Month: March 2016

VOSHA: Two Violations Found in Investigation Into Trooper Kyle Young’s Death (myChamplainValley.com)

Vermont Occupational Safety and Health Administration has released a pre-citation settlement agreement regarding the September 2015 death of Trooper Kyle Young.

According to the report, VOSHA found two violations that did not contribute to Young’s death.

If the Department of Public Safety provides the Department of Labor with a draft comprehensive safety plan by July 1, it will not be cited for the trooper’s death.

Young, 28, collapsed while trying out for the Vermont State Police Tactical Services Unit at the Ethan Allen Firing Range in Jericho on September 17, 2015.

He was pronounced dead at the UVM Medical Center. His cause of death was exertional heatstroke.

The temperature the day of his death was approximately 82 degrees.

“It was like military gear,” said Denise Alosa, describing what Young was wearing when he collapsed.

Denise Alosa and Dr. Suzanne Elliott consulted with VOSHA on the investigation into his death.

They are both medical coordinators for the Vermont City Marathon.

The marathon has seen 26 cases of exertional heatstroke. Everybody has survived.

“Because we were trained and had seen it…we reached out to them and they reached out to us,” said Alosa.

Her takeaway from what happened to Kyle Young: the need for training.

“If you haven’t been trained to recognize it early, many people get it confused with other things,” said Alosa.

One VOSHA violation was due to a lack of a written respiratory program. It was an ancillary finding, and “not associated directly with the investigation into Kyle Young’s death,” the report reads.

Another violation was regarding first aid. While trained first aid responders were on site, “given the nature of the physical activity, the industry standard requires that ice packs or other cooling devices be available,” according to the report.

“The big thing with exertional heatstroke, the big kind of tag line is ‘cool first. Transport second’,” said Alosa.

While VOSHA does not attribute either of these violations to Young’s death, it is requiring the Department of Public Safety to provide a draft safety plan by July 1 to avoid citations.

That department began reevaluating its procedures soon after Young’s death.

“This is a process. It’s not an event so it’s still moving forward,” said Public Safety Commissioner Keith Flynn in an interview late last week.

State Police have recommended training in heat stroke and heat-related injuries, a hydration schedule and wet bulb globe temperature monitoring to monitor the climate before and during physical tests.

“We’ve just entered into a contract with the Korey Stringer Institute so We’re going to have some of the top experts in the country really take a look at our programs so that we make sure we have good programs in place,” said Commissioner Flynn.

In a statement from Flynn Monday, he said “VOSHA acknowledged the Department’s commitment to improving its training and physical testing protocols to better protect its members… The Department is committed to reviewing and improving its testing protocols to protect its members to the greatest extent possible…”

The Department of Labor declined a request for an interview.

Source: myChamplainValley.com

Simple steps help prevent deaths during youth sports (Reuters)

(Reuters Health) – A few key policy changes can reduce sudden deaths during middle school and high school sports activities, according to a best practices statement in the Journal of Athletic training.

More than 90 percent of sudden deaths in sport are due to sudden cardiac arrest, exertional heat stroke, head injuries and exertional sickling, the dangerous decrease in blood flow that can occur in athletes who carry the sickle cell trait, the authors write.

Evidence based safety policies like heat acclimatization, sickle cell trait testing, the “Heads Up Football” program and requiring that automated external defibrillators (AEDs) be available can reduce the risk of all four events.

“These efforts are really starting to pay off,” said Dr. Barry P. Boden, a sports medicine specialist at The Orthopaedic Center in Rockville, Maryland, who was not part of the new statement.

“A lot of them are really just education, not much more than that,” Boden told Reuters Health by phone. “It still takes some time and effort but there’s really no excuse.”

Heat acclimatization policies mandate that in the hottest months of the year, athletes only gradually return to sports practices and exertion. The Korey Stringer Institute recommends no more than one practice per day in the first five days and no more than three hours of practice per day, with athletes wearing only a helmet, if appropriate, and no other extra equipment on day one and two of practice. All protective equipment can be worn and full contact can begin on day six.

