FOOTBALL HELMETS: CERTIFICATION & FITTING

It’s that time of year.  July has flown by and the calendar will turn to August in just a few days.  NFL training camps have already started and pre-season practices will start for colleges and high schools in the coming days and weeks.  Football isn’t the only sport that is ramping up, but it is one of the most equipment intensive.  The continued attention on concussions and minimizing their likelihood has put focus on the equipment, especially helmets.  If you’re not familiar with the guidelines that govern helmets it can be overwhelming.  While no helmet will prevent concussions entirely, properly certified and fit helmets are the most effective at minimizing the risk.

NOCSAE CERTIFICATION

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) is the organization that certifies football helmets in the United States.  They also certify other sport helmets including softball/baseball, lacrosse and hockey.  When checking out your child’s equipment or communicating with the league regarding equipment check for a current NOCSAE label on the back of the helmet.  Schutt, one of the major helmet manufacturers has even started putting QR codes in the NOCSAE label to teach parents and athletes about concussions. 

The NOCSAE certification means the helmet has gone through various laboratory test to assess their ability to withstand a variety of forces.  Once the helmet passes the testing and meets the appropriate standard the helmet receives its NOCSAE label and can be sold by its manufacturer.  For helmets that have  been used for a season they are sent back to the manufacturer to be recertified.  NOCSAE also has specific standards for the recertification process.  If you want to learn more about the reconditioning and recertification process you can check out these videos by Riddell, Schutt and Xenith, three of the major helmet manufacturers.  

SELECTING A HELMET

Often times, coaches, in conjunction with administrators and equipment managers  will make the selection of equipment prior to athletes joining the team based on a variety of factors.  Athletes often are then just fit for the appropriate sized helmet (and other pads) from the available selection.  Parents in the position to select equipment specifically for their child should research the available options.  To start you must know whether you need a youth or adult helmet, what type of helmet is most comfortable for the athlete and what position he will be playing (this influences facemask selection).  Youth athletes should not wear adult helmets and vice versa.  The helmets may be made using different design specifications and especially in the case of an adult wearing a youth helmet, may not provide the expected protection.  Once you have this information, investigating each of the major manufacturers, looking at NOCSAE guidelines and test results for given helmets and even utilizing the Virginia Tech STAR Rating System can help you make your final decision.  As a note, there is some controversy regarding the accuracy of the STAR Rating System so I have linked some recent discussion regarding the topic, so you can make an informed decision.

Virginia Tech STAR Helmet Rating System 2013

NOCSAE Statement Regarding STAR System

Virginia Tech Response to NOCSAE Statement via The Concussion Blog

Also be aware, that some companies are also pushing helmet add-on products as a way to reduce the likelihood of concussions.  This method of additional protection has become so popular that NOCSAE has released a statement regarding the use of such products and how that impacts the helmet warranty.  Personally, I am not an advocate of such products since I believe if they were proven effective helmet companies would be including them as part of the standard design, but others would disagree. They argue there is not enough research available currently to make a determination for or against the products at this time.  Again, I urge you to educate yourself and make an informed decision.  To help in that regard I have included NOCSAE’s statement regarding the use of such products on football helmets.

NOCSAE Statement on Third Party Add-on Products and Certification

FITTING A FOOTBALL HELMET

Finally, the most important thing you can do is to be sure your child’s helmet fits correctly.  There should be someone who is responsible for issuing the equipment that is trained in the proper fitting of such equipment, no matter the athlete skill level.  Colleges often have athletic trainers and equipment managers who have been trained to assess the fit of helmets and other equipment.  For any youth or high school team that does not have an athletic trainer and/or equipment manager, parents should confirm that coaches or administrators who will be issuing equipment have the proper training to do so. 

