Thursday, May 30, 2013

Dietary Supplements: Energy Drinks

The most popular dietary supplement outside of a multi-vitamins are energy drinks.  Red Bull.  Monster. 5-Hour Energy. NOS. Full Throttle and many others.  According to some research there are over 500 different energy drinks on the market.  I bring up the topic of energy drinks because they are particularly popular among teens and young people and some research has shown that energy drink companies are marketing to this group.  The biggest concern connected with energy drinks is the potential for caffeine intoxication and other side effects including seizures, mania and even sudden death.  To understand the popularity of these beverages in the United States you only need to know that in 2012 the energy drink market was valued at $12.5 billion and young adults are considered the core market. 

Energy drinks typically contain caffeine, taurine, sugars and sweeteners and herbal ingredients that are combined to give an “energy boost”.  These drinks are distinctly different from sports drinks and vitamin waters.  According to the National Federation of State High School Association (NFHS) Position Statement and Recommendations for the Use of Energy Drinks by Young Athletes, “An energy drink is a beverage marketed to both athletes and the general public as a quick and easy means of relieving fatigue and improving performance” usually using very high concentrations of caffeine and carbohydrates.  Energy drinks differ from sports drinks because sports drinks are designed to provide rehydration (and basic carbohydrate replacement) during or after athletic activity, containing a 6% - 8% carbohydrate solution and a combination of electrolytes formulated for maximum absorption.

Caffeine is typically the main active ingredient in any energy drink, containing 70-80mg per 8 ounce serving; energy shots can be even more concentrated.   To give you an idea, a typical energy drink contains about 3 times as much caffeine as a cola-based soft drink. The concern with energy drinks is that although the amount of caffeine (added as pure caffeine) may be listed on the ingredient label, the actual amount of caffeine in any given drink is hard to calculate. This calculation is difficult because most of these drinks include additional ingredients that contain caffeine, not reflected on the ingredient label.  Some typical additives are guarana, kola nut, yerba mate, cocoa, green tea, synephrine, and yohimbine among others.

The International Society of Sports Nutrition (ISSN) Position Stand:  Energy Drinks (2013) has published several tables that can easily help you understand the ingredient list of several common energy drinks in the United States as well as the purported effect of many of the ingredients found in energy drinks.

According to some study data teens consume 60 – 70 mg/day of caffeine, mostly from soft drinks.  Caffeine consumption has ranged as high as 800 mg/day in some studies and energy drinks are becoming more and more popular.  Some research shows that drink makers are even marketing to younger consumers.  These companies are savvy and use sporting events and athlete sponsorships, along with key product placement on social media sites and in video games to connect with your kids.  Consumption rates vary, with one study finding that 28% - 34% of 12 to 24 year-olds regularly consume energy drinks,  College students were particularly prone to consuming energy drinks habitually to improve energy (usually due to a lack of sleep). 

Energy drinks can pose a risk to anyone who consumes them, with the most commonly reported symptoms centering around caffeine toxicity.  Energy drinks are not regulated by the FDA because they are considered dietary supplements (unlike soda which is limited to 71 mg caffeine per 12 oz. soda).  The FDA is currently responsible for investigating “Adverse Event” reports related to energy drinks and energy shots.  Currently there are reports regarding Monster, Rockstar, Red Bull, and 5-Hour Energy that you can view HERE.

The top 10 side effects associated with energy drinks according to a study by the Medical Journal of Australia are listed below.  These results are based on analysis of 7 years of phone calls to their poison control center.
  1. Palpitations/tachycardia (rapid heart rate)
  2. Tremor/shaking
  3. Agitation/restlessness
  4. Gastrointestional upset
  5. Chest pan/ischemia
  6. Dizziness/syncope (fainting)
  7. Paraesthesia (altered sensation)
  8. Insomnia
  9. Respiratory distress
  10. Headache

Of these, the most concerning are the cardiac symptoms.  There is a concern that caffeine toxicity in children with a cardiac condition (known or unknown) could ultimately lead to death due to sudden cardiac arrest.  Cardiac events could be especially of concern in children with ADHD, an eating disorder or those with diabetes.  There is some research (although controversial) that suggests calcium deposition in the bone is decreased in adolescents because caffeine interferes with intestinal calcium absorption. I bring this up because the adolescent years are the period of the most significant bone development

An additional concern, particularly for college age adults is the combination of alcohol and energy drinks.  Doing so often gives individuals a false sense of sobriety, leading to poor decision-making.  This topic is beyond the scope of this post, but if you’d like more information check out this article to learn more about the warning issued by the American Medical Association.

