Health & Safety: A Look Back, Gallop Ahead
By
John E. (Jack) Roberts
MHSAA Executive Director, 1986-2018
August 7, 2015
We are just completing year six of eight during which we have been addressing the four important health and safety issues that, for ease of conversation, we call the “Four Hs.”
During the 2009-10 and 2010-11 school years, our focus was on Health Histories. We made enhancements in the pre-participation physical examination form, stressing the student’s health history, which we believe was and is the essential first step to participant health and safety.
During the 2011-12 and 2012-13 school years, our focus was on Heads. We were an early adopter of removal-from-play and return-to-play protocols, and our preseason rules/risk management meetings for coaches included information on concussion prevention, recognition and aftercare.
Without leaving that behind, during the 2013-14 and 2014-15 school years, our focus was on Heat – acclimatization. We adopted a policy to manage heat and humidity – it is recommended for regular season and it’s a requirement for MHSAA tournaments. The rules/risk management meetings for coaches during these years focused on heat and humidity management.
At the mid-point of this two-year period, the MHSAA adopted policies to enhance acclimatization at early season practices and to reduce head contact at football practices all season long.
Without leaving any of the three previous health and safety “H’s” behind, during the 2015-16 and 2016-17 school years, our focus will be on Hearts – sudden cardiac arrest and sudden cardiac death.
Coinciding with this emphasis is the requirement that all high school level, varsity level head coaches be CPR certified starting this fall. Our emphasis will be on AEDs and emergency action plans – having them and rehearsing them.
On Feb. 10, bills were introduced into both the U.S. Senate and House of Representatives, together called the “Safe Play Act (see below),” which addressed three of the four health and safety “H’s” just described: Heat, Hearts and Heads.
For each of these topics, the federal legislation would mandate that the director of the Centers for Disease Control develop educational material and that each state disseminate that material.
For the heat and humidity management topic, the legislation states that schools will be required to adopt policies very much like the “MHSAA Model Policy to Manage Heat and Humidity” which the MHSAA adopted in March of 2013.
For both the heart and heat topics, schools will be required to have and to practice emergency action plans like we have been promoting in the past and distributed to schools this summer.
For the head section, the legislation would amend Title IX of the 1972 Education Amendments and eliminate federal funding to states and schools which fail to educate their constituents or fail to support students who are recovering from concussions. This support would require multi-disciplinary concussion management teams that would include medical personnel, parents and others to provide academic accommodations for students recovering from concussions that are similar to the accommodations that are already required of schools for students with disabilities or handicaps.
This legislation would require return-to-play protocols similar to what we have in Michigan, and the legislation would also require reporting and recordkeeping that is beyond what occurs in most places.
This proposed federal legislation demonstrates two things. First, that we have been on target in Michigan with our four Hs – it’s like they read our playbook of priorities before drafting this federal legislation.
This proposed federal legislation also demonstrates that we still have some work to do.
And what will the following two years – 2017-18 and 2018-19 – bring? Here are some aspirations – some predictions, but not quite promises – of where we will be.
First, we will have circled back to the first “H” – Health Histories – and be well on our way to universal use of paperless pre-participation physical examination forms and records.
Second, we will have made the immediate reporting and permanent recordkeeping of all head injury events routine business in Michigan school sports, for both practices and contests, in all sports and at all levels.
Third, we will have added objectivity and backbone to removal from play decisions for suspected concussions at both practices and events where medical personnel are not present; and we could be a part of pioneering “telemedicine” technology to make trained medical personnel available at every venue for every sport where it is missing today.
Fourth, we will have provided a safety net for families who are unable to afford no-deductible, no exclusion concussion care insurance that insists upon and pays for complete recovery from head injury symptoms before return to activity is permitted.
We should be able to do this, and more, without judicial threat or legislative mandate. We won’t wait for others to set the standards or appropriate the funds, but be there to welcome the requirements and resources when they finally arrive.
Safe Play Act — H.R.829
114th Congress (2015-2016) Introduced in House (02/10/2015)
Supporting Athletes, Families and Educators to Protect the Lives of Athletic Youth Act or the SAFE PLAY Act
Amends the Public Health Service Act to require the Centers for Disease Control and Prevention (CDC) to develop public education and awareness materials and resources concerning cardiac health, including:
- information to increase education and awareness of high risk cardiac conditions and genetic heart rhythm abnormalities that may cause sudden cardiac arrest in children, adolescents, and young adults;
- sudden cardiac arrest and cardiomyopathy risk assessment worksheets to increase awareness of warning signs of, and increase the likelihood of early detection and treatment of, life-threatening cardiac conditions;
- training materials for emergency interventions and use of life-saving emergency equipment; and
- recommendations for how schools, childcare centers, and local youth athletic organizations can develop and implement cardiac emergency response plans.
Requires the CDC to: (1) provide for dissemination of such information to school personnel, coaches, and families; and (2) develop data collection methods to determine the degree to which such persons have an understanding of cardiac issues.
