New Jersey Champions Sports Safety Campaign

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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.

This Is How Being Dehydrated Impacts Your Workouts (SELF)

By Amy Marturana

Chances are, you’ve been and felt dehydrated at some point in your life. Low energy, headache, and dry mouth are all common symptoms of mild dehydration, which is usually not dangerous—it’s most likely just going to make you feel a little uncomfortable until you drink more water to fix it. But when it comes to your workouts, being mildly to moderately dehydrated can negatively impact your performance in a few ways that you might not even realize.

Of course, the effects are much more serious for an elite athlete than an everyday exerciser, Douglas Casa, Ph.D., chief executive officer of the Korey Stringer Institute and research associate in the Human Performance Laboratory at the University of Connecticut, tells SELF. “The difference between first and tenth place is seconds. For a regular person, that difference is not as big of a deal. For an elite athlete, it could be their livelihood.”

Still, if you’re trying to shave some time off your next race, or want to feel your best during a workout (who doesn’t?), making sure you’re properly hydrated can help.

Here’s how being a little dehydrated can impact your workouts, and what you can do to fix it.

Our cells need water to synthesize energy. That’s especially important if you want to get through a tough workout.

The basic form of energy our muscles need to function is called adenosine triphosphate, or ATP. When we exercise, our bodies work to convert nutrients like carbohydrates and fat into ATP through both anaerobic (without oxygen) and aerobic (with oxygen) processes. We can only store a tiny amount of ATP in our cells, so our bodies are constantly synthesizing more to continue fueling our every movement. When you’re working out, the amount of energy your muscles needs increases, so synthesizing ATP is even more important.

While the food we eat is what’s broken down and converted to usable ATP, the process can’t happen without water, Greg Wells, Ph.D., assistant professor of kinesiology at the University of Toronto and author of The Ripple Effect: Eat, Sleep, Move and Think Better, tells SELF. One of the main systems in our bodies that creates ATP is called the citric acid cycle, or Kreb’s cycle. “If you’re dehydrated, the Kreb’s cycle cannot work properly to create energy,” Wells says. This can leave you feeling tired and fatigued (during your workout and in daily life).

When you have less fluid in your body, your heart has to work even harder to pump blood.

This means, ultimately, that you may feel like your cardiovascular system is working even harder (i.e. higher heart rate) than it should be. A workout that shouldn’t feel so intense has your heart pounding. Here’s why: “Your body needs some fluid to keep blood volume up to function,” exercise physiologist Mike T. Nelson, Ph.D., C.S.C.S., tells SELF. “Blood volume, which drives all pressure in the body, is primarily fluid based. If we start losing enough fluid, cardiac function is going to go awry.” When your blood volume drops, your heart has to beat faster to try and circulate the same amount of blood throughout your body.

Dehydration can also make it harder for you to regulate your body temperature.

When we exercise, several areas of our body fight for fluid, Casa says. “The skin is trying to cool the body down, and it needs fluid to sweat. Muscles need blood to carry them oxygen and nutrients and also remove waste products. And the heart needs blood to maintain cardiac output,” Casa explains. If you’re dehydrated and your blood volume is reduced, it can’t meet all of these demands—which means your natural cooling mechanism may not work as well as it should.

If you’re exercising in a cool environment, that’s not a big problem. But the more intense the exercise and the hotter the environment, the more your body needs to sweat, so the greater impact dehydration can have. “Ultimately, the body will prioritize cardio function and you’ll decrease intensity so you don’t need to sweat as much,” Casa says. If you fight through it without slowing down or rehydrating? You can end up overheating, and if the conditions are hot and intense enough, falling victim to heat-related illness like heat stroke.

Remember, if dehydration turns severe, it can lead to even more serious side effects.

While mild dehydration can lead to symptoms that usually just cause a little discomfort, severe dehydration is a medical emergency and can lead to heat stroke, kidney failure, and seizures if it’s not treated properly. Exercising intensely in a hot environment increases your risk, but luckily, drinking when you feel thirsty is sufficient for most people to avoid severe dehydration.

If you’re experiencing dehydration symptoms like fatigue, dizziness, and confusion, and drinking more water doesn’t help, see a doctor. You should also seek medical attention if you can’t keep down fluids or have bloody or black stool.

Certain populations are at higher risk for dehydration, like children, older adults, and those with chronic illnesses, so check with your doctor if you have any concerns about becoming dehydrated while you exercise.

And yes, it is possible to over hydrate—but it’s pretty rare for most everyday exercisers.

Hyponatremia is a medical condition that can happen when you over hydrate to the point that your blood becomes too diluted, causing a severe drop in sodium concentration. When it’s mild, you may not even realize you have it. But a severe case of hyponatremia can cause symptoms that look a lot like those of dehydration—nausea, confusion, and irritability—and be fatal if it’s not treated quickly.

