Pro­tect­ing stu­dent-ath­letes from heat, head in­juries

Walker County Messenger - - Front Page - By Michael Ollove

An­other high school football player, this one a 14-year-old in the Bronx, col­lapsed on the field and died last week, pos­si­bly the re­sult of high heat and hu­mid­ity.

The death of Do­minick Bess of ap­par­ent car­diac ar­rest came at a time when thou­sands of high school ath­letes have re­turned to prac­tice fields. It again raises the ques­tion of whether states are do­ing enough to en­sure that stu­dent-ath­letes are safe as they col­lide into one an­other, run wind sprints, or dig in against hard-throw­ing pitch­ers.

Nearly 8 mil­lion kids par­tic­i­pated in high school sports last year, the most in U.S. his­tory. The shock­ing deaths of young stu­dent-ath­letes have prompted some states to weigh ma­jor changes.

The Cal­i­for­nia Leg­is­la­ture is con­sid­er­ing a bill that would bring ath­letic train­ers un­der state reg­u­la­tion. Oth­ers, in­clud­ing Texas and Florida, are strength­en­ing poli­cies on train­ing dur­ing high heat and hu­mid­ity and on the use of de­fib­ril­la­tors dur­ing sport­ing events and prac­tices. They are also mov­ing to re­quire schools to de­vise emer­gency plans for man­ag­ing cat­a­strophic sports in­juries. And in re­sponse to grow­ing con­cerns about con­cus­sions, the state of Texas re­cently em­barked on the largest study ever of brain in­juries to young ath­letes.

But over­all, a just re­leased study of state laws and poli­cies on sec­ondary school sports found that all states could do more to keep high school ath­letes safe. And some have a long way to go.

The study has prompted a strong push­back, in­clud­ing from the na­tional or­ga­ni­za­tion that rep­re­sents state high school ath­letic as­so­ci­a­tions. But it also has en­cour­aged some ath­letic train­ers and sports medicine physi­cians who hope poor rank­ings will im­pel their states to make im­prove­ments and avoid ex­pos­ing stu­dent- ath­letes to need­less risk.

“I was em­bar­rassed we were last,” said Chris Mathew­son, head ath­letic trainer at Pon­derosa High School in Parker, Colorado, speak­ing of his state’s show­ing in the study’s rank­ing of state safety ef­forts. “My hope is it will kick peo­ple in the pants and get peo­ple to do some­thing about it.”

The rank­ings were de­vised by the Korey Stringer In­sti­tute (KSI), also known as Stringer, which is a part of the Univer­sity of Con­necti­cut and pro­vides re­search, ed­u­ca­tion and ad­vo­cacy on safety mea­sures for ath­letes, sol­diers and la­bor­ers en­gag­ing in stren­u­ous phys­i­cal ac­tiv­ity. It was named for a Min­nesota Vik­ings of­fen­sive line­man who died of heat stroke dur­ing a pre­sea­son prac­tice in 2001. His death sparked changes in NFL train­ing prac­tices and in­flu­enced re­forms at the col­lege and high school lev­els as well.

The rank­ings are based on whether states have adopted more than three dozen poli­cies or laws de­rived from rec­om­men­da­tions pub­lished in 2013 by a task force that in­cluded rep­re­sen­ta­tives from KSI, the Na­tional Ath­letic Train­ers’ As­so­ci­a­tion and the Amer­i­can Col­lege of Sports Medicine. The rec­om­men­da­tions cover such ar­eas as pre­ven­tion of heat stroke, car­diac ar­rest and head trauma, as well as qual­i­fi­ca­tions of school ath­letic train­ers and ed­u­cat­ing coaches in safe prac­tices.

Some state ath­letic as­so­ci­a­tions, in­clud­ing Colorado’s, and the Na­tional Fed­er­a­tion of State High School As­so­ci­a­tions, known as NFHS, which rep­re­sents the as­so­ci­a­tions that gov­ern high school ex­tracur­ric­u­lar ac­tiv­i­ties, have ob­jected to the method­ol­ogy of those rank­ings. They say it re­lies too much on in­for­ma­tion found on the web­sites of state ath­letic as­so­ci­a­tions while fail­ing to note ef­forts those groups have un­der­taken to re­duce risks to high school ath­letes.

“By ‘grad­ing,’ state high school as­so­ci­a­tions based on a limited num­ber of cri­te­ria, KSI has cho­sen to shine a light on cer­tain ar­eas, but it has left oth­ers in the dark,” said Bob Gard­ner, NFHS ex­ec­u­tive di­rec­tor. He pointed to steps his group and its mem­bers have taken re­lated to safe ex­er­tion in heat and hu­mid­ity, use of de­fib­ril­la­tors and track­ing head in­juries, which Stringer didn’t take into ac­count.

In Colorado, Rhonda Blan­ford-Green, com­mis­sioner of the state’s High School Ac­tiv­i­ties As­so­ci­a­tion, said of­fi­cials are “com­fort­able and con­fi­dent that our [poli­cies] meet or ex­ceed stan­dards for stu­dent safety.”

She com­plained that Stringer’s method­ol­ogy is too rigid. For ex­am­ple, she noted that Stringer pe­nal­ized states that did not re­quire that all football coaches re­ceive safety train­ing taught by USA Football, the gov­ern­ing body for am­a­teur football. But, she said, Colorado coaches are trained in other pro­grams that she de­scribed as more com­pre­hen­sive.

She also noted that her as­so­ci­a­tion was pe­nal­ized be­cause it made pol­icy rec­om­men­da­tions to its high school mem­bers, rather than mak­ing them re­quire­ments, as Stringer prefers.

