Preventing Heatstroke Top of Mind for Football Coaches (Athletic Business)

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Naples Daily News (Florida)


Football coaches in Collier County won’t be mandated to buy equipment to prevent heatstroke, but they still are taking some of the steps necessary to prevent it.

Five weeks ago, the Florida High School Athletic Association postponed a decision on whether to mandate access to ice tubs in case of heatstroke, as well as thermometers that measure heat stress.

“Coaches around here expect Florida football to be hot – it always has been,” said Naples High School head football coach Bill Kramer. “But for my team, we have cooling misting fans and kiddie pools filled with water and ice, and we’ve been doing stuff like that forever.”

Kramer has coached at Naples High School since 1998.

“Everybody wants to keep their players safe,” he said. “I don’t know any coach who wouldn’t do the most they can for their players and their safety.”

At Immokalee High School, head coach Anthony Rodelin also has ice tubs, makes his players take mandatory waters breaks and is constantly reminding them to stay hydrated.

“Coach has us hydrating every day,” Immokalee quarterback R.J. Rosales said. “We’ve got the ice tubs and he’s always telling us the conditions outside so that we can stay safe.”

Another way coaches try to help players stay cool is by cooling down the temperatures on the field.

“About 10 years ago, when we got our new field, they put in a sprinkler system that keeps the field temperature down,” Kramer said.

Rodelin goes one step further.

“During the season, right before practice every day, I make sure our sprinkler system comes (on),” he said. “I set it for a time that I will actually be able to see, and sometimes it even gets the players a little wet during warmups.”

Since Rodelin was a player at Immokalee in 2005, things have changed a lot in terms of heatstroke prevention, but he’s still worried about the cost of a new FHSAA policy.

“If you’re going to mandate coaches do something, then provide the funding,” he said. “I’m OK with restrictions on us, but just give us the money.”

Worst state for heatstroke deaths

Since 2010 Florida has had more high school athletes die from heatstroke than any other state, according to the University of Connecticut’s Korey Stringer Institute, a research, education and advocacy organization whose goal is to prevent sudden death in sports.

From 1995 to 2015, 61 football players have died from heat-related illness, 46 of those in high school. Ninety percent of those deaths occurred during practice.

Riverdale High School football player Zachary Polsenberg collapsed from heatstroke last June in Fort Myers during summer practice after registering a core temperature of 107 degrees.

“The FHSAA seems determined not to address heat illness best practice guidelines to protect high school athletes,” Polsenberg’s mother, Laurie Martin Giordano, said. “I am confused why the FHSAA would completely disregard the recommendation of their own advisory board and the nation’s leading physicians and athletic trainers on this topic.

Douglas Casa, head of the Korey Stringer Institute, met with FHSAA board members and medical advisers the past two years on heat safety policies and was just as disappointed in their decision.

“Between now and 20 years from now, they’re going to require cold-water immersion tubs. It’s going to happen,” he said. “Why do we have to keep having more young kids die needlessly because you didn’t enforce a policy that would have saved them?”

The Fort Myers News-Press contributed to this report.

Tips for preventing heat exhaustion

Hydrate before, during and after exercise.

Maintain appropriate work-to-rest ratios based on the heat and conditions.

Increase rest breaks as temperatures increase.

If you think an athlete is suffering from heat exhaustion, elevate legs and cool person with fans, rotating ice towels, ice bags or ice bath.

Source: Athletic Business

Loudoun County Public Schools Approves EHS Protocol

Paul A. Peterson MA, LAT, ATC

Athletic Trainer, Woodgrove High School

(May 17, 2018 Virginia)-  We are proud to announce that Loudoun County Public Schools has approved an exertional heat stroke (EHS) protocol that includes the use of rectal thermometry.  We hope this decision will encourage other secondary school districts in the state of Virginia and throughout the United States, who are having difficulties convincing their administrators the vital importance of rectal thermometry, to continue their pursuit.

In the past, our school district administration was adamantly opposed to approving rectal thermometry.  They denied our athletic trainers, on numerous requests, permission to purchase and use rectal thermistors.  Ironically, this past fall, one of our student-athlete cross-country runners suffered EHS during a championship meet.  The athletic trainers and EMS volunteers immediately assessed the student-athlete’s internal body temperature at 107.7°F via rectal thermometry, placed him in an ice water immersion tub and didn’t transport him to the ER until his internal body temperature dropped to 102°F.  Fortunately, the student-athlete was released from the ER later that night with no organ damage and made a full recovery.

By following best practice guidelines in the treatment of EHS, the athletic trainers and EMS volunteers, almost certainly prevented a catastrophic outcome.  This incident, once again, brought the need for our school district administration to approve the use of rectal thermometry in the treatment of EHS to the forefront.  After an eight-month process to help educate the administration on the vital importance of rectal thermometry, we finally received consent and this policy is now officially part of our EHS protocol.

