Paving the Way for Heat Safety in Athletes, Warfighters, and Laborers

Yuri Hosokawa, PhD, ATC

Vice President of Communication and Vice President of Education

 

Every October, members of KSI travel to Washington D.C. to volunteer at the Marine Corps Marathon medical tent. This year’s trip was also a special one because we were able to continue our efforts from last year in building relationships and exchange ideas with the National Oceanic and Atmospheric Administration (NOAA), Uniformed Services University of the Health Sciences (USUHS), the Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH).

 

On Thursday, October 19th, KSI had the honor of gathering representatives from federal sectors that regulate heat activity modification guidelines or study implications of heat in the welfare of warfighters and laborers. The meeting was sponsored by the National Integrated Heat Health Information System (NIHHIS: https://toolkit.climate.gov/nihhis/), whose mission is to understand global health threat from extreme heat, develop a robust and science-informed response, and build capacity and communication networks to improve resilience. Participating agencies of NIHHIS include: Office of the Assistant Secretary for Preparedness and Response (ASP), Centers for Disease Control and Prevention (CDC), United States Environmental Protection Agency (EPA), the Federal Emergency Management Agency (FEMA), NIOSH, NOAA, OSHA, and the Substance Abuse and Mental Health Services Administration (SAMHSA).

 

KSI has a good history in working collaboratively with the occupational and military sectors, however, it was not until last year that we were able to gather representatives from all three sectors– athletic, occupational, and military­– to convene at single location and exchange ideas for future collaborations. Integration of climate and weather data from NOAA is also critical in making data driven decision to enhance the policies and guidelines for the people in these settings who are often exposed to extreme heat. Participants of this year’s meeting are currently working on a manuscript that gathers current consensus regarding heat activity modification guidelines for the physically active population (athletes, warfighters, and laborers), which we hope to release next year.

 

 

On the following day, we attended the IIRM Sports Medicine Conference hosted by the International Institute for Race Medicine, MedStar Sports Medicine, and MedStar National Rehabilitation Network. The meeting was attended by many medical providers and students who were also volunteering at the Marine Corps Marathon. At the meeting, Dr. Douglas Casa gave a presentation regarding wearable technologies in sport. Despite the recent advancement in wearable technology, his presentation warned that there is yet to be reliable, real-time, noninvasive hydration and internal body temperature assessment devices on the market. As the field of wearable technology continues to grow, researchers and clinicians must stay up-to-date with the technology advancement while also acknowledging the technological limitations to make the best-informed decisions about using data from these devices.

 

 

Later in the afternoon of the conference, we also participated in a workshop that was designed to review various treatment algorithms for medical conditions commonly seen at race medical tents in the form of problem-based-learning scenarios.  Exercise-associated collapse, cardiovascular arrest, exertional heat stroke, exertional hyponatremia, exercise associated muscle cramping and bleeding-control were covered in the workshop, all lead by the content experts. The hands-on workshop provided opportunities for young professionals to practice the skills for the first time and stimulated the exchange of various experiences from the veteran providers.

 

 

KSI was stationed at the Aid Station 9 on the day of the race, which was located between mile-21 and 22. The wet bulb globe temperature reading one-hour past the start of the race was in the mid-60’s, but quickly reached the high 70’s by noon, placing this year’s race as one of the warmer race in the history of the Marine Corps Marathon. The coordination of work among the corpsmen, athletic trainers, nurses, physical therapists, and physicians at the aid station was great. We also treated several exertional heat stroke patients on-site, where we made sure to cool the patients below 39°C before transport.

