Dr. Hosokawa will be leading a webinar for Earth Networks on Proactive Heat Stress Prevention for Athletics on September 20th at 2pm EDT.
When 60-year-old Joseph Lorenc set out on the 7-mile Falmouth Road Race in mid-August, 2015, he was his usual highly-motivated self: healthy, in good shape and used to running longer distances. At 9 a.m. temperatures on Cape Cod, Massachusetts, registered in the mid-70s, rising to around 80 at race’s end an hour later. A 5-mile per hour wind blew at Lorenc’s back instead of helpfully cooling him from the front.
Early on, the former high-tech professional strained a lower abdominal muscle and then he had to “work harder,” Lorenc told HealthCentral in a telephone interview. That led to an “exertional heat event” that could have become life-threatening.
“An exertional heatstroke can happen in otherwise healthy, active people, when the metabolic heat produced from exercise or activity exceeds the physiological limit to regulate their body heat effectively,” says Yuri Hosokawa, Ph.D., ATC, LAT, and vice president of communication and education at the Korey Stringer Institute at the University of Connecticut (UCONN). She responded to HealthCentral in an email interview. “More common classic heatstroke occurs when an individual is passively exposed to heat — being in a hot room during a heat wave.”
Other risk factors for exertional heatstroke include dehydration, partaking in an activity not matched to a person’s fitness level, recent illness, and sleep deprivation, Dr. Hosokawa says.
Medical tent personnel fully submerged Lorenc — totally coherent, but exhausted and wobbly with a body temperature of more than 107 degrees — in a tub of ice water for 20 minutes. The decidedly uncomfortable treatment worked, and later he reflected on his near-miss.
“As an experienced runner, I never saw this coming. It was fortuitous that I was in the right place at the right time,” Lorenc says.
The heat is on
Earth reached its highest temperature on record in 2016, according to NASA and the National Oceanic and Atmospheric Administration (NOAA). Rising summer temperatures around the globe will continue to put humans at risk — especially older adults, very young children, and those with chronic conditions.
A heatstroke is the most dangerous form of hyperthermia or over-heating, affecting the body’s central nervous system and causing changes in consciousness and behavior. “Cognitive damage is a real risk because the brain is a precisely regulated instrument,” adds Dr. Vukmir. “An overheated brain that fails to compensate normally can produce altered mental status.”
The National Institute on Aging (NIA) notes that when heat rises in the body to uncontrollable levels, symptoms of heatstroke can include:
- Mental confusion or agitation.
- Abnormal pulse: In earlier stages of hyperthermia, the pulse may be strong and rapid as the body tries to cope, but as heatstroke progresses, the pulse can become weak.
- Hot and dry skin.
- Fainting, staggering or coma.
Other forms of hyperthermia can also put anyone at risk for less severe problems: unpleasant heat stress, heat syncope (fainting), sudden dizziness after exercising in heat, heat cramps, and heat exhaustion, says Basil A. Eldadah, M.D., Ph.D, program officer and chief of the geriatrics branch of the NIA in a telephone interview with HealthCentral.
Seniors take extra care
Age-related changes increase risk in the elderly, Dr. Hosokawa says. “They may have a reduced ability to sweat, which is the body’s natural cooling mechanism. Normally, the intricate network of blood vessels dilates and constricts, like the radiator of a car, bringing blood closer to the surface of the skin to cool it as heat is exchanged with outside air.”
“Symptoms of hyperthermia may not be very specific, unlike pain in a toe, for example,” Dr. Eldadah says. “They may include fatigue, exhaustion, headache, nausea, or dizziness. Older adults who regularly experience those symptoms may not immediately think the cause is heat-related illness. Also, hyperthermia can affect thinking and planning, which may make it more difficult to take appropriate action in the heat.”
The NIA suggests elders go to places with air conditioning, such as senior centers, shopping malls, movie theaters, and libraries. Cooling centers, which may be set up by local public health agencies, religious groups, and social service organizations in many communities, are another option.
Treat heat-related illness
If you suspect someone is suffering from a heat-related illness, you should:
- Call 911 if you suspect heatstroke.
- Get the person out of the heat and into a shady, air-conditioned or other cool place. Urge them to lie down.
- If the person can swallow safely, offer fluids such as water, fruit, and vegetable juices, but not alcohol or caffeine.