This policy implementation would not have been possible without the support of several individuals. First and foremost, we had the support of our Athletics Supervisor. Second, we received support and the go ahead from our Health Services’ Supervisors and Director.  Third, we received support and further go ahead from our Risk Management Supervisor.  Then finally, we received approval from our School Administration Director to include our EHS protocol in the LCPS policies and procedures section of the student-athlete handbook.

The key to our success was a team effort approach.  With help and support from many individuals most notably, the LCPS athletic trainers, the orthopedic physicians and staff from The National Sports Medicine Institute (NSMI), the researchers at the Korey Stringer Institute (KSI), Dr. Kevin Miller at Central Michigan University, and Darryl Conway at The University of Michigan, we were finally able to convince our administration to allow the medical professionals in the school system to make the medical decisions and act within published best practices.

With patience and perseverance, the LCPS athletic trainers were able to accomplish the goal of getting an appropriate EHS protocol approved to ensure the future health and safety of LCPS student-athletes who may suffer from EHS.

High schools: FHSAA refusing to change stance on heat illness safety equipment (Naples Daily News)

By Seth Soffian

The Florida High School Athletic Association is drawing the ire of heat safety advocates and medical professionals after refusing to change its stance on life-saving equipment.

Five weeks after the state agency postponed a decision whether to mandate access to ice tubs in case of heat stroke as well as thermometers that measure heat stress, the agenda for next week’s board meeting again stops short of requiring the basic items.

That goes against the advice of the FHSAA’s own medical advisers, who spent the past five weeks supplying the FHSAA with additional requested material in support of their position, as well as widespread industry standards for combating heat illnesses.

“It is with extreme disappointment that I review the agenda items,” Pat Helma, a Cooper City chiropractor and chair of the FHSAA’s 15-person Sports Medicine Advisory Committee, wrote in an email to FHSAA board president Frank Prendergast.

“Our Committee seeks to work WITH the FHSAA to improve sports safety; however, without communication from the latter, it appears the FHSAA is moving forward with the medical opinion of its Attorney.”

Prior to the previous board meeting in late April, for which the agenda again only recommended the use of ice tubs and wet-bulb globe thermometers, the agency publicly indicated that it would only mandate their use if required to do so by Florida lawmakers.

Barring a decision by board members next week to override the agenda language and formally mandate the heat safety equipment, that may still occur.

Florida Sen. Kathleen Passidomo, R-Naples, whose district covers large areas of Southwest Florida, previously told The News-Press she was “very concerned” about the issue. Passidomo could not be reached for comment this week.

“In somewhat confusing strategy, it has been suggested that these policies should be initiated through our state Legislators,” Helma wrote, “when in-fact, last year the FHSAA reached out to our Committee members and suggested we craft letters of support for the FHSAA to our state Legislators essentially asking them to back off and leave the FHSAA alone to govern high school sports.

“Now the (board of directors) has been directed to ask the Legislature to tell the FHSAA what to do with a thermometer and a Rubbermaid tub?”

FHSAA spokesman Kyle Niblett noted that next week’s agenda is not yet policy.

“We anticipate there to be further discussion at next week’s Board of Directors meeting regarding the proposed policy changes,” Niblett wrote to The News-Press. “The feedback from the SMAC will be part of that discussion.”

Douglas Casa, head of the Korey Stringer Institute at the University of Connecticut and one of the nation’s foremost authorities on what is known as exertional heat stroke, held out hope that the FHSAA’s position remains the result of not being “fully informed.”

“I think the lawyer’s not informed,” Casa said.

But Casa, who has met with FHSAA board members and medical advisers the past two years on heat safety policies, was equally disheartened by the agency’s position.

“Between now and 20 years from now, they’re going to require cold-water immersion tubs. It’s going to happen,” he said. “Why do we have to keep having more young kids die needlessly because you didn’t enforce a policy that would have saved them?

“It’s such a simple solution to such a serious problem.”

Heat safety experts cite a “100 percent” survivability rate in cases of heat stroke – the most severe heat illness, when core temperatures reach 104 degrees – when the person suffering is immersed in cold water within 5-10 minutes of a medical event.

Florida, meanwhile, has seen more high school athletes die from exertional heat stroke since 2010 than any other state, according to the Korey Stringer Institute, named for the former NFL offensive lineman who died from heat stroke in 2001.

Nationwide, exertional heatstroke killed an average of three football players a year at all age levels from 1995-2015, according to the National Center for Catastrophic Sport Injury Research.

Of 61 deaths in those years, 46 were in high school, 11 in college, two in youth football and two in professional football. Ninety percent of the deaths occurred during practice.

