Standing Tall:Swoboda Overcomes Life-Threatening Ordeal-VirginiaSports

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

Collapse and Confusion: The Death of a Juco Football Player (SI)

Nearly a year after Braeden Bradforth’s death following his first day of junior college practice, his family is still dealing with the loss of its “gentle giant.” Meanwhile, his mother has fought for answers about the day she lost a son, not knowing how hard that fight would be.

NEPTUNE, N.J — Braeden Bradforth called home on his first day at junior college in high spirits, gushing about meeting a fellow student who looked just like him, down to the dreadlocks. After his last-minute acceptance to play football at Garden City Community College (GCCC), Bradforth had begun the process of getting accustomed to life in western Kansas, making friends by playing video games in his dorm. The 6’4″, 300-pound defensive lineman was happy to hear that the care package his mother Joanne Atkins-Ingram was putting together back in New Jersey included Golden Oreos, gum and Oodles of Noodles.

On Aug. 1, as his third day on campus settled into a humid, 84° evening, Bradforth went to a conditioning test on GCCC’s first day of preseason practice. Players were expected to complete 36 sprints of 50 yards at speeds that varied by position group. To two coaches and one trainer looking on, nothing seemed off about how Bradforth completed the drill, but as players moved from the field to a team meeting, the freshman wandered off, hardly acknowledging a coach who called out to him. Less than an hour after practice ended, he was found lying barely conscious with his head against a brick wall in an alley near the dorms. A coach said Bradforth was moaning when he arrived at the scene, and he began to choke and vomit as he was moved to an ambulance. About two hours after practice had ended, Bradforth was pronounced dead at St. Catherine Hospital.

What happened from the start of that workout until the end of Bradforth’s life? His grieving mother thought it was a reasonable question, but it proved to be extremely difficult to answer as the days turned into months and a school halfway across the country that appeared to be a lifeline for his college football career instead became a source of conflicting stories and an obstacle to his family’s search for answers.

Head coach Jeff Sims initially told the media that Bradforth had likely died from a blood clotting disorder, but months later, an autopsy found the cause of death to be exertional heat stroke. As Atkins-Ingram dug deeper, players told her they had had no water breaks during that conditioning test, that Bradforth was struggling and that Sims taunted Bradforth during the workout that pushed him to heat stroke.

In December, a notice of claim was filed on her behalf that named coaches, the school, two juco football governing bodies and several other parties as possible defendants in a wrongful death lawsuit. The school conducted an internal review of the circumstances that led to Bradforth’s death but elected not to release its findings in full. Only on April 18, eight and a half months after Bradforth’s death, did the family receive a summary of the review—which Atkins-Ingram called “full of crap”—that provided a basic timeline of what happened but was silent on crucial controversial details. GCCC’s lawyer notified the family that no “formal report” laying out the entirety of the review’s findings was forthcoming.

In May, GCCC retained outside counsel for the purpose of conducting an independent, external investigation, with the help of Dr. Rod Walters, whose firm was hired last summer by the University of Maryland to conduct a similar safety review into the case of Jordan McNair after the second-year offensive lineman died in the hospital days after collapsing at a May 2018 workout. Walters’s team found that the Maryland training staff did not follow protocol in treating McNair’s symptoms, revelations that led to the resignation (under pressure from the school) of head strength and conditioning coach Rick Court, and the firing of Terps head coach D.J. Durkin.

Atkins-Ingram doesn’t understand why McNair’s death generated so much attention while her son’s did not. With the one-year anniversary of McNair’s death on June 13 and Braeden’s approaching fast, another summer season is upon thousands of football players, coaches, athletic programs and parents across the country. Atkins-Ingram wants to make sure no other parent has to endure the tremendous loss she suffered, or replicate the campaign she launched to get answers from a school that gave her few until nearly 10 months after her son’s death.

“What’s so disgusting is the fact that every bit of information that we have gotten, we’ve had to fight for it,” Atkins-Ingram says. “It just didn’t come naturally. Like, if there wasn’t a problem, it should just be able to roll off your tongue.”

According to the school’s internal review, present along with Sims at the practice were nine other football coaches, head athletic trainer TJ Horton, eight student helpers and three certified trainers. Horton reported in the summary that there were 60 gallons of water on site, and student helpers had water bottles in their carriers. Yet those resources seem to belie the conditions under which Bradforth and his teammates completed their workout.

Five players told SI there was barely a break between each sprint, even though the summary says they were allowed 30 seconds of rest. Six players said that players were not allowed to drink water until the end of the workout and that anyone who stopped running would need to redo the entire workout the next morning. A Garden City spokesperson said water was “readily available” for players during practice, and former defensive line coach Ben Bradley said water was available during the sprints, but since he was busy helping run the drill, he couldn’t confirm whether players were drinking. The coroner’s report, citing GCCC coaches and trainers, states that Bradforth “participated without issue in football practice and was behaving normally.”

After practice ended at approximately 9:05 p.m., safeties coach Caleb Young noticed Bradforth stumbling before regaining his balance as he was trying to speed up within the final group of players walking off the field. In an email sent to school administrators on Aug. 31, 2018 and obtained by the Associated Press through an open records request, Young said he told Bradforth, “Hey, you’re good. Let’s go,” to which Bradforth responded, “Yeah, I’m good. I’m good.” But instead of following the group to a team meeting, Bradforth broke away from the group, leading Young to ask him if he was quitting the team. “He did not respond with words, instead, he shook his head in what looked like to me disappointment and continued to walk away,” Young wrote.

Bradforth was found at around 9:45 p.m., after the team meeting broke up. The EMS report states one coach turned a hose on Bradforth to “see if they could get him to respond and he would not so that is when they contacted EMS.” According to the same report, when emergency personnel arrived, several coaches were around Bradforth, and he was wet and moaning. Young wrote to administrators that he ran to the area where Bradforth was when he was alerted a player was down, and that Bradforth was in “visible distress at this time however still breathing and making a stressful moan.” Instead of immediately calling 911, Young wrote that he called Sims in search of guidance, and the head coach directed him to call the trainer. Young adds that while he was on the phone, “a few of the players were assisting with filling their water jugs and bottles with water from the drinking fountains as we attempted to pour it over him and to get him to drink it.”

Horton had left campus and needed to be called back by the coaches. Horton returned to campus at 9:53 p.m. and was the one to call 911 at 10 p.m. (However, Young wrote in his letter to school officials that he was the one who called 911.) An ambulance reached Bradforth within 10 minutes and arrived back at the hospital at 10:33 p.m. after coaches helped move Bradforth to the ambulance from the alley. Young wrote that as EMTs put him on a stretcher to get to the ambulance, he noticed Bradforth “begin to choke; he then opened his eyes and threw up what looked like dirty motor oil.” Bradforth was pronounced dead at 11:06 p.m. GCCC did not answer follow-up questions about why it took 15 minutes for those who had found Bradforth to call 911, or why 911 was not immediately called if the lead trainer was away from campus.

Sims, who is now the head coach at Missouri Southern State University, told Sports Illustrated two days later that an emergency room doctor had told him a test was indicative of a blood clot that had broken free and caused a heart attack. Sims told SI it was “something that could have happened anytime or anywhere.”

Back on the East Coast, around 1 a.m., Atkins-Ingram got an incoherent, tearful phone call from her other son, Bryce Bradforth. She couldn’t understand what he was saying, so she called her husband Robert Ingram Jr., Braeden’s stepfather. Taking time to find the right words, Ingram Jr. called Atkins-Ingram back and told her that Braeden was gone. All she could do was let out a scream. After that, everything went black.

ince that day, Atkins-Ingram has fought to learn why the place that was entrusted with caring for her son failed to do so. Excluding a conversation with school president Ryan Ruda, campus police chief Rodney Dozier and interim athletic director Colin Lamb before the completion of her son’s autopsy, Atkins-Ingram says not one coach has reached out to her. After a few weeks, Atkins-Ingram recruited her longtime friend Jill Greene, a lawyer, to help her find out more about Bradforth’s death.