Additionally, parents should be familiar with the basics so they can check the status of their child’s equipment as the opportunity presents itself.  Many modern helmets are now fit with air bladders that need to be inflated and re-inflated regularly to ensure the proper fit.  Someone on the team should be designated to check this regularly on all players, but parents can quickly assess this too.  Ask your child to put on his helmet, strapping the chinstrap and then provide a firm downward pressure to the crown of the helmet.  If the helmet is properly inflated there should be a slight recoil of the helmet when you release your hand.  If there is no recoil, the helmet does not have enough air, be sure the helmet is inflated before the start of play.  Secondly, facing the athlete, grasp the facemask and attempt to rotate it left to right and up and down.  The helmet should not move; if it does this could be a sign that the bladder is not properly inflated (as well as other fit concerns).  Refer the athlete immediately to someone trained in fitting helmets to assess whether it’s just the air bladder or adjustments to cheek pads, helmet size or chinstrap need to be made.  Helmets should fit snuggly and should move very little if properly inflated and correctly secured.  Your child should not be able to easily rip off his helmet at any time, nor should his helmet pop off after being contacted by another player (assuming someone didn’t pull illegally on his facemask).  If you notice any of this, the helmet is not being properly worn.  Address it immediately, especially considering there is a growing trend of young athletes deflating their helmets.  Doing so increases the potential concussion risk and decreases the effective protection the helmet provides against head and face injuries.

If you’d like to know more about the exact process of fitting a football helmet I’ve attached some resource links.  The most important thing to remember is that when being fit the athlete should have the hairstyle he is expecting to maintain during the entire season and fit should be reassessed periodically for maximum protection.

Excerpt from The Practical Guide to Athletic Training

MomsTEAM Helmet Fitting Guidelines

Riddell Fitting Guides

Schutt Fitting Guides

Xenith Fitting Instructions

In closing, no helmet is 100% effective at preventing concussions (or any type of head injury for that matter), but properly selected, sized and fit equipment is more effective than inappropriate or poorly fit equipment.  Take the time to educate yourself (check out this article on recent helmet research) and check your child’s equipment to be sure it is functioning as intended.  Spend the time to explain why he should not deflate the air bladder in his helmet or otherwise alter his equipment beyond the manufacturer’s specifications.  Play hard, but play safe.

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

Best Practices for Sports Medicine Management: A Consensus Statement

Not too long ago, guest blogger, Mike Carroll spent time talking to you about how to advocate for getting an athletic trainer hired at your high school.  You can check out that blog post HERE.  What if you already have an athletic trainer available?  How can you be assured that you children are receiving the best medical care possible while participating in sports?  For those of you who have children participating at the high school and college level the answer to that question has recently arrived in the form of a Inter-Association Consensus Statement.

The National Athletic Trainers' Association along with other 10 other associations has developed a statement intended for school and athletic program administrators, athletic trainers and physicians.  This statement focuses on best practice for the administration of a sports medicine program at the secondary and collegiate level.  The statement makes recommendations in these five areas:

1. Define duties of the athletic trainer and team physician
2. Define supervisory relationships and chain of command with sports medicine team members
3. Delineate decision-making authority for student-athlete participation, injury management, and return-to-play
4. Delineate administrative authority for hiring, renewal and dismissal of  related medical personnel
5. Make available performance appraisal tools for the sports medicine team

Each person who reviews this statement will have a different motivation and different area of focus, but I would like to draw your attention to a few areas and expand on them further.  The first, is the area of athlete-centered medicine.  We live in a culture where physicians and other health-care professionals are now trained to care for the whole person when treating an injury or illness.  This means not simply diagnosing the condition and providing the most current treatment, but considering the wants, needs and values of the patient when providing treatment options.  This is true for any patient, including those athletes who become ill or injured while participating in sports.  

The particular challenge in the sports medicine arena is that sometimes patient values are in direct conflict with the most appropriate course of treatment given the illness or injury.  One of the most challenging parts of being an athletic trainer (and I suspect a sports medicine physician) is the decision-making process around allowing athletes to participate following an injury or illness that may not be completely resolved.  Let me be clear, the first priority for an athletic trainer (and physician) when treating an athlete/patient is their health and well being.  I would never return any athlete to play who would clearly further endanger their own health or safety despite their desire to return to play, but we all know that sometimes these decisions are not obvious or clear.  Additionally, pressure from coaches or parents to return an athlete too quickly can make these decisions even more challenging.  Having a clear definition of the roles of the AT and team physician and designating the ultimate decision-maker (typically the team physician) can make these situations much easier to manage and allow the sports medicine team to protect all athletes.  Even if that means protecting them from themselves or their parents or coaches.  In the end, people will not always like the decision made, but if the outlined process is followed, often times all parties will be satisfied that they were treated fairly and understand that the health of the athlete is most important.