Those numbers also are for football only, and they don’t include hospitalizations for heat illnesses that didn’t result in death or other heat events that didn’t result in hospitalizations.

In addition to declining thus far to make ice tubs and wet-bulb globe thermometers mandatory, the FHSAA also has not acted on its sports medicine advisory committee’s recommendation to make its heat safety policies apply to summer months.

Those months are left almost exclusively in the hands of individual districts and schools to regulate.

“The FHSAA seems determined not to address heat illness best practice guidelines to protect high school athletes,” said Laurie Martin Giordano, whose son, Zach Martin Polsenberg, died of exertional heat stroke last summer after collapsing at Riverdale High School football practice.

“I am confused why the FHSAA would completely disregard the recommendation of their own advisory board and the nation’s leading physicians and athletic trainers on this topic. I am also disgusted at the apathy displayed for the loss of children’s lives that will surely continue while they hold the power to prevent them.”


Source: Naples Daily News

Athletes Can Prevent Heat Stroke With This Important First Step (GOOD)

Heat stroke is one of the top three causes of sudden death for athletes.

But it’s 100% survivable when it’s recognized and treated right away, according to the University of Connecticut’s Korey Stringer Institute. The organization is named for the Minnesota Vikings player who died from heat stroke in 2001 after being overcome by the heat during training camp.

Time is of the essence when it comes to bringing the athlete’s core temperature down below the danger threshold.

In a consensus statement published earlier in 2018, experts convened by the institute stressed the importance of cooling athletes immediately on site before taking them to a hospital, given that critical damage to cells can occur when body temperature is at or above 104.5 degrees Fahrenheit for longer than 30 minutes.

This timeframe is what really makes a difference,” says Luke Beval, director of research at the Korey Stringer Institute and lead author of the statement, published in Prehospital Emergency Care. “The sooner you cool someone, the greater their chance of survival.”

Recognizing and treating heat stroke

Being able to provide immediate treatment requires quickly recognizing the symptoms of heat stroke. While central nervous system dysfunction is one of two main criteria, symptoms can be similar to those of other critical health issues common in athletes. For example, dizziness, vomiting, and confusion are also common concussion symptoms.

The consensus statement debunks the misconceptions that athletes with heat stroke will have stopped sweating, have hot skin, or will have lapsed into unconsciousness.

Accurately diagnosing exertional heat stroke requires taking the athlete’s rectal temperature, the authors note. Other methods may not provide an accurate reading of the person’s internal temperature, which can provide a false sense of assurance that the athlete is OK.

Using the principle of “cool first, transport second,” athletic trainers and other on-site first responders should immediately begin cooling the athlete rather than waste critical time waiting for emergency personnel to arrive.

The most effective method is to immerse the stricken athlete in a tub of ice-cold water from the neck down, which cools the maximum body surface area and is more effective than cold wet towels, ice packs, or cold showers. This on-site treatment should continue until the athlete’s body temperature drops to about 101.5 degrees; only then should the athlete be taken to the hospital. Crucially, the consensus statement notes that most hospital emergency departments lack the equipment for full-body cold water immersion.

Practice prevention, but be prepared

In addition to having emergency plans and equipment in place, coaches and trainers should also be prepared to adjust workouts when hot weather is expected. Hot, humid weather heightens the risk of exertional heat stroke, given that it reduces the body’s ability to cool itself by sweating. The most accurate measurement is with a wet bulb globe temperature monitor, which measures temperature, humidity, and other contributing factors.

In an interview with GOOD Sports, Beval stressed the importance of giving athletes time to adapt to the heat. This includes not wearing heavy equipment during the first days of practice, minimizing the number and duration of two-a-day practices, gradually ramping up the intensity level, and allowing adequate rest and recovery time.

Heat acclimatization is incredibly effective. Of all the extreme environments we can subject our bodies to, like cold or altitude, we have the best ability to adapt to the heat,” says Beval. “Where these practices have been adopted, we’ve seen a drop in deaths.”

Of course, it’s far better to prevent exertional heat stroke in the first place.

On its site, the Korey Stringer Institute notes key preventive measures, including proper hydration, wearing appropriate clothing, avoiding practice during the hottest part of the day, and heat acclimatization to allow the body time to adjust to the weather. Similar guidelines can be found in the Heat and Athletes section of the Centers for Disease Control and Prevention site.

Source: GOOD Sports

Korey Stringer Institute Announces 2018 Lifesaving Awards

KSI Perfomance/Safety Logo(May 14th, 2018) — The Korey Stringer Institute (KSI) is proud to honor three individuals for theiroutstanding contributions to preventing sudden death in sport through the KSI’s 2018 lifesaving awards.The awards were presented at NFL headquarters in New York City, NY during the KSI’s annualfundraising gala on May 10, 2018.