- Apply a cold, wet cloth to the wrists, neck, armpits, and groin. These are places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.
- Encourage the individual to shower, bathe, or sponge off with cool water if it is safe to do so.
In the event of a heatstroke, Dr. Vukmir says EMS personnel or those in an emergency department would actually apply ice packs to the armpit and groin to cool the femoral vessels in the leg, as well as the axillary vessels in the armpit — all responsible for major blood flow in the body. Cooling blankets or a cooling vest may also be applied.
Emergency personnel may also remove the patient‘s clothing so a mist of water can be applied to the skin while a fan circulates air, aiding evaporative cooling. In life-or-death situations, separate procedures involving cooled IV fluids, a bladder catheter or gastric tube might also be utilized, as well as a medical device that positions a catheter-type cooling system directly into a large groin vessel.
In the event of exertional heat stroke, as in Lorenc’s case, on-site rapid cooling with whole body, ice water immersion before transporting to the hospital can be a life-saver, adds Dr. Hosokawa. See UCONN’s TEDEd video for more information on heatstroke.
“Know your risk for heat-related illness so you don’t take unnecessary chances,” says Lorenc.
Source: Health Central
The institute, based at the University of Connecticut, studies conditions and exercise habits that can lead to heat-related illnesses and was founded in memory of Korey D. Stringer, an NFL football player who died from complications associated with heat stroke during a game.
This is the fifth year that the institute has come to the road race for collaborative studies.
The Falmouth Road Race, which is relatively short and where people can exert themselves to finish in the hot humid month of August, offers a venue to study ways to prevent heat illness, explained Yuri Hosokawa, vice president of communications and education with the institute.
The institute’s weekend here started Thursday, August 17, where staff presented at the New Balance Falmouth Road Race Sports Medicine Symposium, held with Falmouth Hospital, which staffs the race medical tent.
“It’s an opportunity for runners interested in the science behind running in the heat and medical professionals to receive continuing credit,” Dr. Hosokawa said.
The institute is conducting two studies at the race. The surveillance study, being done for a second year in a row, is following a number of racers as they prepared and trained after watching an informational video on healthy and safe tips for exercising in the heat.
Scientists will follow up with the racers after the race to learn how they felt during the race and how the pre-race information affected their training and experience. Every person who registers for the road race received a study survey. As of Tuesday of this week Dr. Hosokawa said that about 2,000 runners were participating.
“We appreciate their interest and support and hope to get 80 percent response for the post-race,” Dr. Hosokawa said.
Study results will be shared with the Falmouth Road Race and medical staff to better inform pre-race education programs, Dr. Hosokawa said.
The second project selected about 30 runners, ages 20 to 65, for a more in-depth exercise study.
These participants visited the University of Connecticut campus for exercise testing at slower and faster paces to monitor cardiovascular fitness and how these athletes respond to heat and humidity. Their lab results will be compared to data gathered during and after the race.
Dr. Hosokawa said many studies look at the elite runners; here, the institute is following competitive recreational runners, who make up a majority of the race participants.
Medical practices developed at the race to treat heat illness with no fatalities have become the gold standard, she said.
“The Falmouth Road Race sets the standard for medical professionals on how to prepare for exertion-related heat illness,” Dr. Hosokawa said.
Source: The Falmouth Enterprise
Miwako Suzuki, KSI Intern Fellow
My name is Miwako Suzuki, and I am an Athletic Training student at Indiana State University. Gratefully, I was chosen to receive the opportunity to intern at the Korey Stringer Institute in the Summer Fellowship Program. I am originally from Japan, and I studied Athletic Training there as well. While receiving my education in Japan, I found it necessary to learn more about prevention and management of emergency conditions, and this sense of mission brought me to the United States. I became aware of the KSI four years ago when I was still in Japan through Dr. Yuri Hosokawa, Vice President of Education and Communication at the KSI, and I have been attracted to the KSI since then. The past two months and ten days that I spent with the KSI members were full of great experiences and learning.