Listed in this section are current position statements and other articles regarding the consumption of energy drinks with a particular focus on teen and adolescent consumption as sources allow.  I have used these sources to help inform this blog post, but I encourage you to read the full articles and position statements to gain a fuller understanding of the topic.

 Submitted by Heather L. Clemons, MS, MBA, ATC

Friday, May 24, 2013

Drew Babb's Incredible Journey from Arapahoe High School Lax Star to Denver Defenseman

How many athletes can you think of who have been forced to take three years off due to injury or sickness, only to come back stronger and start in their return to their respective sport? I can only think of one – Drew Babb, Senior Defenseman for the University of Denver Lacrosse team.

Drew Babb had just finished his high school career at Arapahoe High School where he was a four-year varsity letterman, a two-time All-State selection, an All-American as a mid-fielder, and a team captain who led his team to a state championship title in 2009. He was slated to play Division I lacrosse at the University of Denver, where he would presumably continue the immense success that he had in high school. Babb’s future coach at the University of Denver, Bill Tierney, was expecting nothing less of the talented, high school phenom.           
“He was a guy you couldn’t stop gushing about,” Coach Tierney told Lax Magazine in an interview last year. “What a great player this kid was.”
Unfortunately for Drew, the story was not going to go quite like that. Drew had been competing with neck pain in his senior season at Arapahoe after his neck began to swell in February of 2009. He was in and out of the doctor’s office for the next few months after repeated failed attempts to treat the swelling. Drew’s doctor had him take a full biopsy on July 1st after graduating from high school. The day after, Drew was watching TV when his father walked back into the house shortly after he was supposed to have left for work and passed on grave news to him from his doctor – Drew had been diagnosed with Stage I Hodgkin’s Lymphoma. Drew’s father received the results and delivered the news to his son. Drew was more shocked than panicked when he heard the news.
“When my Dad told me the news, he was very positive about it. It was very comforting to know how good it was that we caught it that early,” Drew told me over the phone.
Drew subsequently went through five months of chemotherapy while taking classes at the University of Denver during his freshman year. When asked about the difficulties of managing a college course load and attending practices along with the chemotherapy, Drew downplayed it and attributed his ability to manage the work to the administration and professors at DU. There are no classes at DU on Fridays, so Drew would receive chemo Friday, wait for the nausea to subside, and return to class on Monday.
“I would miss classes on Mondays occasionally, especially later in the treatment when the nausea was worse,” Drew commented.
At the end of this five-month period, the doctors could find no trace of the cancer. However, during the third round of his chemo, another obstacle blocked Drew’s path on his way to recovery. Like most cancer patients who endure chemotherapy, Drew lost his hair and was very nauseous. Although, in addition to the other symptoms, Drew had exceptionally bad body aches in his hips. He would later find out that the reason for this was Avascular Necrosis, which is a condition that was deteriorating Drew’s right hipbone because of a lack of blood supply. This meant a year’s worth of inactivity according to Drew’s doctors – thus ending his hopes of playing his freshman year at the University of Denver.

Even after being diagnosed with Hodgkin’s, Drew was expecting to be able to play in the spring of his freshman year. When he found out he had AVN in his right hip, he thought he would at least be ready to play by his sophomore year. When he was rehabbing in the summer of 2010, a week before the fall practices began, the doctors informed Drew that his right hipbone was growing back on schedule; however, the AVN was infecting his left hip as well, and it was not healing like his right hip did. Thus, the doctors drilled holes in Drew’s hips to increase blood flow to expedite bone regeneration. Unluckily for Drew, this meant that his collegiate career was being cut in half because he would not be able to play his sophomore season either.

Although Drew had not been cleared to play for two years, he was still around his teammates and assisting the team in whatever way he could. To stay in shape in the fall of 2010, Drew swam. As time went on, he began to use the stationary bike and the elliptical, but until he had his final bone scan, he would not be able to run unless it was evident that the AVN had disappeared and his hipbones were growing back.

