Wednesday, February 27, 2013

Athletic Training Advocacy: Personal Reflections


“Everybody Needs an Athletic Trainer” is the slogan for 2013 as National Athletic Training Month (NATM) quickly approaches.  Each year in March those of you who have been working in the trenches healing bodies and minds or challenging the next generation of professionals to do it better than we did take a moment to remind everyone else what we do and who we are.  This year’s slogan is particularly appropriate given the growing push for the availability of athletic trainers at the high school and youth levels in order to provide improved safety and health care for athletes of all ages.  This slogan has also become particularly meaningful for me personally.  I recently found myself relocating to San Diego after over 10 years in New York Metro teaching the next generation of professionals wondering how I was going to contribute.  Thanks to Beth Mallon and A4IA I am developing a new role as an advocate for both professionals and young athletes by trying to find informational, educational, and inspirational stories to blog about each week. 

This week I have decided to write about something very personal to me that may help you all understand why I take the time each week to bring you new information about how to make your families and yourself safer when participating in physical activity.  Perhaps after I tell this story you will understand why A4IA is so important to me and why I hope for the day when all athletes can participate under the supervision of a highly trained athletic trainer as part of a broader safety plan. 

The story begins back in 2001 when I was a first year assistant athletic trainer at a smaller Division I institution in New York.  I relocated to New York from Corvallis, Oregon following the completion of my graduate assistantship with the women’s soccer program.  It was mid-November and I was finally starting to settle in.  I has just completed my first women’s soccer season, I was getting to know the men on the baseball team and was looking forward to getting used to the surroundings and culture of New York, since I wasn’t traveling for games every weekend.

This particular afternoon started like any other.  It was slow since many of the soccer players were off enjoying the end of the season and the baseball team was just outside on the quad doing some conditioning work.  I was in the athletic training facility catching up on paperwork and going through an assignment with a student, when everything changed. 

One of the pitchers ran in yelling, saying that something was wrong with one of the other players and I needed to run outside quickly.  I knew without asking something was terribly wrong, grabbed a pocket mask and my phone, and ran outside.  I arrived to find one of the players lying face-up on the field, unresponsive, not breathing and without a pulse.  I immediately instructed the coach to contact 9-1-1 and instructed the student who followed to retrieve the AED (which we has just received a few weeks before) and immediately began CPR.  I continued CPR until the AED arrived at which time it was applied and activated.  During this time, the ambulance arrived and the young man was transported to the hospital.  I followed the ambulance to the emergency department and waited for family, coaches and other relevant personnel to arrive, during this wait I was notified that the young man did not survive.  I was shocked.

That young man was named Jerry Gambardella and he was 19 years old.  He was one of the most happy-go-lucky men I had ever met and now he was gone.  I had done everything I could and all we could do is live with the pain of his loss.  I will never forget the look on his teammates’ faces or the sobs from his parents as they were told of his passing.  That particular baseball season would be the longest in my career.   We were all just trying to find a way to get back to normal, but with Jerry being gone we knew nothing would ever be the same.


It has been over 12 years since that fateful day in my career and I still remember it as if it happened yesterday.  Over time, I have come to understand that despite the fact that I had acted appropriately and was fortunate enough to have an AED available (not common at the time) that sometimes we cannot help everyone.  While Jerry may be gone, I have always tried to use that experience to push myself to be a better professional.  I think that it can be easy to fall in the trap of, “but that will never happen to me.”  The truth is, it can.  Emergencies do not consider whether you have prepared for the possibility, you are a new professional or you have been providing care for years; they just happen.  You need to be ready, whether you are a parent, an athlete, a health care professional. 

I have spent the years since that event trying to help students learn having to save someone’s life is part of the job description of an athletic trainer, anytime you are working.  Have a plan, so when it happens you will be ready.  While Jerry’s story did not end happily, I am determined to use his story to help others have a positive outcome.  I am not currently teaching students, but through A4IA, I hope to continue to advocate for the availability of athletic trainers at more events and occasions as well as help parents and athletes be more prepared to prevent and survive potential emergencies.  

I hope Jerry  and his family would be proud of the work I have done through the years.  Jerry's family did set up a scholarship program in his honor.  If you'd like to know more about that program, or even make a donation:  Jerry Gambardella, Jr.Scholarship


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

Tuesday, February 19, 2013

4th Annual Youth Sports Safety Alliance Summary


The Youth Sports Safety Alliance (YSSA), founded by the National Athletic Trainers’ Association (NATA), hosted its fourth annual summit February 5-6, 2013 in Washington, DC.  YSSA, created in 2010 with the goal of “raising awareness, advancing legislation, and improve medical care for young athletes” according to their website.  The alliance currently includes over 100 members, all with this one goal in mind.  Advocates for Injured Athletes is among the alliance members and Beth Mallon was a speaker at the summit as a parent advocate.  She was among several prominent advocates and researchers who are trying to make sports participation safer for all athletes.