In the second week of practice, two-a-day sessions should alternate with one-a-day sessions. For two-a-day practices, the two sessions should be separated by at least three hours in a cool environment.

The National Collegiate Athletic Association implemented heat acclimatization guidelines like these in 2003, and since then heatstroke-related deaths have dropped from one or two deaths each August before the policy to only one August death since 2003.

The policy saved an estimated 20 lives among college football players, the authors write.

“Heat acclimatization costs absolutely no money,” said coauthor Douglas J. Casa, CEO of the Korey Stringer Institute at the University of Connecticut in Storrs.

Since 2011, 15 states have adopted similar guidelines for high school athletes. But 35 states still do not have these guidelines, Casa told Reuters Health by phone.

“Most states make the changes after they have a tragedy,” he said.

“There’s a lot of kickback from coaches because it requires a change in tradition,” Casa said.

Between 2000 and 2010, 10 Division I collegiate nontraumatic football deaths were in athletes with the sickle cell trait. After 2010, when the NCAA required all institutions to offer sickle cell trait screening or documentation of prior screening, there was only one death attributed to sickle cell trait.

Sudden cardiac arrest, which causes most sudden deaths in youth sports, is largely survivable through immediate recognition, early cardiopulmonary resuscitation and access to an AED, preferably within one minute of collapse, the authors say.

Every sport venue should have easy access to an AED, they write.

“Nothing has had a greater influence than AED policies,” Casa said. One AED costs about $1,000 and can last 10 years, but it must be placed within easy reach of sports venues, so schools may need more than one device, he said.

USA football launched “Heads Up Football” in 2012, which addresses tackling and blocking techniques, equipment fitting, and reducing player contact during practice. The program has reduced all injuries, including concussions.

But only Oregon requires Heads Up Football at the high school level. Another 11 states endorse the program.

“A policy change that can dramatically improve the safety for youth and high school athletes is to have a certified athletic trainer, if they don’t have one,” said Erik E. Swartz of the University of New Hampshire in Durham, who was not part of the new paper.

Many states require that a trainer be present at certain events, but not necessarily all athletic events, Swartz told Reuters Health by phone.

“Having somebody there who is trained to recognize and respond when those things happen is the most effective policy change that an organization can make,” he said.

While college level sports can all be regulated by one governing body, the NCAA, policies for public high schools vary by state, and smaller venue sports club and camps can be even harder to standardize, as they have many governing bodies and may be broken down by sport, Casa said.

Source: Netscape

Second Annual Collaborative Solutions for Safety in Sport (Advance Healthcare Network)

INDIANAPOLIS, March 22, 2016 – In 2015 alone, 50 high school athletes’ lives were lost during sport or physical activity while thousands of others have long-term complications resulting from athletic injuries. The second annual Collaborative Solutions for Safety in Sport press event, hosted by the National Athletic Trainers’ Association (NATA) and American Medical Society for Sports Medicine (AMSSM), addressed these concerns by sharing best practices and encouraging improvement in safety protocols. The event took place at NCAA headquarters.

Sports medicine leaders presented new research, recent successes and challenges pertinent to sports health. A new study, “Implementing Health and Safety Policy Changes at the High School Level from a Leadership Perspective,” and an accompanying commentary, “Sport Safety Policy Changes: Saving Lives and Protecting Athletes,” was advanced released and will be published in the April issue of the Journal of Athletic Training.

Following the press conference, NATA and AMSSM with the support of Gatorade, Korey Stringer Institute, NCAA, National Federation of State High School Associations and Sanford Health brought together sports medicine and high school sports representatives in secondary school athletics. For the second year in a row, representatives from all 50 states attended to discuss safety in youth sports during an intensive two-day meeting.

