By: Mike Anthony

Connecticut ranks in the bottom third nationally in implementation of requirements at the state level to keep high school athletes safe from some life-threatening conditions, a new nationwide assessment of safety guidelines shows.

In fact, most states are failing to properly protect athletes against heatstroke, sudden cardiac arrest and other conditions, according to the study by UConn’s Korey Stringer Institute. The results were made public Tuesday morning at NFL Headquarters on Park Avenue.

Connecticut ranked No. 38 of 51 (each state and the District of Columbia) in graded assessments of the implementation of policies pertaining to the four leading causes of death among secondary school athletes — sudden cardiac arrest, traumatic head injury, exertional heat stroke and exertional sickling, which is a medical emergency that can occur in athletes carrying the sickle cell trait.

“What Connecticut has in place that is really a model program right now is the heat acclimatization policy,” said Douglas Casa, CEO of the Korey Stringer Institute. “That’s the phasing in of activity across time during the first couple of weeks of football practices. Connecticut has every single point you can attain on our rubric related to the first five days of not having two-a-days, not having successive days of two-a-days, phasing in the amount of equipment.

“An example where we need improvement is something related to environmental monitoring. A state like Georgia, for instance, has a great program where if it’s a really hot day, they measure the environmental conditions and make modifications [to practices] based on the conditions. Because we know that almost all heatstroke deaths happen when it’s hotter than usual for where you live.”

States were given a score reflecting how well they have implemented policy aimed toward preventing and managing life-threatening conditions, related mostly to exertion, with scores (the best being 20) assigned in five categories.

Connecticut received a score of 40.001 out of 100, with scores of seven in exertional heatstroke, six in traumatic head injuries, six in sudden cardiac arrest, 15 in appropriate health care coverage and 6.001 in emergency preparedness.

The study did not take into account practices, many of them common and consistent, that take place through policy set by school districts.

“We’re disappointed that the survey is communicated in such a way that seems to be reflective of an entire state’s efforts when in fact it’s really only a very generalized approach to certain categories, and it’s only about state association policy,” CIAC executive director Karissa Niehoff said. “Our state has some of the most stringent requirements for coaching certification and education. We’re required to educate all parents and student-athletes about concussions and cardiac arrest, and we do that. We’re not an association that imposes requirements such as trainers at every single event, or requires certain [weather] measurement systems, because frankly we think that districts are best able to decide what’s appropriate for them and, truthfully, what they can afford.”

North Carolina was found to have the most comprehensive policies and received a top score of 79, followed by Kentucky (71.13) and Massachusetts (67.4). The states with the lowest grades were Colorado (23), California (26) and Iowa (26). The median state score was 47.

The KSI study recommended a course of action for all states to implement the following policies:

• Automatic external defibrillators and certified athletic trainers on site at all athletic events.

• Phasing in summer practices and taking other steps to protect athletes from heat stroke.

• Training coaches on concussion symptoms.

• Detailed emergency action plans for all life-threatening emergencies.

• Mandated screening of athletes for sickle cell trait.

The report notes that there have been 735 deaths and 626 catastrophic injuries among high school athletes between 1982-2015. More than 7.8 million secondary school athletes participate in sanctioned sports annually, the study states.

Korey Stringer was an All-America football player at Ohio State and first-round draft pick of the Minnesota Vikings in 1995. He died at age 27 in 2001 after suffering heatstroke during Vikings training camp in 2001.

The Korey Stringer Institute, founded at UConn in 2010, is a nonprofit organization dedicated to promoting the prevention of sudden death in athletes and active individuals. It has a staff of 20, and 60 volunteers.

Each state’s governing body for high school sports was notified of the study’s results and given 30 days to respond with questions, clarifications, disputes or confirmations. Scores will continue to be updated as new information is provided and policies change.

“We offer the strongest encouragement for best practices, we offer guidelines,” Niehoff said. “We were disappointed that the emphasis was on a ranking as opposed to a really comprehensive and authentic look at everything that’s being done in a state. … Whether or not it feels good to look at study results, it does spark conversation and it’s always good to revisit with urgency whether your health and safety policies are as relevant and supportive as they can be.

“Quite frankly, we appreciate that the legislature does not get involved too deeply in statutory language around implementation around athletic programs because to change legislation is quite an involved process that takes time. When our association develops policy, we can be nimble and respond quickly if there’s new research or something that needs to change in a rapid way.”

The NFL allowed Tuesday’s announcement to take place at its headquarters because it sponsors the Korey Stringer Institute, though the NFL did not sponsor the study.

“While we focus a lot of treating injuries and illnesses, Our role in prevention is just as important,” said another speaker, Morgan Busko Anderson, an internal medicine physician specializing in primary care sports medicine and a sports medicine fellow at Wake Forest University. “Prevention of injuries, prevention of illnesses, prevention of deaths. The evidence shows that prevention practices and policies can prevent these deaths. So why do we have this gap now, between what we know is evidence-based, best-practice medicine, and what some of our high school athletes are receiving?”

Casa said many of the fixes are simple.

“We believe you can get to 85 points out of 100 for less than $5,000 a year,” Casa said. “We’re trying to institute policy and do whatever we can before [young athletes] die, to not have to wait for your particular state to have an emergency or tragedy to implement policy, to maybe learn from a tragedy that happens across a state line. A lot of the states did react in a very positive way after having a tragedy, and we’re trying to prevent them from happening in the future.”