When asked about the frustration of being on the sidelines, Drew said, “It was definitely frustrating, especially sophomore year it got tougher. I was expecting all freshman year to be able to play that season, and it didn’t happen.”

In February of his sophomore year, Drew received news from the doctors that he would be able to play again.
“The week leading up to those scans was the most uncomfortable week I felt throughout the whole experience of not being able to play, and that includes being diagnosed with cancer and going through chemotherapy. Because, essentially, [the scan] was going to determine whether or not I would ever be able to run again.”
That week, Drew met with Coach Tierney in what turned out to be one of the most calming and helpful conversations that Drew would have throughout his treatments. Coach Tierney asked Drew how he was doing, and Drew said he was nervous. Coach Tierney told Drew he may not understand why all of this stuff was happening to him now, but he will someday.

“That really helped me get back to that comfort level. Whether I can play or not was not up to me,” stated Drew after talking about the assurance of Coach Tierney’s words.

Drew always tried to stay positive about the whole process.  He is very open about his faith as a Christian, and it was that faith and the Christian household he grew up in that really helped him get through all of the hardships and stay positive. He stated that it was God’s plan, and that he will do what he can, but ultimately will trust in what God has in store for him.

Even after Drew was informed he would play again, that did not mean he was free of the challenges that being on a nationally ranked, division I lacrosse program would bring. Drew was an All-American mid-fielder in high school, but Coach Tierney was in need of defensemen when Drew’s junior year rolled around. To add even more obstacles to returning to his former self on the field, Drew was moved to close defense in the off-season after showing his propensity for the position in a scrimmage against the Denver Outlaws, the local professional lacrosse team.

When it came to switching positions, Drew just seemed happy to be back on the field and playing again. However, when he exceeded even his own expectations and saw a potential starting spot opening up for him, he began to appreciate the ability to play while also wanting to compete.

When Drew took the field for the first time since his injury, he described the day as follows:           
“It was surreal. During warm-ups, I was just looking around and realizing what I was about to do after what I had been through the past years. It was just so exciting to be playing instead of watching,” Drew said.
Evidently, it did not take Drew long to acclimate himself to playing a new position after taking two years off, because Drew started Denver’s season opener against the Ohio State Buckeyes and never looked back, starting all 16 games that season. He played through intense pain all year, and the amount he was allowed to play was at his own discretion.

In addition to the pain he felt because of the AVN, late in the regular season Drew tore his labrum and played through the pain believing it was the AVN. He went to the doctor for another scan, and was informed he would have to undergo another surgery to repair the labrum and spend six months recovering.

After yet another setback, Drew fought through it and did not allow self-pity to sink in.
“Every time I started feeling sorry for myself, I would start thinking about Tommy [Mallon] and his neck injury. I have seen friends go through things like this,” said Drew. “I did my chemo at the local children’s hospital and saw children taking chemo at ages 4 and 5. I would think about those kids going through worse diseases than me, and say if they could do it then so can I.”
Drew continues to play through the pain. When the weather changes it is especially bad, and on rare occasions he has to pull himself out of the game. At the beginning of this year, the labrum was brutal. However, as time has gone on he has gotten stronger and stronger.

“I feel stronger this year in the playoffs than I did in last year’s playoffs,” said Drew when asked about how he currently feels.

Drew and his teammates at the University of Denver play in the Lacrosse Nationals Semi-Final game against top-ranked Syracuse, and Drew likes their odds.
“We feel good about [tomorrow]. Once you get this far it is really anybody’s game,” said Drew about DU’s chances against the #1 team in Syracuse.
Drew succeeded in battling against cancer, bone deterioration, and a torn labrum just to play in tomorrow’s game, so upsetting the nation's top-ranked lacrosse team would just be like any other day for a guy like Drew.

Wednesday, May 22, 2013

Performance Enhancing Drugs: Anabolic Steroids

I posted last week about using dietary supplements as a way to improve athletic performance and gain a competitive edge; this week I am going to talk about performance enhancing drugs (PEDs).  My specific focus will be(anabolic) steroids, as the larger topic of PEDs is too broad to address in one blog entry.  Athletes who want to be the best at their sport will sometimes make the decision to utilize PEDs in order to gain that competitive edge.  These PEDs, while illegal, more importantly typically have damaging side effects from long-term use.  The focus of this blog is to make parents aware of the possibility that your child-athlete may be using steroids and how to recognize such use.  This post will not address the cultural pressures of sport that may cause young athletes to feel as though resorting to PED use is a key to their athletic success.

