Is Your Child Safe? The Current State of Sports Safety in the U.S.
- Dr. Steven Horwitz
- Apr 17, 2016
- 8 min read
"I'll always regret that Kelli and I relied on chance and luck when we signed up our son for football, and I'm going to tell you that way doesn't work."
Frank Cutinella, father of Tom Cutinella, a high school football player who died after a helmet to helmet hit.
"I sort of just sit there, secretly hoping at the end of every game that they walk of the field in one piece" (Video)
"you try and you pray for the kids every game like we do, to be safe, be healthy" (Article)
Our goal is to provide you with the tools to take the necessary action to make sports safety a reality.
Is your school or league prepared? Watch this!
Don't hope and pray - prepare and act!
"...many parents don't realize how under-resourced the medical care is for their child's team until they're facing an injured child and a dearth of options."
What is "the most vital and important subject" and the "top priority" of the California Interscholastic Federation? Sports Safety! (Ref)
When reading the article, please keep this statement by Dr. Doug Casa of the Korey Stringer Institute in mind,
"Nearly all of the causes of death in sport are influenced by the care [provided] in the first five to seven minutes." (Ref)
Is there Medical Staff at Your Child's Game or Practice?
The likelihood of having trained medical personnel at practices and games was called an “overwhelming challenge” by the National Federation of State High School Sports Associations (NFHS). (Ref) The National Athletic Trainer’s Association (NATA) states that only 37% of all high schools have even one full time athletic trainer and 30% of all high schools have no athletic training services whatsoever. (Ref) This begs the question, if there is only one ATC per school and there are about 8 – 12 sports per season in high school, which sport gets the trainer? And who takes care of the other sports?
"In those situations where a full-time trainer is not an option, schools must assign those duties to other individuals and develop an alternate plan for dealing with catastrophic injuries." (Ref)
What is this “alternate plan?”
Are Your Children's Coaches Trained in Sports Safety?
The National Athletic Trainer’s Association (NATA) says,
"Secondary schools without AT(C) services rely on sports coaches and administrators, such as athletic directors, to determine proper medical treatment when injuries and emergencies arise during a practice or competition. Unfortunately, most coaches do not have the proper medical education to treat injuries or recognize the common causes of life-threatening medical conditions, which puts the lives of athletes in jeopardy. Moreover, if coaches do recognize a medical emergency is present, they are not trained to treat life-threatening conditions, and it should not be their responsibility to do so [emphasis added]" (Ref)
However, when surveyed, most Athletic Directors had a different viewpoint.
They “believed the secondary school coach had sufficient knowledge and training to address the medical needs of student-athletes without an AT." (Ref)
Yet, even the most highly trained person can make an error under the stress of an on-the-field emergency. Read Case 1: Weiss v Pratt, Florida, 2011
So, if there are not enough athletic trainers to cover all the school sports and the coaches do not have the training or education to "treat life-threatening conditions" and "it should not be their responsibility to do so," who is caring for our children?
In the best case scenario, we are attempting to educate coaches with a biannual CPR course and an annual CDC concussion video. This is certainly better than nothing. But, is that training even close to enough to prepare that coach for an on the field emergency? Or to recognize an injury on the sidelines?
Even highly trained paramedics need regular training, practice, not just years of experience in handling cardiac arrest.
"Although out-of-hospital cardiac arrest (OHCA) is a major public health problem, individual paramedics are rarely exposed to these cases."
"Increased paramedic exposure [to out-of-hospital cardiac arrest, thus more opportunities to provide CPR] was associated with reduced odds of attempted resuscitation"
"Paramedic years of experience were not associated with survival."
How can you expect a coach with only biannual CPR training to effectively manage an on-the-field emergency situation?
Concussions
This disconnect is even more disturbing when it comes to concussions. The Zurich 2012 Consensus Statement states,
“Concussion is considered to be among the most complex injuries in sports medicine to diagnose, assess and manage.”
Yet, school systems and leagues think that this annual 30 minute CDC educational program is sufficient to educate coaches on emergency head injury management.
The statement goes on to say,
“At present, there is no perfect diagnostic test or marker that clinicians can rely on for an immediate diagnosis of concussion in the sporting environment. Because of this evolving process, it is not possible to rule out concussion when an injury event occurs associated with a transient neurological symptom.”
And even for the trained medical professional,
“The on-field evaluation of sports-related concussion is often a challenge given the elusiveness and variability of presentation, difficulty in making a timely diagnosis, specificity and sensitivity of sideline assessment tools, and the reliance on symptoms.”
"If your ask me how to diagnose a concussion with 100% accuracy, I will tell you I have no idea." Dan Garza, MD, Assistant Professor, Stanford School of Medicine, Assistant Director of Sports Medicine, Medical Director, San Francisco 49ers.
A helmet sensor went off in a high school player’s helmet. He was evaluated for a concussion. He was returned to the game. Read more here.