 

Our trip to Washington D.C. is a true demonstration of our mission statement– to provide research, education, advocacy and consultation to maximize performance, optimize safety and prevent sudden death for the athlete, warfighter and laborer. Whether we are treating marathon runners from exertional heat stroke or optimizing the regulations for worker safety in the heat, the physiological premise and impact of exertional heat stress is the “same” across athletes, warfighters, and laborers. Integration of minds across disciplines, such as the NIHHIS meeting, and continued advocacy to provide evidence based exertional heat stroke care are some of the core missions we will continue to carry forward from KSI.  #Strive2Protect

CamelBak Elite Athlete Testing

Gabe Giersch, MS

Associate Director of Education and Assistant Director of Athlete Performance and Safety

KSI had the awesome, unique opportunity to test two CamelBak sponsored pro-athletes over

the course of two days! The athletes were Lea Davison, a two-time Olympian Mountain Biker (2012 & 2016), and Gediminas Grinius a decorated Lithuanian trail runner. Some very fit, athletically decorated media personnel underwent testing as well. The athletes were able to undergo heat and sweat testing, where they exercised for 60-minutes total. Because it was a hot environment, the athletes were asked to collect their sweat in a specially prepared towel,and atthe end of their hour, we didwhole-body wash downs to collect samples to assess their sweat electrolyte concentrations. Whole-body wash downs are the gold standard for assessing whole-body sweat electrolyte concentration and very few labs across the country still use this technique. Many have moved over to local collection in sweat pouches, which is a great method of assessing local sweat, but not necessarily valid for whole-body calculations.

The athletes were also able to complete an anaerobic threshold test or a VO2max test where we tested their ability to ward-off an accumulation of lactate (a by-product of anaerobic metabolism) where we could extrapolate their anaerobic threshold based on continual readings, or their maximal oxygen uptake by exercising until volitional fatigue, respectively. This was a great opportunity for KSI and allowed us to use our expertise to interact with some incredible athletes.

The UConn Heat Lab Tests Pro Athletes Under Extreme Conditions (Hartford Courant)

Crouched in a bucket inside UConn’s heat lab, Ironman triathlon finisher Adam Chase brushed water and sweat from his body as a researcher poured water over his head.

Three other researchers held high the plastic tarp that lined the bucket and would catch every drop falling from Chase, 51. Moments later, they tossed in the towels he’d just used to mop his face and back as he ran for 45 minutes at a 7-mph clip in the 94-degree room.

“Sweat soup,” one athlete said as she waited for her turn inside the Korey Stringer Institute’s new, $700,000 heat lab.

This salty concoction is what the University of Connecticut kinesiologists would weigh and test to determine how much Chase had sweat during his sweltering workout, how many electrolytes he’d lost and other metrics he might be able to use to improve his performance and lessen the risks of heat stroke from extreme exertion.

“It’s not half as glamorous as it sounds,” Luke Belval, director of research, joked after describing the process.

The same can’t be said for the lab itself, a 450-square-foot facility that opened Sept. 22 in Gampel Pavilion. After a three-year process, the Korey Stringer Institute unveiled a major upgrade made possible by $350,000 from UConn, $100,000 from Mission Athletecare – an active wear and thermo-regulation technology company that secured the lab’s naming rights – and other donors like the NFL.

The lab’s chamber includes $20,000 treadmills, a cold-water immersion tub, strong air flow that mimics the outdoors and a climate-controlled bathroom. It simulates balmy and humid conditions for athletes who come to UConn for hours-long sessions.

In temperatures that can reach 110 degrees and 90 percent humidity, researchers work with NFL and NCAA teams, the military and apparel companies to analyze the human body’s response to extreme conditions.

On the recent Thursday when the lab studied Chase, of Colorado, it also drew professional athletes who’d traveled to Storrs from Vermont, northern California and Lithuania.

And the lab’s reputation precedes its new digs. UConn researchers have been studying the effects of heat and humidity on exertion for 25 years, since Gampel was newly built and the heat lab inside of it was no bigger than a dorm room..

Researchers would control humidity by toggling between household humidifiers and dehumidifiers. They removed ceiling tiles above the treadmills to accommodate taller athletes.

At some point, someone slapped a sticker that reads, “FUN ZONE,” above the entrance to the lab.

“I’m sure in 1999, it was state of the art,” said Robert Huggins, the institute’s vice president of research and athlete performance and safety.

Even so, it was with that lab that the Korey Stringer Institute was founded in 2010 by its CEO, Doug Casa, UConn’s director of athletic training education.

He and the family of Korey Stringer, the Minnesota Vikings offensive tackle who died from exertional heat stroke in 2001, hoped with research and education, they could maximize athletic performance and save lives.