Located at the University of Connecticut, the Korey Stringer Institute is a national research and advocacy organization dedicated to maximizing performance, optimizing safety, and preventing sudden death among athletes, warfighters, and laborers.

The 2018 award recipients are:

KSI Lifesaving Research Award

This award recognizes exceptional dedication and work in research aimed to advance knowledge regarding the prevention of sudden death in sport.

Scott Anderson, ATC

Head Athletic Trainer University of Oklahoma

The head athletic trainer for the University of Oklahoma since 1996, Scott Anderson is currently president of the College Athletic Trainers’ Society and the Big 12 Conference representative to the NCAA Concussion Safety Committee. He is former co-director of the Summit on Safety in College Football (2014, 2016). His prior service includes

membership on the NCAA Concussion Task Force (2014) and the Inter-Association Task Force on Safety in Football: Off-Season Conditioning (2012). He was co-chair of the National Athletic Trainers’Association Inter-Association Task Force on Sickle Cell Trait in Athletes (2007) and a member of the Inter-Association Task Force on Exertional Heat Illness (2003). He served as chair of the Big 12 Conference Medical Aspects of Sport Committee from 1999 to 2002.

Recognitions: College/University – Athletic Trainer of the Year 2006; All-American Football Foundation, Inc – Outstanding Athletic Trainer 2005; and 2000-01 Big 12 Conference Athletic Training Staff of the Year, and Oklahoma Athletic Trainers Association Hall of Fame.

KSI Lifesaving Service Award

This award recognizes exceptional service aimed to improve policies and advocate for the adoption of policies in order to reduce sudden death in sport.

Larry Cooper, MS, LAT, ATC

Teacher & Athletic Trainer Penn-Trafford High School

Larry Cooper has been a tireless advocate for secondary school athletic trainers.

He has been involved locally, regionally, and nationally on various committees, projects, and several inter-association task forces. Recently, he served as the NATA Secondary School Athletic Trainers Committee (SSATC) Chair and also the District 2 SSATC Representative. Cooper has been a teacher and certified athletic trainer for 35 years. For the last 27 years, he has served as a sports medicine, health, and physical education instructor at Penn-Trafford High School in Harrison City, Pennsylvania. Cooper has also served as a member of the National Federation of State High School Associations (NFHS) Sports Medicine Advisory Committee. In addition, he has held numerous positions within the Pennsylvania Athletic Trainers Society (PATS) including being a member of the Board of Directors and Secondary School Committee Chair. Cooper is a founding member of the Western Pennsylvania Interscholastic Athletic Leagues (WPIAL) Sports Medicine Advisory Committee. He continues to work as a master assessor for the Pennsylvania Interscholastic Athletic Association’s (PIAA) Wrestling Weight Loss rule. Cooper has been an active member in the KSI’s ATLAS Projectsince its inception. This collaborative effort between the NATA and KSI has led to new policies and policy changes that have increased secondary school athlete safety across the country.

Cooper was inducted into the Pennsylvania Athletic Trainer Hall of Fame in 2014. He received the NATA Athletic Trainer Service Award in 2014 and the NATA Most Distinguished Athletic Trainer Award in 2016. In addition, he received the School Health/ Training and Conditioning Magazine Most Valuable Athletic Trainer Award in 2015; The Micro Bio-Medics Scholastic Athletic Trainer Award in 2003; the PATS Service Award in 2005; and the PATS Distinguished Merit Award in 2011.

His favorite role has been that as loving husband to Lisa and father to their three daughters, Sara, Molly, and Delaney.

KSI Lifesaving Education Award

This award recognizes exceptional work to advance knowledge and education in the realm of preventing sudden death in sport.

Cindy Chang, MD

Professor, Primary Care Sports Medicine University of California San Francisco

Dr. Cindy Chang is a primary care sports medicine physician specializing in the prevention, diagnosis, and treatment of injuries and illnesses related to exercise and sports participation in children and adults.

She serves as chair of the California Interscholastic Federation’s SportsMedicine Advisory Committee, and also served on the Sports Medicine Advisory Committee for the National Federation of State High School Associations (NFHS). She is a board member of Racing Hearts, a non-profit organization that increases awareness of and improves access to automated external defibrillators (AEDs) in communities. After co-founding the California Concussion Coalition, Dr. Chang is now co-chair of the Sports Concussion Program at UCSF Benioff Children’s Hospital. She was an elected four-year member of the Board of Directors for the American Medical Society for Sports Medicine (AMSSM), one the largest organizations of primary care sports medicine physicians in the world, and later served as its President in 2011-2012. She is also a fellow of the American College of Sports Medicine (ACSM) and is currently an elected member of its Board of Trustees.

