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WSSAAA News - February 2010
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NATA Youth Sports Safety Summit
Brendon P. McDermott, PhD, ATC
There have been 115 sport-related youth deaths since January 2008 in America. To address this growing problem, the National Athletic Training Association (NATA) recently organized the Alliance to Address the Youth Sports Safety Crisis in America and held a summit on January 12, 2010. The purpose of the alliance, comprised of 30 healthcare and sports organizations, is to raise awareness, advance legislation, and improve medical care for young athletes across the country. A major goal in this endeavor is to help put an end to what has been labeled a crisis.
The summit included nationally acclaimed medical experts, case history testimonials, and guest speakers who addressed catastrophic youth sports-related injuries and illnesses and stressed education, prevention, and treatment of these conditions. With nearly seven million high school students participating in sports today, there are a reported 715,000 high school sports-related injuries each year, and 8,000 children are treated in emergency rooms each day for related injuries. Recent studies point to a significant increase in catastrophic injuries that result in death or permanent disability despite best efforts to prevent and treat them.
The alliance encouraged a call to action and asked concerned individuals to take the following actions:
Ensure youth athletes have access to healthcare professionals qualified to make assessments and decisions.
Educate families about symptoms of musculoskeletal and neurological injuries.
Ensure pre-participation exams before play begins.
Ensure sports equipment and playing surfaces are checked for safety and best conditions.
Write to state legislators, expressing concerns.
Support further research into youth sport injuries and their effects.
Work to eliminate the culture of "playing through pain" without assessment.
Michael West, MS, ATC, athletic trainer and assistant principal at Patriot High School in Riverside, California, and president of the California Athletic Trainers' Association, moderated the event. He reiterated the critical need for legislation and education in light of the prolific increase in youth sport injuries today and set the tone for the compelling panel of speakers. West outlined the three areas of focus for the morning's program: concussion or traumatic brain injury, sudden cardiac arrest and the need for automated external defibrillators (AEDs), and exertional heat illness.
Robert S. Burger, MD, a Sacramento-based orthopaedic surgeon specializing in sports medicine, addressed the importance of preventing musculoskeletal trauma and lifelong injuries and disabilities. As a representative of the American Orthopaedic Society for Sports Medicine, he discussed the organization's Sports Trauma and Overuse Prevention program (STOP) and reinforced the vital relationship between the athletic trainer and orthopaedic surgeon.
Assembly member Mary Hayashi (CA) and Representative Elaine Smith (ID) spoke on the importance of education on the signs and symptoms, and potential long-term consequences of concussions and other sport-related conditions. They both mentioned that they are introducing bills for legislation to improve medical care for young athletes.
Cindy J. Chang, MD, former head team physician for the University of California's 27 athletic teams and assistant clinical professor at UC-Davis and UC-San Francisco, represented the American Medical Society for Sports Medicine and spoke at the summit in support of proper medical screening prior to athletic participation with standardized pre-participation physical examinations (PPEs). These screenings are currently widely absent or cursory prior to participation.
When utilized, PPEs can identify athletes requiring further testing, or conditions that warrant strict observation when physically active. They also provide team physicians and athletic trainers a medical history by which to base future medical decisions. Dr. Chang also stressed the importance of prompt recognition of a potential cardiac event, with the percentage of patient survival drastically decreasing after only three minutes.
Diane Claerbout, a member of the board of directors for Parent Heart Watch, who lost her own son from sudden cardiac arrest, recounted several compelling examples of youth fatalities from sudden cardiac arrest and death that could have been prevented with proper on-site care, and immediate use and access to AEDs. She emphasized the importance of proper screenings for pre-existing conditions and ensuring the right health professionals are available for immediate care. She advocates proper education and training as well as the presence of AEDs at every athletic event, practice or competition.
Rebecca A. Demorest, MD, associate medical director of pediatric and young adult sports medicine at Children's Hospital in Oakland, California, and Brendon P. McDermott, PhD, ATC, assistant professor in the graduate athletic training program at the University of Tennessee at Chattanooga, provided insight on exertional heat illness (EHI), the third leading cause of death in youth and adolescents.
Dr. Demorest, who represented the American Academy of Pediatrics at the summit, stressed the importance of proper hydration before, during, and after sports participation as a means of preventing heat illness. She discussed how to recognize signs and symptoms of EHI and ways to prevent and reduce its incidence.
Dr. McDermott added that complete prevention of heat illness is not possible, which makes proper recognition and treatment of the utmost importance. This requires properly trained medical professionals to be on site. With prompt assessment, death from heat stroke is 100 percent preventable. Adequate treatment modalities should be on-site as well. He also referenced the NATA preseason heat acclimatization guidelines for secondary school athletics as a vital resource. The recommendations include a gradual acclimatization plan, appropriate use of protective equipment and padding, and the scheduling of adequate rest breaks.
Leigh Steinberg, a nationally acclaimed sports attorney and the inspiration for the film "Jerry McGuire," recalled portions of his 30-year career in which he could visibly see the devastating toll concussions were taking on his clients. He has represented 150 professional and Olympic athletes and has seen how concussion can sideline an athlete from play and how critical proper diagnosis and treatment are--for athletes at all levels of sports--to ensure a safe return to play.
Kevin M. Guskiewicz, PhD, ATC, athletic trainer and department chair at the University of North Carolina at Chapel Hill, further supported previous speakers with research statistics documenting the many expected consequences of repeated concussions. A major point from Dr. Guskiewicz was that proper recognition of mild brain injury is important, both for the short- and long-term possibilities. Short-term repeated injury can result in the oft-fatal second impact syndrome, whereas long-term consequences of repeated concussions lead to increased prevalence of dementia, Alzheimer's, and decreased neurological function.
The only medical professional specifically trained to be on site and prevent, recognize, treat, and appropriately refer any of these conditions is an athletic trainer. Athletic trainers are required to demonstrate proficiency in differentiating potential catastrophic injuries and referring to appropriate medical professionals. They must demonstrate this before they can obtain a degree or be eligible to take their national board examination. Athletic administrators should assure proper medical coverage of all athletic practices and competitions, yet only an estimated 42 percent of high schools have access to an athletic trainer.
Beth Mallon and her son, Tommy, are well aware of the importance of proper coverage. They told the story of Tommy's situation when he was playing his last high school lacrosse game and he collided with an opponent with only two minutes remaining. The hit didn't look that bad, and many who witnessed the hit told Tommy to get up. The athletic trainer on site made sure to maintain C-spine alignment and did not let Tommy move. Tommy later found out that he had fractured a cervical vertebra and, most likely, would have caused catastrophic damage had he been allowed to move.
Beyond coverage of practices and events, proper screening with the PPE, development of an inclusive emergency action plan, purchasing medical equipment to execute the emergency action plan, and education of coaches, parents and athletes should be part of all youth, adolescent, and young adult athletic programs. We should all strive to help this endeavor and prevent the next death in youth athletics.
For more information and resources, please visit www.youthsportssafetyalliance.org.
Brendon P. McDermott, PhD, ATC, is an assistant professor in the graduate athletic training program at the University of Tennessee at Chattanooga. This article is reprinted with permission from the National Athletic Training Association.
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