The summit launched the National Action Plan for Sports Safety and introduced the Student-Athlete Bill of Rights.  The primary focus was improving sports safety and achieving appropriate medical care at the secondary level.  The specific focus was on 1) cardiac events, 2) neurological injuries, 3) environmental/exertional injuries, and 4) substance-induced conditions.  Many of the speakers and others in attendance met with and lobbied legislators around these topics.

“Momentum continues to build for comprehensive action to protect student athletes.  Public interest has remained strong; however, much of the focus remains on concussion in high school athletes despite the higher number of student athletes in all grades that suffer other serious or even fatal injuries.”
                                                                        -NATA Press Release

SPEAKER LIST:
James L. Thorton, MA, ATC, CES President National Athletic Trainers' Association
Christopher Nowinski, founder Sports Legacy Institute
Douglas J. Casa, PhD, ATC, University of Connecticut; Korey Stringer Institute
Beth Mallon, Founder Advocates for Injured Athletes and Alliance representative
Charles Gfeller, Esq.
Kevin Guskiewicz, PhD, ATC, University of North Carolina, Chapel Hill:  Matthew Gfeller Sport Related Traumatic Brain Injury Research Center

The plan includes a brief list of general recommendations as well as condition specific recommendations around cardiac events, neurological injuries, environmental/exertional injuries, and substance-induced conditions.  The general recommendations are as follows:

  • Require that all schools have a comprehensive athletic health care administrative program and an athletic health care team to prevent and immediately manage injuries and illnesses.  The team consist of a physician, athletic trainer, school nurse or other health care professional and the athletic director.
  • Require that all schools assure safe practice and safe play facilities appropriate to each sport to reduce accidents and the spread of disease.  Safe facilities are regularly inspected and maintained, routinely cleaned to avoid spread of disease and accessible to treatment and/or transport areas.
  • Require that all schools provide permanent, appropriately equipped areas in which injured athletes may be evaluated and treated by health care professionals, because early assessment and intervention encourages proper healing and decreases the risk of re-injury.  Having a designated area is critical in the management of life- or limb-threatening conditions.
  • Require that all schools have a place for confidential conversations with athletes and parents about medical issues.
  • Require that all schools have a plan for selection, fit, function and proper maintenance of athletic equipment, as well as training for school staff.
  • Require that all schools have injury and illness prevention strategies, including protocols for environmental conditions.  Educated personnel in every sport should understand and utilize professional guidelines for preventing and treating injuries and sports-related illnesses.
  • Require that all schools inform athletes and parents of the potential risks in sports as well as their individual responsibility to avoid and minimize injuries. 
  • Parents should educate themselves in the potential benefits and risks of optional protective equipment.
  • Advocate for the creating of a national fatality registry of secondary school athletes who have died during or as a result of sports-related injuries, such as cardiac arrest, neurologic damage, steroid abuse, etc.
Student Athletes have the right to be coached by individuals who are well trained in sport-specific safety and to be monitored by athletic health care team members.

Student Athletes have the right to equality, regular pre-participation examinations and each athlete has the right to participate under a comprehensive concussion management plan.

Student Athletes have the right to participate in sporting activities on safe, clean playing surfaces, in both indoor and outdoor facilities.

Student Athletes have the right to utilize equipment and uniforms that are safe, fitted appropriately and routinely maintained, and to appropriate personnel trained in proper removal of equipment in the case of injury.

Student Athletes have the right to participate safely in all environmental conditions where play follows approved guidelines and medical policies and procedures, with a hydration plan in place.

Student Athletes have the right to a safe playing environment with venue-specific emergency action plans that are coordinated by the athletic health care team and regularly rehearsed with local emergency personnel.

Student Athletes have the right to privacy of health information and proper referral for medical, psychosocial and nutritional counseling.

Student Athletes have the right to participate in a culture that finds “playing through pain” unacceptable unless there has been a medical assessment.

Student Athletes have the right to immediate, on-site injury assessments with decisions made by qualified sports medicine professionals.

Student Athletes have the right, along with their parents, to the latest information about the benefits and potential risks of participation in a competitive sports including access to statistics on fatalities and catastrophic injuries to youth athletes.

 When my son was injured in 2009, little did I know when rushing to the hospital that just eight months’ post injury, Tommy and I would be speaking in Sacramento, at the Capitol, to reporters and experts on sports injuries.  I know that some of you have had that same experience.  One day we’re parents, the next – parent activists.
                                                                                    -Beth Mallon

The Youth Sports Safety Alliance has come a long way since its inception 2010 and Beth and Tommy and Advocates for Injured Athletes continue to work to improve the safety conditions for young athletes all across the country whether it’s through Athletes Saving Athletes® or speaking as a parent advocate. 

