Interview with Dr. Douglas Casa on the podcast, “All Things AT: Behind the Tape”.
Link here: http://Podcast Link
“It’s 5 a.m. and still dark at the Carlton Complex fire camp in central Washington, except for the fire’s orange glow on a distant ridgeline. Wildlands firefighter Bre Orcasitas, two colleagues, and three volunteers suit up: heavy duty fire-resistant pants, shirt, jacket, and helmet. Their boots weigh 2 kilograms; the backpacks they will haul to the fire—loaded with 6 liters of water, food for a 16-hour shift, safety gear, and hand tools—can weigh 30 kilograms. Sometimes the burden includes a 12-kilogram chain saw.
On this day in August 2014, the crew is not just fighting flames, but also taking part in research. Orcasitas outfits each person with a chest harness and sensors that will record their heart rate, elevation gain, distance traveled, carbon monoxide intake, and skin temperature. Each swallows an ingestible radio thermometer that relays deep body temperature to the chest monitor every 15 seconds via Bluetooth. Orcasitas and her two colleagues will record each firefighter’s activities, be it cutting down trees, digging a fire break, or burning vegetation to keep a larger fire away. It’s all part of a study to assess heat exposure in wildlands firefighters—the biggest ever to do so. From 2013 through 2016, more than 300 firefighters participated.
High body temperatures are inevitable in firefighting: A study in 2013 uncovered about 50 heat-related injuries across the United States during that fire season. But other data from their project have surprised Orcasitas and her colleagues. Warmth from the firefighters’ physical exertion, not heat from the fires, was the greatest danger, the researchers found. Another surprise: “The assumption across the fire community was that if somebody went down, it was because they just didn’t drink enough water,” Orcasitas says. But the team found otherwise. “You can’t drink yourself out of a heat-related injury,” explains project leader Joseph Domitrovich, an exercise physiologist at the U.S. Forest Service’s National Technology and Development Program. “It’s not the magic bullet that people thought.” … article continued at: https://www.sciencemag.org/news/2020/11/heat-killing-more-people-ever-scientists-are-looking-ways-lower-risk
Check out Dr. Casa’s interview on the Healthy Athlete podcast discussing what you need to know about exertional heat stroke!
June 29th, 2020
The Connecticut Interscholastic Athletic Conference announced today the distribution of cold water immersion tubs to 74 CIAC member schools throughout Connecticut. The tubs will be used by school athletic departments as a means of emergency treatment for athletes who incur heat illness brought on through participation in sports.
New emergency medical guidance requires that victims of heat illness are cooled as soon as possible in order to prevent serious consequences which could be life threatening. Nearly all other serious emergencies and injuries require stabilization and rapid transport to the hospital. Schools contract with local EMT services for that transportation. The revised guidelines still require calling 911 immediately, however the new regulations stipulate that for heat illness the victim’s body temperature must be lowered before transportation.
“The best way to lower body temperature for a victim of heat illness is to submerge the athlete in a cold water tub filled with ice,” said Marc Aceto, athletic trainer at East Haven High School. “Having a cold water immersion tub in proximity to athletic practices and contest venues is an essential part of all high school athletic emergency action plans.”
“We at the CIAC make student safety our first priority,” said CIAC Executive Director Glenn Lungarini. “We are glad to purchase and distribute these tubs to our schools that need them in order to help them keep kids safe during an emergency.”
The CIAC surveyed schools about their needs to fulfill an emergency action plan at each school. Athletic directors indicated that there was a need to acquire new tubs as the guidelines had changed. For those schools who didn’t have a tub, the CIAC provided one. The CIAC purchased the tubs with support from H.W. Hine Hardware in Cheshire, an ACE Hardware affiliate.
Aceto, who serves as the liaison to the Connecticut Athletic Trainers Association (CATA) for the CIAC, along with Samantha Scarneo-Miller, from the Korey Stringer Institute advised the CIAC in preparing a new Medical Handbook. The handbook was distributed to all CIAC schools last summer and includes a sample Emergency Action Plan with up-to-date guidelines for treating athletes suffering from heat illness.