Since then, the institute has helped demonstrate that deaths like Stringer’s are preventable with quick, correct treatment – like the kind staff members provided while doing case studies of Falmouth Road Races in Massachusetts.

The lab has studied the effects of cold water immersion and cooling tarps, hydration and caffeination, humidity and sleep.

And it opened its doors to not only athletes – and, naturally, research participants – but people who’ve already suffered heat stroke as well as laborers and military members who want to prepare for hot and humid conditions.

“It was a basic facility we were able to do some cool things in,” Casa said of the old lab. “But this one really ups our ability to help athletes, warfighters and laborers who have to do intense work in the heat.”

“The potential for research and service for people who need help is greater than it’s ever been before.”

Over the course of three years, Casa sought ideas for the new Korey Stringer Institute by visiting high-end heat labs across North America, like the Nike Sport Research Lab in Portland and facilities at the University of Arkansas and University of Ottowa.

He says he borrowed the best features he could find and added some more. This winter, the lab will install radiant heat lamps to mimic the effects of sunlight and cloudy skies.

But already, the weeks-old lab is getting plenty of traffic on campus.

UConn students are not charged to use the facility like typical clients, and the women’s cross country team has taken to using the equipment a few times a week, as Chase, the professional ultrarunner, and Lea Davison, a two-time U.S. Olympian mountain biker, learned when they began their own warm ups.

Source: Hartford Courant

New heat lab at UConn will test limits of athletes, soldiers (Washington Post)

STORRS, Conn. — Douglas Casa acknowledges his new heat laboratory at the University of Connecticut’s Korey Stringer Institute could be viewed by some as a torture chamber.

He’ll be testing athletes, soldiers and others (sometimes for hours at a time) on a treadmill, stationary bike or cooling tub in an environment that can be controlled to reach temperatures of up to 110 degrees and 90 percent humidity.

“The difference is, everyone being tested here is a volunteer,” he said. “And we’re saving lives.”

The $700,000 Mission Heat Laboratory is designed to be used by the NFL, NCAA teams, the military, apparel manufacturers, and scientists interested in preventing and treating heat-related illnesses, optimizing performance in extreme conditions, and learning the temperature limits of the human body.

“The prevention side of heat stroke is one of the big reasons this lab was built,” Casa said. “We can look at things related to hydration, body-cooling strategies, acclimatization and the effects of certain medications, supplements and clothing on how much you heat up.”

Casa decided to make the study of heat and the human body his life’s work after nearly dying of heat stroke while competing in a 10K race at the Empire State Games in 1985.

He helped found the Korey Stringer Institute in 2010, after being approached by the family of the former Minnesota Vikings lineman who died of a heat stroke in 2001.

The institute’s work has helped rewrite heat-related protocols for the military along with the NFL, college football and other sports. Casa’s research, for example, proved that treating a heat stroke immediately on site to bring a body’s temperature down below 104 degrees can dramatically increase survival rates. That led to NFL teams putting cooling tubs at practice sites.

But Casa’s team had been working in a tiny 100-square-foot closet-like lab, using household humidifiers and dehumidifiers to conduct their research. Some of the lab’s ceiling tiles had to be removed to accommodate one of the taller athletes they tested.

UConn provided about $350,000 for the new high-tech lab with its environmental controls, $20,000 treadmills and computer monitoring equipment. It even has a bathroom so test subjects don’t have to leave the controlled environment during longer sessions.

The other half of the lab’s funding came from donors including the NFL, its players association and athletic trainers’ organization. Mission, an athletic apparel company co-founded by tennis star Serena Williams, basketball star Dwayne Wade and soccer star David Villa, spent $100,000 to secure the naming rights.

Josh Shaw, Mission’s chief executive, said it plans to use the lab to test new garments that will not only wick moisture from the body, but eliminate it from the clothing entirely. The lab also will be used to test new wearable technologies, sensors that can be placed in T-shirts for example, that could alert someone when they begin overheating.