Another important component to a successful sports medicine program is understanding the lines of communication and making sure that all relevant parties communicate regularly.  One of the most influential factors in the ability of all parties to communicate is clearly defining the supervisory relationships and delineating the chain of command.  There are a variety of models out there at both the high school and college levels and each has their advantages and disadvantages.  I encourage anyone who has a system already in place to review that system and evaluate how effective the model has been for providing consistent, high-quality sports medicine services to its athletic population.  If the model is effective, why?  If the model is not effective, why not?  Is the model so ineffective that perhaps it needs to be altered, if so, to what type of model should you move?  If you're looking to employ and athletic trainer and team physician for the first time, how do you decide on which model to use?  There is no right or wrong answer to these questions, just the most appropriate model for your organization.  Every effort should be made to maximize the advantages while minimizing the disadvantages.

One of the most valuable parts to this newly issued statement is that it specifically addresses many of the common sports medicine models currently in place throughout the United States at the high school and college levels.  For each model it describes the key relationship(s) in the model and well as the advantages and disadvantages of each.  Every school system is unique and not all models will fit all school systems, but this information is easily accessible and provides administrations the opportunity to easily discuss all of the most popular options before deciding on a final plan.  In the end, no matter the final decision, I believe it is important that this information is now available.  The more educated administrators, athletic trainers, physicians and parents are the better the sports medicine program will be.

So, go ahead, click the statement link and take a look.  See where your program stacks up and lets keep working to make sure that the sports medicine programs at all levels are utilizing best practices when it comes to program management.  Just remember, you need solid professionals working in a well administered sports medicine program to be the most successful, not just solid professionals or a well administered program.  

If you'd like to learn more about the organizations who have endorsed these recommendations to date, just click on their link:

American Academy of Pediatrics (AAP)

American College Health Association (ACHA) 

American Medical Society for Sports Medicine (AMSSM)

American Orthopedic Society for Sports Medicine (AOSSM)

College Athletic Trainers' Society (CATS)

National Association of Collegiate Directors of Athletics (NACDA)

National Association of Intercollegiate Athletics (NAIA)

National Athletic Trainers' Association (NATA)

National College Athletic Association (NCAA)

National Federation of State High School Associationf (NFHS)

National Interscholastic Athletic Administrators Association (NIAAA)

Submitted by Heather L. Clemons

Working as a HS AT: Some Descriptive Statistics

Regular readers of this blog and the Advocates for Injured Athletes Facebook page know that A4IA is a big advocate for athletic trainers, especially in high schools.  I’ve spent a lot of time talking about various topics in an effort to help people become aware of the information and skills that can make sports safer for them and their children.  I’ve also had the opportunity to present local stories about the work others are doing to keep kids safe.  Today I wanted to bring to your attention a recent article published in the Journal of Athletic Training that defines the practice characteristics of those athletic trainers working in the secondary school setting.  We've already established that approximately 40% of high schools in the United States have ATs, with the highest rates being in Florida (79%) and Wisconsin (86%).  Now we have information on what their work setting is like and the services they’re able to provide.

This particular study is important because it helps us understand the current working conditions for secondary school athletic trainers and the athletes who utilize AT services.  It also provides the opportunity to direct future research for a deeper understanding of the setting, to improve the care provided to the young athletes and improve the working conditions for ATs.  According to current statistics almost 55% of secondary school athletes participate in interscholastic athletics, resulting in about 2 million injuries annually.  Athletic trainers have already been shown to reduce injuries, so understanding their high school work settings can help get ATs in more schools and provide improved medical care.

Article citation:

McLeod, TC, Bliven, KC, Lam, KC, Bay RC, Valier, AR, & Parsons, JT (2013).  The National

     Sports Safety in Secondary Schools Benchmark (N4SB) Study:  Defining Athletic Training

     Practice Characteristics.  Journal of Athletic Training, 48(4):  483 – 492.

