School Sports Deaths May Be Avoidable With Key Policy Changes: Report

A prominent sports journal is calling for key policy changes for high school and middle school sports programs throughout the country, which are designed to help reduce the number of school sports deaths that occur nationwide.

In a statement published last week in the Journal of Athletic Training, a journal published by the National Athletic Trainers Association, several risks and practices were outlined that may mitigate the harm athletes face during school sports activities.

The Korey Stringer Institute, Department of Kinesiology, at the University of Connecticut issued the recommended best practices, calling for school sports programs at every level to implement certain, simple interventions that will help keep athletes safe, and reduce the number of sudden deaths during sports activities.

More than 90 percent of sudden deaths in sports are due to four top causes, sudden cardiac arrest, exertional heat stroke, head injuries, and exertional sickling. Of the four, more than 75 percent are due to sudden cardiac arrest.

Researchers from the Korey Stringer Institute say evidence based safety policies can prevent many of these deaths. Simply instituting heat acclimatization, sickle cell trait testing, the “Heads Up Football” safety program, and requiring automated external defibrillators (AEDs) will reduce the heightened risk of all four dangers.

School Sports Safety Recommendations

Researchers outlined a list of interventions that may reduce the number of school sports injuries and deaths.

In response to increasing concerns about the impact of sports head injuries, the American Academy of Neurology issued updated concussion guidelines in 2013. The guidelines recommend that athletes who have sustained even a mild concussion should leave the game immediately, and sit it out until the most severe symptoms have subsided.

Amid the new recommendations is a focus on exertional sickling, which causes a decrease in blood flow and can occur in athletes who carry the sickle cell trait. By calling for mandatory screening, deaths attributed to exertional sickling can be reduced.

Throughout 2000 – 2010, at least 10 exertional sickling deaths occurred at Division I football programs. After 2010, when the NCAA required institutions to offer sickle cell trait screening or documentation of prior screening, only one death was attributed to the condition.

Mandating heat acclimatization policies during the hottest months of the year call for athletes to gradually return to practices and exertion.

The policy recommends no more than one practice per day in the first five days, no more than three hours of practice per day, with athletes wearing only a helmet, if appropriate, and no extra equipment on day one and two of practice. Then all protective equipment can be worn and full contact made on day six.

By week two, athletes can begin twice a day sessions, but those should alternate with once a day sessions. During twice a day sessions, the two sessions should be separated by at least three hours and held in a cool environment.

The NCAA implemented heat acclimatization guidelines in 2003; since then heatstroke related deaths dropped. The policy has saved an estimated 20 lives, among college football players. But the majority of states do not mandate these policies for high school athletes. Only 15 states have adopted similar guidelines.

Researchers say, most states wait to make changes until after a tragedy has occurred and often coaches give the most kickback, because of the change required to implement the policies.

Youth Sports Deaths

Sudden cardiac arrest is the cause of the most sudden deaths in youth sports. However, it is largely survivable through immediate recognition. Authors of the policy statement call for access to AEDs within one minute of collapse.

The machines must be in easy reach of every sports venues and schools, and many schools may need more than one AED. The cost is $1,000 per machine.

“Heads Up Football” is a program launched by USA Football, which addresses tackling, blocking techniques, equipment fitting, and reducing player contact during practices. It has helped to reduce injuries, including concussions.

Currently only Oregon state requires the “Heads Up Football” program at the high school level. Eleven states endorse the program, but do not require it.

The American Academy of Pediatrics called for changes to youth sports last year; including, less contact and improved enforcement of rules. The AAP recommended changes, including the expansion of non-tackling leagues, called for heightened safety for youth football amid growing concerns of brain injuries.

Researchers say having a certified athletic trainer can also help, they can specifically recognize and respond when serious injuries occur. Many states require a trainer to be present at certain sporting events, but not all athletic events or practices. A study published in 2013, concluded athletes who return to play too soon face higher risk of suffering a second brain injury with more severe consequences.

College sports are regulated by the NCAA nationwide, but for high schools regulation varies by state. It may be harder to standardize smaller schools, clubs and camps because of their size.