"These previous types of accelerations that maybe were not counted as hits, maybe they should be counted." Dan Garza, MD, Assistant Professor, Stanford School of Medicine
The first state concussion law, the Zachary Lystedt Law, was a REACTIVE (read not proactive!) response to a horrible injury. “Zach’s injury was preventable. If Zach had just been taken out of the game and remained out, he’d be like every other kid …”
Watch the video here.
How many student athletes are affected? Check out the real story in Dallas, Texas.
DFW Concussions Broken Down by School District and Sport
Does cumulative trauma matter?
Watch this episode of Friday Night Tykes. Watch from 36:35 - 37:55.
Sudden Cardiac Death
The disconnect continues with regard to Sudden Cardiac Death. The National Institute of Health states that rapid treatment of sudden cardiac arrest with an AED "can be lifesaving." (Ref)
Yet, just “19 states in the U.S. require that at least some of their schools have automated external defibrillators.” (Ref)
The two most important interventions for improving the outcome of patients who suffer an out-of-hospital cardiac arrest are timely defibrillation and the administration of high-quality chest compressions (Ref).
At least some schools systems are attempting to educate coaches with biannual CPR certification and a CDC concussion video. This is certainly better than nothing. But, is that training even close to enough to prepare that coach for an on the field emergency? Or to recognize an injury on the sidelines? The NATA says it is not.
Heat Injuries
"We don't cancel practice because of the heat." Football Coach
"What's your policy on players practicing when it's extremely hot in the summer? Well, we have no policy on that...." Deputy Director Arkansas Activities Association which oversees all high school activities in the state.
Two high school football players were practicing the same day in the summer of 2010. It was one of the hottest summers on record in Arkansas. Despite the heat, high school football teams across the state were practicing. On Friday the 13th of August, the heat index in Little Rock was 112.
Both suffered heat stroke on that day. Both were taken to the same hospital that day. They were the same build, same age, same height, and played the same sport.
What happened? One died. "Unfortunately there was more that a trained person could have done."
What was the difference? One team had a properly trained person (ATC) at all games and practices.
"We used to have the aid of a trainer, but we don't do that anymore. There's really not money there. It's not state mandated and a lot of schools just can't afford it. It's just another position that's got to come out of a tight budget already." Coach of boy that died.
Watch here. 2:00 - 4:00 and skip to 37:45 - 45:02
The Scariest Part of This Story - League Sports
What I have just discussed applies ONLY to the kids that play high school sports. What about league sports? Twice as many kids participate in league sports as compared to high school sports.
High School Sports stats - over 7 million youth athletes
League Sports stats - 20 to 40 million youth athletes
By and large, league sports have no sports safety training requirements for coaches. NONE! No ATCs, no education for coaches, and not even a sports physical is required for participation.
Here is a story about a youth soccer player who was saved thanks to several bystanders in the stands. Neither coach knew what to do! There was no plan and neither coach was properly trained or prepared! Read here.
Virtually no league implements an Emergency Action Plan. Some schools have one on a webpage or in a manual, but where is it when the coach needs it?
Does the coach know the field address?
Who runs onto the field to care for the athlete?
Who calls 9-1-1?
What do you tell the operator?
Do you have the child's emergency medical information and contact information immediately available?
Who cares for the rest of the team, who meets the ambulance?
Who travels with the child in the ambulance?
When the coach runs onto the field to care for the injured athlete, what does he/she do?
Is the injured child responsive or unresponsive, face up or face down, breathing or not breathing? Do they have a helmet on? Do you take it off?
Are you able to remove the facemask? How?
A Solution: When Hoping and Praying is Simply Not Enough
So, mom and dad, are you really willing to let a completely untrained, unprepared coach make a determination as to whether or not your child should go back into the game?
In other words, would you EVER drop your kids off at a public pool knowing there was no lifeguard on duty?
No!Then why do you drop off your kids at the sports fields without the knowledge that someone could take care of them if they got injured?
The NFHS says, "We wish we would not have to report another death in high school sports. That goal starts with continuing our efforts to minimize risk for the 12 million participants in high school activity programs." (Ref)
As Zach Lystadt’s dad says, “if there is no accountability, then there is no responsibility.” (Ref)
What is the solution? Is our approach simply going to remain a reactive response? Are we going to continue along the path of horrible injury which begets a lawsuit which begets a new law?
Think about this:
Why do all states now have concussion laws that are named after a youth athlete?
Why do most states have sudden cardiac death (or CPR) laws named after a youth athlete?
Read about the class action lawsuit against FIFA and US Soccer.
Concussion awareness in youth sports dictated by state law
"Playing safe and being able to continue to enjoy your sport for the rest of your life is ultimately what's the most important." Dr. Naomi Albertson
Nike said, "Risk Everything!" When it comes to safety, we say, "Risk Nothing! Be Prepared!"
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