 degrees,” Casa said.

A core body temperature above 105 degrees Fahrenheit for 30 to 60 minutes usually results in temporary damage to vital organs – including brain, liver, kidneys or muscle – that could affect a military career; 60 to 90 minutes results in permanent organ damage and possibly death, Casa explained.

“The bottom line – if you take away nothing else from this training – is that you must get the core temperature under 105 within the first 30 minutes,” Casa stressed throughout the training.

Members of the 559th Medical Group initially met with members of the Consortium for Health and Military Performance and KSI to review response procedures in 2014. During those discussions, the group identified areas that were not up to the current evidence-based standard of care for exertional heat stroke.

“We have updated Air Force-wide policies and created a new medical wing instruction on how heat stroke is to be treated, based on the latest research and guidance from leading experts in the field like KSI. This is so important to the health of our trainees, especially when San Antonio has high heat during the extensive basic and technical school training sessions,” said Maj. Asha Mandhare, 559th MDG Trainee Health Surveillance Flight commander.

Casa and his team taught the new procedures to members of the 559th MDG and the 37th TRW, conducting multiple training sessions with medical technicians, first responders, training squadron staff and military training instructors and leaders Sept. 29-30. Five JBSA training locations where the highest-risk training occurs were selected. The sessions focused on response and treatment procedures for heat stroke victims.

The new policies and procedures focus on three key points: first, accurate diagnosis of core body temperature; second, on-site ice-water immersion for victims of exertional heat stroke; and third, the cool first, transport second principle. Other important points include the role of training instructors and cadre, who are the key to early recognition of dangerous symptoms.

During a heat-related medical emergency, MTLs and MTIs will provide a non-medical support role – such as helping with transportation – while medical technicians and first responders aid the victim. Casa’s team taught medics and cadre to place sheets and towels soaked in ice-cold water on the head and body to cool victims while en route to an immersion tub. If a tub is not available the procedure is a stand-alone measure.

There are currently six immersion sites located at key training areas across JBSA, with a seventh on the way, according to Mandhare.

“We are very grateful to have (Casa) out here; he’s the who’s who of heat stroke,” said Capt. (Dr.) Nathaniel Nye, sports medicine physician and Versatile Injury Prevention and Embedded Reconditioning element chief.

“By far, the most important thing I do is work with the military,” Casa said. “Sports are just wins and losses on the field, what (you) do here is what really matters.”

Source: Air Education and Training Command