“The National Athletic Trainers’ Association has had a longstanding commitment to the health and welfare of student athletes,” Scott Sailor, EdD, ATC, NATA president said. “We remain steadfast in our support of safety protocols along with AMSSM and collectively encourage the establishment of best practices and the appropriate sports medicine professionals on the field for both games and practices to ensure the gold standard of care.”

Currently, only 37% of high schools across the country have full-time athletic trainers who play a vital role in keeping young athletes safe.

“The American Medical Society for Sports Medicine is proud to continue its support of this program in conjunction with NATA,” Jon Divine, MD, MS, AMSSM president said. “This forum allows us to share resources, tools, sports safety protocols and strategies designed to keep young athletes thriving on the field and off the sidelines. Their health and welfare is our primary concern.”

“Today’s program provides us with new insights on successes and challenges for us to discuss and address when shaping state high school sports safety programs,” said Sailor. “Improving and implementing the right policies and putting them into action will help reduce injury and catastrophic outcomes.”

“Our approach to high school student athlete health and welfare requires a collaborative effort. We are inspired by the outcome of today’s forum and encourage all of those in attendance and those who can influence the lives of young athletes to use this information in the sports seasons ahead. We all individually and as a group have a vital role in ensuring youth sports safety in the year ahead,” added Divine.

 

Source: Advance Healthcare Network

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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JOHN DOHERTY: For safety’s sake, summit seeks standards (NWI Times)

ALEXANDRIA, Va. — Coming into this suburb of Washington, D.C. last Monday night, all the talk was of the NFL’s “admission” before Congress, earlier that day, that a link exists between Chronic Traumatic Encephalopathy (CTE) and football.

NFL senior vice president Jeff Miller could just as easily have been Inspector Louis Renault in “Casablanca.” Fans of that movie will recall Renault saying he was “shocked, shocked to find gambling going on” in Rick’s Café at the same moment he was accepting his evening’s winnings.

Previous NFL denials notwithstanding, of course there is a link between CTE and prolonged football participation. To quote a real-life World War II hero, Bob Dole, who went on to some notoriety just across the Potomac River from here, “You know it. I know it. The American people know it.”

Consequently, Miller’s words – other than exciting the media and some lawyers – will have no lasting effect on football.

Whether he said them or not, many youngsters and a few adults will continue to play the game. And hockey, lacrosse, rugby, soccer, and wrestling – some of the other sports to which CTE has also been linked.

The goal then should be to make all those sports safer. And not just the collision sports, but others where heart issues, heat illness, and spinal injuries are a risk.

With that as their purpose, the Youth Sports Safety Alliance and the National Athletic Trainers’ Association co-sponsored the seventh annual Youth Sports Safety Summit, here, a week ago.

To start the meeting, NATA President Scott Sailor requested a moment of silence for the 48 athletes between the ages of 9 and 17, who passed away while engaged in a sport in 2015. The two sports with the highest number of fatalities were football (15) and basketball (12). However, given total participation numbers, basketball had the higher rate. The cause of death was unknown in 22 of the cases, heart-related in 13, trauma-related in six, and heat-related in four.

Perhaps most disturbing about those numbers, though, was they were nearly double those of 2014, when there were 25 sports-related deaths among youngsters.

Keynote speaker Rep. Bill Pascrell (D-NJ), co-chairman of the Congressional Brain Injury Task Force, not surprisingly, focused on one topic. “There is no Democrat or Republican way to address concussion,” he said. “We have gone into space and into the belly of the earth. Now is the time to study the brain. What frontiers will that lead to?”

Rebecca Stearns, PhD, ATC, of the Korey Stringer Institute (KSI) took a broader view, advocating a collaborative approach to better prevent serious sports-related medical events, particularly the life threatening.

Currently working with the governing bodies of most youth sports, KSI has outlined a specific six-step program for leagues to follow that will make their games significantly safer:

1. A venue-specific emergency action plan in place.

2. Formulation of a strategic plan for allocation of resources and emergency equipment.

3. A structure to provide safety-related education and training for all levels.

4. Education for everyone: athletes, coaches, parents, officials, and league administrators.

5. An education and training certification reporting system.

6. A reporting structure for non-compliance.

Stearns said the program is in legal review by each of the various organizing bodies. She hopes it will be in place by January of next year.

