Having a Positive Impact as an Athletic Trainer

In an effort to keep things fresh a reach as many readers as possible A4IA will be having a guest blogger this week.  Mike Carroll, Head Athletic Trainer and Assistant Athletic Director at Stephenville High School (TX) has taken the time to write about his experiences and perspective as an athletic trainer at the secondary level.  Feel free to connect directly with Mike regarding your thoughts on his blog.  Thank you Mike for taking the time to contribute to A4IA's blog:

Regardless of their chosen profession a person wants to know that they are doing a good job and are appreciated.  When I got into athletic training over two decades ago I knew that I was not going to be told that I was doing a good job on a regular basis.  I also knew I wasn’t going to get rich (financially).  What I did know was that I would have to work hard.  Even if no one told me that I was doing a good job I would know I was from what I observed from my student athletes and colleagues.  Does that mean that I don’t want or need people to give me that affirmation?  Absolutely not.  It just means that I didn’t then and I don’t now crave public affirmation of how good I was or am at providing health care services. 

Fast forward from when I emerged from graduate school as a young idealistic, energetic, secondary school athletic trainer to today.  Today I am more businesslike in my approach to my job and in reality is a much better athletic trainer today than I was when I first started. Twenty plus years ago things that I could have never envisioned when I first started are now aspects of being a secondary school athletic trainer that I do not particularly enjoy (unbelievable increases in paperwork comes to mind initially).  At the end of the day, however, being a secondary school athletic trainer is about providing athletic training services to the student athletes at my high school so that they can participate in a safe fashion.  Yes, there are aspects of my job that are unappealing but I still do what I do because I love being an athletic trainer and I love working with this age group.  This brings me back to my original topic of appreciation.

Those of you who are reading this who are athletic trainers in the secondary school setting may nod your head or you may disagree completely, but there are times during the school year where the mentality feels like it is the athletic training room versus the world.  The kids don’t seem to understand the importance of what you are asking them to do.  The coaches are demanding and do not seem to want the star athlete to have the time to adequately recuperate from an injury.  The parents don’t understand that the injury that their child has, such as a concussion, could have negative long term consequences if not treated appropriately.  Some parents just want their kid to play in the big game.  This may go on for days or weeks at a time.  What can we as the athletic trainer do about this? The short answer is you keep on keeping on.  You do your job to the best of your ability and you keep the kids at your school safe.  Trust me.  There are times where it seems like no one appreciates what you are doing and why you are doing it.  The good thing is that couldn’t be further from the truth.

In the past couple of weeks I had two separate parents who renewed my love for this setting and why I work with this age group.  Without violating any privacy laws I will just say that I had one young person with a chronic injury that I helped get well and they returned to play the sport that they love.  With this kid I did it by realizing my limitations and referring them to a health care professional who could better treat the reason for their chronic injuries.  Both of the kid’s parents came up to me in separate conversations and thanked me for everything that I did for their child.  They both said in effect that it was refreshing that someone cared about their child as a person and not just as a good athlete and wanted them to have no lingering long term problems.  The second one was another student athlete that had a concussion that was not initially diagnosed by an ER doctor after an auto accident.  I did what I would have done had they suffered this injury in athletics, which is take them through our district approved concussion protocol.  This particular student is a senior and their team was about to enter the playoffs.  With some kids it wouldn’t be unexpected if the parents would want to overlook this injury just to give their kid one last chance at glory.  This wasn’t the case.  The mother of the child was completely supportive of what I was doing and thanked me for caring so much about her kid that I was willing to do what I thought was right even though others wanted to overlook the injury.  She also told her child this and they then relayed the information to me and the other kids on the team before a game.  This mother said that she completely supported what I was doing and appreciated my dedication to her child and the other kids that are in athletics at my school.

So what is the take away from all of this?  If you are an athletic trainer know that you are appreciated and even though at times it seems like the entire world is against you and what you stand for, that is not the case.  It may not happen often, but you will have a parent, coach, athlete, or someone else tell you that you are indeed appreciated for everything that you do even though at times it seems quite the opposite.  When that conversation happens it puts a little more wind in your sails and keeps you going strong during the seemingly endless seasons of high school sports.  If you are a parent or an athlete and you have read this far I challenge you to go to the athletic trainer at your school and tell them that they are appreciated and that nothing is more important that the health of their child or themselves.

Thanks to Beth Mallon and Heather Clemons for giving me the opportunity to write for the Advocates for Injured Athletes Blog.  I look forward to contributing more in the future.