“Serena Williams competes at 120 degrees at the Australian Open, that’s pretty extreme,” Shaw said. “So, if we can create a product that will help her be safe, we’re probably going to be able to use that technology for people, say, who do roofing or gardening, or contracting.”

The military, which has similar labs, is working in conjunction with Casa and Korey Stringer to conduct tests on people and materials to optimize how soldiers perform in places such as the Middle East, and determine whether certain people are fit for duty in the heat.

“Understanding different stresses in the heat, whether it’s combat load or uniforms that can be mitigated with different materials, different load carriages, different hydration or cooling strategies — those are things we can work out in the lab before they are worked out in the field,” said. Dr. Francis O’Connor, a retired colonel who studies heat-related issues at Uniformed Services University.

The lab also will be used by UConn’s athletic teams to help them prepare for hot-weather competitions and by individual athletes who have suffered heat-related illnesses to help them determine their new heat tolerances levels and develop a recovery plan.

Offensive lineman Hunter Knighton credits the institute with getting him back on the football field following a near-fatal heat stroke during an offseason practice at the University of Miami in 2014. His family donated money for the new lab.

“It’s been kind of a miracle for me,” said Knighton, who now plays for Tulsa. “I was just really blessed to be able to find the institute and Dr. Casa. They were able to guide me back.”

Source: Washington Post

New Lab Opens to Test Human Performance Limits in Heat (UConn Today)

UConn’s Korey Stringer Institute and MISSION have teamed up to open one of the nation’s premier academic heat research labs at the University of Connecticut’s main campus in Storrs.

Outfitted with the latest in climate control technologies and human performance monitoring systems, the MISSION Heat Lab at the Korey Stringer Institute will allow researchers to explore new ways to improve human performance, endurance, and safety in the heat.

“Exertional heat stroke is a constant concern for athletes, active military personnel, laborers, and others who are called on to perform in hot conditions,” says UConn professor Douglas Casa, a national expert on heat stroke and chief executive officer of the Korey Stringer Institute. “This lab will increase our understanding of heat illness and how body temperature impacts performance. It will also help us develop better methods for cooling, which is an important part of our commitment to keeping athletes, warfighters, and laborers safe.”

Gabrielle Giersch, a Ph.D. student and KSI assistant director of athlete performance and safety, looks on while Ryan Curtis, a Ph.D. student and KSI associate director of athlete performance and safety, rides an exercise bicycle at the Mission Heat Lab at the Korey Stringer Institute at Gampel Pavilion on Sept. 21, 2017. (Peter Morenus/UConn Photo)
Gabrielle Giersch, left, a Ph.D. student and KSI assistant director of athlete performance and safety, looks on while Ryan Curtis, a Ph.D. student and KSI associate director of athlete performance and safety, rides an exercise bicycle at the new MISSION Heat Lab at the Korey Stringer Institute in Gampel Pavilion. (Peter Morenus/UConn Photo)

The partnership between the Korey Stringer Institute and MISSION is a natural one. Named after a Minnesota Vikings lineman who died from exertional heat stroke in 2001, the Korey Stringer Institute (KSI) is one of the nation’s leading sports safety research and advocacy organizations specializing in heat illness research. MISSION is a pioneer in the development of temperature-controlling technologies for athletic and active accessories and gear. Co-founded by some of the world’s greatest athletes including Serena Williams, Dwyane Wade, Carli Lloyd, and David Villa in 2009, MISSION is dedicated to providing athletes, workers, and active individuals at all levels with solutions to maximize performance and optimize safety in the heat.

The MISSION Heat Lab at UConn features a first-of-its-kind cooling area that will allow researchers to monitor how the human body responds to different cooling treatments after experiencing heat-related stress and conditions.

“Rooted in sports and science, MISSION works with professional athletes, scientists, and medical doctors to deliver game-changing temperature-control technologies that enhance performance, safety, and comfort,” says Josh Shaw, founder and CEO of MISSION. “Since 2014, we’ve been working hand-in-hand with the KSI, and we are thrilled to sponsor the new state-of-the-art MISSION Heat Lab. For the next 10 years, the MISSION Heat Lab will set new standards in research, development, and testing to combat heat-related illness for athletes, workers, military, and active individuals – globally. As the market leader for cooling technologies, the new MISSION Heat Lab is yet another testament to our commitment to combatting the dangerous effects on everyone who lives, works, and plays in the heat.”