When Atkins-Ingram heard the results of the autopsy, she became frustrated with Sims’s private and public handling of Bradforth’s death as something that could have happened at any time. “That act-of-God business, God has him now,” she says. “But you kind of helped push him there.”

After months of getting nowhere with the school, Atkins-Ingram and Greene took a trip to Garden City in January. There, they spoke with players, trying to learn more about the practice and Bradforth’s final moments. What they discovered disturbed Atkins-Ingram.

In the internal summary, Sims and Horton said Bradforth didn’t complain or drop a knee to the ground during the test, and Bradley told SI he “dominated,” but six players told SI that Bradforth struggled while completing his sprints. Donte Morris, a former Garden City player serving as an unpaid assistant while he finished his classes, told SI that Bradforth seemed short of breath and was wheezing. Defensive lineman Olajuwon Lewis, who said he ran with Bradforth, recalled his white lips and dry mouth: “It was something you’re never going to forget.” Still, Bradforth kept running.

“You couldn’t drink water during running ’cause Sims said and a lot of other coaches said that water during workouts does nothing for you,” defensive back Kirby Grigsby told SI. “It’s how you hydrate before and after. That’s basically their motto about that kind of thing.” When asked about this interpretation of team policy, Bradley said coaches wouldn’t tell kids not to drink water. Morris told SI that although Sims preached the importance of hydration to his players, due to the pace of this particular conditioning drill players didn’t receive water unless they dropped out entirely. When reached for comment, Sims told SI he wasn’t allowed to speak on the matter and instead referred questions to lawyers.

Players also said Sims taunted Bradforth during the practice. According to Bradley, Sims had given Bradforth a loaner pair of shoes to use, and wide receiver CJ Anthony heard Sims yell that he wanted his shoes back, which Anthony took as a motivational tactic to make Bradforth run faster. Three players recalled Sims telling them he spoke with Braeden’s biological father Sean Bradforth, who does not live with Atkins-Ingram and was in and out of Braeden’s teenage life. One player remembers Sims mentioning that Sean Bradforth had told Sims that Braeden was a hard worker in practice. (Sean Bradforth confirmed to SI that he had recently called Sims.) One player said Sims “was up in Bradforth’s face” while running and that he was a “hard-nosed coach,” but that’s how he was with all of his players. Other players corroborated this, saying Sims cussed Bradforth out and screamed at him. Bradley denies this, saying Sims is a “good coach,” though he conceded Sims’s “competitiveness makes him out to be crazy because he’s willing to do whatever.” The school’s summary made no note of any comments made by Sims during practice.

What Bradforth did after walking away from his teammates after practice remains a mystery to his family. The summary of Garden City’s internal report and Young’s letter to his superiors offered no answers on those missing minutes.

Young, who did not return calls made to him for this story, appears to have been the first coach at the scene, according to the internal report summary and his letter to administrators. The few players present had trouble remembering who else was there because it was only the first day of conditioning. Among those present, there appears to have been confusion about how best to immediately help Bradforth. Bradley said he got there after someone had already poured water on Bradforth, and he wasn’t sure what was going on: “I didn’t know he was overheated. I thought he was passed out.” Morris said a trainer poured water on Bradforth. Grigsby said he was asked if he had any water when he arrived, then poured some on Bradforth because he thought he might have been dehydrated. Grigsby says he left after Young assured him that Bradforth would be O.K.

Soon the ambulance came, and Bradley rode with Bradforth to the hospital. In their timelines, school and medical records don’t make any note of Bradforth’s rectal temperature having been taken, a measure the National Athletic Trainers’ Association lists prominently in its instructions for assessing exertional heat stroke.

In New Jersey, on the second floor of Atkins-Ingram’s home, past a hole in the wall that Braeden tripped and crashed into as a teenager, sits a clean bedroom that would be messy if he were still alive. Only Atkins-Ingram and her husband go in now. Duke, the family dog who used to sleep on Braeden’s bed, will only go as far as the door’s threshold. The bedroom has become a shrine of sorts, featuring all of his life’s most important moments. On the bed is a blanket covered in photos, including a close-up of Braeden that Atkins-Ingram strokes daily, as if she were still touching her son’s face. There are stuffed animals, jerseys, letters and an old luggage tag carefully arranged. There are also the towels, sized to fit Bradforth’s hulking frame, that were sent with him as he left for GCCC. Under the TV where Bradforth used to play Xbox sits an inconspicuous white box containing his remains. Atkins-Ingram and her husband take turns opening a blue mason jar to reveal some of Bradforth’s dreadlocks, which they say still smell like him.

Since Bradforth’s death, Atkins-Ingram has seen her life altered in so many ways. On a table in their living room sit the books God Help Me I’m Grieving and Grief is a Journey. The family hasn’t been able to watch a football game, and she’s worried about Bryce, who has avoided talking about his brother’s death. Atkins-Ingram wakes up thinking it was all a dream—then she realizes Braeden is gone, and the nightmare begins again.

“I carry such guilt with me every day just knowing that I ultimately signed off on my son to go to school to follow his dream,” Atkins-Ingram said in February. “My mind knows yes, I did the right thing, but my heart, every single day I just can’t get over the fact that he’s really not here, and it was because he was deprived of the simplest thing: water.”

When the family finally received the autopsy, Greene shared it with Dr. Randy Eichner, a heat stroke expert who has been consulting with the family. After examining documents and seeing news reports on the practice, Eichner called the drill “reckless” and noted that Bradforth had just arrived in Garden City and had experienced a jump in altitude of 2,800 feet from the East Coast to western Kansas, into slightly less oxygen-rich air than he was accustomed to.

“It looks to me very bad judgment on the part of coach Jeff Sims because it’s a clear-cut heat stroke death,” Eichner says. “It’s a tragedy, but it’s a preventable tragedy. Fatal heat stroke should never occur in college football.”

Dr. Douglas J. Casa, who is the CEO of the Korey Stringer Institute at the University of Connecticut, echoed Eichner’s statement. According to Casa, patients whose temperature gets under 104° through cold water immersion within 30 minutes have survived in all known previous cases. From 2000 to ’09, there were 30 heat stroke deaths in high school and college sports. Casa estimates there have been around 35 deaths in the decade since, with one more summer season to go. While those numbers include athletes from all sports, football and cross-country account for about 90% of the fatalities.

Based on the school’s handling of the situation since the notice of claim was filed in early December, Greene said GCCC is giving them no choice with their next move. “It feels as though they want litigation,” Greene said. “To me, that really makes no sense.” She has partnered up with Kansas City lawyer Chris Dove, and Dove said they haven’t made a decision yet in terms of litigation following GCCC’s decision to launch an external review.

Atkins-Ingram said she spoke with someone at the Garden City Police Department in the fall who said that the department wouldn’t be conducting an investigation. Grisell, whose law firm also represents the city of Garden City and thus the GCPD, told SI he didn’t know “that there was any indication that there was any criminal conduct involved in the matter.” He also referred SI to the notice of claim that was filed against the city and the police department. The GCPD released a statement saying it does not comment on cases pending civil litigation.

But Atkins-Ingram has made headway through her representatives. On March 22, U.S. Congressman Chris Smith sent a letter to Ruda requesting an independent investigation after he met with Atkins-Ingram. Grisell wrote back on March 27 that the “college is satisfied with the review that was undertaken.” Ruda told Smith he would meet with Atkins-Ingram, but Grisell indicated details of the internal review would not be discussed at the meeting, and the meeting was subsequently postponed. All 12 members of the U.S. House of Representatives from New Jersey called for an independent investigation on April 30.