Dr. Chang has worked at the U.S. Olympic Training Center in Colorado Springs and was part of the USA medical team for the Winter Paralympic Games in Nagano, Japan, in 1998 and in Salt Lake City in 2002. She served as Chief Medical Officer for the USA delegation at the 2007 Parapan American Games in Rio de Janeiro, the 2008 Summer Paralympic Games in Beijing, and the 2012 Olympic Games in London.

She was the 2003 recipient of the AMSSM Founders Award, given to a sports medicine physician who demonstrates outstanding professional achievement and service to the community. She was also selected to receive the 2013 Dr. Ernst Jokl Sports Medicine Award, given annually to an individual for his/her contributions to the growth and development of sport medicine through practice and/or scholarly activity. In 2016, Dr. Chang was honored with the National Athletic Trainers’Association Jack Weakley Award of Distinction, for a lifetime of outstanding contributions that directly impact health care in the area of athletics, athletic training, or sports medicine and are of major and lasting importance.

Dr. Chang is currently a Clinical Professor at the University of California San Francisco in the Departments of Orthopaedics and Family & Community Medicine. She continues at Cal as a team physician and sports medicine consultant, and volunteers as the team physician at Berkeley High School. She is very invested in supporting her athletic trainer colleagues and advocating for their licensure inCalifornia. Chang is medical director of Emergency Education Services at UCSF Benioff Children’sHospital, and has become credentialed to train others including athletic trainers to become certified instructors in First Aid and CPR/AED. She frequently speaks to community groups, schools, club teams, and the media on a wide range of topics affecting the health and safety of our young athletes.


New Jersey Champions Sports Safety Campaign

KSI Logo

New Jersey Leads National Effort to Adopt 

Lifesaving Measures for High School Athletes


“Raise Your Rank” campaign encourages all states to adopt important safety guidelines

NEW JERSEY– Many states across the country are not fully implementing important safety guidelines intended to protect student athletes from potentially life-threatening conditions. Research has shown that nearly 90 percent of all sudden death in sports is caused by four conditions: sudden cardiac arrest, traumatic head injury, exertional heat stroke, and exertional sickling. Adopting evidence-based safety measures significantly reduces these risks. With more than 7.8 million high school students participating in sanctioned sports each year, it is vital that individual states begin taking proper steps to ensure their high school athletes are protected. The call for action came this past fall when the University of Connecticut’s Korey Stringer Institute (KSI), a national sports safety research and advocacy organization, released a comprehensive state-by-state assessment of high school sports health and safety policies. New Jersey currently ranks 4thnationally in terms of meeting all of the recommended safety guidelines with a score of 67%.



In response to the findings, New Jersey officials are collaborating with the KSI in addressing existing gaps in state policy to improve high school athlete safety. New Jersey is the first state to join the KSI’s national “Raise Your Rank” campaign, which started in 2018. The campaign aims to raise funds to support meetings with state representatives in order to improve mandated best practice policies and increase implementation of those policies.


“With support and guidance from the experts at the Korey Stringer Institute, the New Jersey State Interscholastic Athletic Association and Senator Patrick Diegnan (D-Middlesex) will convene this week to begin taking the necessary steps to improve the health and safety of our secondary school athletes,” says David Csillan (Ewing HS Athletic Trainer and NJSIAA Sports Medicine Advisory Committee). “Our goal is to be the first state to be 100% compliant with the recommended safety guidelines.”


This is not the first time New Jersey has led the way in improving the health and safety of high school athletes.  New Jersey was the first state to implement heat acclimatization policies for high school athletes in 2011. Acclimatization policies require teams to allow athletes to adjust to hot conditions in late summer by phasing in practices, participating without heavy equipment, and requiring frequent breaks to allow athletes to recover and stay hydrated. Since 2011, six states have implemented similar heat acclimatization policies with positive results; there have been no reports of exertional heat stroke deaths in states where acclimatization policies are in place and properly followed.


“A hallmark of my tenure of as a legislator, working collaboratively with the Athletic Trainers’ Society of New Jersey, is to make New Jersey high school sports safer for our children by creating researched-based state policies to address preventable sudden deaths,” says Sen. Diegnan. “My hope is that through this conscientiousness partnership, we will shine a light on the great measures this state legislature has taken to restrict cardiac arrest, exertional heat stroke, and head injury deaths in our student athletes and to develop further needed changes to ensure all athletes enjoy their high school sports experiences — and live to tell about them.”


KSI CEO Douglas Casa has been leading KSI since its inception in 2010 and has made athlete safety a focused effort of the institute. “We know that implementation of these important health and safety policies has dramatically reduced sport-related fatalities,” says Casa. “We are excited that New Jersey is taking action to continue to improve its policies and become a leader in minimizing sport-related high school deaths.”