Source: NWI Times

Health professionals lobby for policy change in high school injury prevention (USA Today)

When the National Athletic Trainers’ Association and American Medical Society for Sports Medicine met for the second annual Collaborative Solutions for Safety in Sport symposium at NCAA headquarters in Indianapolis, the groups focused on uniform reform of outdated policies in order to curb an epidemic that resulted in 50 high school student-athlete deaths in 2015.

The difficulty comes in lobbying all 50 state athletic associations separately and trying to enact meaningful change without a nationwide governing body that can create universal policies, according to two studies to be published in the NATA’s Journal of Athletic Training next month.

“I’m certain that there was some grumbling going on about having to change the way we’ve been doing business for some time at football practice,” an anonymous athletic trainer from Georgia said in a study entitled, “Implementing Health and Safety Policy Changes at the High School Level From a Leadership Perspective,” penned by four doctors from the Departments of Kinesiology at Temple University, University of Connecticut and Northern Illinois University working in coordination.

“Well, it was actually mixed feelings,” a New Jersey trainer said of policy change obstacles he faced from state association officials, most of whom are coaches or former coaches. “But I think it was just chaos that first year, for them [coaches] trying to understand what’s going on and … once they [the coaches] understood it, trying to accept it.”

Ninety percent of sudden deaths in sports result from four causes — cardiac arrest, heat stroke, head injuries and exertional sickling, according to a study entitled, “Sport Safety Policy Changes: Saving Lives and Protecting Athletes,” written by health professionals from UConn’s Korey Stringer Institute and the University of Washington’s Department of Family Medicine. The key point from that study:

Although sudden death from the aforementioned causes is not 100 percent preventable, the implementation of evidence-based safety policies such as emergency planning and access to automated external defibrillators (AEDs), heat acclimatization, instruction on proper tackling techniques (such as the ‘‘Heads Up Football’’ educational program), and sickle cell trait (SCT) screening in targeted populations can dramatically reduce overall risk. American football presents a unique risk profile for head injuries, EHS, and exertional sickling, which have driven many of the policy changes, but best practices for sport safety and emergency planning are relevant across all sports.

Considering the 50 high school student deaths and thousands of other preps who suffered long-term injury last year alone, you’d think lobbying for rule changes would be a relatively simple process, but resistance to that change and cost, among other reasons, make it more difficult. So, the NATA and AMSSM boiled their meeting down to four easy solutions every state association should adopt:

  1. Create an emergency action plan in collaboration with coaches, athletic trainers, other medical professionals and local and campus safety officials.
  2. Have athletic trainers on staff: athletic trainers play a critical role in preventing sudden death in sport such as prevention, diagnosis, emergency care and treatment.
  3. Acquire and place automated external defibrillators (AEDs) on school campuses and at sporting facilities for immediate access in the case of a cardiac emergency.
  4. Ensure that athletes acclimatize progressively to training demands and environmental conditions for optimal safety. Conditioning should be phased in gradually: the first seven to 10 days of any new cycle should be considered transitional. Exercise and conditioning should not be used as punishment.

The first and fourth suggestion require no additional funding, while the second and third seem like no-brainers to build into a school district’s budget. After all, saving one life is well worth the cost of one or several AEDs — roughly between $1,500 and two grand apiece. And it’s hard to believe only 37 percent of high schools nationwide employ a full-time trainer, at least according to the NATA.

Considering some schools are spending $60 million on football stadiums, it’s hard to imagine the large majority of school districts can’t pony up to meet these rather elementary safety precautions. Quite honestly, that’s the least every state athletic association should be demanding at this point.

