Author: Yuri Hosokawa

2nd Collaborative Solutions for Safety in Sport

By Alicia Pike, Assistant Director of Youth Sport Safety 


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.



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.



  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


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.


Cardiac Emergency 101



By Andrea Fortunati, Assistant Director of Elite Athlete Health and Performance

Cardiac Emergency 101


Sudden cardiac death (SCD) is the primary cause of death in youth sports; however, there is currently no gold standard screening tool for SCD.1 Because of this, basic pre-hospital emergency action plans must be put in place in case of a potentially fatal event.

First, public buildings and locations should have designated areas where an automated external defibrillator (AED) can be readily accessible. The device needs to be maintained by changing the battery and pads when appropriate (i.e., check expiration dates annually). An AED, if maintained and applied appropriately by following the instructions on the device, can be a matter of life or death. The sooner the device is applied from the time of collapse, the greater the chance of survival. For every minute defibrillation is delayed the chance of survival decreases by ~10%.

In the event of a sudden cardiac arrest (SCA), one needs to follow these three rules(1) call emergency medical services, (2) attach an AED, and (3) perform cardiopulmonary resuscitation (CPR) if certified and qualified to do so. Average arrival time for emergency medical services is estimated to be 8-12 minutes, so the application of an AED is critical for survival.

There are currently two forms of CPR, which include: (1) conventional CPR with 30 compressions to two rescue breaths, and (2) hands-only compression CPR at a rate of 100 beats per minute. Hands-only CPR has been found to be an effective method, and can be performed at the speed of the popular disco song, “Stayin’ Alive.” The conventional method is best utilized for infants, children, anyone found unconscious without a pulse, and those who have collapsed due to breathing problems.2

Regardless of which CPR technique you decide to utilize, any attempt will more than double the likelihood of the individuals’ survival rate.3 Hands-only CPR was suggested in an attempt to increase bystander CPR, which in most cities only accounts for 27-33% of responses.3

AEDs must be applied in the event of a SCA to defibrillate the heart for a chance of survival. Every public location, including outdoor facilities, should have an AED within a close proximity.

When was the last time you checked where the closest AED is located from your practice facility/office/game venue?



  1. Shabana A, El-Menyar A, Gehani A. Sudden cardiac death in athletes: where do we stand. Crit Pathw Cardiol. 2013;12(3):161-169.
  2. CPR & First Aid Emergency Cardiovascular Care. Am Heart Assoc. 2015.
  3. Sayre MR, Berg RA, Cave DM, Page RL, Potts J, White RD. Hands-Only (Compression-Only) Cardiopulmonary Resuscitation: A Call to Action for Bystander Response to Adults Who Experience Out-of-Hospital Sudden Cardiac Arrest A Science Advisory for the Public From the American Heart Association Emergency Cardiovascular Care Committee. Circulation. 2008;117(16):2162-2167.

ATLAS Project- Gaining Momentum

By Robert Huggins, PhD, ATC, Vice President of Research and Elite Athlete Health and Performance

ATLAS SocialMedia

As we prepare for Athletic Training month to hit in March, secondary school athletic trainers from around the country are helping KSI and the NATA secondary schools committee get a better grasp on the extent of athletic training services that our profession provides. “The KSI team has been working diligently to market the ATLAS Project in various media outlets and get the word out there to secondary school ATs” said Sarah Attanasio assistant director of sports safety policies. “Thanks to the help of Rachael Oats and all of her colleagues at the NATA offices, the ATLAS project was sent out via e-blast in the NATA Range of Motion and has been posted on the NATA website The ATLAS Project ” said Huggins, VP of Research at KSI. One week earlier, secondary school chair Larry Cooper allocated some time during the NATA board of directors meeting in Dallas, Texas for KSI to speak with the members of the Secondary School Committee. Each district representative was provided with content related to the project for distribution to their members and for easy website viewing. As a sign of their excitement and eagerness to start, some regional athletic training associations such as The Far West Athletic Trainers’ Association and state associations such as Michigan Athletic Trainers Society and Louisiana Athletic Trainers Association are linking directly to the ATLAS Project and it appears to be making rapid progress.