Among the several projects that I worked on during the summer, the main focus was placed on the Athletic Training Locations and Services (ATLAS) Project. The aim of the ATLAS Project is to determine the extent of current athletic training services provided in the secondary school setting, and it was launched in January 2016 with these goals:
- Create a real-time database of athletic training services in secondary schools
- Create a directory for each state’s athletic training association and high school athletics association
- Assist states in moving toward full-time athletic training services
- Provide useful data to each state’s athletic training association and high school athletic association
- Identify common factors associated with increased athletic training services across the country
- Provide data to assist with legislative efforts to improve healthcare for high school athletes
At the beginning of the summer, the ATLAS Project was at the stage of figuring out the extent of athletic training services in the last 10% of high schools that we had been unable to reach. To reach those schools, I have tried multiple methods such as making phone calls, writing emails to athletic directors, and searching their website for athletic trainer’s information. Even though I made some progress with these strategies, the most effective method was reaching out to athletic trainers of the neighboring high schools of the unknown schools for help. From this experience, I have learned firsthand that ATLAS is not only a great database but also a very useful communication tool. While interacting with high school athletic trainers throughout the nation, many of them showed their appreciation and support for this study. I am very grateful to be one of the members to propel this important project forward. I would like to thank Dr. Robert Huggins for including me in this project and always guiding me. I also would like to thank Sarah Attanasio, ATC, for teaching me and providing help whenever I asked.
Testing for the Falmouth Road Race study began in mid July. We conducted a modified heat tolerance test on recreational runners of a wide range of ages who are participating in the New Balance Falmouth Road Race on August 20th, 2017. Although the study will not be completed until the race day, collecting data on individuals’ physiological responses to exercise in the heat was a great learning opportunity for me. I believe that the wide distribution of demographics of this study allowed me to encounter various responses among the subjects. With regard to conducting a laboratory test, I observed the effort of the KSI members to make the study robust. I was very fortunate to learn from such experienced and passionate colleagues. I would like to express my deepest gratitude to Dr. Yuri Hosokawa and Kelsey Rynkiewicz, ATC, for their effort to involve me in this study.
On August 20th, which will be my last day as a KSI fellow, I will be at the New BalanceFalmouth Road Race and will serve as a medical volunteer with the KSI staff. The Falmouth Road Race has been recognized for its high incidence rate of exertional heat illnesses because of the environmental conditions and its short duration (7.1 miles), which allows runners to maintain relatively high intensity throughout the entire duration of the course. According to a previous study from the KSI, this race has saved multiple exertional heat stroke patients each year. Since I have never encountered a real exertional heat stroke case, I would like to take this opportunity as a great hands-on learning experience.
I appreciate every aspect of the activities that I had the opportunity to take part in at the KSI. The KSI was an even greater place than I expected. All the members are making a great effort for their projects with the strong passion and commitment for the KSI’s mission. I believe that this is the reason why the KSI has been successfully leading our profession. Lastly, I would like to thank Dr. Douglas Casa for providing such a great opportunity. I fully enjoyed summer 2017 with such great colleagues.
FARMINGVILLE, N.Y. — A high school football player lifting a large log with teammates as part of a Navy SEALs-style drill was hit in the head by the log and died Thursday, raising questions about adapting such military training to young athletes.
Joshua Mileto, a 16-year-old Sachem East High School junior, and about five of his teammates were carrying the log overhead when the accident happened at a preseason exercise camp supervised by a half-dozen coaches, Suffolk County police said.
The 5-foot-6, 134-pound wide receiver and defensive back was declared dead later at a hospital.
Sachem East graduate Carlin Schledorn, who played football as a junior, said carrying the log — about 12 feet (3.7 meters) long and the diameter of a utility pole — was a “team building” exercise.
“It’s very big. It’s like a tree, and it’s a challenge for people who weightlift,” he said. “Five or six people do it at once. I feel horrific for the team and coaches because I know them, and they are all great men.”
School officials, including the head coach, did not comment on the exercise.
A person at Mileto’s home declined to speak with reporters.
Classmate Olivia Cassereli said Mileto “cared about everyone else.”
“He put others before himself, and everyone loved him and was friends with him,” said Cassereli, who called him her best friend.
Some colleges and other high schools around the country have incorporated log-carrying drills and other military-inspired exercises into their football preparations in recent years, sometimes bringing in SEALs to teach and motivate.
Players at Indiana’s New Albany High School teamed up last month to tote 6-foot-long, 200-pound logs two miles from a local amphitheater to the school.
SEALs and Green Berets trained the players first on how to lift the logs and carry them on their shoulders, coach Steve Cooley said. Accompanied by coaches and a police escort, the groups paused for water and put the logs down every one or two blocks, and each six-person squad had an extra man who could sub in if someone got tired.