Additional Reference:

Appropriate Medical Care for Secondary School-Age Athletes Consensus Statement (2008)

The study, using data collected as part of the National Sport Safety in Secondary Schools study, solicited participation in the descriptive study using NATA members as potential participants.  Over 4054 secondary high school athletic trainers completed some portion of the study.  The authors did acknowledge that there may be potential participants that were missed because they are not members of NATA.  The results of the study provided descriptive data regarding three primary areas:

• AT demographics 
• Secondary school demographics
• AT practice characteristics

AT DEMOGRAPHICS

Based on the data collected the typical high school athletic trainer has the following characteristics:        

• Only slightly more likely to be male (51%) than female
• Average age is 35.7 +/- 9.9 years
• 55.4% have master’s degrees
• 69.6% hold title of Head AT (most often as a the only AT in the school)
• 91% are licensed/regulated by state credential
• 48% hold ATC© as their only credential, additional credentials include teaching certificate, CSCS, EMT    

Reflecting on these characteristics, most ATs who work at the high school level are relatively young professionals, many with 10 years or less of experience in the profession and tend to work alone as the school’s Head AT.  A slight majority have a master’s degree and likely hold additional certifications.  This is great news, as young ATs with master’s degrees they are likely to be familiar with some of the most recent information published on the care of young athletic patients and additional certifications also mean additional skills, making them more prepared to care for your child.  Working alone may present challenges for a young AT in executing their responsibilities and their overall professional development (particularly in very young professionals (less than 2 years)).    One of the things I like most about working in the college setting with a staff of ATs was that there were always other professionals to ask questions and seek advice from.  Also, there was always easy access to library resources and current sports medicine information.  This is not to say that an athletic trainer cannot be successful on his/her own as a clinician and take significant steps to continue growing professionally at the secondary school level (ATs are a very committed group when it comes to professional development), but school administrators, team physicians and others need to make sure the resources are available so this development happens.  Everyone  wants their athletic trainer to apply the most current information and techniques with their athletes, we all can help with this.

SECONDARY SCHOOL DEMOGRAPHICS

Based on the data collected the typical high school with an athletic trainer has the following characteristics:

• 77.2% of high schools are grades 9 – 12, with 73.5% being defined as public
• 80% of schools have football
• 35% have 200 – 399 male athletes
• 34.3% have 200 – 399 female athletes
• 33% have a total enrollment of 1000 – 1999

These are very basic descriptive statistics, but at least they give an idea of the types of schools who are hiring athletic trainers.  Based on this data public schools have done well to get ATs into the schools, it’s not just private and charter schools employing ATs.  Based on the data it appears that one of the factors in having an AT is having the sport of football.  Also, you cannot use school size to predict who may have an AT, as ATs work at schools of all sizes with the largest percentage working in medium-sized schools.  While this data may be useful, there is also additional information that could be helpful in understanding the types of schools and students who have access to an athletic trainer, including other socioeconomic and geographical data.  Data could include looking family income, school location (rural, suburban, urban), etc.  This information could help us better understand the distribution of available AT care among various types of students/families.

ATHLETIC TRAINING PRACTICE CHARACTERISTICS:

Based on the data collected the typical job characteristics for an athletic trainer in the secondary school setting are:

• 57% of ATs use a budget or bidding mechanism to get supplies; typical budgets are around $2000
• 47.1% of ATs hold full-time positions that are paid by the high school
• 65.1% of ATs are supervised by the Athletic Director (non-medical personnel)
• 22.8% of ATs hold a teaching credential, 62.7% of these are paid a teaching salary and a stipend for AT duties with about 56% working between 20 – 40 hours per week as an AT (on top of teaching)
• 72% of ATs travel to away FB games, 45% travel to non-FB playoff events, 15.6% travel during regular season and playoffs for non-FB events
• 72% perform on site evaluations regularly, with a lesser percentage performing treatment (60.3%) and rehabilitation (39%)
• 46.9% of ATs work under the direction of an orthopedist, while 19.1% work under the direction of a primary care physician 

Looking at this information almost half of all ATs are in full-time positions in the high school setting with a particular focus of covering football games and practices (especially travel).  ATs, considered medical professionals, are often supervised on a day-to-day basis by the athletic director, but also function under the school’s physician.  Their primary job function is injury evaluation, but where appropriate many also provide regular treatment and in some cases rehabilitation services. 

I am glad to see that almost half of the ATs are in full-time positions that are financially funded by the high school I believe this provides consistency of care for all athletes involved in the athletic program and students know there will always be someone available.  I know in the case of clinic-outreach positions limits (if in place) on hours allowed in the high school can sometimes be a challenge to negotiate because of clinic commitments.  While it is better to have an AT than, not I would hope that someday all ATs would be full-time and funded by the school.  Additionally, for those that are teacher-athletic trainers I would hope that there would be additional resources for them to avoid burnout since they are working two very challenging jobs within the school.  I have had the pleasure to know many teacher-athletic trainers and I know their primary challenge was always balancing both responsibilities since teaching and being an AT are easily full-time jobs on their own. 