Directs the Department of Health and Human Services to award grants to enable eligible local educational agencies (LEAs) and schools served by such LEAs to purchase AEDs and implement nationally recognized CPR and AED training courses.
Amends the Elementary and Secondary Education Act of 1965 to require a state, as a condition of receiving funds under such Act, to certify that it requires: (1) LEAs to implement a standard plan for concussion safety and management for public schools; (2) public schools to post information on the symptoms of, the risks posed by, and the actions a student should take in response to, a concussion; (3) public school personnel who suspect a student has sustained a concussion in a school-sponsored activity to notify the parents and prohibit the student from participating in such activity until they receive a written release from a health care professional; and (4) a public school's concussion management team to ensure that a student who has sustained a concussion is receiving appropriate academic supports.
Directs the National Oceanic and Atmospheric Administration to develop public education and awareness materials and resources to be disseminated to schools regarding risks from exposure to excessive heat and humidity and recommendations for how to avoid heat-related illness. Requires public schools to develop excessive heat action plans for school-sponsored athletic activities.
Requires the CDC to develop guidelines for the development of emergency action plans for youth athletics.
Authorizes the Food and Drug Administration to develop information about the ingredients used in energy drinks and their potential side effects, and recommend guidelines for the safe use of such drinks by youth, for dissemination to public schools.
Requires the CDC to: (1) expand, intensify, and coordinate its activities regarding cardiac conditions, concussions, and heat-related illnesses among youth athletes; and (2) report on fatalities and catastrophic injuries among youths participating in athletic activities.
Next Play: Heart of the Matter
June 25, 2015
By Rob Kaminski
MHSAA benchmarks editor
From the retirement of NFL players in their mid-20s fearing long-term disability, to NASCAR drivers suffering injuries against concrete walls when alternative substances are available, to MLB outfielders running into barriers which place aesthetics and tradition over safety, the focus of highlight shows, apps and old-fashioned sports pages is shifting from action inside the lines to the sidelines.
As the reality of human vulnerability continues to invade our favorite escape from reality – athletics – protecting those in the spotlight needs to be Job 1.
While the quest for risk management protocols and health and safety provisions is a never-ending loop, the MHSAA bolted from the starting blocks with a 4H plan (Health Histories, Heads, Heat and Hearts) in the fall of 2009, a mission that enters the fourth turn for the 2015-16 school year.
And, as pulse quickens for the “Heart” stage in the fall, the MHSAA will continue to step up initiatives involving the other three initiatives during the next lap.Think of it as a continuous relay, where the baton is never dropped and fresh runners continue the race.
While organizations at other levels might be asking, “What to do,” the MHSAA is focusing on “What’s next?”
In this playbook the next plays are critical in allowing student-athletes to continue providing their communities with inexpensive and entertaining breaks from reality.
The Heart of the Matter
The 2015-16 school year brings with it an ambitious but paramount stage in the MHSAA’s mission to protect and promote the well being of student-athletes across the state.
Beginning in the fall, all high school varsity coaches will need to have Cardiopulmonary Resuscitation (CPR) certification by established deadlines which correspond to rules meetings.
The requirement is new, and the volume of personnel affected is vast. Yet, plans have been in place during the past few years, and schools in many communities are ahead of the curve.
“We’ve fielded some questions regarding the requirement, but I think that many of our schools already have similar protocols in place,” said MHSAA assistant director Kathy Vruggink Westdorp. “Increasingly, schools have become more prudent with regards to health and safety, and programs which emphasize these initiatives have been well received.”
Pete Ryan, MHSAA Representative Council member and athletic director for Saginaw Township Community Schools, concurs.
“The CPR requirement will not be a change for Heritage, as we have required CPR for eight years,” Ryan said. “We offer certification through our district nurse at no charge to the coaches and train about 20-30 coaches per year.”
The training vehicle might vary from district to district, but so long as the end result is certification, the coaches are free to take course by any means possible, whether online or in person.
“I think we’ll see a blend of online and classroom delivery,” Westdorp said. “And, I don’t think it will be just the coaches. At the MIAAA Conference (in March), school leaders were proactive in terms of certification for athletic directors, too.”
Mike Bakker, President of the Michigan Interscholastic Athletic Administrators Association and athletic director at Fenton High School, says CPR certification is a must in the risk management plans for all school settings.
“As an educator who has been a CPR and first aid instructor for the American Heart Association for a number of years, I am excited that the MHSAA will require CPR training for varsity coaches,” Bakker said.
“I certainly hope that in the future we will see that all coaches are trained in CPR. There might be a bit of a challenge at first to get our coaches trained, as schools look for the most economical as well as timely way to accomplish this mandate. The biggest hurdle that I can foresee is trying to find qualified trainers in all areas of the state that have multiple training dates available to fit the needs of such diverse coaching staffs.”
Ryan believes there is no substitute for the personal touch.
“We are doing in-person training which I feel is better because the individuals have to perform the procedure on the practice dummy," he said. "It’s simply more hands-on training.”