“The purpose was not to try to see how tough they are … the purpose was to accomplish a goal,” Cooley said. “It was very rewarding for all of us.”
But after Mileto’s death on Thursday, sports safety expert Douglas Casa questioned the wisdom of having teenagers perform an exercise that involves carrying a heavy object and that was developed for Navy SEALs, who are “potentially a very different clientele.”
“There’s so much potential for things to go wrong that I would really want people to think twice before doing something like that,” said Casa, executive director of the University of Connecticut’s Korey Stringer Institute, which works to improve safety for athletes.
Football, at all levels, has become more safety-conscious in recent years amid scrutiny of head injuries in the sport. In college football, for instance, the NCAA this year barred the two-a-day contact practices that coaches once used to toughen up their teams in the preseason, though many teams had ended them already.
For high schools in Suffolk County, offseason practices are permitted as long as they are not mandated and are open to everyone, said Tom Combs, executive director of the athletic organization that oversees high school sports in the county.
“What exercises that are conducted are the privy of the school district and individuals running the workouts,” he said.
In an unrelated incident, another player fell and hit his head Wednesday at the school during training, police said. His injuries were not life-threatening.
Sachem Superintendent Dr. Kenneth Graham extended condolences to Mileto’s family and friends and said support services will be offered “for as long as needed.”
The team’s training officially starts Monday, and the football season starts in September.
Samantha Scarneo, MS, ATC
Director of Sport Safety
On Tuesday, August 8th, the Korey Stringer Institute held a press conference for the release of the Health and Safety Policy Ranking for High School Athletics. The goal of this project was to review publically available information from high school associations and state legislation to determine how states are mandating safety standards for their athletes. A positive finding from this study is every state, including the District of Columbia, has some type of health and safety policy requirement for their high schools to follow. However, not a single state meets all of the minimum best practice requirements for the areas focused on in this project; which happen to be the top causes of sudden death in sport, accounting for over 90% of sport-related deaths.
North Carolina is leading the way scoring a 79%, followed by Kentucky (71.13%) and Massachusetts (67.4%). KSI was honored to have Mr. Bob Gfeller, Mr. David Csillan, and Dr. Morgan Anderson as well as Dr. Douglas Casa and Dr. William Adams, speak at the press conference. Dr. Adams began the press conference stating the methods used for this project, which included accessing publically available information from state high school associations and legislation. Dr. Casa followed up with information pertaining to the results of the study. Csillan, athletic trainer from New Jersey, provided comments about his continued advocacy for New Jersey to implement best practice standards statewide. Mr. Gfeller spoke on the importance of implementing policies to ensure that no parents need to go through the tragic loss of a child. Dr. Morgan Anderson echoed these comments by stating “We have tragic examples from the past that motivates us daily to make a change.”
The Orthopedic Journal of Sports Medicine will publish the study with these findings in the September issue. The accepted version of the PDF can be found here.
Change is difficult. There may be states who are not thrilled with these published findings, too. However, these data are the reality of current health and safety policies in high school athletics. This report is dedicated to the parents who have lost, or those parents who have their sons and daughters participating in sport, and it can be the conduit in making sure that your children’s safety are accounted for by the governing organizations. I urge you all to contact your state high school association leaders and legislators to find out if they are 1) aware of where they stand in the ranking and 2) their plans forward for improvement.
By: Mike Anthony
Connecticut ranks in the bottom third nationally in implementation of requirements at the state level to keep high school athletes safe from some life-threatening conditions, a new nationwide assessment of safety guidelines shows.
In fact, most states are failing to properly protect athletes against heatstroke, sudden cardiac arrest and other conditions, according to the study by UConn’s Korey Stringer Institute. The results were made public Tuesday morning at NFL Headquarters on Park Avenue.
Connecticut ranked No. 38 of 51 (each state and the District of Columbia) in graded assessments of the implementation of policies pertaining to the four leading causes of death among secondary school athletes — sudden cardiac arrest, traumatic head injury, exertional heat stroke and exertional sickling, which is a medical emergency that can occur in athletes carrying the sickle cell trait.