I am also glad to see that many ATs have an orthopedist who is responsible for overseeing the healthcare of the athletes, along with primary care sports medicine physicians they are most familiar with the injuries the AT will be addressing.  It can be challenging to work with a physician who is not familiar with the challenges specific to sports medicine. 

Finally, I would invite all schools to look that money budgeted for AT supplies and be sure it is enough to appropriately meet the medical needs of the student-athletes (the authors of the article discuss this briefly).  ATs are very good at doing more with less, but that can only go so far.  Let’s make sure we’re offering the best care possible.  You've taken the first step by hiring an AT, now let’s make sure they have the resources they need.

Reflecting on the study in its entirety I think it paints a generally positive picture of the work setting for high school ATs and the athletes to whom they are providing care, but that is not to say there isn’t room for improvement.  While we have a long way to go before all high schools have an AT, perhaps understanding this information can help get us there faster.  I hope it opens up the dialogue between ATs, school administrators, sports medicine physicians, and parents about who is providing care for their athletes/children.  I hope it will also cause people to reflect on whether the AT has the necessary professional and financial resources to provide the appropriate standard of care for all athletes.  Given that ADs are most often the direct supervisors of the AT I encourage them to do the necessary work to learn what it takes to operate a safe and high-quality athletic program that includes appropriate sports medicine services.  There is much work to be done, but in order for us to move forward we must first understand where we are, our strengths, our weaknesses and our opportunities.  I think this study is a first step in the right direction.

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

Summer Camping Trip Safety: Basic Prevention and First Aid

July 4^th fireworks have come and gone and summer is in full swing.  Family vacations, trips to theme parks and other summer fun are in the works.  These family trips are what make great summer memories.  Camping trips are a common family adventure that often lead to great stories and fond memories that are relived for years to come.  Let’s just be sure those memories are happy ones of silly pranks and majestic views.  One of the most important ways to ensure a positive experience is to be prepared for potential emergency situations that can arise during your trip.  No one wants to have a trip impacted by someone spraining an ankle or getting bit by a snake, but it is important to be prepared with the knowledge and  supplies to handle these situations.  This blog will be a list of key situations you should be able to handle and the supplies necessary to address them. 

Most importantly, you or someone in your camping party should be trained in basic first aid and CPR before venturing out.  You can learn more about how and where to become trained in these techniques through the American Red Cross or the American Heart Association.  You can never be over prepared to handle an emergency.

CHOOSING A FIRST AID KIT

When camping it is always important to have a first aid kit with you at all times.  This kit should include a variety of items that can address blisters, cuts, abrasions and other minor injuries.  As appropriate (consider your camping location) it should also include insect repellent and a snake bite kit.  One of the most complete lists of items that should be included in your first aid kit is available from REI.  Some sources recommend purchasing an airtight container to keep your supplies in and purchase what you need instead of buying a pre-stocked first aid kit as a way to minimize cost.  Either is appropriate, just have a first aid kit available.  Check out this article if you have questions on how to choose a first aid kit.

SUN PROTECTION

Part of the joy of camping is being in the great outdoors.  It’s important to protect yourself while outside to minimize sunburn and cancer risk.  No one wants to be slowed by a severe sunburn that could have easily been prevented.  The American Academy of Dermatologists say that sunscreen should be broad spectrum, water resistant, and at least 30 SPF.  It should also be reapplied every 2 hours, more frequently if you’re going to be in the water.  For more specific details regarding sunscreen and how to protect yourself, check out this A4IA blog entry. 

WEATHER EMERGENCIES

Checking the weather before you leave for a camping trip is always the responsible thing to do.  Knowing the weather report for where you’re going can help you plan accordingly with appropriate supplies, tools and clothing.  Paying attention to the weather once you are immersed in your camping trip is also important.  Making appropriate decisions regarding your trip and impending weather can sometimes mean the difference between having a great time and getting caught in a storm.  It can be as simple as staying in during the middle of the day when the sun is hottest, especially in desert climates.  You should also be weary of thunderstorms and the associated lightning.  Lightning can be very dangerous and depending on the location can move quickly.  If you suspect a lightning storm, seek safe shelter.  Do not remain in the water or out on a hike.  Finding safety while camping can be particularly challenging, especially if you’re backpacking in the wilderness, be sure to have a plan.  Use the 30 minute rule to determine whether you can return to activities.  This means you must wait at least 30 minutes to return outside (or to activity) after the last audible thunder and/or visible lightning.    For more specific recommendations on how to protect yourself during a storm check out this recent A4IA blog post.