Finally, the school released its internal review summary—to the family on April 18 and then to the media on May 2. Atkins-Ingram said she was excited to read the school’s report, but she soon realized its limits. “Whoever wrote this, they just threw it together and they tried to piece together a summary of what I think they have read in all the different articles ’cause that’s what it looks like to me,” she says. When Greene followed up asking for more information on the internal review, Grisell wrote back that he had directed all work be done for him “in advance of, and preparation for litigation.” Grisell described how Lamb, the school’s interim AD who had not yet been elevated to the role on the day of Bradforth’s death and was replaced by a full-time AD in late May, was “primarily responsible for compiling information” regarding the events and that witness interviews and statements, medical records and athletic practices were collected and reviewed. Lamb prepared a basic outline and presented it to Grisell, which the lawyer then prepared into the summary. Grisell called the summary an “accurate representation of what occurred and what the college knows regarding the matter involving Braeden.”

In addition to describing the events of the day of Bradforth’s death, the summary also touts several improvements the school has made since the review’s completion. GCCC has hired an additional athletic trainer and strength and conditioning coach, and CPR and first aid training will now be required for all coaches. The school will also follow up with players for welfare checks and will develop a policy specifically for recognizing and treating heat-related illnesses to build off of standing protocol for “having the necessary water, equipment and training staff at each practice.” The school also plans to increase campus police personnel and develop an athletic training handbook, but there is no timetable for those changes yet.

“They immediately listed all these changes that they put in place, but at the same time you said you did nothing wrong, but therefore you also needed all these changes,” Atkins-Ingram says. “Why is that?”

Dr. Kathleen Bachynski, a postdoctoral fellow in the Department of Medicine at NYU Langone Health, read about the release of Garden City’s findings and questioned the logic of adding another trainer and coach when the summary stated there were already 10 coaches and four certified trainers on site. “To me, the fundamental question doesn’t seem to be the quantity of personnel that were there but the actual level of oversight and safety that they provided and whether safety was actually prioritized,” she says.

The move that Atkins-Ingram and Greene had been waiting for finally came on May 14, when the school authorized an external review of Bradforth’s death. Atkins-Ingram said she was “overwhelmed” by the news. GCCC said in a statement that while the “internal review served its intended purpose” at the beginning of the process, the authorization of an external review is the “most logical sequential step in the process.” The statement also said, “The GCCC Board and Administration are aware of the misconception that the college is unwilling to give answers to the family or has interfered with information about the events that transpired on the day of Braeden’s death. An external investigation may be able to provide the answers that are still sought by Braeden’s family and others, and it may also serve to confirm the findings of the GCCC internal review.”

Congressman Smith said in a statement that he hopes the announcement “will prove to be a very important step towards true transparency,” and said they are “cautiously optimistic” the decision will “finally reveal what happened during Bradforth’s last day and what can be done to prevent others from suffering the same fate.”

As Atkins-Ingram has fought to learn what happened to Bradforth, she has passed along updates to the family’s advocates and supporters. In April, her “village” gathered for a community meeting about Bradforth at a church in Asbury Park.

Atkins-Ingram called herself an “accidental activist” as she nervously prepared for people to arrive. She greeted supporters with hugs while family members placed T-shirts featuring her son’s face in some pews. A slideshow with photos looped, while someone made sure it wasn’t sacrilegious to hang a #Justice4Braeden banner on the pulpit. As the night went on, Congressman Smith and other guests delivered case updates and spoke on heat stroke as more people filed in. Atkins-Ingram watched with her husband’s arm around her.

As sunlight faded through the stained glass windows, Atkins-Ingram rose to speak last. Thanking everyone for their support, she started to choke up as she talked about Braeden, lifting her glasses in an effort to fight the tears. From across the room, Ingram Jr. whispered, “You all right.” Atkins-Ingram carried on, every so often pausing to compose herself with only the sounds of ceiling fans and the occasional restless child breaking the silence.

It’s clear that moment in April won’t be the last time Atkins-Ingram speaks out, and she’s determined to make others aware of heat stroke with plans to start a foundation once she retires in June. The release of the internal summary in early May came at a difficult time for her: This year, Bradforth’s birthday and Mother’s Day fell two days apart. She went to Miami that weekend to avoid any painful reminders at home, but on the flight back, she sat behind a man with a similar build to her son, who even had the same dreads as him. She says she spent the entire flight leaning up toward him, smelling his hair like she still does from time to time with Braeden’s. She remembered the first flight they took together, not long before Braeden left for Garden City, and she spent the rest of her trip home playing a tortuous game of what-if: Would Braeden have had kids? Would he have played in the NFL? What would his life have been?

“It’s a good day,” Atkins-Ingram said in mid-May, as the wheels were put in motion for an external review—but even good days will never be the same.

“Even now, I’m about to cry,” she said. “I’m feeling so good, but it’s just still so sad cause at the end of the day none of this is going to bring Braeden back.”

 

By: Charlotte Carroll

Sports Illustrated

Soccer and Extreme Heat: US-France World Cup Match (GMA)

Soccer and Extreme Heat: a Potentially Dangerous Mix for US-France World Cup Match

Good Morning America, ABC News

The U.S. Women’s National Team faces France on Friday night in Paris in probably the most-anticipated match so far in the FIFA Women’s World Cup.

The energy on the pitch and in the stands is expected to be electric despite a scorching heatwave in Europe this week. Temperatures are expected to top 100 degrees Fahrenheit during the day and may still be hovering around 90 when the match kicks off at 9 p.m. local time.

The dangers of heat-related illnesses, like heat cramps, heat exhaustion and heatstroke, are real and potentially life threatening, but they are preventable.

“We’ve put a lot of time and effort into sourcing the world’s experts, the leaders in all kinds of conditions of performance,” James Bunce, director of High Performance for USA Soccer, said in an interview with ABC News. “Specifically, in this environment, we’re obviously making sure that we can cool them quick enough.”

Providing cool drinks that replace electrolytes and salts sweated out during playing is important, Bunce added. So it giving cooling towels to players and having them take cold baths after matches.

The Centers for Disease Control and Prevention considers athletes a vulnerable group when playing in hot weather, and heatstroke, the most severe form of heat illness, is a leading cause of death on the field among young athletes.

Heatstroke happens when the body overheats to over 104 degrees Fahrenheit. Early symptoms include dizziness, fatigue and dry mouth. Those can progress into confusion, a racing heart rate and vomiting. If untreated, heatstroke can damage vital organs including the kidneys and heart.

Dr. Clifford Stark, medical director of Sports Medicine at Chelsea in New York City, and not affiliated with USA Soccer, told ABC News that “drinking water constantly is key. Once you’re behind on hydration, it’s hard to catch up. The body can only absorb about a one liter of water per hour.”

“We prompt our players to drink regularly and often,” Bunce said. “If you feel thirsty, it’s too late. Dehydration has snuck in.”

For elite athletes like those on the USWNT, their fluid intakes are monitored and customized, and “each player is getting a different drink filled with different fluids, different electrolytes,” Bunce added.

Heatstroke is a medical emergency.

Treatments focus on cooling the body to prevent further damage. Experts at the University of Connecticut’s Korey Stringer Institute — named in honor of an NFL player who died from heatstroke during training camp — emphasize the importance of initiating cooling in affected athletes while they’re still on the field awaiting emergency personnel.

“When you have a heatstroke it’s very important to cool the core by using ice packs under the armpits and in the groin,” Stark said.

The CDC also recommends sponging with cool water and spraying with a garden hose but warns against giving the ill person fluids because of possible electrolyte imbalances.

Even coaches and fans can be at risk for heat-induced illnesses, depending on conditions.