“What Connecticut has in place that is really a model program right now is the heat acclimatization policy,” said Douglas Casa, CEO of the Korey Stringer Institute. “That’s the phasing in of activity across time during the first couple of weeks of football practices. Connecticut has every single point you can attain on our rubric related to the first five days of not having two-a-days, not having successive days of two-a-days, phasing in the amount of equipment.
“An example where we need improvement is something related to environmental monitoring. A state like Georgia, for instance, has a great program where if it’s a really hot day, they measure the environmental conditions and make modifications [to practices] based on the conditions. Because we know that almost all heatstroke deaths happen when it’s hotter than usual for where you live.”
States were given a score reflecting how well they have implemented policy aimed toward preventing and managing life-threatening conditions, related mostly to exertion, with scores (the best being 20) assigned in five categories.
Connecticut received a score of 40.001 out of 100, with scores of seven in exertional heatstroke, six in traumatic head injuries, six in sudden cardiac arrest, 15 in appropriate health care coverage and 6.001 in emergency preparedness.
The study did not take into account practices, many of them common and consistent, that take place through policy set by school districts.
“We’re disappointed that the survey is communicated in such a way that seems to be reflective of an entire state’s efforts when in fact it’s really only a very generalized approach to certain categories, and it’s only about state association policy,” CIAC executive director Karissa Niehoff said. “Our state has some of the most stringent requirements for coaching certification and education. We’re required to educate all parents and student-athletes about concussions and cardiac arrest, and we do that. We’re not an association that imposes requirements such as trainers at every single event, or requires certain [weather] measurement systems, because frankly we think that districts are best able to decide what’s appropriate for them and, truthfully, what they can afford.”
North Carolina was found to have the most comprehensive policies and received a top score of 79, followed by Kentucky (71.13) and Massachusetts (67.4). The states with the lowest grades were Colorado (23), California (26) and Iowa (26). The median state score was 47.
The KSI study recommended a course of action for all states to implement the following policies:
• Automatic external defibrillators and certified athletic trainers on site at all athletic events.
• Phasing in summer practices and taking other steps to protect athletes from heat stroke.
• Training coaches on concussion symptoms.
• Detailed emergency action plans for all life-threatening emergencies.
• Mandated screening of athletes for sickle cell trait.
The report notes that there have been 735 deaths and 626 catastrophic injuries among high school athletes between 1982-2015. More than 7.8 million secondary school athletes participate in sanctioned sports annually, the study states.
Korey Stringer was an All-America football player at Ohio State and first-round draft pick of the Minnesota Vikings in 1995. He died at age 27 in 2001 after suffering heatstroke during Vikings training camp in 2001.
The Korey Stringer Institute, founded at UConn in 2010, is a nonprofit organization dedicated to promoting the prevention of sudden death in athletes and active individuals. It has a staff of 20, and 60 volunteers.
Each state’s governing body for high school sports was notified of the study’s results and given 30 days to respond with questions, clarifications, disputes or confirmations. Scores will continue to be updated as new information is provided and policies change.
“We offer the strongest encouragement for best practices, we offer guidelines,” Niehoff said. “We were disappointed that the emphasis was on a ranking as opposed to a really comprehensive and authentic look at everything that’s being done in a state. … Whether or not it feels good to look at study results, it does spark conversation and it’s always good to revisit with urgency whether your health and safety policies are as relevant and supportive as they can be.
“Quite frankly, we appreciate that the legislature does not get involved too deeply in statutory language around implementation around athletic programs because to change legislation is quite an involved process that takes time. When our association develops policy, we can be nimble and respond quickly if there’s new research or something that needs to change in a rapid way.”
The NFL allowed Tuesday’s announcement to take place at its headquarters because it sponsors the Korey Stringer Institute, though the NFL did not sponsor the study.
“While we focus a lot of treating injuries and illnesses, Our role in prevention is just as important,” said another speaker, Morgan Busko Anderson, an internal medicine physician specializing in primary care sports medicine and a sports medicine fellow at Wake Forest University. “Prevention of injuries, prevention of illnesses, prevention of deaths. The evidence shows that prevention practices and policies can prevent these deaths. So why do we have this gap now, between what we know is evidence-based, best-practice medicine, and what some of our high school athletes are receiving?”
Casa said many of the fixes are simple.
“We believe you can get to 85 points out of 100 for less than $5,000 a year,” Casa said. “We’re trying to institute policy and do whatever we can before [young athletes] die, to not have to wait for your particular state to have an emergency or tragedy to implement policy, to maybe learn from a tragedy that happens across a state line. A lot of the states did react in a very positive way after having a tragedy, and we’re trying to prevent them from happening in the future.”
