State-by-state Secondary School Athletic Trainer Map

Four years ago the National Athletic Trainers’ Association (NATA) and the Korey Stringer Institute (KSI) embarked a large scale project, known as the CATCH-ON study, which we have posted about back in November of 2013 and again in June of 2014 in our blog where we called public and private high schools all across the United States. KSI successfully called over 20,000 schools if you don’t include technical, magnet, and charter schools. The NATA wanted to determine how many schools all across the country have Athletic Trainers (AT), if the AT was part-time, full-time, working in a clinic, etc., and they also wanted to know questions like “How many athletes are in your school?”, “If you don’t have an AT, why?”, and “What type of medical coverage do you have?” Lastly, potentially the most important question we asked of each school and the reason for writing today was “What is your zip code?” Yes….that’s right, your zip code!

With each zip code, we at KSI were able to map each school that we called all across the country and state-by-state in a software program called ZeeMaps. The ZeeMaps software utilizes Google Maps and allows you to create your own custom maps. So what did we do? We first created maps (as seen below for the state of New York) for each state based on the results of the calling for both public and private schools separately. If a high school had an AT it was categorized as “green” while those without were “red”, and schools that did not respond to our survey were defaulted as “black.”

We knew that maps like these would be convenient in identifying the strategies to promote athletic training services in the secondary school settings. In fact, the information included in these maps were immediately demanded by the NATA as they were in the process of combining forces with the National Football League (NFL) Foundation to launch the NFL Foundation’s AT Grant Initiative (http://www.nata.org/nata-news-blog/latest-nfl-foundations-grant-initiative), where the NFL the NATA and the Professional Football Athletic Trainers’ Society have teamed up to get AT services provided in the 31 NFL cities at high schools that need it the most. The NFL Foundation agreed to provide a $1 million dollars and NATA $125,000 towards the initiative, and currently 16/32 teams have applied. In order for the NFL and NATA to identify which high schools their clubs should reach out to, they looked to KSI’s expertise and our ZeeMaps.

KSI provided the Athletic Trainer ZeeMaps to any NFL club head Athletic Trainer or community relations director so that they could identify (1) which high schools in their areas did not have AT’s, and (2) which schools they would be able to coordinate AT services to.

The feedback on these maps was fantastic. KSI and NATA will continue to work on this initiative to gather more data to enhance the maps so that state athletic training associations could be more informed about their own state’s numbers. Specifically, the state athletic training associations wanted to see to what the employment status is for each high school (as depicted below for Missouri) by utilizing the map’s function to select out Full Time and Part Time . Furthermore, continuing this project will help the NATA keep tabs on what the job market is like for ATs and most importantly help them reach their goal in getting AT services into every high school across the country.

We plan on releasing the ZeeMaps for public access in the spring of 2015.

11 Ways to Improve Concussion Guidelines- Reflection from Hartford Courant article series

Last week, the Hartford Courant featured a four-day series on issues surrounding the risks and the recent heightened awareness of concussions in sport. The societal concern over sport related concussions seems to have accelerated as the National Football League, National Collegiate Athletic Association, and the military put more focus on setting guidelines and rule changes to better manage concussions and to provide adequate time and a plan to return concussed athletes back to the playing field.

Currently, all fifty states have a concussion law in place to address the concussion issues in high school sports; however, the details of the law in each state varies greatly, and much could be done (and should be done) to enhance the law to effectively minimize the risk of brain injuries that could have been prevented. Many state high school athletic associations also have guidelines set for their school’s athletics program.

The Korey Stringer Institute (KSI), a not-for profit organization that is housed at the University of Connecticut, works to advocate for the safety and prevention of sudden death in sport and physical activity. KSI endorses the following eleven criteria for concussion policies that follow minimum best practices that should be included in the guidelines for each state’s athletic associations and written into the legislative laws surrounding concussion:

1. Schools should develop an EAP for handling potentially life-threatening injuries and a referral plan for concussions
2. Use certified helmets/equipment
3. The pre-participation exam should include concussion specific questions
4. Preseason education for personnel, coaches, and athletes (should be tailored to the group being taught, strongly recommend educational materials for parents) on basics of concussion (i.e. that helmets do not prevent cerebral concussions, signs and symptoms, treatment, testing options, return to play considerations)
5. High school athletes suspected of sustaining a concussion are not permitted to return to a practice, game, or activity involving exertional activity on the same day.
6. Athletes suspected of a concussion are not permitted to return to participation until written release from a licensed physician or athletic trainer
7. No child/adolescent should return to sport/activity unless he/she has managed to return to school
8. Implementation of a graduated return to participation protocol (see Zurich/AMSSM example, at least 5 steps, no more than 2 in one day)
9. Comprehensive medical-management plan for acute care of a potential head or cervical spine injury
10. Limiting the number of contact by monitoring the number of hits made or sustained and also keeping track of total practice time
11. Strict enforcement to remove head contacts out of the game by placing rules such as suspension from the game once intentional head contact is witnessed.

Starting next year, Connecticut Interscholastic Athletic Conference (CIAC) will introduce a new guideline to limit the total number of regular season football games, including the playoffs, to ten. CIAC is also drafting a guideline to mandate at least four to five days between the three-playoff games, but the number of days is still yet to be determined.

Just like the state of Connecticut, many states are striving to make improvements in their concussion laws every year to reflect the evidenced-based practice and recent research findings. However, unless the laws and guidelines are reinforced and mandated by the high school athletics associations with strict penalties for violating the law, we are unlikely to change the behavior of coaches, parents and athletes. In addition, the public must understand that the risk of concussion is inherent in every sport, not just football. The false sense of security among athletes parents and coaches of non-football sports may put themselves at a greater risk from complications from concussions due to lack of recognition, prevention, and management plans.

In the desperate need to better recognize and prevent sport related concussions, many research groups and companies have introduced potential ways to quantify and monitor the impacts from collisions. However, consumers must be sensible to the fact that there currently is no device or technology that could detect or prevent concussions. Many companies are aware of their limitations in their products and often have disclaimers, but those may not be obvious to the consumers and provide them with misleading information that could lead to a false sense of security. Thus including parents in concussion education becomes essential in providing them with good knowledge to make appropriate decisions for their children’s safety.

We are at a time where we have the momentum to make changes to make sports safer. The state legislators and state high school athletics associations have the duty to keep the laws and guidelines up-to-date with the current evidence-based medicine, and the duty to ensure that everyone is adherent to them. We must continue to make more effort to ensure that correct information is being delivered to the coaches, parents and athletes via education, and that the education is leading a behavioral change for better and safer game.

1st Sports Safety Symposium in Japan

The first annual Sports Safety Symposium in Japan was held in Tokyo, Japan on December 29^th, 2014. This symposium was hosted by Sports Safety Japan, a not-for-profit organization based in Tokyo whose mission is to bring awareness of sports safety to Japanese society and promote safer sports via education.

Speakers at the symposium came from various backgrounds: Mr. Koichiro Mochizuki, a lawyer from Toranomon law firm who has worked numerous cases related to sudden death in sports; Dr. Ryo Uchida, a professor from Nagoya University who is known for the work that investigated the Judo related deaths in youth athletes; Mr. Katsuhiro Ichihara, ATC, who presented the importance of emergency action plans along with his personal experience in working with major and minor league baseball; and Mr. Yutaka Saho ,ATC, the COO of Sports Safety Japan, who presented his future visions and initiatives to fulfill the organization’s mission to promote safer sports.

Yuri Hosokawa, MAT, ATC from the Korey Stringer Institute was also one of the speakers who spoke at the symposium. She presented “lessons learned” from how sports organizations and athletics associations in the United States have evolved to ensure athlete safety and provided examples of initiatives that KSI and other organizations have done and are currently working on to promote sports safety in sport and physical activity.

Similar to what we are observing in the U.S. after the lawsuit filed by the NFLPA against the NFL regarding concussions sustained by retired players and the long term health effects of those injuries, Japanese society is also starting to realize the lack of education and the false sense of security that made people believe “nothing bad will happen”. That is not the case anymore. Athletic trainers, teachers, parents, school board administrators, and coaches in Japan are now starting to raise questions; how can we make sports safer? Why do similar deaths occur in youth sports? What can we do better to prevent deaths from happening again? Was it really an accident that could not have been prevented?

The Sports Safety Symposium was the first of its kind to be held in Japan. It was an eye-opening event for KSI to learn that many issues and obstacles addressed in the symposium were similar to what we are seeing in the U.S., too. #Strive2Protect