For more information about the Raise Your Rank campaign, including how to apply for KSI support and how to donate to the cause, please visit




Media Contacts

Douglas Casa, Korey Stringer Institute, UConn                      David Csillan, NJ Sports Medicine Advisory Committee                                                           

(860) 486-0265 (office)                                                                         (609) 651-3053 (cell)



ATLAS Update

Sarah Antasio, ATC

Assistant Director of Research

As of February 21st 2018, the ATLAS project is 100% Mapped. Translation = we have identified every high school with an athletics program in the United States (including the District of Columbia) and whether or not the student-athletes have access to an athletic trainer (AT). We have identified 20,443 high schools, those being public, private, magnet, alternative and special education schools. Within these high schools we have identified a total of , working either full or part time and providing care for the student-athletes during treatments and rehabilitation programs, practices and game competition.

A mission of KSI is to promote the athletic training profession as well as increase the number of ATs and appropriate health care provided to the athletes across all levels of sport. Our ATLAS data has determined that 66% (n = 13,492) of schools with athletic programs have access to an AT in some capacity. The National Athletic Trainers’ Association District 2 (DE, NY, NJ, PA), has the highest percentage of ATs, providing 57% of full-time coverage and 25% part-time.

The ATLAS survey began in June 2015 and we currently have a 49% completion rate. Surveys  have been completed by secondary school athletic trainers throughout the country.

The ATLAS project is a thirteen-person staff, consisting of 1 KSI faculty member, Dr. Robert Huggins, 2 Masters’ students: Brad Andres and Sarah Attanasio as well as ten undergraduate students volunteering their time to KSI and the project.

Click this link for type of AT services by district

Applied Performance Science: Stress, Travel Fatigue and Recovery Techniques

Ryan Curtis MS, ATC, CSCS

Director of Athlete Safety and Performance

Stress and subsequent fatigue are a normal part of sport and life and often desired in order to augment adaption to training. The concept of periodization, being the organization of training stress and recovery, is usually on the forefront of performance and medical practitioner’s minds. When training and physical stress is balanced with adequate rest and recovery, acute fatigue is often diminished in a matter of hours or days. However, if the body is not allowed to return to a balanced state (homeostasis) before excess stresses are introduced, maladaptation occurs. In optimizing performance for sport or life, it’s important to note that not all stresses are desired or accounted for.In the midst of a hectic season or normal life demands, it’s easy to forget to acknowledge and appropriately prepare for things such as the stress of travel, sleep impairment, poor nutrition and/or hydration and injury. Implementing fatigue countermeasures begins first with recognition of outside stressors and then adherence to a few best-practice techniques.Below are a few visuals to help us become aware of undesired stress outside of training and techniques in combating travel fatigue and promotion of optimal recovery.

Love, Sweat, and Engineering II (UConn Today)

By Mike Enright

This is a story about love.

This is a story about UConn.

This is a story about measuring the content of a triathlete’s sweat.

But at its core, this is a story about two UConn alumni who met on campus as undergraduates, got married, and are absolutely crazy proud of their alma mater.

Former student-athlete Laura Marcoux ’10 (CLAS) developed a passion for Ironman triathlons after graduation, but when she faced a life-threatening situation in a recent triathlon, it wasn’t long before she discovered that the best place to get answers to her questions was back home at UConn.

Laura and her husband Ryan ’08 (BUS) returned to Storrs last month, primarily for a visit to UConn’s nationally renowned Korey Stringer Institute, which specializes in research and education to prevent heat stroke injuries and deaths.

The trip was also an opportunity for some Husky nostalgia.

But at KSI, they found hope that Laura will be able to continue in the Ironman triathlons that mean so much to her.

A Husky love story

Ryan and Laura met on the first day of classes in the fall of 2006, when she was a freshman and he was a junior transfer from Manhattan College. They met in front of the Engineering II Building, where a lot of great academic works happens, but it’s an unlikely place to meet your future spouse.

Laura was Laura Eichert at the time and a member of the women’s lacrosse team from Columbia, Maryland. Ryan was a marketing major from New Milford, Connecticut, and was working as a student assistant for coach Jim Penders and the Husky baseball team.

They dated throughout their time at UConn, and moved out to Colorado following Lauren’s graduation in 2010.

“We love the outdoors and hiking,” says Laura. “That’s how we decided on Colorado.”

The couple now live in Morrison, Colorado. When they were married three years ago, they incorporated a number of UConn themes in their wedding: Each guest table was named after a building on the UConn campus, and the cake topper even included Engineering II; “UConn Husky” was played as the entrance song, and guests gestured U-C-O-N-N for pictures.

Finding new limits

During Laura’s time as a lacrosse player at UConn, there were several changes in head coach, but the strength and conditioning program was consistent, including Amanda Kimball, who remains on the UConn staff today.