Source: Hartford Courant
By: Yuri Hosokawa, PhD, ATC, LAT, Korey Stringer Institute, University of Connecticut
As the brutal summer heat takes a toll across the country, high school athletes and youth sport leagues are ramping up their summer camps and pre-season workouts in preparation for the fall season. While the importance of hydration is often emphasized during summer workouts, the use of environmental-based activity modification guidelines is often overlooked. The two major roles of environmental monitoring and activity modification guidelines are: (1) to minimize prolonged exposure to dangerous heat stress and (2) to optimize the use of practice time in the heat without overstraining the athletes.
Two of the well-accepted environmental-based activity modification guidelines for exercise in the heat are published by the National Athletic Trainers’ Association and the American College of Sports Medicine. Each guideline provides specific wet bulb globe temperature (WBGT) ranges and recommended modifications, with different types of athletic activities and populations in mind. Understanding the differences between the two guidelines will help clinicians decide which guideline better fits their needs.
National Athletic Trainers’ Association’s Guidelines (2015)1
The most recent position statement from the National Athletic Trainers’ Association (NATA) provides example WBGT guidelines from the Georgia High School Athletics Association. The uniqueness of these guidelines is that it provides activity modification recommendations that best suits fall American football training. Epidemiological studies suggest that youth football athletes are one of the most vulnerable populations to exertional heat stroke given the time of the year they start the season and the unique physical demands in the heat that is amplified with wearing protective equipment. Therefore, having football specific modification guidelines required at the high school level across the country could direct not only the athletic trainers, but also the coaches and referees in what the appropriate modifications should be given the environmental temperatures.
It should be noted that the example provided by the NATA is adjusted for the regional environmental conditions normally observed in the state of Georgia during fall football training. Consequently, the temperature threshold may not be realistic for states in the northern part of the continental U.S. (i.e., the threshold temperatures are set too high to be practical). To address this potential regional discrepancy, Dr. Andrew Grundstein and his colleagues have proposed adjustment to the WBGT threshold by regions to account for the environmental differences observed (i.e. environmental conditions observed in Louisiana versus environmental conditions observed in Maine).
American College of Sports Medicine Guidelines (2007)2
Football is not the only form of physical activity that takes place during the summer months. While other team sports, such as soccer and lacrosse, may benefit from adapting the NATA guidelines, sports such as cross country may not find the guidelines as helpful due to the different nature of activity (i.e., intermittent vs. continuous activity). In such case, coaches and clinicians may be referred to the guidelines published by the American College of Sports Medicine (ACSM). Their activity modification recommendations are less specific to the type of sport, making it easier to implement as a global precaution for any type of physical activity in the heat. For that reason, the ACSM guidelines are also often implemented by various road race organizers in deciding if they should cancel, modify, or postpone mass participation events such as road running races.
It should also be noted that the same study by Dr. Grundstein and his colleagues have made the regional adjustments based on the ACSM guidelines to accommodate for the various climatology we observe in different part of the country.
Take Home Message
Environmental monitoring is a simple way for athletic trainers and coaches to reduce the risk of heat related injuries. It also ensures that the athletes are getting quality practice time during the summer days, where many athletes may be just getting ready to not only get used to the heat but also to exercise itself. For more information regarding the activity modification guidelines, please visit our website at ksi.uconn.edu or contact us here. #KnowYourCondition
1. Casa DJ, DeMartini JK, Bergeron MF, et al. National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses. J Athl Train. 2015;50(9):986-1000. doi:10.4085/1062-6050-50.9.07.
2. Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, Roberts WO. American College of Sports Medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc. 2007;39(3):556-572. doi:10.1249/MSS.0b013e31802fa199.
3. Grundstein A, Williams C, Phan M, Cooper E. Regional heat safety thresholds for athletics in the contiguous United States. Appl Geogr. 2015;56:55-60. doi:10.1016/j.apgeog.2014.10.014.