“The momentum of the ATLAS project has really shown a positive trend after the official national launch of the ATLAS Project in January,” said Huggins, “we have seen an exponential increase in the number of ATLAS surveys taken.  At one point we were averaging almost 100 surveys per day. In the last week or so it has leveled off to 40 per day which is still fantastic.” In response to the increased demand, KSI has brought on five additional workers per week bringing the total workers to 10 (8 undergraduate, 1 graduate and 1 post doctoral fellow). “We all to help sort the data, work directly with secondary school committee chairs in each state, and make each map as accurate as possible” said Rachel Morris, KSI undergraduate research assistant.

The ATLAS Project is rapidly approaching 3,000 surveys and KSI hopes that their goal of 8,000 surveys by June will come to fruition. “As the word continues to spread within each state, our results will become more accurate and we will be able to not only quantify the extent of AT services, but gather valuable information about where ATs are hired, in what capacity they are hired, and the commonalities from state to state” said Huggins. With this project KSI hopes that AT associations will utilize the maps as a directory to improve the continuity of healthcare within their state, promote legislative efforts to hiring full-time athletic trainers, and potentially reduce medical and insurance costs. “The possibilities are endless” said Larry Cooper, NATA secondary school chair “and we are so excited about where this project will go in the future!”

Youth Sport Safety Governing Bodies Meeting

By Samantha Scarneo, MS, ATC, Director of Youth Sport Safety

2016 YSSGB Meeting Photo

Last week, KSI had the honor of hosting the second annual Youth Sport Safety Governing Bodies meeting with the National Athletic Trainers’ Association, Jones & Bartlett Learning, and Kestrel, at the National Football League Headquarters, in New York, NY. The goal of this meeting was to improve health and safety standards at the youth sport level. In last years’ meeting the goal was to educate the youth sport governing bodies on top causes of sudden death in sport This years goal was to create a consensus document to serve as a best practices document for all governing bodies and its members to strive towards. This consensus document touches on the top causes of sudden death in sport and polices & procedures of how to improve these safety standards. The attendees of this years meeting included:

Michael Clayton – USA Wrestling

George Chiampas, DO – US Soccer

Elizabeth Chaffin, DPT, ATC and Alexis Colvin, MD– USTA

Lynn Moskovitz-Thompson – USA Gymnastics

Bruce Griffin, PhD – US Lacrosse

Kevin Margarucci, ATC – USA Hockey

Steve Alic – USA Football

Jack Ransone, Phd, ATC – USA Track and Field.

We also had the honor of having key representatives from the American Medical Society of Sports Medicine (Matthew Gammons, MD), National Athletic Trainers Association (Scott Sailor EdD, ATC, Tim Weston Med, ATC, AJ Duffy MS, ATC, PT, Rachael Oats CAE, Katie Scott, MS, ATC), American Academy of Pediatrics (Cynthia LaBella, MD) and Safe Kids Worldwide (Kate Carr, Ali Flury).


The meeting was moderated by some of the KSI staff (including Robert Huggins, PhD, ATC, Doug Casa, PhD, ATC, Rebecca Stearns, PhD, ATC, Samm Scarneo, MS, ATC, Yuri Hosokawa, MAT, ATC, Lesley Vandermark, MS, ATC, Luke Belval, BS, ATC, and Ryan Curtis, MS, ATC) and was largely discussion based to create a best practice consensus. The first day of the meeting focused on cardiac conditions, emergency action plans, and exertional heat stroke. The second day was moderated identical to the first and focused on head injuries, medical personnel and other conditions (asthma, anaphylaxis, and lightning).


One of the unique aspects of this meeting is that all of the governing bodies have strong and weak points in different areas. For example, one organization may have extraordinary policies in place for heat acclimatization yet may be very weak in an area of emergency action plans. However, despite the various levels of safety attained by each organization, all attendees had a strong will to improve standards across the board. Dr. Huggins called this meeting “one of the most important meetings that he has been to in his career.” We are hopeful that consensus document will provide a template for all leaders of youth organizations, and their members, to expand health and safety standards for the athletes.

“If you want to go fast, go alone; if you want to go far, go together.”