EXERTIONAL HEAT ILLNESS

Exertional heat illness (EHI) can range from heat cramps (relatively minor) to exertional heat stroke (life-threatening).  There are a variety of factors that can lead to someone suffering from heat illness, but one of the most common factors is dehydration.  Dehydration is preventable.  When camping and hiking be sure to take enough water (or have a water filter and utilize natural sources) for your hike based on the length and difficulty of your hike.  You can also monitor your hydration level based on urine color and level of thirst (although if you’re thirsty, it may be too late).  As a reference, when hiking a general rule of thumb is to drink 500mL per mile.  For more recommendations on how to manage your hydration demands when hiking check out this hiking blog.  Another resource on hydration and heat illness prevention is the NATA Position Statement on the topic.  If you need advice on how to select a hydration pack, one of the most common ways to carry water, check this out.

INSECT BITES & STINGS

A key item that should be included in your first aid kit is bug repellent.  It is important to protect yourself from insects of all kinds.  Mosquitos are notorious for carrying diseases (such as West Nile) as are ticks (most notably Lyme disease).  Another concern is being stung.  There are people who are very allergic to insect (bee/wasp) stings and if not treated immediately these situations can become emergencies.  When planning your trip, along with bug repellent you should be sure to have an antihistamine cream and tablets (oral medication) to treat the itching associated insect bites and stings.  You should also be aware of anyone in your party that has a sting allergy and how severe it is.  Many of those with severe allergies will be prescribed an Epi-pen.  Be sure you know how to administer the pen, in case the individual that has been stung is unable to administer it him/herself.  For more information on how to deal with stinging insects by properly removing their stingers and using an Epi-pen check out this A4IA blog post on anaphylaxis.

Ticks and tick bites are another concern.  While not common in all areas of the United States it is important that after a day in the wilderness in high risk areas that all campers check themselves  for ticks and tick bites.  Ticks are carriers of Lyme Disease.  According to the most recent research by the CDC in 2011 96% of all Lyme Disease cases were reported from 13 states:  Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Virginia and Wisconsin.  It is notably concentrated in the Northeast, but it does not mean it cannot be contracted elsewhere. 

When protecting yourself against Lyme Disease it is important to recognize the signs and symptoms of a tick bite and Lyme Disease symptoms as well as how to remove a tick safely. If you are bitten by a tick and it is still attached use a pair of fine-tipped tweezers and pull upward with a steady even pressure, being sure not to twist.  Clean the area of the bite using rubbing alcohol, an iodine scrub or soap and water. The most obvious symptom is an expanding rash called erythema migrans, but you may also experience fatigue, chills headache, muscle and joint aches and swollen lymph nodes.  If you believe you may be suffering from Lyme Disease it is important to seek medical attention as soon as possible so antibiotics can be administered.  The discussion of Lyme Disease Syndrome is beyond the scope of this blog but check out the CDC for more information.

SNAKE BITES

Admittedly, until I moved to San Diego a year ago I wasn't as worried about being bitten by a snake.  Not that there are not snakes of all kinds around the United States, but there weren't many that I was especially concerned about like the rattlesnakes that are indigenous to San Diego.  The best protection against snakes is to avoid them and be respectful their territory.  The American Hiking Society (AHS) makes some great recommendations (check out the link) on how to hike safely and protect yourself.  One recommendation is that if a log has crossed your path, step on the log then down instead of over the log. Doing this, gives you a chance to see if there is a snake on the opposite side of the log and you can avoid stepping on it. 

If you should get bitten by a snake you should call 9-1-1 immediately or go to the nearest emergency department.  Minimize activity if possible and remove any restrictive clothing from your arm or leg to minimize complications from swelling.  Do not elevate the bite area above the heart.  The AHS also recommends that you do not try to suck the venom out, use a tourniquet or take aspirin.  If you’re alone you may need to find a way to hike out to the nearest phone or roadway for help.