For endurance athletes who are exercising for a few hours at a time (covering a marathon distance or more) and drinking a ton of water without replenishing their electrolytes too, hyponatremia is a real, life-threatening risk. A 2007 review published in the Clinical Journal of the American Society of Nephrology notes that studies have found the incidence in endurance athletes to be anywhere from 13 to 29 percent, with at least eight reported deaths in the U.S. from exercise-related hyponatremia.

In general, experts agree that it’s not something most non-endurance exercisers need to worry about. But it’s good to at least be aware of it—severe hyponatremia, like severe dehydration, is a medical emergency that requires immediate intervention.

The good news is that staying optimally hydrated doesn’t have to require any fancy calculations.

Elite athletes monitor their body weight and calculate their sweat rate to determine how much hydration they need. That’s pretty unnecessary for the rest of us—you really just need to listen to your body, Casa says. “During activity, your thirst is a fantastic cue. Thirst kicks in when you’re somewhere around 2 percent dehydrated. If you squelch it then, you can stay below 2 percent, which is a good place to be. If you meet your thirst, then you won’t over hydrate.”

The American College of Sports Medicine also recommends making sure you’re properly hydrated before you plan to exercise—so that you don’t start your workout dehydrated—and that you’re rehydrating after you’re done.

Regular water is usually sufficient for most of us. “People who are exercising for 60 to 90 minutes don’t have to worry too much about electrolytes. People are getting what they need eating an American diet, so a 1-hour bout of exercise isn’t going to result in a deficit.” The exceptions: If you’re exercising intensely in extremely hot and humid conditions, you sweat a lot or have particularly salty sweat, or you’re on a low-sodium diet, it wouldn’t hurt to add some electrolytes into the mix to be safe. For most people, however, remembering to drink water before exercising and carrying a water bottle so you can drink when you’re thirsty is all you need to do to stay hydrated, energized, and ready to power through a workout.

Source: SELF

98th American Meteorological Society Meeting

Korey Stringer Institute Medical and Science Advisory Board Member

Yuri Hosokawa PhD, ATC


As one of my last tasks as the Vice President of Education and Communication, I attended the 98th American Meteorological Society (AMS) Meeting in Austin to present at the joint session, Informing Heat-Health Practitioners to Reduce Risk through Impact-Based Decision Support. The first half of the session was comprised of case study presentations that showcased the use of weather data, such as the wet bulb globe temperature (WBGT), to conduct health risk assessment in public health, occupational health, and athletics. While there still remain limitations in deducing the association between WBGT and health outcomes, use of weather data to make informed decisions for future heat events to minimize its adverse effects on health, economy, and productivity are being investigated across the U.S.A continued effort in observational and intervention-based studies are warranted to identify successful models.

Presentations included in the latter half of the session, including my presentation from the KSI, were reports from current initiatives supported by the National Integrated Heat Health Information System (NIHHIS). The NIHHIS is being developed by the Centers for Disease Control and Prevention (CDC), the National Oceanic and Atmospheric Administration, and domestic and international partners to understand this problem, develop a robust and science-informed response, and build capacity and communication networks to improve resilience. My presentation at the session featured KSI’s on-going inter-agency collaboration in drafting a round table document among athletics, military, and occupational settings to use WBGT for activity modifications in the heat. Other NIHHIS projects featured in the session included a project lead by the National Oceanic and Atmospheric Administration in North Carolina that investigated the use of web-based forecasting tool (Heat Health Vulnerability Tool) by community stakeholders and the Hot Spots project, which aimed to increase the heat resilience in Mexico border region through education and evidence-driven public health interventions.


As depicted by presentations in the session, a successful environmental heat risk assessment requires an inter-agency and interdisciplinary network. Projects led by NIHHIS provide great examples for others to follow, and it is no doubt that exercise physiologist and athletic trainers play integral roles in examining the impact of heat.

EATA Meeting 2017

Kelsey Rynkiewicz, ATC, NREMT

Assistant Director of Education

The winter weather did not stop the 70th Annual Eastern Athletic Trainers’ Association (EATA) Meeting and Clinical Symposium from being held in Boston, MA on January 5th-January 8th.


The 4-day conference started off with an Educators Conference in which numerous professionals presented information on competency based learning, fostering clinical capabilities, incorporating research components, and integrating evidence based practice within Athletic Training Education. The Educator’s Conference also included a Profession Development & Peer to Peer Session.  Jessica Barrett and Dr. Stephanie Mazerolle, both members of the UConn Department of Kinesiology, facilitated the Young Educators Peer to Peer Session.