CATA president Perry Siegel who serves on the CIAC Sports Medical Committee along with other members of the CATA offered to distribute the tubs to schools who were not able to pick them up at H.W. Hine, an undertaking that began on November 5th.
Lungarini was quick to recognize the collaborative effort; “CATA, The Korey Stringer Institute and the CIAC Staff all worked together to provide current information and support to our member school athletic departments. We want all of our schools to have the most up-to-date training and to be prepared for all athletic emergencies.”
Article here: CIAC Sports
Published: October 16, 2020
“In September 2017, the Korey Stringer Institute (KSI) published a report providing a snapshot of state-level policies concerning sudden death and catastrophic injuries in high school sports. Since this initial landscape analysis and a robust effort to strengthen these policies across the country, 38 states have adopted legislative or State High School Athletic Association changes improving on that baseline. This remarkable progress was chronicled in KSI’s most recent policy evaluation report, released in August 2020.
It’s no coincidence that three-quarters of states have adopted changes in just three years. This nationwide movement towards stronger safety rules has been driven by the work of Team Up for Sports Safety (TUFSS), a KSI-led initiative aiming to propel the adoption of high school athletic policies proven to reduce the incidence of catastrophic sports injuries. The rapid, widespread success of TUFSS has been fueled by robust support from the National Football League Foundation and the National Athletic Trainers’ Association along with numerous private donors.
As part of the TUFSS initiative, KSI hosts meetings within states and invites local high school sports leaders and policy makers to engage in conversation aimed as fueling the adoption of health and safety policies that enhance the wellbeing of high school student athletes. Through the implementation of TUFSS-recommended policies and procedures, schools can be well prepared in the unfortunate event of a catastrophic injury, helping to reduce risk of athlete fatality from sudden cardiac arrest, traumatic head injuries, exertional heat stroke, and exertional sickling.
Research, Advocacy and Education
The Korey Stringer Institute draws its name and inspiration from Korey Stringer, a Minnesota Vikings offensive lineman who passed away from exertional heat stroke in 2001. In an effort to prevent additional exertional heat stroke deaths, Stringer’s widow, Kelci, joined forces with exertional heat stroke expert Dr. Douglas Casa at the University of Connecticut to form KSI, which launched in April 2010. KSI’s mission is to provide research, education, advocacy and consultation to maximize performance, optimize safety and prevent sudden death for the athlete, warfighter and laborer”
The entirety of article can be found here: Player Health & Safety Article October 2020
“In the three years since UConn’s Korey Stringer Institute published its initial report examining health and safety policies for high school athletes, 38 states have adopted legislative or State High School Athletic Association changes that make high school athletes safer in their respective states, according to its latest findings.
The update, released this month, reflects the notable progress states have made in the past year (August 2019-August 2020) in adopting important new policies to protect student athletes. States adopting policy changes that went into effect this year include Alabama, Arkansas, Colorado, Delaware, District of Columbia, Florida, Hawaii, Illinois, Iowa, Louisiana, Missouri, New Jersey, New Mexico, New York, Oklahoma, Tennessee, Texas, and Vermont.
These changes come as the NFL Foundation and the National Athletic Trainers’ Association, along with countless private donors, have announced their support of Team Up for Sports Safety (TUFSS), a KSI-led initiative with a goal to help propel the adoption of policies proven to reduce the incidence of catastrophic sports injuries.
As part of the TUFSS initiative, KSI hosts state meetings and invites local high school sports leaders and state legislatures to engage in conversation and help encourage the adoption of health and safety policies that benefit the wellbeing of high school student athletes. In the coming years, KSI will visit all 50 states, the District of Columbia, and Puerto Rico.