Located within UConn’s Gampel Pavilion sports arena, the MISSION Heat Lab is capable of creating a broad range of environmental conditions. High-end exercise bikes and treadmills along with advanced temperature controls will allow researchers to mimic specific environments for races, competitions, and events – from a hilly 10K New England road race on a cloudy 70 degree day with 40 percent humidity to a stifling hours-long military march in 100 degree heat under hot sun with 90 percent humidity. Radiant heat panels being installed later this year will further enhance lab simulations.

A full suite of continuous physiological monitoring systems will capture a test subject’s heart rate, internal temperature, skin temperature, and other vital signs hundreds of times per second. The test chamber also includes restroom facilities and resting areas designed to allow test subjects to remain in a designated environment for hours at a time without the need for outside breaks that might skew data regarding how their body is reacting to conditions.

Private donations supported the lab’s creation. One of those donors was Carole Knighton, whose son Hunter nearly died of exertional heat stroke during a 2014 football practice at the University of Miami. Hunter, whose body temperature was reportedly 109 degrees when he collapsed, spent two weeks on a ventilator in a medically induced coma, but ultimately survived the ordeal.

“This is a cause that is near and dear to my heart,” says Knighton, who lives in Fort Myers, Florida. “If it were not for the Korey Stringer Institute, my son would not be where he is today.”

With a desire to return to football, Hunter, now 23, visited the Korey Stringer Institute on several occasions to have his heat tolerance tested. In the process, he and his family learned a lot about heat illness and how it can be avoided. Winner of the 2015 Brian Piccolo Award for being the ”most courageous” football player in the Atlantic Coast Conference, Hunter now plays for Tulane.

Another donor, Jonny Class of Maryland, shares a similar story. His son, Gavin, suffered an exertional heat stroke during a Towson University football practice in 2013. Like Hunter, Gavin was hospitalized as his liver and other organs began to fail. His heart stopped and he was resuscitated, beginning what was to be a very long road to recovery that included a liver transplant. And like Hunter, Gavin was subsequently tested at the Korey Stringer Institute to make sure his body was ready to return to football.

“With their help, he was able to return to all physical activities and is now able to lead a normal life,” says Jonny Class, Gavin’s father. “The knowledge we learned from KSI was amazing. We have since started a foundation, YOLT (You Only Live Twice) to help raise awareness about heat illness and the importance of organ donation.”

University officials say the new MISSION lab will be a strong addition to UConn’s nationally renowned kinesiology program.

“This new state-of-the art lab will be one of very few such facilities in the U.S., and has some design elements that make it stand alone,” says Cameron Faustman, interim dean for UConn’s College of Agriculture, Health, and Natural Resources, which houses the program. “We are confident it will attract even more research funding, research scholars, and students to our campus. The cost of this initiative has been met with contributions from the University, college, department, private donors, and companies. This speaks not only to the recognized need for the types of research that this facility will support, but also to the confidence that many others have in our faculty members.”

The MISSION Heat Lab will be available for use by outside companies and organizations to maximize research opportunities in heat safety awareness, as well as other areas of temperature-related studies.

Source: UConn Today

Is your school prepared to protect your student athlete from potentially life threatening conditions? (WTNH)

By 

STORRS, Conn. (WTNH) – High school sports create a frenzy, on the field, in the gym, and in the stands.

But the first study of its kind — a state by state analysis into safety practices — reveals what needs to be done to better protect student athletes.

“We’re looking at the key things that can cause death in high school sports. So cardiac issues, heat issues, head injuries and other things that can protentially prevent serious consequences from playing high school sports,” says lead researcher Douglas Casa, who heads up the Korey Stringer Institute at UConn – a national sports research and advocacy organization.

Connecticut he says ranks 38th — among the other states and District of Columbia.

But Casa stresses that statewide policy changes at little or no cost, could easily boost that ranking.