Source: USA Today

Athletic Trainers in the Secondary School Setting

By Rachel VanScoy, Assistant Director of Sports Safety Policies

#AT4ALL Value Model

Athletic Trainers are health care professionals who work under the direction of a licensed physician and who specialize in the prevention, recognition, emergency care, treatment, and rehabilitation of sports related injuries. A recent study reported that only 37% of high schools in the United States provide full-time athletic training services.1 Seventy of the public secondary schools acknowledge the importance of athletic training services and provide some level of medical coverage.1 With the increasing number of sports participation and sports related injuries in the high school setting, it is essential that appropriate medical coverage is available. It is important to understand what services and coverage athletic trainers’ provide.

Athletic trainers do not just provide “coverage” during sporting events but provide quality health care to active individuals on and off the field. During emergencies, athletic trainers are onsite to provide immediate care to potentially life-threatening conditions and are trained to provide prompt treatment to help prevent sudden death (i.e., sudden cardiac arrest, exertional heat stroke). Furthermore, athletic trainers provide a link of communication between physicians, coaches, parents, and school nurses. Care of an athlete not only includes physical care but also psychosocial care. A safe environment is created which can result in an athlete confiding in the athletic trainer. Athlete trainers are trained to recognize potential problems (i.e., eating disorders) and can refer to the appropriate medical or professional services.

Additionally, athletic trainers work towards the prevention of injuries and sudden death. Before participation, athletes are screened using medical questionaries’ and preparticipation physical examinations. Athletic trainers are trained to identify potential risk factors and can make appropriate referrals for further screening. The preparticipation screening also allows athletic trainers to identify at risk individuals (i.e., Sickle cell trait, asthma, diabetes). Risk mitigation can be accomplished though educating parents, coaches, athletes, and administrators, as well as, through injury prevention programs. Off the field athletic trainers develop, practice and implement Emergency Action Plans (EAPS) and Policy, and Procedure manuals. A few examples of the policies that athletic trainers develop are heat acclimatization, concussion, lightning, hydration, and environmental (i.e., cold and hot weather) policies. Athletic trainers are responsible for ensuring policies are implemented and followed.

Athletic trainers provide on and off field services to continually maintain health and safety in sports. Described above are just a few of the many services athletic trainers provide at the high school level. For more information, visit the National Athletic Trainers’ Association (NATA) webpage for the Secondary School Setting.

 

References

  1. Pryor RR, Casa DJ, Vandermark LW, et al. Athletic Training Services in Public Secondary Schools: A Benchmark Study. Journal of Athletic Training. 2015;50(2):156-162. doi:10.4085/1062-6050-50.2.03.

 

ATLAS Update: Vermont Taking Initiative

By Sarah Attanasio, Assistant Director of Sport Safety Policies

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Happy National Athletic Training Month! As the word is spreading, more information is being collected about the extent of athletic training services through out the country. KSI and the NATA secondary schools committee continue to work together to encourage athletic trainers employed in the high school setting nationwide, to complete the ATLAS (Athletic Training Locations and Services) survey.

The ATLAS team has been working very closely with Denise Alosa, the District 1 secondary school representative from Vermont the past months. Thanks to her hard work in the state of Vermont, they are one of the first states to have responded and collect information whether an athletic trainer is present and the extent of coverage at every school in the state of Vermont. “The information in the survey is amazing, it can provide contact information within their own state or if you are looking to higher an AT for your school or improve a situation; the maps can be useful,” Alosa said.

As of March 2016, more than 3,400 athletic trainers nation wide have responded to the ATLAS survey. Alosa working hard with the ATLAS initiative comments, “Being in the profession for a long time, I have seen it evolve, you have to get involved to keep things moving forward”. The use of these maps can be helpful for present athletic trainers in the work force as well as new athletic trainers seeking positions as the vocation continues to grow and evolve.

With the influx of completed surveys the last few months, it is becoming more apparent what the survey can provide. Denise Alosa added, “Eventually we will be able to obtain insurance information, policy information and best practices within each state. It is good to start somewhere now, where it is doable. Any grass roots have to start somewhere.” The ATLAS Project has grown immensely since it was created years ago, with the dedication of an extensive work force of volunteers, undergraduate students, graduate students, post-doctorates, professors and athletic trainers nationwide.