“One of the most important projects in the history of the Korey Stringer Institute is TUFSS,” KSI Chief Executive Officer and professor of kinesiology at UConn Douglas Casa says. “The project deeply reflects our core mission and provides an unbelievable opportunity to effect positive change that will influence so many youth athletes. Working with the state level policy leaders has been rewarding, but seeing the change in policies from the collective efforts of so many is truly inspirational- knowing that we are doing things that will literally allow more kids to arrive home for dinner instead of at a hospital or a morgue.”
Following KSI’s visit to Louisiana, a sweeping student athlete safety bill was signed into law by Gov. John Bel Edwards on June 15, 2020. It mandates emergency action plans, requires heat acclimatization and the use of wet bulb globe temperature (WBGT) to monitor environmental conditions.
“The Louisiana Project was a cooperative endeavor bringing the LA High School Coaches Association, LA Football Coaches Association, LA High School Athletic Association, LA High School Athletic Directors Association, LA Association of School Executives, and the LA Athletic Trainers’ Association together with one goal,” says Scott Arceneaux, Director of Athletic Training at St. Amant High School and President-elect of the Louisiana Athletic Trainers’ Association. “The goal…was to improve the health and safety of the student athletes in our great state. This was the key factor in Louisiana passing ACT 259 in the 2020 legislative session. Without the guidance and resources of the TUFSS program, this would not have been possible.”
Florida was another state visited by KSI that made legislative policy changes this year. The Zachary Martin Act requires Florida High School Athletic Association member schools to modify athletic activities based on heat stress guidelines and require emergency action plans to include procedures for onsite cooling before transporting a student for exertional heat stroke. Zachary Martin was a 16-year-old offensive lineman who collapsed during a hot summer football practice. His core temperature was 107°F, and he was taken off life support 11 days after his collapse. Zachary’s mother, Laurie Giordano, was instrumental in the passage of this bill.
“Sharing this tragedy with a room full of strangers was difficult, but I was encouraged by the heartfelt concern of Florida legislators and their commitment to ensuring the safety of our high school athletes,” she says. “KSI was instrumental in motivating lawmakers to address exertional heat illness safety through a state survey of high schools that included KSI’s High School Sports Safety Policy Review data for Florida. This survey highlighted inconsistent safety policies and revealed a shocking number of exertional heat illnesses along with a lack of Emergency Action Plans and heat safety equipment. As I spoke to each committee about losing Zach to exertional heat stroke, KSI’s recommendations became a clear path to athlete safety in Florida high schools. I am grateful for KSI’s influence in Florida and I am both humbled and proud that this law is named in honor of Zach.”
The new Florida law also requires Florida High School Athletic Association member schools to make automated external defibrillators available on school grounds in clearly marked, public locations. The Zachary Martin Act was signed by Gov. Ron DeSantis and went into effect July 1, 2020.
“We initially expected to have our policy changes enacted through our state high school athletic association but that did not occur,” said Dr. Michael Seth Smith, Clinical Associate Professor at the University of Florida Department of Orthopedics and Rehabilitation. “Ultimately, through the continued efforts of family members of athletes who have been affected by exertional heat stroke, like Laurie Giordano of the Zach Martin Memorial Foundation, athletic trainers like Bob Sefcik of the Jacksonville Sports Medicine Program, the Florida Alliance for Sports Medicine, the state of Florida Sports Medicine Advisory Committee, and countless other sports medicine professionals, administrators, and coaches along with the support of KSI, the Zachary Martin Act was signed into law on June 23, 2020. It is a great honor to see HB 7011 approved in the FL legislature, which hopefully ensures that our secondary school athletes can continue to participate in sports in a safer manner than in the past in regard to exertion heat illness, sudden cardiac death, and other sports medicine emergencies. I would encourage other state sports medicine groups, who are interested in policy changes, to explore the quickest way to get policy changes approved but not to be afraid to pivot to different paths if the initial one is obstructing their ability to approve mandatory policy changes to keep our young athletes safer while participating in sports.”