The scholas­tic as­so­ci­a­tion in Cal­i­for­nia, which fin­ished just ahead of Colorado, also ob­jected to the sur­vey. Its ex­ec­u­tive di­rec­tor, Roger Blake, sug­gested that fund­ing was a chief bar­rier to progress.

Cal­i­for­nia In­ter­scholas­tic Fed­er­a­tion “mem­ber schools will need more fund­ing, more AEDs [au­to­mated ex­ter­nal de­fib­ril­la­tors], more ath­letic train­ers and more re­search to help sup­port our ef­forts to min­i­miz­ing risk,” Blake said. “With the as­sis­tance of every­one who cares about young ath­letes, in­clud­ing KSI, we can con­tinue to progress.”

High School Deaths

Be­tween 1982 and 2015, 735 high school stu­dents died as a re­sult of their par­tic­i­pa­tion in school sports, ac­cord­ing to the Na­tional Cen­ter for Cat­a­strophic Sport In­jury Re­search at the Univer­sity of North Carolina. The vast ma­jor­ity of those deaths were re­lated to football, and three-quar­ters of the over­all deaths were at­trib­uted to car­diac ar­rest, res­pi­ra­tory fail­ure or other ail­ments as­so­ci­ated with phys­i­cal ex­er­tion. The rest were linked to trauma, such as head in­juries.

More of those deaths oc­curred in the 15 years prior to the year 2000 rather than the 15 years af­ter — likely a re­flec­tion of the fact that most of the poli­cies and laws per­tain­ing to safety in high school sports were put in place af­ter 2000, par­tic­u­larly in the last nine years.

In 2014-15, the last year for which there are statis­tics, 22 high school ath­letes died, 14 of them football play­ers.

Some of the re­forms carry the names of stu­dent-ath­letes who died while par­tic­i­pat­ing in school sports. That was true in North Carolina af­ter the 2008 death of Matthew Gfeller, a 15-year-old sopho­more line­backer who died in the fourth quar­ter of his first var­sity game in Win­ston-Salem af­ter col­lid­ing hel­met-to­hel­met with an­other player.

Now a foun­da­tion and a brain in­jury re­search in­sti­tute at the Univer­sity of North Carolina are named af­ter Matthew. His name and that of an­other North Carolina high school football player, Jaquan Waller, who died the same year as a re­sult of on-field head in­juries, are at­tached to a 2011 North Carolina law that spec­i­fies con­cus­sion ed­u­ca­tion for coaches and con­cus­sion pro­to­cols to be fol­lowed in high school ath­let­ics.

“Was the in­for­ma­tion out there in ’08?” said Matthew’s fa­ther Robert, who cre­ated the foun­da­tion. “No, but it’s out there now, big time.”

De­spite the progress, the Stringer rank­ings demon­strate the dis­tance many ath­letic train­ers and doc­tors be­lieve states still need to go to pro­tect stu­dent-ath­letes.

For in­stance, al­though North Carolina fin­ished No. 1 in the Stringer rank­ings, it has adopted only 79 per­cent of the laws or poli­cies used in the rank­ings. In par­tic­u­lar, Stringer found the state hadn’t done enough to make cer­tain that de­fib­ril­la­tors — and peo­ple trained to use them — were present at sport­ing events.

A Sense of Ur­gency

Many ath­letic train­ers, such as Ja­son Ben­nett, pres­i­dent of the Cal­i­for­nia Ath­letic Train­ers’ As­so­ci­a­tion, say the rank­ings should cre­ate ur­gency in his state and oth­ers. “This is life and death,” Ben­nett said. “The sad thing is that in many of these cases, the deaths were 100 per­cent pre­ventable.”

Cal­i­for­nia fared par­tic­u­larly poorly be­cause it is the only state that does not reg­u­late ath­letic train­ers.

“Some­times it’s the school’s jan­i­tor or maybe a friend of the coach,” said Demo­cratic Cal­i­for­nia As­sem­bly mem­ber Matt Dabab­neh, who in­tro­duced a bill that would cre­ate state li­cen­sure for ath­letic train­ers. “These are peo­ple who are mak­ing de­ci­sions about whether a kid who has just been hit in the head can safely go back into a game. And they have no qual­i­fi­ca­tions to make that de­ci­sion.”

The bill would not re­quire all schools to em­ploy an ath­letic trainer, al­though that’s ex­actly what many ath­letic train­ers and sports medicine doc­tors say would best en­sure the safety of stu­den­tath­letes.

“The No. 1 thing we can do to make high school and youth sports safer is to have ath­letic train­ers at any sport­ing event,” said Michael Seth Smith, co-med­i­cal di­rec­tor of a sports medicine pro­gram at the Univer­sity of Florida fo­cused on sports medicine for ado­les­cents and high school stu­dents.

A sur­vey from Stringer and oth­ers pub­lished this year found that fewer than 40 per­cent of public sec­ondary schools in the U.S. had a full-time ath­letic trainer.

Mathew­son, the ath­letic trainer in Colorado, said he has lit­tle sym­pa­thy for smaller schools who say they can’t af­ford ath­letic train­ers. “If you can af­ford to put a football team on the field, you should be able to af­ford an ath­letic trainer.”

In a num­ber of places, in­clud­ing in Florida and North Carolina, hos­pi­tals sub­si­dize ath­letic train­ers work­ing in public schools, some in the ex­pec­ta­tion that af­ter a year or two, the school dis­trict will pick up the costs.

Aside from the salary of an ath­letic trainer, schools could adopt most of the best prac­tices at an ini­tial cost of $5,000 and an out­lay of less than $2,500 a year there­after, ac­cord­ing to Springer CEO Doug Casa.

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