Key Concussion Statements Released

Two prominent organizations have released statements regarding sports-related concussions in the last week or so.  The first statement released was the Consensus Statement on Concussion in Sport:  The 4^th International Conference on Concussion in Sport Held in Zurich, November 2012 and the second was the Summary of Evidence-Based Guideline Update:  Evaluation and Management of Concussion in Sport:  Report of the Guideline Development SubCommittee of the American Academy of Neurology.  This week’s blog post will attempt to highlight some of the key points and additional resources associated with these statements. Where possible I will discuss what it may mean for concussion management moving forward.  Since the publication of these documents, a variety of posts and/or stories including opinion and reaction have been published.  It is not the purpose of this blog post to provide my personal opinion on each statement, but to highlight the key information presented in each and allow informed readers to develop their opinions based on their understanding of this available information.

DEFINING CONCUSSION:

While each statement defines a concussion using different language, the key components are the same.  A concussion is a brain injury as the result of a direct or indirect force to the head resulting in functional changes to the brain.

4^th INTERNATIONAL CONFERENCE ON CONCUSSION STATEMENT (Zurich):

Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces.  Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include 1) direct blow to head or face, or indirect blow to the body; 2) results in rapid onset of short-lived impairment neurological function; 3) may result in meuropathological changes, but the acute clinical symptoms reflect a functional disturbance rather than structural injury; ad 4) results in a graded set of clinical symptoms that may or may not involve loss of consciousness.  Resolution of the symptoms typically follows a sequential course, but may be prolonged in some cases.

AMERICAN ACADEMY OF NEUROLOGY (AAN):

Concussion is recognized as a clinical syndrome of biomechanically induced alteration of brain function, typically affecting memory and orientation, which may involve loss of consciousnesss (LOC).

According to the 4^th International Conference Consensus Statement a majority (80 – 90%) of concussions resolve in 7 – 10 days, but can be longer in children and adolescents.  Very few concussions present with loss of consciousness.

CONCUSSION DIAGNOSIS: 

Diagnosis of concussion should be made by a licensed health care professional (LHCP), [athletic trainers fall into this category] according to both the AAN and Zurich statements.  The Zurich statement provides a much more detailed list of signs and symptoms that can lead to a diagnosis of concussion including: physical and/or emotional symptoms, physical signs, behavioral changes, cognitive impairment, sleep disturbance. 

CONCUSSION ASSESSMENT TOOLS:

The Zurich statement recommends the SCAT3 and Child SCAT3 when initially evaluating concussions.  The Sport Concussion Assessment Tool (SCAT) is a combination of injury history, Graded Symptom Checklist (GSC), cognitive function assessment, Standard Assessment of Concussion (SAC), and Balance Error Scoring System (BESS).  The AAN statement does not discuss the SCAT3 specifically, but does address some of the included assessments on an individual basis with moderate to high effectiveness with regards to recognizing concussion. AAN does recommend a combination of assessments work best, but does not recommend a specific combination of assessments.

Both Zurich and AAN reiterate that CTs cannot diagnose a concussion, but may be useful in ruling out more serious traumatic brain injuries (TBI).

NEUROPSYCHOLOGICAL TESTING:

Zurich recommends that neuropsychological assessment should not be the sole basis of management decisions, but should be seen as an aid to the clinical decision-making.  Formal NP testing is not required for all athletes, but when used should be utilized by trained neuropsychologists and should be one part of the return to play (RTP) decision-making process for the medical professional caring for the athlete.  Baseline testing was not considered a mandatory aspect of assessment, with insufficient evidence to mandate such testing according to Zurich.  Baseline may be appropriate in individual cases, but not as a standard of practice at this time.  AAN recommends that when NP is used that it be interpreted by a qualified neuropsychologists and should not be used in preadolescents as evidence to support such use is lacking.

CONCUSSION EVALUATION PROCESS:

According to Zurich when an athlete shows any features of a concussion a player should: 

1. Be evaluated onsite by a LHCP,
2. If no HLCP available player should be safely removed from play IMMEDIATELY,
3. Assessment of concussion should be made once first aid concerns have been addressed (rule out neck injury),
4. Do not leave the player alone following injury; should be consistently monitored for the first few hours after injury, it is possible that symptoms could worsen during this time,
5. Should not return to play on the day of injury.

AAN provides a very similar recommendation regarding concussion evaluation.  It provides additional emphasis on not returning athletes to play on the same day they have been suspected (not diagnosed) of having a concussion, particularly for adolescent athletes.  AAN also emphasizes that athletes must ultimately gain medical clearance for a LHCP in order to begin the return to play process.  Many states now also require these steps as part of their concussion management protocols as part of a legal mandate.

CONCUSSION MANAGEMENT AND RETURN TO PLAY:

Zurich emphasizes BOTH physical and cognitive rest until acute symptoms resolve. This seems particularly important for adolescent athletes and modification of activities such as texting and watching television should be considered as part of the cognitive rest component.