The EATA Student Program provided additional opportunities for student learning and involvement. The annual District 1 and District 2 Quiz Bowls were hosted Friday night. Patrick Coley, a senior in UConn’s undergraduate Athletic Training Program and the President of UConn’s Athletic Training Society, represented UConn during the District 1 Quiz Bowl. Presentations as part of the Student Program included topics such as Blood Flow Restriction Therapy, Current Topics of Concussion Evaluation and Management, and Prosthetics. There was a panel presentation known as “Stories from The Sidelines” in which panelists discussed their involvement in caring for victims of the Boston Marathon bombing and introduced the ATs Care peer support group.


The EATA General Session included a wide variety of presentations including injury response behaviors, eating disorders, athletic insurance, concussions, healthcare communication, and the rehabilitation and treatment of athletic-related injuries.  Attendees also had an opportunity to earn evidence based practice continuing education units which are part of the Athletic Training Board of Certification continuing education requirements.


Members of KSI had the opportunity to not only attend the conference, but also share recent research with the Athletic Training community.


Dr. Douglas Casa presented a lecture titled “The KSI State Rankings of Health and Safety Policies for High School Athletes: What it Means for the EATA Member States.” Dr. Casa discussed the rankings of the 51 State High School Athletics Associations which were released on August 8, 2017.  The states were ranked based on a 100-point rubric that assessed compliance with the current best practices for health and safety in high school athletics. Dr. Casa focused on the EATA member states and provided suggestions and strategies for improving health and safety standards.

Kelly Coleman presented original research in the form of a poster presentation titled “Junior Faculty Knowledge of Institutional Expectations for Tenure and Promotion.” Justin Rush also presented a poster titled “Spatting Increases Ankle Stability in Collegiate Field Sport Athletes: A Critically Appraised Topic” from his undergraduate work.


As always, the EATA provided a great weekend of education, sharing important research, and networking. Next year’s conference will be held in Valley Forge, PA.  We hope to share more research from KSI in the future to continue to educate others and promote the Athletic Training profession.


Understanding the Science of Sweat (Motiv Running)

December 19, 2017

Rectal thermometers.

Children dread them. And most adults probably do, too. They’re something one figures will be nicely tucked away, in the rear view, so to speak, never to be seen or, rather, felt once capable of holding an oral thermometer under the tongue. However, taking a subject’s core temperature during hard physical exertion has, until recently, always required the insertion of a rectal thermometer connected to a long wire. [See Exhibit A below.]

Fortunately, thanks to NASA and its Space Shuttle astronauts, including then-77-year-old Senator John Glenn, there is now a digestible transmitting thermometer that serves as an alternative. [See Exhibit B.] The size of a giant vitamin pill, or about three Tic Tacs, the transmitter is swallowed and, after a couple hours from ingestion, it reaches the intestinal tract and is able to send a wireless transmission, providing real-time core temperature readings. The transmitter then passes through the digestive system and is eliminated within a normal cycle of 18-30 hours. It’s one of the many advancements that have helped improve the study of human performance in athletics, including and especially endurance sports.

UConn’s New Facility

On September 22, 2017, the University of Connecticut’s Korey Stringer Institute (KSI) opened its $700,000 “Mission Heat Lab,” a state-of-the-art laboratory designed to facilitate research and education for maximal performance, optimal safety and the prevention of death from exertional heatstroke (EHS). The lab was made possible by donations from, among others, the NFL—Korey Stringer was an offensive tackle for the Minnesota Vikings who died in 2001 from EHS—Gatorade, Camelbak, and the namesake thermo-regulating active wear company, Mission.

I was fortunate enough to visit the lab and serve as an early test subject less than two weeks after it had opened. I was even more fortunate to have the option of using the digestible thermometer, thus foregoing the rectal alternative. Taking the subjects’ core temp readings is an absolute requirement of the lab. If the core rises above 103 degrees F, the test ends.

A glimpse inside the University of Connecticut’s Korey Stringer Institute Mission Heat Laboratory.

Other test participants were cyclists, including two-time Olympic mountain biker Lea Davison, and runners, such as Gediminas Grinius, winner of this year’s Ultra Trail World Tour. As a runner, I was put on a treadmill and told to go at an exertion level I could maintain for 90 minutes. The room measured 94 degrees F and the humidity was set at 60 percent. The highly-trained lab technicians, PhDs and doctoral students, guided by KSI’s CEO and UConn’s director of athletic training, Dr. Doug Casa, a passionate trail runner, performed the gold standard “body washdown” test on us. Very few labs are equipped to do this test, designed to measure your sweat content, down to the drop.