Yuri Hosokawa, PhD, ATC
Vice President of Communication, Vice President of Education
Earlier this summer, when everyone was relieved to have completed the spring sport season, we were invited to give a lecture and hands-on training for exertional heat stroke emergency at CoxHealth Sports Medical Conference in Springfield, MO. This was their second annual gathering to review and practice updated policy and procedures for athlete health and safety. Physicians, athletic trainers, emergency medical technicians, athletic directors and coaches of local high schools attended this meeting. During the hands-on training, multiple scenarios were practiced. For example, what do you do when the first responder was an individual who was not medically licensed? What is the chain of command when an athletic trainer is present and not present? What cooling modalities are acceptable? What precautions must be taken during cooling? This lab also reiterated the importance of cool first, transport second. I am happy to say that their updated policy specifically states to cool first and then transport after the patient’s rectal temperature is down to 102 degrees Fahrenheit and that no other measures of body temperature assessment is acceptable. Throughout the meeting, I was very impressed to see their collaboration and understanding of each other’s role and I know their athletes are in good hands.
A month and half after the meeting, I received an email from CoxHealth stating that their emergency preparedness was put to a test– where an athlete was successfully recognized and treated for exertional heat stroke.
Sarah Bankhead (ATC, athletic trainer at CoxHealth), who treated the athlete, recalls the day as follows: When our athletes were putting away the blocking bags after practice, a coach noticed one of the athletes closing his eyes and beginning to fall over in the shed. The coach caught him and immediately called for help. The first coach to reach him checked his pulse and noticed shallow rapid breathing. The head coach called 911 and the other two coaches started putting ice in the groin, neck, and armpit areas. I, the athletic trainer, soon came over with a rectal thermometer, inserted it, and got an initial temperature of 108 degrees Fahrenheit. After confirmation of exertional heat stroke, a tarp was immediately place underneath the athlete and began to be filled with ice and water to start the cooling process before the emergency medical service arrived. We ensured that the athlete’s temperature was cooled to 102 degrees Fahrenheit, and then the athlete was transported via ambulance for follow up evaluation. The athlete has made a full recovery with no deficits thanks to the quick actions of those above, an effective policy in place, and the Sports Safety Summit which prepared my coaches to respond.
Many teams have now begun their fall pre-season training. Do you know the chain of command and procedures when a heat emergency occurs on your practice field? It is never too late to review and build a consensus among the stakeholders of your sports medicine team. Take a “time out” and go over your emergency action plan. #Strive2Protect
SALT LAKE CITY — Utah’s stringent approach to concussion protocol is protecting the well-being of high school athletes, according to a new national report.
But critical athlete safety precautions such as accessible defibrillators and detailed emergency action plans are not required in Utah, and that significantly hurts the state’s standing in protecting those same competitors, according to the report from the University of Connecticut’s Korey Stringer Institute.
In all, Utah earned 44 points out of a possible 100 after being graded on student safety criteria. All states were analyzed on the same criteria, according to the institute, which cited 735 high school athlete deaths between 1982 and 2015 as a reason the research was needed. Data comparing states’ results were not immediately available.
Utah scored full points for its traumatic head injury protocol because schools are required to not allow student athletes to return to activity on the same day of a suspected concussion. Utah also requires any subsequent clearance to play to come from a sufficiently licensed medical professional, and students may not resume participating in athletics before returning to school.
“I think we’ve led the country when it comes to concussion policy,” said Rep. Paul Ray, R-Clearfield, who played high school football while living with a heart condition.
Ray sponsored the law passed in 2011 that’s responsible for much of the concussion protocol for high school athletes, including requirements on how to obtain medical clearance to return to competition, and mandating that parents of minors participating in amateur sports sign that organization’s head injury policy.
Rob Cuff, director of the Utah High School Activities Association, said he’s appreciative of that law, adding that it “was good for kids and it was good for parents to be educated, and that was the only way it was going to happen.”
It is helpful that member schools are required not only by UHSAA regulations but by law to treat concussions with caution, Cuff said.
“(It) is really binding,” he said. “Schools need to make sure they’re not only following our guidelines, but also state law.”
Utah’s overall score as it pertained to traumatic head injuries was pulled down 10 points because coaches are not required to participate in Heads Up concussion prevention training.
Cuff said that score is not reflective of the instruction Utah schools undergo in the regular course of their jobs and independent of that program.
“You have to pay for that,” he said, “and we feel like (concussion prevention) is an education piece that’s already been covered by the coaches and their training.”
It is the athletes and their parents who most often need the most persuasion to err on the side of caution following a concussion, said Ray, a former high school basketball coach.
