Athletic Trainer

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.

Loudoun County Public Schools Approves EHS Protocol

Paul A. Peterson MA, LAT, ATC

Athletic Trainer, Woodgrove High School

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

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

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

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

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

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

Korey Stringer Institute Announces 2018 Lifesaving Awards

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

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

The 2018 award recipients are:

KSI Lifesaving Research Award

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

Scott Anderson, ATC

Head Athletic Trainer University of Oklahoma

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

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

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

KSI Lifesaving Service Award

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

Larry Cooper, MS, LAT, ATC

Teacher & Athletic Trainer Penn-Trafford High School

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

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

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

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

KSI Lifesaving Education Award

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

Cindy Chang, MD

Professor, Primary Care Sports Medicine University of California San Francisco

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

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

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

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

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

 

2018 Collaborative Solutions for Safety in Sport Florida Meeting

SAMANTHA SCARNEO, PHD, ATC

VICE PRESIDENT OF SPORT SAFETY

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

 

 

 

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

 

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

 

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

 

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

 

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

 

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

98th American Meteorological Society Meeting

Korey Stringer Institute Medical and Science Advisory Board Member

Yuri Hosokawa PhD, ATC

 

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

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

 

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

EATA Meeting 2017

Kelsey Rynkiewicz, ATC, NREMT

Assistant Director of Education

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

 

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

 

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

 

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

 

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

 

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

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

 

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

 

2017 Summer Intern KSI Fellowship Experience

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.

Health and Safety Policy Ranking for High School Athletics

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.

Seamless triage saves a life of an athlete

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

 

NATA Clinical Symposia & Expo

Alexandra Finn

Assistant Director of Education

Athletic trainers from around the country gathered in Houston, Texas for the 2017 Annual NATA Clinical Symposia & AT Expo. The four day Clinical Symposia provided athletic trainers with the ability to explore new areas and benefit from the latest research. KSI was well represented by fifteen presenters who continued the mission of educating athletic trainers about our latest research. The warm weather of Texas was a constant reminder of the significance of heat in our southern states, but the strong interest showed by attendees from across the country demonstrated that athletic trainers are gaining an understanding that exertional heat illnesses are an issue of national concern. The selection of so many KSI members provided a unique opportunity for KSI to further its educational mission to maximize performance, optimize safety and prevent sudden death in sport.

Presentations kicked off early Tuesday morning when Andres Almeraya presented in the Master’s Oral Student Finalist session. His research about “Implementation of Automated Defibrillator Policies in Secondary School Athletics” demonstrated the strong need for additional state legislation to mandate that all secondary schools follow best practices. Andres entered the day as a finalist and was selected overall the best oral presentation in this section. Congratulations and well done, Andres! Dr. William Adams presented his work on the “Implementation of Heat Acclimatization Policies in Secondary School Athletics” during the Treat the Heat Session.

This year four KSI staff members: Luke Belval, Alexandra Finn, Rachel Katch and Brad Endres were selected to present a Free Communication Poster Presentation on Tuesday morning. Luke Belval presented on “Sex-based Comparison of Exertional Heat Stroke Incidence in a Warm-Weather Road Race.” Alexandra Finn presented on the “Implementation of Wet Bulb Globe Temperature Policies in Secondary School Athletics.” This research revealed that currently there are only three states that meet all the best practice recommendations in this area. Rachel Katch presented data titled “Cold Water Immersion in the Treatment of Exertional Heat Stroke Remains the Gold Standard at the Falmouth Road Race,” which demonstrated the significance of a road race having immediate cold water immersion available to treat exertional heat stroke. Finally, Brad Endres presented on the “Epidemiology of Sudden Cardiac Death in American Youth Sports.” Congratulations to both Alexandra Finn and Brad Endres who were selected as Master’s Poster Presentation Finalists. Brad’s poster proved to be the judges’ favorite taking home top honors for KSI in this category. Well done Brad and his research team!

Dr. Rebecca Stearns presented research during the session “When Exercise Gets Hot.” Her study focused on “Repeated Exertional Heat Stroke Incidence in a Warm-Weather Road Race.” Following Dr. Stearns presentation, two KSI members; Kelly Coleman and Alicia Pike spoke during the Diversity and Inclusion Considerations in Athletic Training session. Kelly Coleman presented data about the “Perceptions of Race and Ethnic Diversity on Athletic Training Clinical Practice” while Alicia Pike spoke about “Providing Medical Care to Male Sports Teams: Attractors to Employment for Female Athletic Trainers.

To finish the day, Dr. Robert Huggins provided an update on “An Overview of Secondary Schools ATLAS Project: Where Are We Now?” demonstrating the progress in mapping secondary schools across the nation.

The second day started off strong with three KSI members presenting. First, Sarah Attanasio provided insightful information about the ATLAS project. In a well-attended session, Dr. Douglas Casa discussed “Catastrophic Heat and Exertional-Related Condition Among Athletes.” Lastly, Samantha Scarneo presented data about “Implementation of Emergency Action Plan Policies in Secondary School Athletics.” Her study focused on the importance of every high school having an athletic trainer prepare an emergency care plan.

On the final day of presentations KSI members Kelsey Rynkiewicz, Dr. Robert Huggins, Dr. Yuri Hosokawa, Dr. William Adams and Alicia Pike all had an opportunity to present their data. Kelsey Rynkiewicz presented data on the “Implementation of Concussion Policies in Secondary School Athletics.” Dr. Robert Huggins presented on three different topics on Thursday. The first presentation looked at the “Presence of Athletic Trainers, Emergency Action Plans, and Emergency Training at the Time of Sudden Death in Secondary Athletics.” His second presentation provided data to support why all athletic trainers should be staffed and the importance of an athletic trainer in the ability to reduce risk and save lives. His last presentation was titled “State High School Athletic Policy Change Successes and Barriers: Results from Collaborative Solutions for Safety in Sports Meeting.” Dr. Yuri Hosokawa presented information on “Optimizing the Direction of Care: A Secondary Insurance Claim Analysis.” Dr. William Adams presented information on the “Current Status of Evidence-Based Best Practice Recommendations in Secondary School Athletics.”  Lastly, Alicia Pike looked at “Examining Sport Safety Policies in Secondary Schools: An Analysis of States’ Progress Toward and Barriers to Policy Implementation.”

It was a privilege for so many KSI members to have the opportunity to provide much needed information about subject matters such as the prevention and care of exertional heat illnesses to athletic trainers who are heading to summer sport training camps or planning for preseason training for fall sports. When not presenting, KSI staff members took advantage of the tremendous opportunity to learn from colleagues from other institutions. The annual conference, which will be moving to New Orleans, LA next year, is well worth the investment to attend!