“The players will be fine, the weather in the evening will be nicer,” Bunce added. “It’s the fans I’m concerned about — the ones who are out in the sun all day, drinking all day, in the heat of the day.”

Steering clear of alcohol and caffeinated substances is important to maintain hydration, as is staying covered up and reapplying sunscreen to prevent sunburn, which can also cause dehydration.

Detecting signs and symptoms of heat-related illnesses early can save lives, Stark said.

“If you catch it in time,” Stark added, “there’s a high probability that you’re going to survive.”

As the USWNT heads into the quarterfinals, Bunce feels confident in the team’s plan for coping with the heatwave.

“We have 23 world class pros who have completely dedicated their lives to doing what’s right to perform at the highest level,” he said. “We have plans in place.”

 

https://www.goodmorningamerica.com/news/story/soccer-extreme-heat-potentially-dangerous-mix-64007843

Vanessa Cutler, MD is a resident physician in Psychiatry at Rush University Medical Center working with the ABC News Medical Unit.

ABC News’ Henderson Hewes contributed to this report.

After 2 boot camp deaths at Great Lakes base, Navy urges vigilance for recruits with sickle cell trait (Chicago Tribune)

Following two recent deaths during physical fitness testing, officials at the Navy’s Great Lakes training base are withholding people with “specific medical traits” from intense exercise pending further review.

A Great Lakes spokesman, citing privacy concerns, wouldn’t name those traits, but an administrative memo issued by the Navy suggests the focus is on sickle cell trait, a genetic blood condition that can pose a lethal danger during vigorous workouts.

The memo, released earlier this month, singles out the trait as a risk factor requiring extra vigilance. It instructs people leading fitness exercises to familiarize themselves with the condition and ask recruits about it before training. It also urges African-American personnel, who are disproportionately affected by it, to “engage with medical (staff) to determine their status and understand the risk.”

It’s not clear whether any particular medical condition was a factor in the deaths of the recruits at the north suburban base. Both collapsed at the end of a 1.5-mile timed run during their final physical readiness test of boot camp, and died while receiving treatment.

Kierra Evans, 20, from Monroe, La., died Feb. 22. Kelsey Nobles, 18, from Mobile, Ala., died April 23. Lake County Coroner Dr. Howard Cooper said the investigations into their deaths have not been completed. Neither of their families could be reached for comment.

The Navy memo said two sailors who were not at Great Lakes also died during physical training over the last year.

Sickle cell disease causes blood cells to harden, grow sticky and morph into a “C” shape. The cells can clog blood vessels, robbing tissues of oxygen and causing severe pain and the risk of sudden death.

Sickle cell trait, by contrast, is a genetic characteristic. Most who have it don’t experience the symptoms of the disease, though they can surface during hard workouts.

The Navy memo said two sailors who were not at Great Lakes also died during physical training over the last year.

Sickle cell disease causes blood cells to harden, grow sticky and morph into a “C” shape. The cells can clog blood vessels, robbing tissues of oxygen and causing severe pain and the risk of sudden death.

Sickle cell trait, by contrast, is a genetic characteristic. Most who have it don’t experience the symptoms of the disease, though they can surface during hard workouts.

The trait’s prevalence in African-Americans is well known — roughly 1 in 12 have it — but Dr. Victor Gordeuk, director of the sickle cell center at the University of Illinois Hospital in Chicago, said people with roots in Italy, Greece, Saudi Arabia, and other areas around the Mediterranean can have it, too (the trait helps people withstand malaria, he said).

He said people with the trait can have their cells deform dangerously during periods of intense exercise. Why that happens isn’t fully understood, he said. It often comes in tandem with heat illness, but not always.

“Some of the patients just have sudden collapse, loss of consciousness, loss of strength in their extremities,” he said. “Sometimes they can have painful cramps. We don’t fully understand the mechanism whereby that’s occurring.

“In some cases, on postmortem, the brain looks normal, the blood vessels look normal, but they’ve had this coma develop while they’re exercising. To a certain extent it’s a medical mystery, but we do know that people with sickle cell trait are at increased risk for this happening.”

The military has long recognized those risks. Researchers as far back as the 1960s have documented sickle cell-related deaths that occurred during the rigorous workouts of basic training. One study in the 1980s found that black Army recruits who had the trait were about 40 times more likely to suffer sudden death than recruits who were not black.

The services take varying precautions for recruits with the trait, according to military health researchers. The Navy screens everyone entering boot camp, and requires those with the trait to wear a red belt during strenuous exercise. Other branches use different identifiers or don’t screen for sickle cell at all, focusing instead on mitigating heat-related risks.

The Navy memo highlights a condition known as “exertional collapse associated with sickle cell trait,” or ECAST, that can strike some recruits.

“An ECAST victim may have been a front runner, or off to a strong start, but will be noted somewhere before the collapse as slowing down, falling behind and struggling,” it says. “They begin to lose smooth coordination, they evolve into an awkward running posture and gait, with legs that may look wooden or wobbly.

“The victim may complain of progressive weakness, pain, cramping or shortness of breath. … The ECAST victim will initially be mentally clear, before the onset of confusion and loss of consciousness.”

The memo says Navy officers should adopt a liberal “bad day” policy that allows people struggling with the physical readiness test to stop and try again after a medical evaluation.

“No one should risk their life by pushing through life-threatening conditions during a (physical test),” it says.

Great Lakes spokesman Lt. Cmdr. Frederick Martin said boot camp already follows the guidelines laid out in the memo, but that changes could come as a result of the investigation into the recruits’ deaths.

Douglas Casa of the Korey Stringer Institute at the University of Connecticut, which aims to prevent sudden death in athletes, helped craft a statement about treating sickle cell emergencies for the National Athletic Trainers’ Association. He said people with the trait can endanger themselves during high stakes physical tests, such as the 1.5-mile run Navy recruits must conquer in a set time to graduate from boot camp (women in their late teens, for example, have to finish in less than 14:45).

“If someone’s really struggling, no one should be pushing or screaming at them to continue,” he said. “They should stop and be protected. We really have to ask if (the 1.5-mile run) is the best way to evaluate the fitness of someone with sickle cell trait.”

By: John Keilman

jkeilman@chicagotribune.com

Twitter @JohnKeilman

Source: https://www.chicagotribune.com/news/ct-met-great-lakes-death-exercise-20190521-story.html

Study Examines Sudden Deaths in Youth Athletes (Athletic Business)

New research by the Korey Stringer Institute (KSI) and the University of Connecticut revealed the most common cause of sudden death in American youth sports for athletes aged 6-17 years.

According to a press release by the National Athletic Trainers’ Association, which published the first-of-its-kind study in its Journal of Athletic Training, the majority of sudden deaths among youth athletes were cardiac-related and took place during practices within organized middle school sports.

The research looked at data from 2007-2015, where there were 45 cases of sudden deaths reported in American youth sports. It found that sudden cardiac death accounted for 76 percent of those deaths. The researchers found that basketball was the most deadly sport, accounting for 36 percent of sudden deaths. Baseball and football each accounted for 16 percent of sudden deaths, and soccer accounted for 13 percent.

Fully 73 percent of sudden deaths occurred in kids between the ages of 12 and 14, and about 80 percent of the sudden deaths were boys.

“Until this study, sudden deaths occurring in youth sport had been grouped with sudden deaths occurring in older athletic populations in previous epidemiological studies,” Brad Endres, the study’s lead author and the assistant director of sport safety at KSI said. “Our goal was to clearly define the understanding of ‘youth sport’ so that more appropriate and evidence-based policy decisions aimed at improving youth sport safety can be implemented.”

In the release announcing the research, NATA and the National Basketball Athletic Trainers’ Association recommended five tips for keeping their student-athletes safe while playing basketball:

  1. Get a checkup before play. The groups advised parents of athletes to get a pre-participation evaluation from a medical professional, even when it’s not required.