Before and after the exertion we were carefully weighed and then, while we ran or rode, we mopped up all the sweat and the technicians kept the wet towels. After we finished we were washed down inside of a giant trash bag, with a set amount of purified water so that the lab techs could later remove that control from the sample. Any water we consumed during the test was also factored into the results. Before the test, we had to follow a careful protocol of washing, including our exercise clothes, using only water, as detergent, lotion or deodorant would alter the results. Similarly, we were instructed not to drink alcohol or coffee for 24 hours before the testing.


Once we were washed down with the pre-measured purified water (see above), the technicians placed the sweaty towels and our drenched exercise clothing into the “sweat soup” to be measured for various electrolyte levels. My sweat loss was 3.8 percent of my body mass and my sodium loss was 980.0mg, which was in the normal range (0.18 to 1.5) for exercise in heat.

After exercising, all test participants were washed down with the pre-measured purified water.

Based on our before and after weight and the amount of water consumed during the exertion, KSI determined our sweat rate, measured as liters per hour. Normal sweat rates are 1.5-2.5 L/hr for men, 1.3-2 L/hr for women. I lost almost exactly 5 pounds during my test and had a high sweat rate of 2.31 L/hr. My core rose to the high of 103.1F, running a max speed of 9mph and I consumed a measly 35g of water.  My heart rate went from 90 to 160 and, according to my follow-up anaerobic threshold test, spent the last 15 minutes above that heart rate level.

Alberto Salazar was tested at UConn’s predecessor lab, run by Dr. Lawrence Armstrong, a leading expert on hydration and who now serves on KSI’s Medical and Science Advisory Board, and he had the outlier sweat rate of 3.7 L/hr. Salazar would lose as much as 8 percent of his body weight during his races and he put great emphasis on training for heat tolerance before the 1984 Olympic Marathon in Los Angeles. Humans are only able to take in 1.3-1.4 L/hr so, while a high sweat rate helps to cool the body during exertion, it isn’t all good because the loss of hydration can be a real detriment if you lose too much. According to my measured sodium loss, I’d need to have consumed 4.5 salt capsules or drank enough Nuun hydration mix for 2.5 tabs.

Exhibit A (left): an old-school rectal thermometer used to record internal body temperatures; Exhibit B (right): a modern pill-sized digestible transmitting thermometer.

Clear and Copious

Dr. Armstrong invented the urine color chart and, with that simple educational measure, has probably done more for more individuals than any other campaign to address dehydration. The chart has been helpful to many and was even converted to resemble beer types at one of the Western States 100 aid stations, where they used it to illustrate the command of avoiding stouts and sticking to lagers. Clear and copious urine is usually a sign of adequate hydration.

We learned from Dr. Armstrong that, without excess, caffeine doesn’t have an impact on hydration. But he and Dr. Casa were quick to point out that one needn’t be dehydrated to suffer heat stroke and that if you wait until you are thirsty, you are already late because thirst isn’t triggered until you dehydrated by 1-2 percent. In contrast, however, there are schools of thought, namely, Dr. Tim Noakes of South Africa, who professes that runners are over-hydrating and need to listen to their bodies and let thirst be their guide. Dr. Casa agreed with Noakes that, for purposes of avoiding hyponatremia, a sodium imbalance suffered by recreational runners who drink excessive water, thirst is a safe guide.

The key determining factors of one’s sweat rate are intensity of exertion, body size and environmental factors, such as heat and humidity. The body is an incredible system for trying to thermoregulate and what you drink can show up in your sweat as soon as 10 minutes after you consume it.

The takeaway from KSI’s Mission Heat Lab was that there are considerable performance benefits to be gained from knowing your sweat rate, sweat content, how, when and with what to rehydrate. As an easy rule, if you use your morning weight, thirst and urine color as basic guiding indicators, you can stay on top of your hydration needs.

Dr. Casa, with the help of many of his assistants and PhD students, is publishing a book in early 2018, “Sport and Physical Activity in the Heat,” as a full resource for serious athletes, coaches, trainers, sports medicine practitioners, kinesiologists, concerned about performance in hot conditions.

“Since we do not currently have an accurate wearable technology that can provide real-time assessment of hydration status, it is essential for high-level athletes to have an understanding of factors that influence sweat rate (amount of fluid/electrolytes lost in a given amount of time in a given environmental conditions at a given intensity),” Casa said. “This knowledge can allow an athlete to train hydration replacement and develop an appropriate race-day strategy.

“We will eventually have an accurate real-time wearable for hydration status that athletes can perpetually monitor so tweaks can be made—although lab data would still establish the general plan. But until that time, the lab work helps establish a plan and race-day thirst, environmental changes, intensity, pre-event hydration, and etc. need to be considered to make hydration decisions.”

Source: Motiv Running