WATER RELATED ILLNESS & INJURY

Aside from hiking one of the most common activities while camping is usually swimming.  You should always be aware of your surroundings and take care to enjoy the water safely.  The CDC has several resources that provide tips for healthy swimming, to avoid drowning and how to stay safe while boating.  Generally speaking, to avoid water-borne illnesses you should avoid swimming when you have diarrhea, shower before and after swimming and don’t drink the water.  When boating (ex.:  canoe, kayak or motorboat) be sure to wear a life jacket.  Most importantly, be sure you’re familiar with the water where you’ll be swimming or boating.  Finally, you should never swim alone.

OTHER EMERGENCIES

Other things you be familiar with include recognizing poison ivy, oak or sumac plants.  These plants can cause contact dermatitis when they touch your skin.  The rash is caused by an oil in the plants and can be extremely itchy and irritating.  Check out this photo. The rash can take up to several days to appear, but if you believe you have been exposed you should wash the area immediately after contact.  Most minor rashes can be treated with antihistamines (such as Benydryl) and calamines to relieve the symptoms.  A more severe rash may require treatment from a physician.  For more information checkout this link.

Finally, you should be prepared to handle basic first aid situations ranging from abrasions, blisters, to sprains and strains.  One of the most important acronyms you can remember when treating basic orthopedic injuries is RICE (Rest, Ice, Compression, Elevation).  This technique will allow to appropriately treat almost any acute orthopedic injury (see sprains and strains link for more information).  You should also be prepared to splint a potential fracture.  Taking a sanctioned first aid class can give you the skills you need to handle all these situations confidently.  If you suspect a fracture there are a few easy steps you can follow:  1) splint the body part in the position it is found; 2) check the pulse before and after applying a splint; 3) you can use anything rigid to splint (think tree branches, tent poles, cardboard, pillows) and 4) be sure you've had someone contact 9-1-1 immediately or hike to a phone or road to get help.  If you're in a large party it is best to send one person for help while others remain with the injured camper.  You should always avoid leaving the injured camper alone unless you have no other option.

OTHER RESOURCES

Camping Health & Safety Tips from the CDC

Expert Advice-REI

American Hiking Society Gear & Resources

US Outdoor Camping Resource Guide

In the end, many of these sections are brief introductions.  It will be important for anyone who is taking a camping trip to be familiar with this information and much more.  My hope with this post was to introduce you to a variety of camping safety resources you may not already be familiar.  I also wanted to give you an idea of the types of things you need to be prepared for.  The best first aid for any emergency is to be prepared in advance and avoid troubling situations in the first place.  Of course, despite appropriate prevention efforts injuries and other stressful situations can still happen.  When they do, will you know what to do?  The best advice I can give is be prepared and know your plan for potential common emergency situations.  If an emergency arises execute your plan.  You should also know what you can handle and what needs more advanced medical attention.  This decision is often the most important one you'll make in any situation.  Happy camping!

Heather L. Clemons, MS, MBA, ATC

Soft Drinks to Enhance Performance?

The dietary supplement topics posted to the A4IA blog in the last month or so have really piqued an interest with those of you who have been reading.  Given this, I posted a request to the A4IA Facebook page to see what other related topics you wanted to learn more about.  One topic that was brought to my attention was the role of carbonated beverages (soft drinks/sodas) as a performance enhancer.  This post will attempt to summarize the information I was able to review. 

Before I jump into what I was able to find regarding soft drinks and athletic performance I think it is important to understand some of the basics regarding soft drinks and their typical consumption.  As of 2000 the average soft drink consumption was 600 (8 oz.) servings annually, up from 90 servings annually in 1942.  The significance of 1942 is that this is the first year the AMA (American Medical Association) first recommended against the consumption of soft drinks to help limit sugar intake.  Consumption of sugar sweetened beverages (juices, soft drinks, energy drinks and sports drinks) continues to increase in most age groups and soda is the most heavily consumed beverage.  Where there is a decrease in soda consumption for adolescents, sports drink and energy drink consumption are on the rise.