According to Drug Free Sport, Inc., PEDs are defined as, “any substance taken to perform better athletically.”  These substances typically fall in the following categories:
  • Ergogenic aids
  • Amphetamines
  • Prescription drugs
  • Alcohol
  • Over-the-counter drugs (OTCs)
  • Recreational and street drugs

Ergogenic aids is a particularly broad category that can include anabolic steroids, human growth hormone (HGH), ephedra (and its derivatives), and creatine to name a few.  Drug Free Sport, Inc. does provide some free information on its website, but is primarily a client-based service that provides information regarding many PEDs, banned substances and dietary analysis of dietary supplements.  Many NCAA institutions may have access to this resource as well as other leagues and teams.  If you’re wondering if a team or program your child is associated with has access, ask the appropriate administrator or coach.  If your child’s team or league does not have access, perhaps you could advocate for a membership as appropriate.  This site can be a valuable tool in learning more about what your child is ingesting and why they should avoid PEDs.

Last week I pointed you in the direction of the Taylor Hooton Foundation, whose mission is to educate us all on the prevalence of anabolic steroid (and more generally PED) use among middle school and high school athletes and non-athletes alike.  The organization was founded because of the suicide of Taylrr Hooton, a 17-year old from Plano, TX, as a result of using anabolic steroids.  According to their FACT SHEET, over 1.5 million teens (12-19 years old) admit to using steroids and it’s not just the boys.  The median age for using steroids for the first time is 15 years old.  Also, many users (62.5%) do so to improve their looks, not just their athletic performance.  Steroids can be found online in about 1 second.  Check out the fact sheet for more!

Anabolic steroids can result in a variety of physical and emotional signs that in combination should be a red flag for any parent.  The Taylor Hooton Foundation lists a variety of physical and psychological effects that range from acne, oily skin, and gynocomastia (male breasts) as well as severe mood swings, aggressiveness and sudden anger.  Girls who use steroids tend to develop typical male secondary sex characteristics such as deepened voice, facial hair, and irregular menstrual cycles.  Steroids negatively impact bone development and your liver, kidneys and heart.  These effects are often irreversible once you have discontinued steroid use.  Refer to this LINK for a complete description of all listed side effects.

The NATA Position Statement:  Anabolic-Androgenic Steroids (2012) takes a more clinician, evidence-based approach to addressing steroid use, but for those who are interested is some of the current references on the topic , you may find this source useful.  The statement reiterates and emphasizes the need for recognition and education around the topic of anabolic steroids, but includes information particularly relevant to college-age athletes.  The statement importantly notes there are situations where certain types of steroids may be used therapeutically, in very low doses.  Steroid abusers often uses extremely high doses of steroids in comparison. 

One of the biggest challenges for all parents is talking to their kids about difficult topics, drug use (of any kind) among them.  As a college athletic trainer I always found it challenging to talk to adult athletes about difficult topics when they were not my children.  I can only imagine the difficulty for parents trying to reach a child.  I am falling back to the Taylor Hooton Foundation here.  They have put in the time and effort and have an organized list of pointers to help you talk to your children about steroids, click HERE to learn more.  Most importantly, you should talk to your children before they have an opportunity to use steroids, set the expectation that such behavior is inappropriate, unsafe and illegal.  If you believe your child is using steroids you should conduct a urine test.  If you’re unable to complete a home test, take your child to the physician and specifically request it be tested for steroids. Screening for steroids is not part of a typical urine test panel.  It is important that you make the difficult choice as a parent to address the drug use and be persistent until you have reached your child and change their behavior.  Your child’s life could depend on it, especially at the middle and high school level where there may not be an athletic trainer (or another educated individual)  looking out for their safety.

The NATA Position Statement recommends random drug testing (as allowed) as part of a regular abuse prevention program.  At the collegiate level, drug testing programs are often a regular part of athletic participation.  These tests not only screen for steroids, but other banned substances.  Make yourself familiar with the NCAA Banned Substance List to understand exactly what athletes are being tested for.  Remember, the NCAA has also partnered with Drug Free Sport, Inc., so use them as additional resource as necessary.  You can also learn more about the standard drug testing procedure through the NCAA website.