“Really, the protocol was put into place for parents and students because they’re the ones who want to push the envelope on that,” he said.
Having a plan
UHSAA officials currently are focusing on shoring up schools’ emergency preparedness plans, an area in which Utah lost points in the report’s evaluation. Those efforts include ensuring that emergency transportation access for severely injured athletes from various venues is adequately thought out, Cuff said.
“It’s very simple,” he said. “It’s just the protocol of what happens in the case of emergency. It just depends on the community or the area.”
Emergency preparedness plans, as defined in the institute’s analysis, may address where to keep the necessary emergency equipment, how to identify health providers that would respond to athletic venues, and determining responsibilities for school personnel in a crisis.
Issues outlined in such a plan, Cuff said, also address other questions: Do medical personnel come to the games? Which sports so they attend?
“(Some) schools have them on call,” he said, while others have a vehicle on hand.
“The bottom line is: What is their plan and do they have a plan in place?” Cuff said.
Part of emergency preparedness means having athletic trainers on site, said Ray, who sponsored a bill earlier this year to require high schools with athletics programs to have a full-time athletic trainer on staff.
Ray’s athletic trainers bill was voted down in a legislative committee following opposition from groups worried about how feasible such a requirement would be for rural schools.
But Ray said high school sports programs are not worth the trouble if they can’t afford to provide that type of care, which he called essential, for the safety of their athletes.
“They just have to step up to the plate,” he said. “If they’re going to have a sports program that has the potential to put youth safety in jeopardy, they need to step up to the plate or they need to not have athletics. … It’s a matter of time before one of these schools get slapped with a multimillion-dollar lawsuit.”
Valerie Herzog, president of the Utah Athletic Trainers Association, agreed that students are left too vulnerable without such a professional employed with the school full time. Because of their inherent risk, sports programs just aren’t worth it without that safety guarantee, she said.
“If you’re going to drive a car, and you say, ‘I can’t afford a seat belt,’ then you shouldn’t buy a car,” Herzog said. “I wouldn’t buy my kid a bike if I couldn’t also afford to buy them a helmet.”
Cuff said he likes the idea of requiring athletic trainers in schools, but he can sympathize with those who believe it’s not doable.
“Well, certainly when you can get athletic trainers in your schools, you’re going to have the advantage of people who are already in the know,” he said. “Some of our rural districts just do not have access to an athletic trainer who’s willing to come live in the community. … So that’s really where the pushback (comes from).”
Cardiac arrest preparedness issues also knocked Utah down a peg in the Korey Stringer Institute report.
“That’s one thing that we’re improving on, and we were aware of that score,” Cuff said, “but I think we’re doing a much better job (than before).”
The state scored zero points out of a possible 16 on the report’s criteria that looked at policies mandating easy access to defibrillators at each athletic venue, training of athletics staff on how to properly use them, and sufficient maintenance of the devices.
But even though the report reflects that there aren’t policies formally requiring access to defibrillators, the state activities association has “made a big push” in recent years to get schools to buy them, Cuff said.
“What we do is tell them to apply for the grants” to be able to afford defibrillators, he said.
There are typically multiple defibrillators at sporting events between two schools, but “it’s at practice that we’re most concerned,” Cuff said. Simply having one is no substitute for knowing where it is and having the proper training to remove and use it, he said.
“We found that with the defibrillator, they may have one in the school, but it may be locked up in the principal’s office,” Cuff said. “They need to be placed somewhere (accessible), similar to a fire extinguisher.”
At next year’s legislative session, Ray said his bill to mandate athletic trainers in schools will also include language requiring easy access to defibrillators throughout athletic facilities.
Herzog agreed that there needs to be defibrillators at schools, and coaches need to know where they are and how to use them.
Such preparedness genuinely saves lives, the Utah Athletic Trainers Association president said.
“A lot of these are preventable deaths, (and) if it’s your kid, one’s too many,” she said. “This is real stuff. I mean, sports are dangerous. They push their bodies. … They push them as far as they can go.”
Utah also received mixed remarks for heat stroke prevention, earning credit for its regulations on high school sports practices but missing out on points associated with requirements on heat-related workout modifications.
The state received high marks for UHSAA providing catastrophic health care coverage to all member school athletes in the case of severe injury.
Source: Deseret News