  2. Ask about the coach. The groups recommended ensuring that a coach creates an environment where players feel comfortable to report injuries and get medical attention if necessary.

  3. Ask about emergency plans. The groups suggested asking about venue-specific emergency action plans.

  4. Get a CPR/AED-certified person at every practice and game. The groups suggested knowing where the nearest AED is, and asking if someone certified in administering it in an emergency would be present at every event (practices and games). If not, the groups recommended advocating for that equipment and those roles.

  5. Ask if there is an athletic trainer. Having athletic trainers on hand at every event can be an additional boon to emergency and cardiac care.

Source: Athletic Business

NCAA’s role in protecting student-athletes could be clouded by legal liability, among other factors (Sporting News)

By Dan Bernstein

The NCAA could end up becoming more liable to lawsuits if proposed measures aimed at protecting student-athletes pass, just one of the barriers to the organization taking a more active role in player health and safety issues.

As the NCAA introduces regulatory policies like guidelines to prevent non-traumatic deaths and improved accreditation standards for strength and conditioning coaches, it might expand its legal duty to provide care, thus making it more vulnerable to civil negligence claims, according to attorney Bob Wallace, who represents athletes and sports teams for national law firm Thompson Coburn. Two Oregon football players hospitalized in a January 2017 workout have filed such cases against the NCAA and the University of Oregon.

“When organizations or companies or industries are regulating conduct,” Wallace said, “there’s always a balancing act of how far can you go, should you go before you shift a bunch of the responsibility onto your organization.”

NCAA spokesman Christopher Radford, however, told Sporting News in a statement that “NCAA health and safety efforts are not calculated by whether there is increased legal liability but on what is in the best interests of our student-athletes.”

Fear of liability is one of several explanations offered by legal analysts, medical experts and college sports officials as to why the NCAA has not substantially addressed the issue of student-athlete fatalities. At least 27 Division I college football players have died in offseason conditioning sessions from non-traumatic causes since 2000, according to a 2017 study authored by Oklahoma head athletic trainer Scott Anderson.

Dr. Douglas Casa, who leads the Korey Stringer Institute (named after the former Minnesota Vikings player who died of heatstroke complications in 2001), blamed the NCAA’s hesitation to act on player safety issues on a philosophical disagreement between its sports science department — which is adamant the organization should have a role in health and safety issues — and the priorities of individual conferences and athletic departments, particularly as it relates to football.

“You have really stubborn people working in football (and college athletics) who don’t think in a particular way for a really long time,” Casa said, “and they don’t want to be told what to do.”

Casa’s view was echoed by several sources with direct knowledge of how conferences and member institutions think, including two who have participated in NCAA Committee on Infractions hearings, representing both the NCAA and member institutions.

Even so, Dr. Brian Hainline, chief medical officer of the NCAA’s Sports Science Institute, told SN “the needle is shifting rather rapidly” toward his organization playing a greater role in health and safety matters. He said he was aware of several NCAA investigations into schools that did not implement an NCAA-mandated independent care model, instituted in 2017.

Radford declined to elaborate on those investigations, but told SN its legislation was intended to reinforce standards of care and help schools understand their obligations.

“The NCAA does not determine the medical standard of care or second-guess the judgments exercised by health care professionals,” Radford said. “NCAA legislation does allow for limited review of whether our institutions have the structures and policies to support the health and safety of student-athletes.”

NCAA’s history with student-athlete safety issues

Anderson, the Oklahoma trainer who has become a leading advocate of student-athlete safety, said doctors realized in the late 1990s that people who carried the trait for sickle-cell anemia were at increased risk for collapsing during workouts, particularly when training in hot climates. This had led to a string of deaths in offseason conditioning sessions.

Anderson said a unified movement to screen for the trait — and educate athletic departments of its perils — began soon after, eventually leading the NCAA to require sickle-cell screening, starting in 2010.

Anderson said the screenings have prevented deaths, and he lauded the NCAA’s independent care model measure that discourages trainers from reporting directly to coaches or athletic personnel. The NCAA has also begun addressing concussions, a lightning-rod issue that has brought it criticism and put it in the crosshairs of frequent litigation.

But Anderson said it has been frustrating to watch other initiatives struggle to gain traction.

Student-athlete deaths have largely followed a pattern, wherein players are jeopardized by strenuous offseason workouts that follow sustained periods of inactivity, such as winter break or between spring and summer practices. Misunderstanding of basic medical principles has also played a role in hospitalizations.

Maryland football player Jordan McNair died in June 2018 after being asked to complete a conditioning test of 10 110-yard sprints in the team’s first organized conditioning session of the summer. His heatstroke was initially misdiagnosed, and trainers did not apply cold water immersion, a widely accepted practice to counter the effects of heat-related illness.

Those who have criticized the NCAA for not taking a more active stance as it relates to player safety say the organization could mitigate those kinds of mistakes with stronger regulation, such as the proposed best practice guidelines for preventing non-traumatic deaths.

“When you’re a 17-year-old kid or 18-year-old kid, and parents say you’re going to play in a sport and you’re provided with a scholarship, they’re basically turning that child over to make sure that kid is taken care of,” Wallace said. “And so there’s a whole bunch of things you could have a real discussion about with college athletics and the way they’re treating athletes.”

Legacy of NCAA’s stances on non-health scandals

If the NCAA was worried about how regulation might impact its legal liability before 2013, the events of that year seemingly added to its level of concern, according to ESPN college basketball analyst Jay Bilas and several legal experts.

Penn State took the NCAA to court after the latter imposed heavy sanctions on the Nittany Lions following former assistant coach Jerry Sandusky’s years of sexual abuse of children (sometimes on Penn State property). At first, the NCAA imposed a $60 million fine, four-year postseason bowl ban, scholarship reduction and vacation of all Penn State wins after 1998. It was forced to rescind many of those penalties, however, as part of a settlement with the school.

“They basically overreacted and they imposed an enormous amount of sanctions that then they had to pull back from,” said a source who has worked with the NCAA as a legal consultant. “Now they’re just hesitant to do anything.”

Since then, the NCAA has not reacted to most off-field issues, not just those relating to offseason workouts. Recent abuse cases such as former Michigan State doctor Larry Nassar’s decades-long sexual abuse of gymnasts went unpunished by the NCAA.

“I think the NCAA and those in charge within the structure, the presidents, they realize they screwed up with regard to the Penn State matter and how they went outside of the normal structure,” Bilas said. “And you can tell that because they haven’t taken any similar action in any way, shape or form on nearly identical cases that have come up afterward.”

Scandals that have involved competitive advantages or threats to amateurism, such as an FBI probe into college basketball programs paying athletes through shoe companies, have been met with more forceful responses.

“These allegations, if true, point to systematic failures that must be fixed and fixed now if we want college sports in America,” NCAA president Mark Emmert wrote of the FBI probe. “Simply put, people who engage in this kind of behavior have no place in college sports. They are an affront to all those who play by the rules.”

While Bilas does not believe the NCAA should govern any off-field issues, he said it was hypocritical for it to offer such strong public rebukes while it remained relatively quiet in instances of student-athlete deaths. The NCAA did not condemn Maryland after McNair suffered a fatal heatstroke at the team workout.

“Essentially the silence is deafening,” Bilas said. “Where’s the commission on that? Where’s the outcry on that? And there isn’t one.”

Moving forward

When Casa was a senior in high school in 1985, he suffered a heat stroke during a 10K race. He collapsed and spent several hours in a coma. He nearly died.

As a result, he has devoted his life to reforming conditioning sessions so student-athletes are no longer endangered. But given the seemingly constant wave of negative news at the collegiate level — there is an average of more than one death every offseason — it can be difficult for him to remain confident in the level of progress being made.