Both Zurich and AAN recommend a graded RTP program prior to full medical clearance and return to sport.  Zurich recommends a minimum of 24 – 48 hours of rest (symptom free) prior to beginning return to play protocol.  Also, child and adolescent athletes should not return to sport until they have returned to schools successfully.  A specific graded RTP protocol is provided in the Zurich statement, but it should be individualized and progressed only when the athlete is symptom free following completion of the current stage.  Children and adolescents recover more slowly and the RTP should take a more conservative approach.

OTHER INFORMATION:

When it comes to other factors likely to affect the likelihood of concussion or prolonged symptoms from a concussion both Zurich and AAN agree that a previous history of concussion makes an athlete more susceptible to future concussions.  The AAN statement goes on to list other factors that may increase risk including being a male in collision sports such as football or rugby.  Some evidence demonstrates that female athletes are at greater risk for concussion in soccer and basketball as compared to their male counterparts.  Body checking in hockey is also likely to increase risk.  Zurich lists several factors as “modifying factors” and conveniently lists them in a table as part of their statement. 

Understanding the role of protective equipment in the prevention of concussions has come into further focus and according to both Zurich and AAN there is currently no evidence that shows mouth guards or helmets prevent the occurrence of concussions.  Mouth guards do prevent dental and orofacial injuries, while helmets can reduce forces placed on the brain, but this does not translate to preventing concussions.

The ability to predict whether an athlete is at increased risk for prolonged or chronic impairment following diagnosis of a concussion is difficult at best.  According to the AAN statement there is some evidence that shows that elevated post concussion symptoms, lower SAC scores, and BESS deficits could be associated with more severe or prolonged postconcussive impairments.

The AAN goes on to recommend that education of school-based professionals (coaches, teachers, administrators, etc.) by LHCP trained in understanding concussion and their prevention is critical.  The LHCP should also be involved in the education of athletes and parents regarding the risks, recognition and management of concussions.

SUMMARY:

After reviewing both statements it seems there is much that Zurich and AAN can agree on when it comes to diagnosing and managing concussions.  The Zurich statement seems to be focusing on sports-related concussions as a whole and does include some additional information about CTE and other topics not addressed by AAN.  The AAN statement clearly focuses on concussions as it relates to children and adolescent athletes whereas Zurich includes information about this population as part of a greater athlete population.   In the end I think the AAN has it right when it recommends education of school-based professionals who will be dealing with concussed athletes in some way.  I would argue that education is the one biggest tool we have to improve prevention, diagnosis and management of sports-related concussion whether they happen to a child or a professional athlete.

ADDITIONAL RESOURCES:

SCAT3

Child SCAT3

AAN Sports Concussion Took Kit

(this includes some fact sheets and the new app)

HERE is Beth at a recent ASA event talking about the AAN Guidelines.

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

Casinelli Survives Neck Injury to Return to Sports

This past week I had the privilege of sitting down with Samantha Villa to talk about October 14, 2011.  For those of you who do not know, Samantha was working a high school football game versus Carlsbad High School as the athletic trainer for La Costa Canyon High School that night.  The game was a typical high school football game when Sam Casinelli went to make a tackle on an opposing player and ended up face down on the field. 

One… Two… Three… and Sam has not tried to get up.  At this point Samantha ran out onto the field along with her team physicians to assess the situation.  Sam was conscious and complaining of neck pain, but was able to wiggle his fingers and toes.  He did admit to having numbness and tingling in both arms at the time of the hit.  Given this information, Samantha made the decision to spineboard Sam.  An ambulance was called during this time, since there wasn’t one on site and he was transported to the nearest trauma center.

At the hospital Sam’s x-ray revealed two fractured vertebrae in his neck.  Shortly, thereafter more testing showed damage to ligaments that stabilize the vertebrae as well, leading to surgery to repair this damage.  Sam was in the hospital for about a week and out of school for about 11 weeks.  Sam went through a rigorous rehabilitation process, but did not require a halo brace during his recovery. 

During this time, Sam and the family expressed their thanks to Samantha Villa as the athletic trainer and all the other health professionals involved in Sam’s treatment and recovery.  Neurosurgeon Sanjay Ghosh, M.D. wrote the following in a letter to La Costa High School and those involved in Sam’s care with the permission of the family:

“It is my opinion that if Sam had suffered at most 10lbs more of force during his injury, this would have rendered him permanently partially quadriplegic.  Furthermore, if it were not for the great attention to detail of the first responders in the field, I am quite certain that we would have had the same catastrophic result.  You and your staff are to be commended for attending to him in such a manner and recognizing the serious nature of his injury, as your care and attention clearly had a profound impact on this young man’s life.”