School nurses and trainers will play a substantial role in the certification process, as will community health organizations in many locales.
“In many of our schools, the health educators are certified to conduct CPR courses,” Westdorp said. “We’ve also had numerous calls from non-school entities alerting us to their availability to provide training, such as fire departments and local medical centers.”
Fenton is one such school with the luxury of on-site personnel to train its staff.
“We are fortunate in Fenton that our athletic trainer and athletic director are certified trainers so we can accomplish our training in-house, but I know that not all schools are as fortunate,” Bakker said.
Which is exactly why it’s necessary for coaches to become certified, and ideally not just the head coaches.
“It should be encouraged that all coaching staff become CPR certified so that they are able to take action, especially for schools which do not have an athletic trainer on staff and if the head coach is unavailable or present, in the unfortunate event that a potential cardiac emergency and/or sudden-death incident occurs,” said certified athletic trainer Gretchen Mohney, the Clinical Coordinator and Instructor for Western Michigan University Undergraduate Athletic Training Program.
Mark Mattson, athletic director at Traverse City Central, indicated that while not previously a requirement, the district has been proactive in prepping the coaches.
“From the moment the requirement was announced, we've been out in front of it,” Mattson said. “What’s great is, even though it hasn’t been a requirement for Traverse City Area Public Schools, many coaches are indeed already certified. The district also offers training sessions once a month and those dates are passed on to our coaches. Jason Carmien (AD at Traverse City West) and I have also had conversations about providing training at our preseason coaches meeting for those still in need prior to the start of the fall season.”
Coaches can also count on a familiar training source to come through for certification: the MHSAA Coaches Advancement Program. Westdorp, who heads up the expansive continuing education program for the state’s coaches, envisions coursework at select sites which will build CPR training into the session, giving attendees more added incentive and training opportunities.
CAP has also served as a siren to inform and remind the MHSAA’s constituents about the upcoming regulation.
“In all CAP courses this school year, we’ve been educating the coaches about the CPR requirement,” Westdorp said. “We also can format the courses to include a two-hour block for CPR certification within the CAP training. We could even do it with a league and conference group where we set up rotations, and the CPR aspect would be one of the rotations.”
Westdorp added that many athletic directors currently schedule coaches meetings and additional coursework around CAP training. It’s a perfect fit to deliver pertinent messages while all parties are in one location.
Such gatherings could also provide the opportunity for athletic leaders to share emergency action plans.
Along with the CPR component of the MHSAA’s health mission for the coming school year, schools will be asked to have in place and rehearse emergency action plans involving cardiac and other health-related emergencies.
To assist, schools will receive this summer the “Anyone Can Save a Life” program developed by the Minnesota State High School League and endorsed and delivered nationally by the National Federation of State High School Associations (check back for more on this program later this week).
“The ‘Anyone Can Save A Life’ initiative promotes the need to have and to practice planning for different kinds of emergencies; it involves students as well as adults; and it invites schools to include their previously existing plans,” said MHSAA Executive Director Jack Roberts.
“The result can be a fresh, comprehensive emphasis on preparing for emergencies well before they occur and then responding with more confidence when those emergencies inevitably happen. It is the perfect link between the last two years when we focused on heat illness and the next two years when we focus on sudden cardiac arrest,” Roberts added.
It will also be of primary concern to place automated external defibrillators (AEDs) in all schools and provide training for use of the devices.
The reasoning behind such a full-court press can be backed by simple facts.
- At any one time, an estimated 20 percent of the U.S. population congregates on school grounds, increasing the likelihood of school-based cardiac emergencies.
- Victims of SCA can be brought back to life by providing chest compressions and early defibrillation with an AED.
- Every second counts. When SCA occurs, chest compressions and the use of an AED need to start immediately.
- The AED can only help and will only deliver a shock if it is needed.
- The AED is very easy to use. Just turn it on and follow the voice prompts.
The best way to combat such situations is to create an atmosphere of preparedness; making sure all people in close proximity to potential victims can respond with quickness, confidence and precision to help reduce fatalities.
“In order for best practices to be achieved, it will require coordinated efforts to establish a quality emergency action plan among the entire athletic department staff, which should be practiced annually. This should be viewed as the first line of preparedness and defense in sports safety,” said James Lioy, an adjunct professor in athletic training at WMU who was named Michigan High School Athletic Trainer of the year in 2000-01.
That’s the goal of action plans such as those included in MHSAA CAP Levels and the Anyone Can Save A Life program.
“We've taken the ‘know-how’ out of it. You don't have to know how to perform the medical procedures to be trained and prepared as part of an effective emergency response team,” said Jody Redman, associate director of the Minnesota State High School League and one of the authors of the Anyone Can Save a Life program.
A common refrain in athletics to assign perspective on sport in society is, “It’s just a game; it’s not life or death.”
However, in the most dire of circumstances, participants indeed can be faced with life or death. Knowing how to respond can make all the difference.