As a parent of a high school athlete you may not have regular, random drug testing to help you determine if your child is using steroids (testing minors without consent is not allowed), making it even more important for you to recognize the signs and address the matter immediately.  As a previously mentioned, if you believe drug testing is a necessary step you may be able to purchase a test kit, or request that your family physician compete a steroid test.

As you review some of these resources you’ll notice how dietary supplements keep coming up.  The reason for this is the purity issue that I addressed last week.  According to the Taylor Hooton Foundation up to 20% of dietary supplements are spiked with a banned substance (often steroids), which is why it’s important to know what your child is taking.  You may believe your child is taking something that is safe, effective and pure.  Remember, if you are going to utilize dietary supplements, use those that have been verified as pure by a third-party verification system.

In the end, as parents all you can do is educate yourself and then educate your children to make positive choices.  Unfortunately, positive choices aren’t always the easy ones and children can make poor choices under pressure.  I hope this post has given you a head start on learning how to recognize steroid use in young athletes and the strength to help you send a powerful message about the dangers of anabolic steroids.  I hope that no one ever has to take the difficult step of confronting a child about steroid use, but should that situation arise, the earlier you recognize the signs and intervene, the better for your child and his or her health and safety.

Submitted by Heather L. Clemons, MS, MBA, ATC

Wednesday, May 15, 2013

Dietary Supplements 101

As the sporting landscape becomes more and more specialized and ultimately more competitive at a younger and younger age many athlete are looking to improve their performance in any way they can.  Often times this doesn’t mean just improving sports-specific skills and overall fitness through additional practice or training, it may mean considering dietary supplements as part of a daily regimen and diet.  While these supplements may be appropriate in some cases, it is important for parents to understand what their children may be taking.  The dietary supplement industry is a highly unregulated one, meaning choosing the right supplement that is proven effective can be challenging at best, in many cases.  Knowing this, what can parents do to learn more?   

As part of this post today I am going to point you to yet another position statement from the National Athletic Trainers Association:  Evaluation of Dietary Supplements for Performance Nutrition.  Obviously, the intended audience for this statement is athletic trainers who are often the first line of help with athletes who considering supplements, but much of the information is easily understood and appropriate for parents of young (high school) athletes who may be considering dietary supplements. 

According to the Federal Drug Administration (FDA) dietary supplements are defined as “products taken by mouth that contain a ‘dietary ingredient’ that include vitamins, minerals, amino acids, and herbs or botanicals as well as other substances that can be used to supplement the diet.”  These supplements can come in various forms:  tablets, capsules, powders, energy bars and liquids.  An important note regarding these supplements is that while the FDA regulates the definition of dietary supplements and labeling requirements, there is no requirement for third-party verification of the content of the supplements (meaning the purity is not guaranteed).

The NATA Position Statement makes several key recommendations regarding dietary supplements.  I always encourage people to read the entire position statement, but in an effort to help you focus on what I believe to be most important, here are key messages parents should be aware of:

  • When helping your child improve their performance the first option should always be to adapt the daily diet through natural food intake rather than supplements.  The body can more effectively use naturally occurring ingredients as opposed to synthetic ones.  Nutritional recommendations are beyond the scope of this post, but finding a local sports nutritionist may useful in some situations.
  • Dietary supplements are not clearly regulated through third-party verification to assure purity.  Safety cannot be assumed because they are sold over-the-counter and in some cases athletes may risk unknowingly ingesting a banned substance.
  • Be aware of the resources available that can help you understand the actual dietary analysis of any dietary supplement that your child may use.  A list of resources is available in the appendix of the position statement.  Utilizing these resources will help ensure the safety, purity and efficacy of a given substance.
  •  If you are a parent that who likes to do research on your own be careful when looking at efficacy data regarding any given supplement since an overwhelming majority of it is done by the company who produces the supplement.  This potential conflict of interest may result in misleading efficacy information regarding that particular dietary supplement.

