Preventing Sudden Death in Sport

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.

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!

Preventing Sudden Death in Sport– CoxHealth Sports Safety Conference

Brad Endres, ATC, CSCS

Assistant Director of Sports Safety Policies

The prevention of sudden death in sports begins well before a catastrophic injury occurs.

It may be true that heroes are made in how they respond when they are needed most. Many stories throughout the country give testament to the life-saving nature of an appropriate and timely response to medical emergencies in sport. While these stories are indeed uplifting, they are often the result of a great amount of effort dedicated to being prepared in the event of an emergency. During their 2017 Sports Medicine Conference, the Sports Medicine team at CoxHealth exemplified the old adage that “practice makes perfect”, and it was truly a sight to behold. This team, led by Dr. Shannon Woods, was a shining example of how to collaborate with multiple health care providers in order to create, implement, and practice “best-practice” policies and procedures intended to promote athlete safety. KSI was invited to travel to Springfield, MO to take part in the Conference, and it was inspiring to witness the rubber meet the road in regards to the practical application of research.

Throughout the two days of the conference, KSI staff led evidence-based educational sessions on exertional heat illnesses. KSI Vice-President of Communication and Education Dr. Yuri Hosokawa started off the conference on Friday morning with an evidence-based presentation about the prevention, recognition, and treatment of exertional heat illnesses. After the presentation, she led the participants through a practical lab session on the “best-practices” of responding to an individual suffering from exertional heat stroke (EHS).  The participants attending the Friday session of the conference included athletic trainers, coaches, sports medicine physicians, EMS personnel, and school administrators from local area high schools, given that these practical skills would be vital for treating one of their athletes in the event they developed EHS while participating in sports. On Friday afternoon, CoxHealth staff led mock emergency scenarios where participants  were able to gain hands-on practice of what they had learned in the morning. The participants took the scenarios seriously, which led to great discussions during the scenario debriefings. Additionally, the local Springfield news station recorded a news segment about the Conference in order to spread the word about emergency preparedness and athlete safety.

On the final day of the conference, the participants included physical therapists, physicians from other specialties, parents of young athletes, and other interested members of the community. Yuri and I geared our presentations to a slightly different audience, but the message was largely the same: evidence-based policies and procedures can indeed save lives.

Yuri and I were thankful to be invited to the 2017 CoxHealth Sports Medicine Conference, and proud to represent KSI at such an impressive collaborative event. Being in compliance with “best practice” emergency response policies is not always the easiest thing to do, but networks like CoxHealth Sports Medicine are proving that it can be done. Because of their efforts, the athletes they serve will undoubtedly be safe and well cared for.

Pre-College Summer @ UConn

Pre College Summer

By Rachel Katch, MS, ATC, Associate Director of Military and Occupational Safety

The Korey Stringer Institute at the University of Connecticut is conducting its first Emergency Issues in Sports Medicine Pre-College Summer academic focus. In total there will be four, 1-week (17.5 hour) long seminars targeted towards future leaders in the high school setting, which features a curriculum of evidence-based prevention, recognition, and treatment of the Nation’s leading emergency issues in sports, military, and occupational settings. Each session includes interactive presentations disseminated by the experienced staff of the Korey Stringer Institute, as well as a hands on learning lab simulating the emergency treatment of a life threatening aliment. A broad range of emergent topics will be covered during the sessions including:

 

  • Cardiovascular events
  • Exertional heat illnesses
  • Concussions
  • Traumatic injuries
  • And other significant contributors to sudden death

 

Despite recent and proposed rule and policy changes at all levels of activity (i.e., NFL, USA Youth Soccer, NCAA, etc.), including the now punishable act of head-to-head contact during tackling in football and the removal of heading in youth soccer, sudden death due to the above conditions can still be an inherent aspect of sport and physical activity. Participants can expect to learn imperative knowledge in the understanding of today’s leading causes of death in sport and physical activity, including essential firsthand skills in the prevention, recognition, and treatment of these emergent injuries and illnesses.

 

With our first Sports Medicine session in the books, our curriculum has been very well received by students and has been regarded as interactive, engaging, rigorous, and very informative. Students have come away from this course with a new understanding of sports medicine and the number one causes of sudden death in sport and physical activity. When asked what was the most interesting/important thing they learned in our seminar, all responded with a resounding, “Everything!” Unfortunately, registration has closed for our 2016 seminars; however, keep a look out next year for our 2017 Pre-College Summer Sports Medicine Seminars!

 

If you have questions regarding the Emergency Issues in Sports Medicine Pre-College Summer academic focus, or the activities of the Korey Stringer Institute, please contact Rachel Katch at rachel.katch@uconn.edu

Pre-College Summer at UConn

By Rachel Katch, Assistant Director of Military and Occupational Safety

Pre College Summer

The Pre-College Summer at UConn program is a rigorous academic opportunity offering rising high school juniors and seniors (class of 2017 or 2018) the chance to study and live on a top-ranked public university campus. Students are immersed in challenging and intensive one-week sessions in an academic area of their choice, choosing from a multitude of topic areas. The Korey Stringer Institute is proud to announce that we will be offering four sessions of our first ever Pre-College Summer Sports Medicine course.

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Our one-week (17.5 hour) programming features a curriculum of evidence-based prevention, recognition, and treatment of the nation’s leading emergency issues in sports, military, and occupational settings. Each session includes interactive presentations disseminated by the experienced staff of the Korey Stringer Institute, as well as hands on learning labs simulating the emergency treatment of life threatening aliments. A broad range of emergent topics will be covered during the sessions including:

  • Cardiovascular events
  • Exertional heat illnesses
  • Concussions
  • Traumatic injuries
  • Other significant contributors to sudden death

Despite recent and proposed rule and policy changes at all levels of activity (e.g., NFL, USA Youth Soccer, NCAA, etc.), including the now punishable act of head-to-head contact during tackling in football and the removal of heading in youth soccer, sudden death due to the above conditions can still be an inherent aspect of sport and physical activity. Participants can expect to learn imperative knowledge in the understanding of today’s leading causes of death in sport and physical activity, including essential firsthand skills in the prevention, recognition, and treatment of these emergent injuries and illnesses.

 

To register for our course, as well as find additional parent information regarding cost, accommodations, scheduling, etc., please visit the Pre-College Summer at UConn Sports Medicine website:

http://precollege-summer.uconn.edu/academic-areas/sport-medicine/

 

For any additional questions regarding the course’s curriculum, or the activities of the Korey Stringer Institute, please contact Rachel Katch at rachel.katch@uconn.edu. We look forward to seeing you in the summer!