Such as a detailed emergency action plan, “Like kind of set policy-like a recipe to follow like I call this number, open this gate, meet this ambulance driver and take the person there.”

He also recommends — modifying routines when needed, “When it’s really extreme environmental conditions, you make modifications, so like the state of Georgia has an outstanding policy that when it gets hotter outside, you have more rest breaks, and you have longer rest breaks.”

The unexpected can happen anytime.

Baseball pitcher Joey Ciancola died soon after collapsing on the first day of winter workouts on a practice field at a New England college.

“He was in perfect health and pushed to his limits,” says his mother, Michelle Ciancola.

She says that visible symptoms of exertional heat stroke went unchecked, “Joey became delirious, started to run backwards instead of forward. He was definitely struggling. When he collapsed he was having seizures.” She adds, “I strongly urge all parents and athletes that are going off to school — going off to high school — or going off to college in the next few weeks — to check in with your athletic department and ensure that they are following proper protocol and that they are trained.”

Casa says, “We need parents to make sure that when every time their kid goes out to a playing field, that there is an athletic trainer there, that there’s treatment for heat stroke, that they have an A-E-D just in case there’s a cardiac event.”

Even if a state doesn’t have a policy, Casa says that individual schools can set their own.

For example he says, E-O Smith High School in Storrs has immersion tubs on the practice field, even though it’s not required by the state.

Source: WTNH

Protecting Student-Athletes From Heat, Head Injuries (The Pew Charitable Trusts)

By Michael Ollove

Another high school football player, this one a 14-year-old in the Bronx, collapsed on the field and died last week, possibly the result of high heat and humidity.

The death of Dominick Bess of apparent cardiac arrest came at a time when thousands of high school athletes have returned to practice fields. It again raises the question of whether states are doing enough to ensure that student-athletes are safe as they collide into one another, run wind sprints, or dig in against hard-throwing pitchers.

Nearly 8 million kids participated in high school sports last year, the most in U.S. history. The shocking deaths of young student-athletes have prompted some states to weigh major changes.

The California Legislature is considering a bill that would bring athletic trainers under state regulation. Others, including Texas and Florida, are strengthening policies on training during high heat and humidity and on the use of defibrillators during sporting events and practices. They are also moving to require schools to devise emergency plans for managing catastrophic sports injuries. And in response to growing concerns about concussions, the state of Texas recently embarked on the largest study ever of brain injuries to young athletes.

But overall, a just released study of state laws and policies on secondary school sports found that all states could do more to keep high school athletes safe. And some have a long way to go.

The study has prompted a strong pushback, including from the national organization that represents state high school athletic associations. But it also has encouraged some athletic trainers and sports medicine physicians who hope poor rankings will impel their states to make improvements and avoid exposing student-athletes to needless risk.

“I was embarrassed we were last,” said Chris Mathewson, head athletic trainer at Ponderosa High School in Parker, Colorado, speaking of his state’s showing in the study’s ranking of state safety efforts. “My hope is it will kick people in the pants and get people to do something about it.”

The rankings were devised by the Korey Stringer Institute (KSI), also known as Stringer, which is a part of the University of Connecticut and provides research, education and advocacy on safety measures for athletes, soldiers and laborers engaging in strenuous physical activity. It was named for a Minnesota Vikings offensive lineman who died of heat stroke during a preseason practice in 2001. His death sparked changes in NFL training practices and influenced reforms at the college and high school levels as well.

The rankings are based on whether states have adopted more than three dozen policies or laws derived from recommendations published in 2013 by a task force that included representatives from KSI, the National Athletic Trainers’ Association and the American College of Sports Medicine. The recommendations cover such areas as prevention of heat stroke, cardiac arrest and head trauma, as well as qualifications of school athletic trainers and educating coaches in safe practices.

Some state athletic associations, including Colorado’s, and the National Federation of State High School Associations, known as NFHS, which represents the associations that govern high school extra-curricular activities, have objected to the methodology of those rankings. They say it relies too much on information found on the websites of state athletic associations while failing to note efforts those groups have undertaken to reduce risks to high school athletes.