#NATM2016

Son’s loss guides family on heat safety mission (The Island Now)

After their son Ariel died two years ago from exertional heat stroke suffered while hiking in Israel, Mark and Ellen Newman set out to improve heat safety procedures across the world.

The result was Ariel’s Checklist, a 10-point guideline on how hikers and those performing physical activities in hot temperatures can better protect themselves.

“I want Ariel’s name to go on and the actions of his soul to go on through saving the lives of others,” Mark Newman said. “He doesn’t have a body to be the vehicle, so we are now his vehicle.”

After graduating from Yeshiva University High School for Boys in June 2014, the 18-year-old Ariel set off for a nine-month educational program at Mechinat Yeud in Israel on Sept. 3, 2014.

Ellen said the program serves students through educational and religious studies, as well as with physical activities like hiking and traveling through the country.

“It was a very small program so we thought this would be nice and he wouldn’t fall through the cracks,” she said. “There would be a sense of camaraderie and he would really feel like a part of the group of young men.”

But while hiking in the Judaean Desert on Sept. 10, 2014, Ariel collapsed from exertional heat stroke. He died later that day in an Israeli hospital.

Mark said when they learned of their son’s death, he and his wife headed to Israel to find out what caused his death.

After speaking with the head of the hospital’s trauma unit, he said, they believed his son died from a heat stroke rather than a separate health issue.

“When we came back we said, ‘what can we do? Our son died,’” Ellen said. “How do we make his life have some meaning? What is our purpose now?”

A family friend, she said, suggested the Newmans contact the Korey Stringer Institute, a research center at the University of Connecticut that aims to prevent death in sports through health and safety initiatives.

The institute is named after former National Football League offensive lineman, Korey Stringer, who, in 2001, suffered exertional heat stroke during preseason training camp and died.

After speaking with Dr. Robert Huggins from KSI, Mark said, he was determined to create a method of informing the public on how heat safety can be improved.

He said he decided on a detailed checklist that used simple terms so all people, not just academics, could understand the heat stroke prevention procedures.

“Mark worked on it like it was a PhD paper,” Ellen said.

She added that they wanted to speak with heat stroke professionals to back the claims Mark made in Ariel’s Checklist.

“We felt it wasn’t enough for two grieving parents to come up with this list,” she said. “This really has to be grounded in real science.”

The list includes detailed steps to preventing exertional heat stroke such as hydration, heat acclimation, ample sleep prior to physical activity, preparedness for medical emergencies and more.

Mark said the list has been vetted by both Huggins and KSI professor Douglas Casa, as well as Yoram Epstein, an Israeli professor who, he said, is a leading exertional heat stroke expert in the world.

“Nothing alone on this checklist, except in ridiculous extremes, is going to harm you to the point of hospitalization,” Mark said. “But if you have a multiplicity of factors to dangerous degrees, then you’re virtually guaranteed hospitalization and/or death.”

He added that KSI has posted Ariel’s Checklist on its website even though its main focus is on sports safety.

“They realized they could include hiking and expand their realm,” Mark said.

While they want to see change enacted in heat safety procedures all over, the Newmans said they expect opposition to stricter safety procedures on tour guides in both Israel and America.

“We’re going to have a lot of push back,” Ellen said. “It’s going to be very painful to hear people say ‘don’t change our rules.’”

“Nobody wants change,” Mark added.

Despite possible opposition, the Newmans said they will continue to push their efforts and spread Ariel’s Checklist to as many people as they can possibly reach.

“The bottom line still is, we want this to get to as many people as possible to save other lives,” Mark said. “That’s the real goal.”

“This is not about trying to scare people from Israel,” he added. “It is about trying to make it safe to help encourage more people to go.”

Source: The Island Now