“You have to balance the things, right?” Casa said. “The frustration of all of these things happening, but you still need to have the motivation and the passion to continue to try to make the changes.”

Casa is optimistic the two proposed measures currently being considered by the NCAA will make a difference. But given the obstacles that have limited its role in safety matters in the past — some of which continue to weigh on the organization — it remains unclear to what extent the NCAA will play a role in managing the healthy and safety of its student-athletes.

Molly Richman, an attorney who has represented both the NCAA and schools in infractions cases, said the NCAA becoming a stronger regulatory body faces challenges that eclipse simple liability in lawsuits.

She noted member schools would need to agree to the shift in the NCAA’s philosophy and maintain respect for it, even when under investigation. She said an expanded rulebook would necessitate the NCAA hiring additional enforcement staff members. She also emphasized other areas the NCAA has traditionally monitored — like recruiting — have not been clear of wrongdoing.

But she didn’t rule out the possibility the NCAA would take that challenge on in the future.

“It’s a hard question,” Richman said. “I think it depends on the member schools, and then you have to get all the internal protocols in place for being able to enforce those rules because you don’t want to just make rules that you can’t enforce.”

Source: Sporting News

A dirty little secret vexes high school sports in Utah: Athletic trainers aren’t required for practices and games, so many schools go without. It needs to be addressed. (The Salt Lake Tribune)

There’s a dirty little secret plaguing high school sports in Utah. The fact that the plague might not be as bad here as it is in some other states shouldn’t bring much comfort.

Here’s what would bring comfort: More full-time athletic trainers hired and utilized at Utah schools.

At a conference on safety in prep sports held on Thursday in a suite at Rice-Eccles Stadium, David Perrin, Dean of the College of Health at the University of Utah, asked a significant question: “Don’t high school athletes deserve the same care as college and professional athletes in the treating and prevention of injuries?”

Anybody who answers that question with a big old negatory never pulled on the pads or laced up a hightop or a soccer or baseball cleat, or had a kid in his or her family who did so. And to those who claim that schools can’t afford it, Perrin says they should count the number of remunerated coaches on the sidelines: “They can afford it, if they will. It has to be a priority.”

Right now, it is not.

Lisa Walker, a veteran athletic trainer at Springville High School who has been on the state’s Sports Medicine Advisory Council, as well as national committees for her profession and who addressed Thursday’s conference, estimates that just more than half the high schools in Utah have “access” to an athletic trainer, but that schools that have athletic trainers on site during school days, at practices and games are “significantly fewer.”

“There is no requirement in Utah for an athletic trainer or medical personnel to be on hand,” she says. “Schools that make it a requirement should be commended. But there is no [statewide] mandate. To me, it’s disturbing.”

Doug Casa, a professor at UConn, the CEO of the Korey Stringer Institute, a national expert on exertional heat stroke, and a speaker also featured at the conference, says the problem reaches far beyond Utah: “We contacted all 21,000 high schools in America and found that only 40 percent of them had full-time athletic trainers on campus. Some schools had two or three, some had none. A third had no access to an athletic trainer, at all.”

Casa’s organization, KSI, is in the middle of a four-year outreach to enlighten and educate administrators at schools around the country about the importance of proper preparation and planning for health emergencies among student-athletes. With national and local concerns growing about concussions and heat strokes and heart events among athletes, awareness about preventing and treating such issues is on the rise.

“In the past three to five years, we’ve made more progress than the last 25 years combined,” Casa says. “We need to expand education for coaches in proper tackling techniques and in other areas and in other sports. We’re going to see good news in that space, but education needs to be mandatory for all sports.”

He adds that deaths in high school sports occur 15-20 times annually, but that lasting effects from improperly treated conditions, such as in cases of heat exhaustion and head-and-neck injuries, affect hundreds of student-athletes.

“We’re fighting to have the right protocols in place.” he says.

In 70 percent of the cases where prep athletes died over the past year, there was no athletic trainer present.

Walker, Perrin and Casa are all trying to limit, prevent those tragedies.

One of the keys to change, attendant with pushing for additional athletic trainers at schools, is changing the over-the-top macho culture that persists in some athletic programs, including coaches who not only neglect to call for appropriate treatment for distressed players, but who ridicule those who struggle in training and conditioning.

“At any time, an athlete can have head, heart or heat issues,” Walker says. “It’s not just in June or July. Education is so important — for athletes, parents, coaches and administrators. Most coaches aren’t looking to do harm, but they might not know. That’s why it’s so important to have licensed athletic trainers on hand.”

She pauses.

“It always comes down to money. I’m sensitive to that. But you would never go wrong to have an athletic trainer at each school protecting the lives of the kids. Prevention is better than having to deal with a tragedy.”

Walker concurs with Casa that progress in policy-making is rising — for instance, a 14-day-heat-acclimation period is now required for prep sports in Utah, eliminating so-called hell weeks, in which back-to-back-to-back-to-back two-a-day practices are implemented.

“Some would say, ‘Ah, you’re making the kids weak,’” Walker says. “My response is, ‘No, we’re preserving their health for today and the future.’”

A state law on concussions requires a plan and protocol for treating a high school athlete suspected of suffering one, approved by a parent.

“Any athlete thought to have had a concussion must be evaluated by a health-care professional specifically trained in concussion in the last three years,” she says. “That suspicion can come from a coach, a parent, a player.”

It should come from an athletic trainer, paid to be present at the school.

“We encourage schools to provide the best medical care they can for their students and their school community,” says Jon Oglesby, assistant director of the UHSAA. ”We have trainers at our championships.”

But making athletic trainers comprehensively mandatory would have to come from the State Legislature.

In Utah, all coaches must be current in first-aid and CPR, among other certifications, and some schools have physicians who volunteer their services at games, but that’s not enough. Immediate treatment should be available on campus throughout the day — at practices, games, even for P.E. classes.

That’s a conclusion that everyone — those at Thursday’s conference, coaches, parents and especially the athletes themselves — should agree with and find comfort in.

Source: The Salt Lake Tribune

Preventing Student Athlete Injury or Sudden Death – Interview with Dr. Douglas Casa (Principal Matters)

Dr. Douglas Casa began his study of student athletic safety in 1985 when he suffered an exertional heat stroke while running a 10K race.

As he explains, “I was fortunate to receive amazing care on-site from the athletic trainer; the EMT’s in the ambulance; and at the hospital from the emergency room physicians and nurses. I only survived because of the exceptional care I received. I was just 16 years old at the time, but I have been driven by this experience since that day.”

Whether you a leading an elementary school or high school, school activities and athletics play such an important role in the lives of your students. These programs also contribute to the overall culture and climate of your school community. As positive as these opportunities can be, it is equally important that best-practices are in place for activities, practices, and games. This includes knowing ahead of time how you or your staff will handle emergency situations.

Meet Dr. Doug Casa

Dr. Douglas Casa is a Professor at the University of Connecticut and the Chief Executive Officer for the Korey Stringer Institute.Additionally, he is the editor of a book titled: Preventing Sudden Death in Sport and Physical Activity (2nd edition, 2017), published by Jones & Bartlett in cooperation with the American College of Sports Medicine. His new book titled Sports and Physical Activity in the heat: Maximizing Performance and Safety will be published by Springer soon.

The Korey Stringer Institute

In August 2001, Korey Stringer, an All-Pro offensive tackle for the Minnesota Vikings of the NFL, died from exertional heat stroke. In April 2010, Kelci Stringer (Korey’s widow), James Gould (Korey’s agent), and the NFL asked Dr. Casa to develop and run the Korey Stringer Institute (KSI) at the University of Connecticut. The mission of the KSI is to provide research, education, advocacy, and consultation, to maximize performance, optimize safety, and prevent sudden death for the athlete, warfighter, and laborer.