In New Jersey, two bills were signed by Gov. Phil Murphy on January 9, 2020, which mandate the use of accepted best practices in the state. The first requires the use of WBGT to monitor environmental conditions, and the second requires the establishment and implementation of emergency action plans. The KSI and TUFSS team has worked closely with New Jersey high school sports leaders over the last three years assisting in this policy change process.
“Both bills are the Athletic Trainers’ Society of New Jersey’s (ATSNJ) product of many years striving to keep New Jersey’s secondary school student athletes safe,” says David Csillan, MS, LAT, ATC, member of the NJSIAA Sports Medicine Advisory Committee. “S2443 mandates all New Jersey secondary schools to follow the New Jersey State Interscholastic Athletic Association’s (NJSIAA) Heat Participation Policy. The policy utilizes WBGT to access environmental conditions and, if safe, allows for activity to continue with the appropriate modifications of increased water breaks, removal of equipment and decreased intensity of activity. S2494 requires school districts to have an emergency action plan at the ready, should a serious or potentially life-threatening sports-related injury occur. According to the 2018/19 participation data from the National Federation of State High School Associations (NFHS), New Jersey had approximately 280,000 secondary school athletes participating in interscholastic sports and we have a responsibility to keep them safe while under our watch.”
More information about the current review from KSI’s high school sport safety study and details regarding each state’s assessment can be found online here. “
“The Korey Stringer Institute (KSI), with the help of several other experts in the field of sports medicine and athletic performance, has published a critical document with recommendations on how to return to sports and exercise safely during the current pandemic. In this episode, Dr. Douglas Casa, the CEO at KSI, shares his perspective on this document and the unique challenges COVID-19 presents.”
(Reuters Health) – One in every three high schools in the U.S. has no access to an athletic trainer, according to a large study.
Even among the schools with some access, in roughly half the trainer is only part-time, the researchers report in the Journal of Athletic Training.
“Every athlete who participates in sport at the high school level deserves the best when it comes to emergency best practices and athletic injuries,” said lead author Robert Huggins of the University of Connecticut, in Storrs.
Athletic trainers provide emergency and non-emergency care for athletes and are the main healthcare professionals trained in injury prevention for physical activity. At the high school level, they coordinate care and follow-up, conduct rehabilitation and return players to the game. They help with concussions, orthopedic injuries, eating disorders, heat illnesses, heart issues, weight management, diabetic episodes and substance abuse concerns.
“Athletic trainers are the standard of care,” Huggins told Reuters Health by email. “Athletes, parents, administrators, and high school athletics associations all need to be made aware of – and self-assess – the care being provided in their schools.”
Smaller studies had found that roughly a third of U.S. high schools had no access to athletic trainers. For a more detailed picture, Huggins and colleagues gathered data on all 20,272 public and private high schools in the U.S. with school-sanctioned interscholastic athletics programs.
Between 2015-2018, the researchers contacted school administrators and athletic trainers through phone calls and emails, and also surveyed trainers online.
The remainder of the article can be found here: Reuters Health
CINCINNATI (WKRC) – On Friday nights in the fall, in big cities and small towns, you find the heart and soul of a community on full display.
High school sports have become a staple of community pride and success and, this fall, a stage to highlight a growing issue in high school athletics. It involves a simple sticker and the letters “A” and “T.”
As important as the results on the field is the safety of the athletes competing. That’s where an athletic trainer comes in said Greater Cincinnati Athletic Trainers Association president, Mike Gordon.
“Our whole goal is prevention,” Gordon said. “If we can prevent that injury from happening, if we can prevent that emergency from happening, then we’re doing our job well. Then hopefully we’re providing the best care possible. If we’re not doing those things, if we’re not looking forward or being those risk-management type mentality, then we could be putting our kids at risk.”
A lack of athletic trainers, though, continues to be a problem at high schools across our area and the country.
“If you have no medical provider on site, if you have someone who doesn’t know what they’re doing, that is just a person out of the stands, that can get really get dicey,” Gordon said. “Especially for schools that are looking for places to prevent injuries and liability.”
