Using Heads in the Heat of Competition
December 20, 2013
By Rob Kaminski
MHSAA benchmarks editor
With so much recent attention to the risks and recognition of concussions in collision sports, athletic leaders have put their heads together to address far more common – but often overlooked – threats to the health of our student-athletes: heat and sudden cardiac arrest.
The No. 1 killer of young athletes is sudden cardiac arrest, while heat stroke victims can surpass that during the year’s hottest months. While the moment of impact leading to a concussion is totally unpredictable, athletic trainers, coaches and administrators have the ability to diminish the occurrences of cardiac arrest and heatstroke. Typically, there is a pre-existing condition, or family history suggesting probabilities for sudden cardiac arrest, which can be treated when detected. And, the perils associated with hot weather – heat stroke, prostration – are almost always completely preventable.
The MHSAA has addressed both issues recently. With assistance from numerous medical governing bodies, the annual pre-participation physical form was revamped and expanded prior to the 2011-12 school year to include comprehensive information regarding participants’ medical history.
In May, the Representative Council adopted a Model Policy for Managing Heat & Humidity (see below), a plan many schools have since adopted at the local level. The plan directs schools to monitor the heat index at an activity site once the air temperature reaches 80 degrees and provides recommendations when the heat index reaches certain levels, including ceasing activities when it rises above 104 degrees.
The topic of heat-related illnesses receives a lot of attention at the start of fall when deaths at the professional, collegiate and interscholastic levels of sport occur, especially since they are preventable in most cases with the proper precautions. In football, data from the National Federation of State High School Associations shows 41 high school players died from heat stroke between 1995 and 2012.
“We know now more than we ever have about when the risk is high and who is most at risk, and we’re now able to communicate that information better than ever before to administrators, coaches, athletes and parents," said Jack Roberts, executive director of the MHSAA. “Heat stroke is almost always preventable, and we encourage everyone to avail themselves of the information on our website.
“Schools need to be vigilant about providing water during practices, making sure that students are partaking of water and educating their teams about the need for good hydration practices.”
All of which is not to say concussions aren’t a serious matter; they are. In fact, leaders in sport safety can take advantage of the concussion spotlight to illuminate these additional health threats.
A recent New York Times story (May 2013) by Bill Pennington featured a February 2013 gathering in Washington organized by the National Athletic Trainers Association. In the article, Dr. Douglas J. Casa, professor of kinesiology at the University of Connecticut and Chief Operating Officer of the Korey Stringer Institute (founded in the late NFL offensive lineman’s name to promote prevention of sudden death in sport), suggests just that.
“All the talk about head injuries can be a gateway for telling people about the other things they need to know about, like cardiac events and heat illness,” said Casa in the article. “It doesn’t really matter how we get through to people as long as we continue to make sports safer.”
Education and prevention methods need to find a permanent place in school programs if those programs are to thrive and avoid becoming targets at which special interest groups can aim budgetary arrows.
Dr. Jonathan Drezner, the president of the American Medical Society for Sports Medicine, said in the New York Times piece that sudden cardiac arrest is “so incredibly tragic and stunning that people aren’t comfortable putting it into the everyday conversation. I do wish, to some extent, it was something people talked more about because we are getting to a place where we could prevent many of these deaths.”
When it comes to heat-related deaths or illnesses, the prevention efforts can be even more successful by educating the masses. And, these efforts can be done at minimal cost to schools.
“That’s the thing about curtailing exertional heat illness: it’s 100 percent preventable, and unlike other health threats to athletes, the solutions can be very low-tech and inexpensive,” said Dr. Michael F. Bergeron, the director of the National Institute for Athletic Health & Performance at the University of South Dakota’s Sanford Medical Center, in the New York Times story.
To assist with cost and data maintenance, the MHSAA has teamed with Sports Health to provide schools with psychrometers (heat measurement instruments) at a discounted rate, and has built online tools to track heat and humidity conditions.
Managing heat and humidity policy
- Thirty minutes prior to the start of an activity, and again 60 minutes after the start of that activity, take temperature and humidity readings at the site of the activity. Using a digital sling psychrometer is recommended. Record the readings in writing and maintain the information in files of school administration. Each school is to designate whose duties these are: generally the athletic director, head coach or certified athletic trainer.
- Factor the temperature and humidity into a Heat Index Calculator and Chart to determine the Heat Index. If a digital sling psychrometer is being used, the calculation is automatic.
If the Heat Index is below 95 degrees:
All Sports
- Provide ample amounts of water. This means that water should always be available and athletes should be able to take in as much water as they desire.
- Optional water breaks every 30 minutes for 10 minutes in duration.
- Ice-down towels for cooling.
- Watch/monitor athletes carefully for necessary action.
If the Heat Index is 95 degrees to 99 degrees:
All Sports
- Provide ample amounts of water. This means that water should always be available and athletes should be able to take in as much water as they desire.
- Optional water breaks every 30 minutes for 10 minutes in duration.
- Ice-down towels for cooling.
- Watch/monitor athletes carefully for necessary action.
Contact sports and activities with additional equipment:
- Helmets and other possible equipment removed while not involved in contact.
- Reduce time of outside activity. Consider postponing practice to later in the day.
- Recheck temperature and humidity every 30 minutes to monitor for increased Heat Index.
If the Heat Index is above 99 degrees to 104 degrees:
All Sports
- Provide ample amounts of water. This means that water should always be available and athletes should be able to take in as much water as they desire.
- Mandatory water breaks every 30 minutes for 10 minutes in duration.
- Ice-down towels for cooling.
- Watch/monitor athletes carefully for necessary action.
- Alter uniform by removing items if possible.
- Allow for changes to dry T-shirts and shorts.
- Reduce time of outside activity as well as indoor activity if air conditioning is unavailable.
- Postpone practice to later in the day.
Contact sports and activities with additional equipment
- Helmets and other possible equipment removed if not involved in contact or necessary for safety.
- If necessary for safety, suspend activity.
Recheck temperature and humidity every 30 minutes to monitor for increased Heat Index.
If the Heat Index is above 104 degrees:
All sports
- Stop all outside activity in practice and/or play, and stop all inside activity if air conditioning is unavailable.
Note: When the temperature is below 80 degrees there is no combination of heat and humidity that will result in need to curtail activity.
PHOTO: The Shepherd volleyball team includes hydration during a timeout in a match this fall.
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.