In the end, it is important that you gather as much information as you can before allowing your child to use a dietary supplement.  The position statement includes a decision-making algorithm that will walk you through all the important questions you should ask before making a final decision.  The appendix includes resources regarding:  1) food/nutrition, 2) regulatory information, 3) safety, 4) purity (third party verification), and 5) efficacy information and fact sheets.  Utilizing these resources should give you some comfort in your final decision.  I would always advocate that any dietary performance improvements be made through your daily food intake, but in some situations dietary supplements are a key addition.  If a dietary supplement is appropriate for your situation I encourage you to do the work to educate yourself to be sure you’re making the best choice for your specific need.

NOTE:  In a future post I will take the time to address the issue of supplement purity and the potential to test positive for a banned substance (particularly for college athletes) as I discuss performance enhancing drug (PEDs) use with athletes.  As a primer check out this information from the Taylor Hooten Foundation.

Submitted by Heather L. Clemons, MS, MBA, ATC

Wednesday, May 8, 2013

Bringing an Athletic Trainer Position to Your High School: Getting Started

If you are the parent of a child who participates in organized sports at their high school you want to know who is taking care of your kid from a health and safety standpoint.  A4IA (and other research) has shown that person should be an athletic trainer.  If your child’s school already employs an athletic trainer then that is good news for your child, your school, all of the other student athletes.  This is also good news all of the student athletes from other schools that come to your school for some type of game or competition who will have access to a medical professional if the need arises.  If your child’s school does not employ an athletic trainer then as a parent you should be not asking, but demanding that the school find a way to have an athletic trainer available for all student athletes.

An athletic trainer’s educational background and scope of practice is not the focus of this blog post.  For that information please go to the National Athletic Trainers’ Association website, the Board of Certification, Inc. website or to to find out more about the athletic training profession.  These websites have the complete listing of all educational requirements necessary to become an athletic trainer as well as provide a summary of the skills an athletic trainer possesses.  In this blog post I intend provide the tools necessary for a parent, coach, administrator, or someone else a framework to propose the addition of an athletic trainer to the high school (or district) staff.

The most important resource for anyone who is proposing an athletic training position be added at their school is the Position Proposal Guide developed by the NATA Secondary School Athletic Trainers Committee. This document provides resources that a person should have to before they speak with representatives of a school district.  As a parent (or anyone else initiating the proposal) take some time to go through this document and that way you will be able to make a more articulate argument for the addition of an athletic trainer.  NOTE:  This guide, originally published in 2002 is currently being updated, as the timeline for the new guide becomes available, we'll let you know.

It is critical for parents (or others) who are proposing adding additional staff go through the chain of command when speaking to various school and district representatives.  While it seems like you should start at the top of the food chain and go straight to the school board that usually is not the best plan.  Going through the chain of command may take a little longer, but it helps the parent gauge the support level of each person.  Once the parent knows what the level of support is and what the concerns of each individual in the chain are it is much easier to formulate a lucid argument and address concerns of all parties regarding the addition of an athletic trainer.
The decision-making chain of command in school districts usually goes something along the lines of head coach, athletic director, HS Administration, District Administration, and finally the School Board.  Skipping steps in the chain of command can lead to alienating the people that were skipped.  This alienation can lead to potential opponents to your proposal.  To maximize the potential for success it is important to build relationships with as many allies as possible.  Promote the positives and address concerns.
When speaking with any of people in the chain of command the parent (or other advocate) should try to schedule appointment with the person/administrator so that there is designated, uninterrupted time to spend discussing the proposal.  Whether or not that person is approachable and willing to talk to you at an event or at a chance meeting in the community, sitting down in a quiet office and talking face-to-face is still the best approach.  Scheduling a one-on-one meeting gives you the best opportunity to provide a clear, concise rationale for your request and provide current, accurate information without being interrupted, distracted or having others present who provide confusing or inaccurate information.  Speaking face-to-face in a scheduled appointment will allow the administrator you are meeting with to focus solely on you, ask questions, and take notes.