Only 37 percent of high schools in the United States have a full-time athletic trainer, according to the National Athletic Trainers Association (NATA).
At the University of Connecticut, there is an institute named after a former NFL player who died while playing professional football, former Minnesota Viking Korey Stringer. The Korey Stringer Institute (KSI)’s mission is to provide research, educate and advocate for athletes at all levels.
KSI created ATLAS, or Athletic Training Location and Services, and then mapped the status of athletic training at the more than 20,000 high schools across America.
According to ATLAS, of the 840 schools that make up the Ohio High School Athletic Association (OHSAA), only 390 schools have a full-time athletic trainer on staff and 290 schools have a part-time trainer. That leaves 160 schools in the state without any athletic training services at all.
In Kentucky, 100 of the 289 schools don’t have an athletic trainer, and in Indiana, 72 of the 438 don’t have one either, according to ATLAS’ data.
“If you have money to be able to have football and to have soccer and to have volleyball and all these sports, if you have money to be able to provide for all that, you need to be able to find money to be able to help have someone on site like an athletic trainer,” Gordon said, “to be able to prevent some of the injuries and to be able to be the risk managers for you.”
Schools with part-time trainers often only have a medical professional present at games, leaving athletes without a medical professional during regular practice hours.
“So when they are there only for game days and you just see them on the sideline with their fannypack on or their slingback on,” Gordon said, “and they are just handing out water bottles you think, ‘OK, they’re safe during that time.’ But the vast majority of the injuries happen during the week and prior to the game.”
CHARLOTTESVILLE –– When Virginia’s first-team offense took the field at Scott Stadium for a recent intrasquad scrimmage, Ryan Swoboda lined up at right tackle. Nothing remarkable about that, many observers might have said. At 6-10, 305 pounds, Swoboda is a huge presence, and his background in basketball is evident in his footwork.
To those who know what he had to overcome to be in that position, however, the sight of Swoboda on the field alongside his teammates stirs strong emotions.
“It makes you so excited for him and proud of how hard he’s worked,” said Kelli Pugh, UVA’s associate athletics director for sports medicine. “We love all these guys, but because of what Ryan went through, he’s certainly always going to have a special place in our heart.”
Head coach Bronco Mendenhall said: “It’s gratifying. I love the change in people that occurs through struggle, and we think struggle is the law of growth. That doesn’t mean we want hardships or mishaps to befall people, but once it happens, then how you frame it and how you respond is everything, and Ryan’s done a really nice job of how he framed it and how he responded and how he worked through it and how he persevered. And it’s so rewarding to him and myself and the team to see him out there playing.”
On July 12, 2017, a typically steamy summer day in Central Virginia, Swoboda and the other freshmen in Mendenhall’s program gathered for a conditioning session on the practice field next to the McCue Center. About six weeks earlier, Swoboda had graduated from Windermere Preparatory School outside Orlando, Fla., and now he was ready for his third workout as a Cavalier.
“It was just a normal morning,” Swoboda recalled. “I drank my gallon of water [beforehand]. I did everything normally.”
But as the workout progressed, his core body temperature started to climb, and Swoboda began to feel unsteady, unbeknownst to the athletic trainers overseeing the session, Keith Thomson and Jeff Boyer. Swoboda said nothing to them, “because I didn’t know how serious it was in the moment. I just wanted to push through the workout.”
Eventually, he collapsed, and the athletic trainers rushed to him. A core temperature of 104 degrees or higher, Pugh said, is considered heat stroke. Swoboda was at 109 degrees.
He remembers little of what happened next, but UVA medical staff, while waiting for an ambulance to arrive, used ice and water to lower Swoboda’s temperature. Among those who treated Swoboda was Jeremy Kent, a UVA primary care physician.
Keith, Jeff and Dr. Kent saved his life,” Pugh said.