For the past 18 years, Dr. Casa has worked toward his goals at the Department of Kinesiology, College of Agriculture, Health, and Natural Resources, University of Connecticut. You can read his entire bio here.

Interview Takeaways

In this podcast interview, Dr. Casa explains several important ways schools can be prepared with sound prevention policies and procedures:

  1. Find out where you state ranks in comparison to other states in the rubric provided for KSI on safety and prevention. (See KSI’s State Rankings page here.)
  2. Discover best practices for the four H’s. (Explore KSI’s website under the tab, Emergency Conditions for information on):
      • Heart
      • Heat
      • Head injuries
      • Hemoglobin, sickle-cell trait
  3. Explore affordable and practical ways to be prepared for heat-related incidents.
  4. Be prepared with written emergency plans for multiple settings on and off campus where students practice or perform.
  5. Understand the sickle-cell trait tendencies so that student athletes are appropriately rested and treated.

Let’s Wrap This Up

Dr. Casa also explains how his own story of heat stroke has come full-circle after more than 30-years in a compelling and surprising story he tells at the end this interview. Take time to listen and share this episode with others in your schools or communities who want best practices for keeping activities safe and healthy for students.

Now It’s Your Turn

What are ways you can evaluate your own school or district policies and practices in light of the KSI’s recommendations for best-practices? Do you have emergency plans for practice or competition locations? Study KSI’s state rankings and see where where your policies or procedures may need revisiting.

Source: Principal Matters

NCAA considering guidelines to help prevent offseason workout deaths (Sporting News)

The document outlines how schools should acclimate student-athletes into workouts following low-activity periods, which carry greater risk of injury or death because players have not yet adjusted to strenuous drills. It would also discourage the use of intensive workouts as a form of punishment, and establish how to properly diagnose and treat heatstroke.

Fourteen medical organizations, including the National Athletic Trainers’ Association and the Korey Stringer Institute — which strives to prevent sudden death among athletes at all levels — are reviewing the proposal and suggesting amendments. Brian Hainline, chief medical officer of the NCAA’s Sports Science Institute, said roughly half the organizations involved in the process have approved it, and the rest are expected to deliver formal reviews by Jan. 31. Hainline said he expects the document will be officially enacted and published by late spring.

“It’s a huge leap forward,” Hainline told SN, “because frankly, and we state this in the document, the vast majority of these non-traumatic catastrophic deaths and injuries are preventable.”

According to a 2017 study by University of Oklahoma head athletic trainer Scott Anderson published in the Journal of Athletic Training, 27 Division I athletes — all football players — have died from non-traumatic causes since 2000. That number does not include Maryland football player Jordan McNair, who died in June following a May 29 workout.

Still, it’s unclear how the best practices would be enforced, or whether the NCAA would eventually penalize institutions that don’t abide by the guidelines.

“Hopefully it’ll spur some dialogue and attention and cause some people to look at their programs,” Anderson said. “And you know I hear all the time, ‘The NCAA, all that is is a guideline. It has no teeth. There’s no punishment in there.’ And I understand that. But I also understand the power of a guideline.

“It’s not a law or a bylaw or legislation or anything else like that, but there’s a standard of care, and medically we violate that at our own peril. We’ve had to elevate our standard of care, our standard of how we train people. There needs to be absolutely some level of accountability and transparency.”

There was little public response from the NCAA when McNair died from heatstroke, eight months before initial review of the NCAA’s best practices guidelines. McNair’s medical treatment was marred by some of the same shortcomings that have contributed to the non-traumatic deaths of other student-athletes over the past two decades. The NCAA’s best practices proposal offers ways to avoid those mistakes.

The workout in which McNair suffered the heatstroke was the team’s first conditioning session of the summer, according to records obtained by Maryland student newspaper The Diamondback. Rather than being gradually acclimated to camp, McNair, a rising sophomore, was asked to complete a conditioning test of 10 110-yard sprints. He showed signs of exhaustion midway through the test and struggled to complete the drill, according to an independent reportcompleted by private investigative firm Walters Inc.

Maryland’s trainers then failed to meet basic protocol for diagnosing and treating heatstroke, not applying cold water immersion therapy to McNair, according to the same report. Cold water immersion is known to help patients recover from heatstroke when applied right away, according to Community Healthcare System athletic trainer John Doherty, who advises trainers in the Midwest how to respond to emergencies.

“It’s a very simple step that I work with my athletic trainers both at the collegiate and high school level constantly,” Doherty said. “I’m always reminding them that especially when there’s hot weather around, how valuable and necessary the cold water immersion stuff is because it is such a simple step and its success rate is to my knowledge 100 percent.”

After Maryland accepted “legal and moral responsibility” for McNair’s death during an August news conference, an NCAA spokeswoman told The Washington Post the university had “offered steps to ensure this does not happen again.”

At that point, however, DJ Durkin was still the Terrapins’ football coach, and assistant athletic director of athletic training Steve Nordwall and head football trainer Wes Robinson had not yet been dismissed. An independent investigationinto the football program’s culture, which found frequent instances of verbal abuse from coaches, would not conclude for another two-plus months.

When contacted for an update on Maryland’s plans to prevent future deaths, a school spokeswoman linked SN to a page listing corrective measures, saying 17 of 20 changes recommended by Walters Inc. had been completed. (Those recommendations can be found on page 67 of the below document).

The lack of action from the NCAA regarding McNair’s death consequently led critics to point out the organization’s refusal to weigh in on player safety issues while openly investigating and disciplining schools for competitive-balance violations, like paying college basketball players.

“Essentially the silence is deafening,” ESPN college basketball analyst Jay Bilas told SN. “It’s an odd feeling to see the NCAA sort of act in one fashion with regard to amateurism, and then with health and safety of athletes there’s not the same sense of urgency.”

An NCAA spokesman said the best practices currently being reviewed are the result of an NCAA-hosted information-gathering summit in 2016. That said, the document uses recommendations from a 2012 inter-association task force — composed of leading organizations in the sports medicine industry — that met independent of the NCAA and presented its findings in hopes of being formally adopted by the organization.

Hainline — who wasn’t affiliated with the NCAA at the time the 2012 task force presented its findings — said he felt the organization has moved at an appropriate pace in putting the document together. He cited required input from people throughout the college landscape, including athletic departments and school presidents who make up the board of governors.

Korey Stringer Institute head Dr. Douglas Casa, though, said better cooperation at all levels of the NCAA, particularly from football coaches, could have facilitated change sooner.

“If (the NCAA) had endorsed that back in 2012, there’s a really good chance the deaths that have happened since 2012 would have never happened,” Casa said. “Some of the things we had written were simple things that would have required modifications to prevent these deaths for happening. You know, Jordan McNair is the perfect example because it was extremely simple solutions to save Jordan’s life.”

Hainline hopes by publishing these guidelines, the NCAA can begin taking a more active stance on student-athlete health and safety. And while he and Casa both feel the best practices now being weighed are a sign of progress for improving student-athlete safety, the impact of that document will likely hinge on the receptiveness of the college sports community.

A high-ranking conference official with direct knowledge of how institutions view the NCAA’s place on this issue told SN it could prove difficult for the NCAA or conference leadership to regulate workouts. The official said schools are fiercely independent and bristle at attempts to manage their practices. Most do follow proper protocol already, the official added.

“(The NCAA and conferences) are not in the trenches, we’re not there on a daily basis,” the official said. “Now could we or should we be? That’s a philosophical question, one we’re not built for today.

“Historically, institutions have a strong desire to have their autonomy when it comes to how they spend their money, their academic integrity … and their medical training.”

To that end, Hainline emphasized his belief in a “philosophical shift” from the traditional model of self-regulating institutions to one where the NCAA provides oversight on health and safety matters — potentially even punishing schools unwilling or incapable of following along.