"I am very humbled and proud to be involved with the NATA and the YSSA since the initial summit in 2010 when Tommy and I gave testimonials in Sacramento.  Since that time, it has been very rewarding to see the number of YSSA members grow to over 100.  In addition, we have seen student athlete fatalities drop.  I cannot help but feel when we all work together we have a much larger voice and impact on the mission of protecting student athletes.  I was honored to deliver the YSSA update and look ahead to seeing the benefits of our collective efforts for this coming year."
                                                            -Beth Mallon, following the Summit (2013)

If you’re interested in some of the press from the summit (including a video interview with Beth) check out Advocates for Injured Athletes’ Facebook page.  Additionally, for those of you who would like pdf versions of either the National Action Plan or the Student Athlete Bill of Rights feel free to contact A4IA for copies or click the links above that will take you to copies available on the YSSA website.

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

Wednesday, February 13, 2013

INFECTIOUS MONONUCLEOSIS (MONO) AND SPORTS PARTICIPATION


Infectious Mononucleosis (IM), better known as “mono” is a medical condition that affects thousands of athletes annually.  This condition can present itself in a variety of ways and will often resolve on its own without complications, but there is the rare risk of splenic rupture.  Splenic rupture if not addressed immediately via surgical removal of the spleen can be fatal.  Given this possibility, it is important for sports medicine professionals and parents to take reasonable precautions based on available evidence when returning athletes to activity following IM.

The American Medical Society for Sports Medicine has developed and published a consensus statement regarding infectious mononucleosis and athletic participation.  The citation for the positions statement is as follows:


According to this statement, currently there is no evidence to suggest that IM is more prevalent in the athletic population than in the non-athletic population.  The infection is most common in adolescents and young adults with an average infection rate of approximately 15% of the previously unexposed individuals.

Some of the major highlights from the article:

HISTORY AND PRESENTATION:
  •           The condition is typically spread through oral secretions often spread by sneezing, sharing drinking glasses or food.
  •          Symptoms can last anywhere from 4 – 6 weeks, some cases have been known to last as long as 3 months
  •          Most common symptoms include fever, lymphadenopathy (swollen glands) and pharyngitis (sore throat).  Other symptoms can include headache, rash and spleenomegaly (enlarged spleen).
  •           Keys to referral for further evaluation would be prolonged fever and lymphadnopathy


COMPLICATIONS:
  •            Severe complications only occur in approximately 5% of all IM cases
  •           The most familiar complication is splenic rupture, but there are others
  •           Splenic rupture is estimated to occur in 0.1% - 0.2% of all cases and can occur spontaneously, meaning a specific trauma is not required to cause rupture
  •          Typically most ruptures occur within the first 3 weeks of illness, and about half of those were spontaneous


RETURN TO PLAY GUIDELINES:
  •          Exact guidelines for return to play are difficult with IM because there is no ideal laboratory or imaging technique that can confirm the status of the spleen or the resolution of the illness via virus levels
  •          Based on current available evidence regarding the potential for splenic rupture return to non-contact activities can be a gradual progression assuming the athlete no longer has a fever and can tolerate aerobic activities
  •          For return to contact activities, suggestions are much more difficult; minimally the athlete should be held out for at least 3 weeks where the likelihood of rupture is believed to be minimal and other indicators are present to allow for a safe return


Returning athletes to activity following a bout with IM can be highly challenging given the lack of clear return to play guidelines.  Parents should be aware that when returning from activity the risk of splenic rupture is very rare decreases significantly after 3 weeks based on current research, but it is never zero until the illness has completely resolved.  Parents should also be aware that physical exam for an enlarged spleen is highly ineffective.  If examination of the spleen is deemed necessary the standard evaluative technique is ultrasound, but a computed topography (CT) scan is also a possibility depending on the needs and preference of the physician.  Be sure to address any concerns you have with your athlete’s physician as they prepare to return to activity following a bout of IM. 

Whether splenomegaly (enlarged spleen) is of concern or not, the athlete’s return to activity should be gradual, based on their level of fatigue and other symptoms.  A gradual fitness program means progressing not only from shorter to longer periods competing in activities, but also considering the intensity of exercise.  This means, progressing how hard the athlete is working from 50% or so up to 100%.  The program can be progressed over several days to weeks depending on how the athlete responds to training.  The key to remember is that the degree of fatigue the athlete experiences the day after a training session will let you know whether s/he can handle an increase in activity (whether that is time or intensity) or not.

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