Eastern Athletic Trainers’ Association Meeting 2016

By William Adams, Director of Sport Safety Policies

EATA Boston 2016

This past weekend KSI traveled to Boston, MA for the Eastern Athletic Trainers’ Association Annual Meeting. KSI had the great opportunity to present during a 2-hour symposium on the recent projects, initiatives, and accomplishments of KSI to the EATA membership. The presentation was very well received and we received a lot of positive feedback following the talk.

Lecture #3 EATA 2016

The talk titled, The Work of the Korey Stringer Institute-Assisting Athletic Trainers and the Profession, was presented by 8 of the staff from KSI. Doug Casa, began the symposium discussing the latest updates on policy changes at the high school level and how policy changes can save athletes lives. Rebecca Stearns followed discussing heat tolerance testing and how KSI has been active in this service area in helping return Exertional Heat Stroke Victims back to full activity. Yuri Hosokawa discussed how KSI utilizes Social Media to share our current initiatives and latest sports medicine related news to our followers.

Lesley Vandermark, Alicia Pike, and Samm Scarneo presented KSI’s work related to investigating the extent of AT services at the high school level. Vandermark presented the results from the Benchmark Study published in Early 2015 by former KSI staff Riana Pryor that showed the extent of AT coverage in public high schools across the United States. Pike followed up with the recent data collected looking at the extent of AT coverage at the Private School setting across the country. Scarneo closed out this topic discussing the ATLAS project, which KSI is partnered with the NATA in helping map the AT services across the United States using an interactive geographical map.

Rob Huggins presented the available data we have on the insurance initiative that we are working on for the NFL. This project is focused on investigating the potential cost savings from an insurance perspective for high schools employing a full time athletic trainer. Lastly, William Adams presented on the current work KSI is doing in the world of wearable technology from both an athlete monitoring perspective and current research being conducted examining the validity and efficacy of using wearable technology in measuring hydration status during exercise.

KSI Group Photo EATA 2016

We are hoping to get the chance to present our current work at other district/regional AT meetings to keep other Athletic Trainers aware of what KSI is doing and how KSI is promoting the profession of Athletic Training from many different avenues.

2015 New Balance Falmouth Road Race

Falmouth Group Picture

By Yuri Hosokawa, Director of Communication and Education

Korey Stringer Institute had another successful year working with the Falmouth Road Race, which took place on Sunday August 16th. KSI and the Falmouth Road Race expanded their collaboration together even further this year. On August 13th, William Adams, Director of Sports Safety Policies, Yuri Hosokawa, Director of Communication and Education, and Rachel Katch, Assistant Director of Research, presented at the 1st Annual New Balance Falmouth Road Race Sports Medicine Symposium, with Dr. John Jardine, Chief Medical Advisor of KSI. This was the first time that Falmouth Road Race hosted a medical symposium for local medical professionals and volunteers who have traveled across the country to work at the medical tent on race day. At the symposium, Adams presented on evidence based prevention, treatment, and care of exertional heat stroke, Hosokawa presented on emerging topics on sudden cardiac arrest in runners, and Katch presented on exertional hyponatremia and best practices for hydration. On August 15th, Dr. Robert Huggins, Vice President of Research and Elite Athlete Health and Performance, spoke at the EXPO on maximizing athletic performance in the heat.


Huggins and Meb

Also during race weekend, we had the opportunity to invite professional videographers to film interviews with Richard Dodakian, one of the exertional heat stroke survivors from the Falmouth Road Race, and Huggins. As they recalled the same event from 2013’s race, it was incredible to hear their stories from different perspectives—exertional heat stroke victim/survivor and the rescuer. The interview is currently under production. Please follow our social media and webpage for the video release. Their words will change the way you view medical care provided at the road race for thousands of runners. Remember, exertional heat stroke is 100% survivable with prompt recognition and appropriate care: cool first, transport second.

Richard Interview

This year’s race was very warm and humid, setting a perfect storm for exertional heat illness risk. To counter that, the road race organizers came prepared with rows of cold water immersion tubs and stations, with close to 200 medical professionals volunteering on the race day. KSI primarily assisted in the care of exertional heat stroke patients, educating the medical volunteers who are unfamiliar with the condition at the pre-race medical meeting and serving as leaders at each cooling station.


We were also fortunate to have representatives from our corporate partners, Kestrel and MissionAthlete Care, to join us at the race as volunteer. It was their first time to experience the intensity of a road race medical tent and see the treatment of exertional heat stroke cases.