Back in Orlando, his parents, Kirk and Sophia Swoboda, learned of their son’s plight.
“As a parent the worst call you can get is that something has happened to your child,” Kirk Swoboda said.
He couldn’t get a flight out of Orlando until the next morning, so Kirk got in his car and left for Charlottesville immediately. What was usually a 12-hour drive for him took 10. When he arrived at the hospital, Kirk found several members of UVA’s athletics department with his son, including Mendenhall, who had postponed his vacation and stayed all night with Swoboda.
“My presence was the best way I could let the family know that we are here and we are supportive and we want to contribute, in any way possible, to his recovery,” Mendenhall recalled.
That recovery did not go as doctors hoped. Swoboda ended up staying in the hospital about three weeks.
“At one point they had 12 machines hooked up to him,” his father said, “keeping him alive.”
In an attempt to stabilize Swoboda’s temperatures, doctors finally induced a coma. Pugh was out of town when Swoboda collapsed, and he was unconscious when she returned and saw him in the hospital.
“It was absolutely terrifying,” she said.
When it was time to bring Swoboda out of his coma, his doctors were unable to do so initially, an excruciating experience for his family.
“At that point I thought he was going to die,” his father said.
Swoboda’s temperature eventually stabilized and slowly returned to normal, and his condition improved. But he doesn’t remember significant parts of his stay in the hospital.
“Where my memories start is a little blurry, I guess,” Swoboda said.
When he was finally released, there was no guarantee he’d ever be able to play football again. His doctors “told me if I wanted to play again, it would be a really long process, I’d have to be really patient, and I’d have to go and take certain tests and pass those,” Swoboda said.
He was determined to try, “but I think I started for the wrong reason,” Swoboda said. “I was frustrated when I first started, and it was kind of like this I’ll-prove-people-wrong kind of thing. But I learned quickly that I wouldn’t have the patience to do the whole process if I had that attitude. Later I just wanted to prove it to myself and become the best football player I could be for myself and not for other people.”
He did so with the blessing of his parents, who told him they’d support him no matter which path he chose to follow.
When his son was in the hospital, said Kirk, who played football at Pacific University in Oregon, “you’re like, Please just walk again and live and you’ll be fine. But afterwards, when he starts healing, you don’t want to take [football] away from him. It’s his goal.”
His comeback proceeded at a glacial pace. Swoboda, who lost about 40 pounds after the incident, was able to begin the fall semester at UVA as scheduled in 2017, and “once I started going to classes, Keith had me walk pretty slowly on a treadmill for about 10 minutes,” he said. “And then maybe after a week of that I’d do 12 minutes, then 15.”
Swoboda smiled. “But I remember that 10-minute walk on the treadmill was pretty hard.”
For his 19th birthday in September 2017, the athletic training staff gave Swoboda a present: They let him run for the first time since his collapse.
“I was real jazzed about it,” Swoboda said. “I’d do a 60-second jog and then go back to walking. Then a 60-second jog. I did that for about a month or so, and then slowly they’d let me do more running, and by about the end of the year, I’d run about two and a half, three miles [at a time] on the treadmill. That’s all I could do, run.”
As 2017 gave way to 2018, Swoboda’s workload increased, and he began doing pushups and planks under Thomson’s supervision. In January 2018, something more important occurred: UVA sent Swoboda to the Korey Stringer Institute in Storrs, Conn.
The institute, which opened in 2010, is named for the Minnesota Vikings’ Pro Bowl lineman who died of exertional heat stroke during training camp in 2001. In addition to educating schools, teams, athletes and others about ways to prevent heat stroke, the Stringer Institute tests people’s tolerance for heat.
In his first visit to the institute, Swoboda failed the heat tolerance test, “but they said my numbers were good enough that I could work out under monitoring.” The testing involves exercising on a treadmill in a heat chamber while vital signs such as heart rate, sweat rate and core temperature are monitored.
Rest of the Article can be found at: Virginia Sports By: Jeff White