Our [strength and conditioning] sessions [at UConn] were designed to take us out of our comfort zones both mentally and physically.— Laura Marcoux

Unlike many student-athletes, Laura enjoyed the time spent conditioning more than practice.

“I worked with the highest level of strength and conditioning coaches at UConn,” she says. “Our sessions were designed to take us out of our comfort zones both mentally and physically, and to break new barriers and find new limits.”

Her love of training developed into a passion for the Ironman triathlon – a grueling event with a 2.4 mile swim, and 112 miles of biking, followed by a marathon run of 26.2 miles. Laura did her first sprint triathlon the summer before her senior year, and was hooked.

She has finished four full Ironman triathlons, including the world championship in Hawaii. She placed in the top 10 three times, and was in the top three twice.

But while competing at the Ironman Los Cabos in Mexico last November, Laura developed a condition called hyponatremia and was unable to finish.

“It was a hot race and I felt super-bloated. I was stopping at all the aid stations during the bike ride and pouring water over myself, but it did not help,” she says. “I began to panic.”

She pushed herself further than she should, wound up finishing the bike ride, and started the run, but at that point it was a walk for her. She walked about 11-and-a-half miles and then had to pull out and sit down.

Ryan knew she was in trouble and found her on the course. He immediately got medical help, and soon an ambulance was on the way.

Laura had become unable to answer even the most basic questions. She didn’t know her name or Ryan’s, where she was, or where she was from. She was able to remember just one fact, the name of her pet dog – Luna. The dog is of course a Husky, whose middle name happens to be Jonathan.

Laura was given several IV treatments at a local hospital, but blacked out and lost consciousness for about eight hours. It was the scare of a lifetime.

Fans of all things UConn

“We are like proud parents when it comes to UConn,” says Ryan. The Marcouxs have every television sports package available, and are constantly re-arranging plans to watch Husky teams.

“It doesn’t matter what sport it is, we love them all,” he says. “A few years ago, the women’s soccer team was on ESPNU playing for the American Conference championship. We canceled everything we were doing that afternoon to watch.”

The Marcouxs are huge fans of Hall of Fame women’s basketball coach Geno Auriemma.

“I try to draw parallels from Geno’s coaching strategies to triathlons,” says Laura, who is also a triathlon coach, fitness director at a gym, and a personal trainer. “I’ve learned that if you hold athletes to the highest standards, believe in them, and put them in positions to develop belief in themselves, then they will live up to those standards.”

Ryan works in systems integration for Conga Inc., in Colorado. He credits lessons learned from Penders during his involvement with the Husky baseball team.

“Coach Penders puts an emphasis not only on player development, but also on personal development,” says Ryan. “I still hold onto many of Coach Penders’ mantras, like WIN (What’s Important Now) and ACE (Attitude, Concentration, Execution). I would not be the person I am today without the guidance I received from Coach.”

Ryan himself is just getting into competitive running, and still plays baseball in an adult league back home as an infielder.

‘The best place in the country’

As the Marcouxs were searching for solutions to Laura’s issues, they wanted to find the best place in the country to get help. After a few conversations, all recommendations pointed to the Korey Stringer Institute at UConn.

The fact that the best teaching facility in the country [for athletic performance issues] was at the school I love was a sign just too strong to ignore.— Laura Marcoux

The center is named for Korey Stringer, a Pro Bowl offensive tackle from the Minnesota Vikings who died of heat stroke during training camp of 2001. His wife Kelci worked with the NFL to create a non-profit organization dedicated to preventing sudden death in sport, which later became the KSI at UConn in 2010.

Laura submitted an inquiry on the KSI website and got a phone call back in about 30 seconds from KSI vice president of research and athletic performance Rob Huggins.

She was impressed by the prompt response, and by Huggins’ interest and concern for her case. She says it reinforced her UConn pride.

The Marcouxs quickly planned a trip to UConn for mid-January for Laura to get testing at KSI. It was also a chance to visit the campus they love.

Developing a personalized strategy

The first day on campus, KSI staff met with Laura to gather additional information. She then went through a rigorous test to measure her substrate utilization and determine the appropriate level of calories she needs at various levels of exercise intensity.

“This test will allow Laura to develop a caloric strategy for the events she takes part in,” said Huggins. “We will be able to let her know what she needs to do during the different parts of the Ironman triathlons.”

That same night, the Marcouxs took the opportunity to attend a UConn women’s basketball game at Gampel Pavilion.

The next day, Laura was back at KSI for an intensive sweat electrolyte test. The team wanted to know literally everything all about her sweat – how much sodium is in it, what her rate of sweat is, and how much fluid she is losing and at what rate.

This testing consisted of a two-hour stationary bike ride followed by a “washdown” to collect her sweat and a one-hour stationary run followed by another “washdown.” Laura did these tests in a chamber at KSI that was set for 95 degrees and 60 percent humidity. Her core temperature was monitored throughout the process through a pill she took.