In most of the literature the overarching concern with soft drinks are their potential connection with the child obesity epidemic in this country. There are a variety of articles out there that discuss the nutritional and health implications of soft drink consumption.  A recent meta-analysis tried to sift through the current information available to answer some key questions regarding soft drinks.  The study shows:

• Soft drink consumption does lead to increased energy intake as those who consume it typically do not reduce consumption of other foods to compensate
• While difficult to make direct comparisons between various studies there seems to be a trend between soft drink consumption and an increase in body weight
• Some studies have shown that drinking one less 16 oz. soda per day will result in the consumption of an additional 4 oz. of milk
• The impact of soft drink consumption on changes in nutrient consumption are still unclear at this time
• Research most strongly links soft drink consumption to the Type 2 Diabetes, but links between soft drinks and other diseases are still being investigated

Moving beyond the health and nutrition concerns soft drinks raise, soft drinks do contain two main ingredients that could potentially be beneficial to athletes looking to improve performance:  caffeine and sugar.  We discussed caffeine in detail previously when talking about energy drinks, while the use of sports drinks has increased because of their ability to replenish glucose (sugar) stores following long bouts of exercise.  On the surface it appears that it is plausible that soft drinks could in fact improve performance, but what does the available research say?

One recent study on male college athletes who performed 60 minute exercise bouts on an ergometer demonstrated that soft drinks are no more beneficial than non-carbonated beverages.  The study states that there were no statistical differences when comparing glucose serum levels, sodium (Na) and potassium (K) levels, insulin and free fatty acids. These biomarkers are the most common markers assessed when trying to understand improved exercise physiology.  Those in the soft drink group did state that they felt more refreshed when drinking soft drinks, but it was found that the carbonation limited the total volume of fluid drinkers were able to consume impacting the participant’s ability to maintain appropriate hydration.

Many of the other studies I reviewed focused specifically on the physiological utilization of carbohydrates (CHO) without a particular focus on soft drinks.  Most often, studies assessing the utilization of carbohydrates focus particularly on the percentage of carbohydrates in a solution and how quickly the stomach can utilize them.  Soft drinks most often are about 10% CHO, but research has most consistently shown that drinks that are 6% - 8% CHO (most sports drinks) are the most effective in providing CHO replenishment following intense exercise.  It is important to note that sports drinks or other CHO replenishment options should only be used following exercise bouts of 60 minutes or more, exercise for shorter periods often do not require CHO replenishment and drinking water to replace lost fluid is sufficient. 

I have previously discussed the positive and negative effects of caffeine and will not spend additional time discussing them here.  If you need a refresher you can check out this article or review my initial blogs regarding dietary supplements and energy drinks.  Caffeine is found primarily in colas, but in total is found in 70% of all soft drinks.  Remember, while it is proven that caffeine does improve alertness and focus when consumed in sufficient quantities it is also possible to suffer from caffeine toxicity.  Minimally this can result in nausea, but in a worst case scenario it can also lead to sudden cardiac arrest or death. 

From my perspective, while soft drinks do potentially offer the benefits of improved focus and carbohydrate replenishment after long, prolonged exercise I am hesitant to recommend soft drinks as a performance improvement option.  I believe the costs far outweigh the positives.  This is based primarily on my understanding of the significant negative outcomes associated with regular, significant consumption of soft drinks and the available alternatives.  Sports drinks are specifically formulated to help you replenish carbohydrates, water and electrolytes following long periods of intense exercise, a soft drink is simply meant as a basic form of refreshment and exercise physiology is not considered in their formulation.  Additionally, while caffeine in small doses is typically not of concern for minor improvements in alertness, when consumed in high doses (such as in energy drinks) it can be dangerous or even cause you to fail an NCAA drug test (see the banned substance list).  Children are also more sensitive to the effects of caffeine and I would recommend keeping consumption of caffeine based beverages to a minimum in young and adolescent children.

Finally, when attempting to maintain hydration during activity it is important to note the key for children is to get them to consume as much fluids as possible.  Children should consume 13mL/kg bodyweight during exercise and 4mL/kg bodyweight post exercise for each hour of exercise to avoid dehydration during future exercise bouts.  Children often do not consume enough fluids to appropriately stave off dehydration during and after activity and adults should assure appropriate consumption.  Providing beverages that taste good and stimulate thirst are key.  I realize saying this may seem like I’m advocating for soft drinks, bur remember the carbonation in these beverages can give a false sense of fullness actually inhibiting sufficient fluid consumption.  If your child doesn't like to drink just water, consider other beverages such as juices (watered down as necessary), milk and sports drinks to encourage regular consumption of fluids. Soft drinks are fine as an occasional treat at the family picnic, but I would recommend against using them as a regular part of your exercise nutrition regimen.

Heather L. Clemons, MS, MBA, ATC