“I believe there should be consequences. I believe the membership and board of governors are moving in that direction,” Hainline said. “The needle is shifting. … I would say for an organization like (the NCAA), the needle is shifting rather rapidly. Others can say it’s 100 years too slow.”

Source: Sporting News

National Winter Sports Traumatic Brain Injury (TBI) Awareness Month

Brad Endres, MS, ATC, CSCS

Assistant Director of Sport Safety, Korey Stringer Institute

The new year is upon us, and with the changing of the calendar comes the increased participation in our beloved winter sports. Fittingly, January is National Winter Sports Traumatic Brain Injury (TBI) Awareness Month, so before you dust off the skates or head up the ski-lift, here is a breakdown of what you need to know to stay safe out on the slopes or in the rink.

What is a traumatic brain injury (TBI)?

The types of traumatic brain injuries include sport-related concussion (SRC), diffuse brain injury, second impact syndrome, subdural hematoma, and epidural hematoma.  Although cerebral concussions rarely cause death, they can be the starting point for other deadly brain injuries.

 

How often does TBI occur?

Between 1.6 million-3.8 million TBIs are seen in sports each year in the United States. Athletes under the age of 15 represent the majority of TBIs. Also, in every age group males show a higher rate of TBIs than females.

 

What is a sport-related concussion?

According to the 5th International Conference on Concussion in Sport held in Berlin, October 2016, a SRC is defined as a TBI induced by biomechanical forces. Several common features that may be utilized in clinically defining the nature of a concussive head injury include:

  • SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
  • SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.
  • SRC may result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
  • SRC results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.

 

What are the signs and symptoms of a SRC?

The suspected diagnosis of SRC can include one or more of the following:

  1. Mechanism of Injury (eg, direct blow to the head)
  2. Physical signs (eg, loss of consciousness, memory loss, neurological deficit)
  3. Balance impairment (eg, unsteady gait)
  4. Behavioral changes (eg, irritability)
  5. Cognitive impairment (eg, slowed reaction times)
  6. Sleep/wake disturbance (eg, sleepiness, drowsiness)
  7. Signs and Symptoms including the following:
Signs Symptoms
  • Disorientation, confusion
  • Retrograde/anterograde amnesia
  • Loss of consciousness
  • Automatism
  • Unequal pupil size
  • Combativeness
  • Slowness to answer questions
  • Loss of balance
  • Atypical behavior/personality changes
  • Vacant stare
  • Nystagmus
  • Headache
  • Nausea
  • Balance issues/dizziness
  • Tinnitus (ringing in the ears)
  • Diplopia (double vision)
  • Blurred vision
  • Trouble sleeping
  • Trouble concentrating
  • Memory issues
  • Irritability, sadness,
  • Sensitivity to light or noise

 

What to do if a TBI / SRC is suspected?

Any person suspected of a SRC should be removed from the mountain or event area immediately and evaluated by a licensed healthcare professional who is trained in the evaluation and management of concussions. The injured person suspected of a SRC should not return to activity on the same day as injury. Finally, continued monitoring of an athlete evaluated of having a SRC is necessary in order to observe any deterioration of physical or mental status (which warrants transport to local healthcare facility).

 

How do you treat an individual with a TBI / SRC?

After being evaluated by a health professional, treatment and management of a TBI/SRC includes:

  • Physical and Cognitive Rest: Physical and Cognitive activities that result in an increase in symptoms should be avoided during the acute phase of concussion treatment
  • Medications that mask the symptoms of a concussion (NSAIDS, Aspirin, stimulants, and antidepressant) should be avoided, especially in the acute phase of the injury.
  • The use of acetaminophen (Tylenol) may be considered in treating symptoms such as headache but should be used after the acute phase of the injury
  • Athletes sustaining a concussion should have a follow-up appointment with their general practitioner to evaluate the mechanism of injury, the course of symptoms, and any previous history of concussive injuries.
  • Return-to-play following a concussion should follow a graded return-to-play protocol. This protocol should consist of 5-7 stages and take 5-7 days to complete (if there is no recurrence of symptoms). The graded return to play protocol should begin once the athlete has a cessation of symptoms for at least 24 hours. An athlete must be prohibited from returning to activity if they are still experiencing symptoms.
  • The goal of the return to play protocol is to progressively increase the duration and intensity of exercise to ensure that there is no return of symptoms with physical exertion. See the table below to see an example of a 6-stage return-to-play protocol.
Rehabilitation Stage Functional Exercise at each Stage of Rehabilitation
1.  No activity Complete physical and cognitive rest
2.  Light aerobic exercise Walking, swimming, or stationary cycling keeping intensity <70%
No resistance training
3.  Sport specific exercise Skating skills in ice hockey, slide board for skiing, general agility drills
No head impact activity
4.  Non-contact training drills Progression to more complex training drills (eg: passing drills in ice hockey, bunny slopes for skiing/snowboarding)
May begin progressive resistance training
5.  Full-contact practice Participate in normal training activities
6.  Return to play Normal game play or event competition

 

How do I prevent a TBI / SRC?

Based on the most updated consensus statement created by a committee of sports medicine professionals at the 5th International Conference on Concussion in Sport, the following steps were recommended for TBI prevention:

  • Protective Equipment: There is sufficient evidence in terms of reduction of overall head injury in skiing/snowboarding to support strong recommendations and policy to mandate helmet use in skiing/snowboarding. The evidence for mouthguard use in preventing SRC is mixed, but suggests a positive trend towards a protective effect in collision sports (such as hockey).
  • Rule Change/Risk Compensation: The strongest and most consistent evidence evaluating policy is related to body checking in youth ice hockey (ie, disallowing body checking under age 13), which demonstrates a consistent protective effect in reducing the risk of SRC.
  • Aggression/Violence: Appropriate competition and the aggressive nature of some sports is not discouraged, however unnecessary violence or other aspects should be evaluated based on the merit they provide in the sport.
  • Education: The ability to detect and deal with a TBI is enhanced when everyone on the slope or ice is looking out for the safety of the athletes.  Education should include the athletes themselves, coaches, administrators, and parents.  It should cover basic tools for recognition, what to do if they suspect a concussion, and the process of treatment and returning to participation.

What are the risk factors for SRC?

  • Previous concussions: A previous history of a concussion increases the risk of sustaining another concussion on the order of 2-5.8 times greater risk
  • Number, severity and duration of symptoms: Evidence has shown that those who report a greater number of symptoms, or report a greater severity of symptoms or duration, may experience a longer recovery than those who experience less severe symptoms.
  • Sex: Research has shown that females experience a higher incidence of concussion in addition to reporting a increased number/severity/duration of symptoms, and prolonged recovery.
  • Age: Young athletes may experience a prolonged recovery from a concussion and may be due to the differences in the developing brain of a child/adolescent compared to that of an adult brain
  • Sport, position, and style of play: Depending on the sport, position, and the athlete’s style of play increases the risk of concussion. In sports where there is player-to-player contact, the risk of concussion increases. The table below outlines the incidence the risk of concussion for various sport.
  • Mood Disorders: Mood disorders such as depression, anxiety, and irritability may complicate both the diagnosis and management of a concussion
  • Learning disabilities and attention disorders: Learning disabilities such as ADD/ADHD or others that result in some form of cognitive dysfunction can complicate the management of a concussion and may lead to a longer recovery time post-concussion

So bundle up, have fun, and most importantly stay safe this Winter! For further information, check out the TBI page at the Korey Stringer Institute’s website at https://ksi.uconn.edu/emergency-conditions/traumatic-brain-injury/. The 5th International Conference on Concussion in Sport publication can be found at https://bjsm.bmj.com/content/51/11/837.full.pdf.