“By ‘grading,’ state high school associations based on a limited number of criteria, KSI has chosen to shine a light on certain areas, but it has left others in the dark,” said Bob Gardner, NFHS executive director. He pointed to steps his group and its members have taken related to safe exertion in heat and humidity, use of defibrillators and tracking head injuries, which Stringer didn’t take into account.

In Colorado, Rhonda Blanford-Green, commissioner of the state’s High School Activities Association, said officials are “comfortable and confident that our [policies] meet or exceed standards for student safety.”

She complained that Stringer’s methodology is too rigid. For example, she noted that Stringer penalized states that did not require that all football coaches receive safety training taught by USA Football, the governing body for amateur football. But, she said, Colorado coaches are trained in other programs that she described as more comprehensive.

She also noted that her association was penalized because it made policy recommendations to its high school members, rather than making them requirements, as Stringer prefers.

The scholastic association in California, which finished just ahead of Colorado, also objected to the survey. Its executive director, Roger Blake, suggested that funding was a chief barrier to progress.

California Interscholastic Federation “member schools will need more funding, more AEDs [automated external defibrillators], more athletic trainers and more research to help support our efforts to minimizing risk,” Blake said. “With the assistance of everyone who cares about young athletes, including KSI, we can continue to progress.”

High School Deaths

Between 1982 and 2015, 735 high school students died as a result of their participation in school sports, according to the National Center for Catastrophic Sport Injury Research at the University of North Carolina. The vast majority of those deaths were related to football, and three-quarters of the overall deaths were attributed to cardiac arrest, respiratory failure or other ailments associated with physical exertion. The rest were linked to trauma, such as head injuries.

More of those deaths occurred in the 15 years prior to the year 2000 rather than the 15 years after — likely a reflection of the fact that most of the policies and laws pertaining to safety in high school sports were put in place after 2000, particularly in the last nine years.

In 2014-15, the last year for which there are statistics, 22 high school athletes died, 14 of them football players.

Some of the reforms carry the names of student-athletes who died while participating in school sports. That was true in North Carolina after the 2008 death of Matthew Gfeller, a 15-year-old sophomore linebacker who died in the fourth quarter of his first varsity game in Winston-Salem after colliding helmet-to-helmet with another player.

Now a foundation and a brain injury research institute at the University of North Carolina are named after Matthew. His name and that of another North Carolina high school football player, Jaquan Waller, who died the same year as a result of on-field head injuries, are attached to a 2011 North Carolina law that specifies concussion education for coaches and concussion protocols to be followed in high school athletics.

“Was the information out there in ’08?” said Matthew’s father Robert, who created the foundation. “No, but it’s out there now, big time.”

Despite the progress, the Stringer rankings demonstrate the distance many athletic trainers and doctors believe states still need to go to protect student-athletes.

For instance, although North Carolina finished No. 1 in the Stringer rankings, it has adopted only 79 percent of the laws or policies used in the rankings. In particular, Stringer found the state hadn’t done enough to make certain that defibrillators — and people trained to use them — were present at sporting events.

A Sense of Urgency

Many athletic trainers, such as Jason Bennett, president of the California Athletic Trainers’ Association, say the rankings should create urgency in his state and others. “This is life and death,” Bennett said. “The sad thing is that in many of these cases, the deaths were 100 percent preventable.”

California fared particularly poorly because it is the only state that does not regulate athletic trainers.

“Sometimes it’s the school’s janitor or maybe a friend of the coach,” said Democratic California Assembly member Matt Dababneh, who introduced a bill that would create state licensure for athletic trainers. “These are people who are making decisions about whether a kid who has just been hit in the head can safely go back into a game. And they have no qualifications to make that decision.”

The bill would not require all schools to employ an athletic trainer, although that’s exactly what many athletic trainers and sports medicine doctors say would best ensure the safety of student-athletes.

“The No. 1 thing we can do to make high school and youth sports safer is to have athletic trainers at any sporting event,” said Michael Seth Smith, co-medical director of a sports medicine program at the University of Florida focused on sports medicine for adolescents and high school students.