Once your meeting is scheduled, you must be prepared.  Collect, organize and review the necessary data and information before you go to the meeting and be sure to bring it with you to the meeting.  Providing hard copies of key information you’d like to leave with the administrator(s) may be highly useful.  You need to make a clear argument about why it is that the school should have an athletic trainer (use the position proposal guide!).  You should also emphasize the position needs to be a dedicated staff position (this should connect to why an AT is best for the job) with a specific role: to deal with the prevention, treatment, care, and rehabilitation of the injuries suffered by the student athletes at the school.  In 2013 most people you connect with will agree that an athletic trainer should be available for all student athletes.  Unfortunately, these same people will often argue that, “We would love to have an athletic trainer, but we just can’t afford it.”  Do not let them make that argument and have the meeting end.  It is critical that you as the parent (or other advocate) do some research so that you can refute the lack of finances argument.  Potential arguments to refute this claim can range from providing creative options to pay for the position (find out what comparable schools in your area and state are doing) to demonstrating that the costs for the positions are heavily outweighed by the benefits in terms of improved healthcare, safety and decreased liability.  When using other schools as examples it is important that they are similar to your school in size, sport offerings and budget so that your argument is that much more compelling.
Hopefully, as you meet with each school representative they will agree with your request and forward it to the next person in the chain of command, ultimately leading to a proposal before the school board.  In reality it is likely that you will face some resistance as you move through the proposal process well before it reaches the school board.  If the person you meet with does not share your view that the district should hire an athletic trainer, then be clear that this is not a request that you will give up on and let them know that you will continue to pursue it with a different person.  This may be where it is important to have the support of others who have vested interest in having an athletic trainer (especially parents).
Remember that the wheels of progress often move very slowly in the education world.  Adding staff is not something that schools do very often, so it may take some time.  As a parent of a student in a school without an athletic trainer you should look it at as your responsibility to provide the district with a compelling argument to add an athletic trainer.  The old adage is that the squeaky wheel gets the grease.  If you can make a strong argument to the decision-makers in a school district then they will have to consider and hopefully act on your request.
Post submitted by guest blogger, Michael Carroll.  Head Athletic Trainer at Stephenville HS, Stephenville, Texas.


Wednesday, May 1, 2013

Protecting Yourself in the Summer: Lightning Safety

The summer is a great time for travel, the beach and other adventures (athletic or otherwise).  Many of these adventures are likely to be outdoors given the warm sun and the cool breezes that this time of year can bring.  Last week I reminded everyone to play it safe in the sun and to protect yourself from sunburn and skin cancer. (If you missed last week’s post, click here.)This week I’d like to talk about lightning safety.  Lightning-related deaths are consistently in the top 2 of storm-related deaths each year in the United States.  Over the last decade there have been an average of 42 deaths and an estimated 10 times as many injuries in the US annually.  It is very important to get yourself and those with you to safety in the event of a storm.  This blog post will outline some of the key things you should know to protect yourself in the event of lightning.

The recommendations I will be making today will be based on the National Athletic Trainers’ Association Position Statement:  Lightning Safety for Athletics and Recreation (2013).  There are other resources you can access to learn more about lightning safety available from the National Oceanic and Atmospheric Administration. The linked NATA Position Statement consolidates much of the important information you need to know whether you are an individual trying to get yourself to safety or you are enacting an Emergency Action Plan (EAP) at a large sporting venue.


  1. Formalize and implement a comprehensive lightning-safety policy or emergency action plan (EAP).
  2. Designate and locate primary choices for a safe location in the event of a lightning strike.
  3. Designate and locate secondary choices for a safe location in the event of lightning strike.
  4. Seek a safe structure or location at the first sign of lightning or thunder activity.
  5. Postpone or suspend activity if a thunderstorm appears imminent before or during an activity or contest regardless of whether lightning is seen or thunder is heard.
  6.  Suspended activities should only be resumed if 30 minutes have passed since the last sound of thunder or lightning flash.
  7. Avoid being in contact with, or in proximity to the highest point of an open field or on the open water.
  8. Avoid taking showers and using plumbing facilities and land-line telephones.  If a phone must be used in an emergency cell phones are safer.
  9. Assume the lightning safe position if you feel your hair stand on end or your skin tingle.  Do not lie flat on the ground.
  10. Know the appropriate first aid procedures for a lightning strike victim.

The most important thing anyone can do is understand your risk for thunderstorms and lightning strikes.  That means knowing if you’re in an area where thunderstorms are common as well as having a dependable weather report resource available for decision-making.  This map is from the National Oceanic and Atmospheric Administration (NOAA) represents the lightning strike density based on data collected by the National Lightning Detection Network (NLDN).  To read the map, the more red the area the greater the lightning strike density, meaning those in Florida and other areas of the Southeast and Midwest are most at risk.