Lastly, Hosokawa and Katch conducted the third field research study at the Falmouth Road Race, looking into the inflammatory response observed in runners completing the race. The study started 4 weeks before race, where the participants were asked to log their training. In addition, researchers invited the participants to the University of Connecticut campus to complete VO2max and lactate threshold testing to examine their fitness level prior to the race. Hosokawa is also working in collaboration with the EC Lee Lab, lead by Dr. Elaine Lee, at the University of Connecticut, to investigate potential genetic markers that may explain the variations of heat tolerance observed in runners. Our hope is to provide evidence-based recommendations for runners who are participating in the summer races and assist the Falmouth Road Race to become one of the safest summer road races in the world.



Falmouth Road Race weekend is by far the busied but most exciting weekend for KSI. We hope that our collaboration with the race will continue to grow in future years and hopefully inspire other races to have similar partnerships with KSI.

Recent KSI Initiatives


By Rachel VanScoy, Assistant Director of Sport Safety Policies

The Korey Stringer Institute (KSI) is keeping busy this summer. Here is a look into what we are up to:

  • On June 22nd, the NATA and KSI publically launched the Athletic Training Location and Services (ATLAS) database. This is an interactive map allowing athletic trainers’ to view their service location and coverage. For more information and to include/confirm your high schools information visit the KSI
  • KSI recently announced our online course on Preventing Sudden Death in Sports and Physical Activity through Jones & Bartlett Learning. For any Athletic Trainer looking to complete their Evidence-Based Practice CEUS or just looking to learn more about the preventing sudden deaths in sport then check out this course!
  • Andrea Fortunati, Assistant Director of Elite Athlete Health and Performance, continues to work with UCONN Men’s Soccer team as preseason is fast approaching.
  • Yuri Hosokawa, Director of Communication and Education, and Rachel Katch, Assistant Director of Research, will be running a study at the Falmouth Road Race August 16th, 2015. This will be the 3rd consecutive year that KSI will conduct research at this amazing race. The race consists of 7 miles and roughly 12,000 runners along the Falmouth, MA shoreline.
  • William Adams, Director of Sports Safety Policies, is running a study examining non-invasive biomarkers to assess physiological changes during and after exercise in the heat.
  • Yuri Hosokawa and Luke Belval, Director of Military and Occupational Safety are investigating the use of temperature monitoring devices and thermal imaging, and the use of two cooling methods to optimize the early recognition and management of Exertional Heat Illness.
  • Samantha Scarneo, Director of Youth Sports Safety is leading a study following concussion throughout the fall season within collegiate club and varsity athletes.
  • The Korey Stringer Institute is also testing athletic clothing to investigate efficacy and performance benefits of various fabrics in a hot environment.


Stay tuned for updates and publications on all of our initiatives!


Ironman Lake Placid

Lake Placid Team KSI

By William Adams, Director of Sport Safety Policies

A few representatives from KSI traveled to Lake Placid, NY for the annual Ironman Lake Placid race on July 26th. For those that are unfamiliar with an Ironman race, it involves a 2.4-mile swim, 112-mile bike ride, and a 26.2-mile run. Competitors have 17 hours to complete the race and if successful can be proud to call themselves an Ironman.

Ironman Village

This year’s race was unique in a number of ways; 1) there were no professional triathletes that raced, allowing the overall male and female finisher to be an amateur athlete and 2) the environmental conditions became very hot (above normal for Lake Placid) halfway through the bike portion of the race, making the race much more stressful than anticipated, and 3) this year’s race saw an athlete suffer from exertional heat stroke which is normally an uncommon sight at a race of this length and duration.

Kestrel at Mirror Lake

KSI’s trip to Lake Placid for the 2015 race was to volunteer to assist in the medical tent at the finish line to treat the athletes that became injured during the race. This year’s race saw a variety of injuries that came to the medical tent throughout the day. Injuries that were treated inside the medical tent included dehydration, hyponatremia, musculoskeletal injuries, and many others.

Medical Tent

The most fortunate part of this experience was being able to see medical providers from various fields of expertise, from various geographical locations and settings come together to provide top-notch medical care for the 2,600 athletes participating in this year’s race. Without these volunteers, the race would not have been a success.