A survey from Stringer and others published this year found that fewer than 40 percent of public secondary schools in the U.S. had a full-time athletic trainer.

Mathewson, the athletic trainer in Colorado, said he has little sympathy for smaller schools who say they can’t afford athletic trainers. “If you can afford to put a football team on the field, you should be able to afford an athletic trainer.”

In a number of places, including in Florida and North Carolina, hospitals subsidize athletic trainers working in public schools, some in the expectation that after a year or two, the school district will pick up the costs.

Aside from the salary of an athletic trainer, schools could adopt most of the best practices at an initial cost of $5,000 and an outlay of less than $2,500 a year thereafter, according to Stringer CEO Doug Casa.

Source: The Pew Charitable Trusts

Back in Falmouth– 2017

Yuri Hosokawa, PhD, ATC

Vice President of Communication, Vice President of Education

Ryan Curtis, MS, ATC, CSCS

Associate Director of Athlete Performance and Safety

 

Our summer is not complete without going to Falmouth, MA, to work at the New Balance Falmouth Road Race medical tent and continue our research and educational initiatives. We have been very fortunate to have the support from the race board members to have KSI presence at the pre-race medical symposium, health & fitness expo, and at the race as medical volunteers and research staff.

 

NB Falmouth Road Race Medical Symposium

With a host of medical volunteers and invited guests in attendance, this year’s NB Falmouth Road Race Medical Symposium featured presentations on a range of relevant topics including recognition and treatment of running-related orthopedic injuries, physiological concerns when developing strategies to optimize performance in the heat, and wearable technologies that can assist in optimizing performance.

 

Veteran NB FRR orthopedic medical provider, Dr. Don O’Malley, drew upon his experneces to give a thorough review of his top 10 running related orthopedic injuries. Dr. William Adams, a member of KSI’s medical and science advisory board and current assistant professor at the University of North Carolina at Greensboro, presented on physiological concerns and strategies when optimizing performance in the heat. The third invited speaker was Ryan Curtis, MS, ATC, CSCS, Associate Director of Athlete Performance and Safety, who discussed integration of wearable technology to optimize performance in the heat.  The symposium was concluded with our Chief Medical Officer, Dr. John Jardine, who also serves as the Co-Medical Director of the NB Falmouth Road Race. He briefed attendees on the logistics and chain of command that will be followed on the day of the race. Overall, the 2017 NB FRR Medical Symposium featured not only relevant topics in medicine but additionally offered a glance into the future of health and performance optimization.

 

Health & Fitness Expo

This year was our first time to participate in the Health & Fitness Expo as an exhibitor. The increased recognition of the KSI among the Falmouth runners was evident. We had many runners come stop by, and it was such a rewarding experience to have some of them share their personal stories about how they or their family members and friends were saved from exertional heat stroke by the NB Falmouth Road Race medical volunteers.

 

 

At the expo, we also met with this year’s study participants who already participated in a series of laboratory tests at the University of Connecticut in mid-July to early August. These runners were provided with an ingestible thermistor pill, which allow researchers to readily measure their internal body temperature on the day of the race.

 

 

Race Day

Race day for both medical and research volunteers started before dawn on Falmouth Sunday. The research crew set up the morning data collection booth at Lawrence School, which was where all runners met to get on shuttle buses to the starting line in Woods Hole. The research data collection included measurements such as participants’ gastrointestinal temperature, sweat rate, and pre- and post-race blood and urine collection.

 

 

At the medical tent, medical volunteers gathered to review the triage protocol and proper methods for treating exertional heat stroke. Chris Troyanos, Medical Coordinator of the NB Falmouth Road Race, Dr. Jardine and Dr. Robert Davis, the co-medical directors, and Dr. Douglas Casa from KSI lead the group of veteran and novice medical volunteers so that the medical tent was ready for runners who would be finishing the 7.1-mile course in the forecasted warm and humid conditions.

 

 

Findings from the NB Falmouth Road Race study will be analyzed over the course of the next several months and will be prepared for scientific presentations at the National Athletic Trainers’ Association and American College of Sports Medicine annual meetings in 2018.

 

 

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