At the time of his injury, Sam was a junior at La Costa High School. He is now a thriving senior there who no longer plays football, but continues to be a key member of the school’s baseball team.  In fact, Sam was able to play baseball last spring (2012), just several months after his injury.  Sam was also a student-coach as a member of the football team this past fall, giving him the opportunity to continue to support his teammates.  For her part, the California Athletic Trainers’ Association (CATA) recognized athletic trainer Samantha Villa for her actions that evening with the Save A Life Award.  Her colleague Christina Scherr, who is also an athletic trainer in the San Dieguito UHSD nominated her.

If you would like to see more regarding Sam’s injury check THIS out. 

If you know Samantha take the time this March to thank her for being an athletic trainer, after all it is National Athletic Training Month.  If Samantha isn’t your athletic trainer, but you have one at your high school, be sure to take the time to thank him or her, you never know when he or she may be the one to save your life.

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

National Athletic Training Month Helps Kick Start Fundraising for A4IA

As National Athletic Training Month (NATM) is now officially here I thought it would be interesting to find out what people are doing to raise awareness about athletic trainers and their important role in athletic health and safety.  I did not have to go far.  Stephenville High School in Stephenville, Texas and the Athletic Training Club at The Ohio State University has taken it upon themselves to help raise funds for A4IA.  Given A4IA’s mission of promoting the profession of athletic training and this year’s motto of “Everybody Needs and Athletic Trainer” it seems a natural fit.

I had the opportunity to speak with Kendall Goldberg, one of two athletic trainers, along with Mike Carroll at Stephenville High School who put together a t-shirt sale as part of their promotion of NATM.  Both Mike and Kendall are not only advocates for A4IA, but are very active within the NATA and Southwest Athletic Trainers’ Association (SWATA).  Their idea is to sell t-shirts that include on the front, “I 'HEART' My Athletic Trainer” in an effort to promote the need for athletic trainers in high schools.  If you are interested in a t-shirt, you can download an order form and contact Mike or Kendall (their information is available via the Stephenville HS link above).

While speaking with Kendall I learned that there is a small athletic training student program at Stephenville which includes a basic sports medicine class as well as first aid and CPR.  Additionally, Mike and Kendall work with all the athletes on campus.  It is commonplace for older students to advocate for the athletic training staff to the younger students who are hesitant to seek help or are unsure of what Mike and Kendall do.  There is another type of advocacy happening at Stephenville because of this t-shirt sale; Stephenville students are realizing how fortunate they really are to have Mike and Kendall.  They often return from away trips where there is no athletic trainer surprised and disappointed that athletic trainers are not available to them or their opponent.  These high school athletes are beginning to understand at a very young age the importance of athletic trainers.  I would argue that this awareness and understanding could lead to future parent advocates for athletic trainers at more high schools.

At The Ohio State University Alexis Heimert, Vice President and the rest of The Ohio State University Athletic Training Club are planning and participating in the 4^th annual Running with the Buckeyes, a 5K race coordinated by the group.  Each year the event promotes NATM and happens on March 24, 2013.  You can register in advance or race day.

Alex and the rest of the group found out about A4IA through the Facebook page and Tommy’s video.  They did more research to learn about the organization and its goals.  The club, impressed by A4IA’s desire to promote the profession of athletic training, a primary purpose of the club, decided to help.  They felt it was their responsibility as future professionals to advocate for organization that promotes their profession through public education, pushing for increased access to athletic trainers, and the important role athletic trainers play in athletic health care.

These are only two examples of athletic training advocacy happening this month that could use your support.  These two groups decided to help A4IA by raising money on its behalf.  If after reading this, you want to get involved it can be as simple as saying thank you to your athletic trainer for all their hard work, supporting one of the events above or checking with your local, state or regional athletic training organization to see what events they have planned.  Other events to consider:  1) write your state representative in California to support passage of AB864, state licensure for ATs, 2) check out the Far West Athletic Trainers’ Association (FWATA) site for a variety of events, or 3) come up with an event of your own! 

Grassroots advocacy can make a difference as the students at Stephenville High School and The Ohio State University have shown us.  Every little bit helps, so what will you do? 

Happy National Athletic Training Month!

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

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

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

Dawn Comstock, PhD, Colorado School of Public Health at University of Colorado, Denver

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

NATIONALACTION PLAN FOR SPORTS SAFETY:

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.

STUDENTATHLETE BILL OF RIGHTS:

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

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:

Putukian, M., O’Connor, F.G., Stircker, P.R., McGrew, C., Hosey, R.G., Gordon, S.M., Kinderknecht, J., Kriss, V.M., and Landry, G.L. (2008).  Mononucleosis and athletic participation:  An evidenced-based subject review.  Clinical Journal of Sports Medicine, 18(4), 309 – 315.

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