It will take some time for KSI staff to determine the full results of these tests, and what Laura needs to concentrate on to stay healthy in the Ironman triathlons as she looks forward to her next event in Dallas on April 29.

She hopes to find out exactly what she is losing in sweat during an Ironman, in terms of both water and electrolytes, so that she can turn the information into a precise fueling and hydration strategy for her upcoming races.

Although there are some general guidelines for Ironman athletes regarding how to properly fuel in a race, Laura has learned that these guidelines don’t work for her because of her uniquely low sweat rate and probably some other factors that she will find out from KSI.

“In order for me to take the next step in my triathlon career, in both safety and performance, being able to utilize the data that I will receive from KSI will allow me to replace exactly what I lose in a race,” she says, “and therefore allow me to decrease the rate at which I fatigue – which is the name of the game in Ironman!”

A positive experience at KSI, a chance to see the Huskies play, spending “way too much money” at the UConn Bookstore, and a few good meals in Storrs Center.

All in all, a perfect few days for the Marcouxs.

Source: UConn Today

2018 Collaborative Solutions for Safety in Sport Florida Meeting



Last week, Dr. Casa and I were fortunate to attend the 2018 Collaborative Solutions for Safety in Sport (CSSS) meeting for the state of Florida. Stemming from the national CSSS meeting, the goal for this meeting was to implement the best practice policies at a state level for high school athletes. This same meeting occurred in 2017, and while the program was educational and facilitated some changes, the ultimate goal of the current meeting was to bring well thought-out policies to the sports medicine advisory committee and board of directors to pass. While this program was meant educational, it was not meant to be continuing education; rather a workshop with the goal to create and fully vet the wording of policy to be implemented by the Florida High School Athletics Association.




The program, designed and facilitated by Bob Sefcik, ATC, included dinner and a keynote address from Dr. Casa on Monday evening. Dr. Casa’s presentation provided context to the reasoning behind and the methodology utilized for the creation of the policy rubric and the rankings. Starting bright and early on Tuesday, the meeting was kicked off by Dr. George Canizares and Dr. Casa who discussed the current policies and stated that the current meeting was held based on the foundation that was laid in the 2017 meeting. They also noted that the goal of this meeting was to leave with written policy language.


Following the morning speakers, we heard from two families whose children suffered catastrophic injuries while playing high school sports in Florida. Courtney Sapp’s son, Payton, suffered a catastrophic head injury while participating in a junior varsity football. She described the pain and long-term consequences that not only Payton, but her entire family has ensued since his injury. Lori and Ed Giordano’s son, Zach Martin, suffered a fatal exertional heat stroke during a football practice in the summer of 2016. Unfortunately, in both cases, there was no athletic trainer present to care for the safety of the student athletes. Further, the families advocated for increased education of sport related injuries such as concussion, exertional heat stroke, and cardiac arrest. They charged the members in attendance to remember their stories and to do everything in their power to make sports safer.


For the purpose of this meeting, there were five specific areas to focus on creating policies for – cold-water immersion, environmental monitoring, concussion, coach education, and minimal expectations for high schools. Each topic area had its own break-out group with a variety of stakeholders (athletic trainers, physicians, administrators, coaches, and parents) represented in each meeting. Prior to the start of the meeting, a white paper document corresponding to the group you were assigned were disseminated, and thus a majority of the discussion surrounded the material provided on this white paper. I was fortunate to facilitate the Environmental Monitoring group with Dr. Seth Smith. Having tangible, realistic goals of creating specific wording for policies from the breakout sessions allowed for a focused message and resulting actionable items for the sports medicine advisory committee (SMAC) to discuss at their meeting that night.


I was honored to be invited to the SMAC meeting that evening to provide additional insight and expertise, if needed. The members of the FHSAA SMAC are a very professional, determined and organized with the common goal of wanting to improve the health and safety standards for student athletes. I was very grateful for the invitation, and thoroughly enjoyed listening to the discussions that occurred.


To conclude, it was remarkable to see the amount that can be accomplished when key stakeholders within a state, with a common goal, collaborate to improve the current standards. It is truly a team effort and the comradery between the members in attendance was aspiring to be a part of. The policy ranking project was meant to be a project to help states identify areas of strengths and areas of improvement. We are excited to see states such as Florida take the findings of the project and use it as ignition to help improve the safety for our athletes. We fully believe that through policy change at the state level, and thus influencing the local implementation, that we can significantly reduce the amount of catastrophic injuries.


I would like to reiterate our deepest gratitude to Bob Sefcick for his generosity, helpfulness and invitation for Dr. Casa and I to participate in this event. We would also like to thank George Tomyn and the FHSAA for hosting the meeting.