For those of you who are not planning the athletic event it may not be your responsibility to develop a lightning safety specific EAP, but if you are I encourage you to be proactive and have a plan.  For those of you attending tournaments and events, make sure you know what the plan is.  It is especially important to know what the event will be using as primary and secondary safe locations and how long it will take you to get to those locations should a storm move into the area.  There may be times where a storm approaches suddenly and you have little time to get to safety, knowing where you need to go in advance will save you time and worry. 

As soon as you see lightning or hear thunder you should get to a designated safe location and seek shelter.  Previous recommendations stated that once the flash-to-bang reached 30 seconds you should begin to seek shelter.  This recommendation has now become once the flash-to-bang reached 30 seconds you should ALREADY be in a safe location.  The flash to bang time is the number of seconds between the lightning flash and its associated thunder boom.  Five seconds of time is equal to one mile of distance to strike from where you’re standing.  A time of 30 seconds means the lightning is within 6 miles and can potentially strike where you’re standing next (it’s been shown to jump up to 6 miles from strike to strike).  Once it’s clear you need to leave, you need to know where to go.

PRIMARY SAFE LOCATION:  Any substantial building that has plumbing, electrical wiring and telephone service would make an ideal safe location.  It is likely that the lightning current is more likely to follow plumbing, electrical wiring and telephone wiring to the ground, aiding in grounding the structure.  However, given the conductive nature of plumbing and wiring congregating in locker-room shower areas, swimming pools or areas with a large number of electrical appliances should be avoided.

SECONDARY SAFE LOCATION:  The best example of a secondary safe location is an automobile.  The metal (not the rubber in the tires) in the car ground the car and make it a safe alternative for seeking shelter in a storm if something else is not available.  Be sure the windows are rolled up.  A convertible, golf cart, bleachers or a storage shed are not acceptable safe locations.

If you are caught outside and you don’t have an option to seek shelter the most important thing is DO NOT seek shelter underneath a tree or other tall objects in the area.  Lightning is attracted to the tallest objects and highest points in an area and so these should be avoided.  Your goal should be to assume the lightning safe position in the largest, lowest open area you can find (especially if your hair has started to stand up and you feel your skin tingling).  Doing this minimizes your contact with the ground and makes you as small as possible.  DO NOT lie flat on the ground.

The Emergency Action Plan should clearly delineate the decision-making process for postponing or suspending events and activities.  It’s important that decisions about events be made if a storm appears to be imminent based on available data, not once the storm has begun.  Once an event has been suspended it should not be resumed until the lightning and thunder has stopped for at least 30 minutes.  If you’re interested in decision-making for large athletic venues review that section of the position statement, since it’s beyond the scope of this blog post.

Individuals can be injured by the lightning strike itself, as well as by the secondary results of the strike such as fire, falling objects or the strike shockwaves.  If you are in a position to help, the victim should be moved to a safe location, but do not compromise your own safety to help.  Once to safety, it’s likely you will need to begin CPR and rescue breathing.  If an AED is available it should be used as soon as possible.  Remember, victims do not carry an electrical charge after they have been struck, you can safely tough them without being injured yourself.  Additional information about caring for lightning victims and the long-term effects of injury are available in the NATA Position Statement.

As an athletic trainer for the last 15 years I have had plenty of situations where thunderstorms and lightning have impacted athletic events I have covered.  Sometimes these events were postponed and resumed, sometimes they were cancelled.  Reflecting on my personal experiences with lightning safety if I could give parents and athletes any advice on how to handle such situations, it would be to please listen to those in charge and do what they ask.  As appropriate move to the designated safe location and wait for further instructions, even if you don’t see lightning or hear thunder.  They have your best interest in mind (as well as access to weather forecasting and other information you may not).  Also, I know that your first instinct may be to run under the bleachers or the nearest tree to take shelter from the rain, but this actually puts you at further risk for being struck by lightning.  In the end, know the lightning safety plan for where you are and listen to the decision-maker in case of an impending storm and stay safe!

‘‘NO Place Outside Is Safe When Thunderstorms Are In
The Area!’’

‘‘When Thunder Roars, Go Indoors!’’

Submitted by Heather L. Clemons, MS, MBA, ATC