11/20/2012 Why are we allowing it to happen? Over burdening athletes with non- stop activity; Casual attitude with “collateral damage”; No recovery period, especially if season was unsuccessful; Charlie Thompson, MS, ATC Creation of “irrational intensity” not consistent with needs of the sport; Head Athletic Trainer Lack of science based programs (“make them Princeton University tougher”). One of several authors for Preventing Sudden What is happening and why? Death in Sport and Physical Activity , Jones & What can we do when it does happen? Bartlett. How can we stop this from happening? Some of the information provided here came from the book. USOC- Colorado Springs There have been 21 non- traumatic deaths since Jeff Anderson, MD, Chair, NCAA Competitive 2000- Safeguards and Medical Aspects of Sports (CSMAS), and Team Physician, U. of 10 SCT, 4 EHS, 1 Asthma, 6 SCD; Connecticut 18 during conditioning, 3 during practice. 23 Exertional Sickling deaths in 12 years. “Serious attention needs to be paid to the manner in which some of our student- athletes are being asked There has not been one traumatic death in college to train.” football in that time. 1
11/20/2012 James Knochel, MD, JAMA, 1975- “Dog Days Four most common causes of non- traumatic Prevention- and Siriasis- How to Kill a Football Player” death are : Health History and Physical Exam 7 ways to kill a FB player- practice time, no water/ Sudden Cardiac Death; ECG- tepid, sodium chloride/ no water, diuretics, full Exertional Heat Stroke; Controversial (interpretation, $$$) pads, amphetamines. Exertional Sickling; How often? Upon matriculation? Yearly? “Heat acclimatization is achieved by gradual, step- Who? Asthma. wise increments.” Recognition “Since it is almost always preventable, AED/ CPR acknowledgement of it’s occurrence is embarrassing, and therefore under- reported”. Since 2000, in NCAA FBS, conditioning and “Sudden death of an individual within 1 hour “Medical emergency involving life- threatening hyperthermia (rectal temp > 40.5 o C [105 o F]) training is the only setting for non- traumatic after exercise due to cardiovascular disorder”. death. w/ concomitant CNS dysfunction.” SCD is the leading cause of death in young These incidents continue to be considered “isolated athletes during exercise. From 1975- 95, there were 24 EHS deaths. rather than serial”, and are blamed on Distribution- From 1996- 2009, there were 42 EHS deaths. “predispositions”. 2 : 1 M : F Even with the new technology in sport drinks, 3 : 1 B : W clothing and our own knowledge, we have 1: 13,000 male black athletes regressed. 1 : 7000 male basketball Belief that we are mirroring sport but merely “manufacturing” intensity. Causes - Exercise is the culprit, as it can occur in any FB work: rest is 1:6; workouts are more like 1:1. condition(s). Hypertrophic Cardiomyopathy- 33% Doesn’t fit in any scientific approach to conditioning. Coronary Artery Anomalies- 17% Prevention- be aware of both extrinsic (ambient 11 of 21 deaths are in the first 2 days of activity. Are we doing too much too soon? Myocarditis temp, uniform/ clothing, work: rest, fluids, Arrhythmogenic Right Ventricular Cardiomyopathy medical conditions) and intrinsic factors (increases in intensity, dehydration, diuretic Aortic Ruptures w/ Marfans use, inadequate acclimitization). Ion Channel Disorders (Long/ Short QT, etc.) 2
11/20/2012 Prevention- SCT has resulted in 10 of the 16 non- traumatic First and foremost is prevention (#1 domain of deaths in college FB since 2000. AT). Hydration- Urine color/ specific gravity. Evaluation- Preparation- have a plan; prepared cold immersion. First well- known case was in 1974 (U. of CO). Health History/ Physical Exam AND follow- up. Recognition- core temp, outward signs. Specialist/ special testing as necessary. . Activation of EMS. All deaths were the result of conditioning drills and not playing. BEGIN COOLING RIGHT AWAY PRIOR TO TRANSPORT- first 30 minutes are critical. Not heat related. Use cold, circulated water. Rectal temperature “controversy”- Prevention- Communication Rectal temperature is the only accurate Know which of your athletes has SCT. Between medical staff. measurement. Understand the S & S’s. Follow- up from PPPE, specialist visit Position statement allows for start of cooling in lieu Between medical staff, sport coaches, and S & C staff. Communicate to S & C staff and sport coaches so of obtaining a rectal temperature. that they are aware of who has SCT. Individual medical concerns (SCT, asthma, hx of EHS, hx of syncope, etc. Don’t let your athletes get into a situation where Approval for sharing information they end up in distress. Who has what? Weather considerations. Etc. Sickle Cell Trait- inherited genetic disorder; Defined by National Heart, Lung, and Blood Emergency Action Plans (EAP’s)- increased exercise intensity causes red blood Institute as “ lung disease in which the airway NATA Position Statement. cells to sickle when they release O 2 . becomes inflamed and restricted to airflow, NCAA guideline/ recommendation. along with brochoconstriction”. Causes a log jam in the small blood vessels which Legal standard?! results in fulminent ischemic rhabdomyolysis. Extrinsic factors- allergens, pollutants, smoke, Develop, practice, implementation. Thought of as being a concern with African- OTC NSAIDS. Involve administrators, facility staff, public safety, Americans but is technically “malarial”. local EMS. S & S include difficulty speaking, chest pain, 8 % AA; .5 % Hispanic; .2 % Cuacasion. wheezing, shortness of breath, and accessory muscle breathing. 3
11/20/2012 Emergency equipment- Venue specific documents- Don’t be the next to regret not doing “Time Out” something; Indicate emergency phones, permanent AED locations, emergency access , lightening shelters. Availability. Don’t have any regrets for your actions or failure to Emergency phone numbers and procedure (on- campus Location. act; vs. off campus dialing). Operating condition. Don’t be the news story. Venue specific signage. Information availability- THESE ARE PREVENTABLE DEATHS. Venue activity specific plans, as necessary. Posted prominently in each venue. Telephone instructions at every telephone. Pocket cards. Away contest instructions in case of an injury/ emergency. Emergency “team” and roles- Discuss the workout goals/ plan prior to Progressive acclimatization. starting. Physicians Gradual introduction of new conditioning NCAA- “the athletic trainer has the unchallengeable AT’s activities. authority to stop any workout they deem unsafe.” Public Safety officers Do not use exercise and conditioning as a form Does that give us the “ultimate responsibility”? Local EMS of punishment. Do we have to protect our S- A’s from our own staff? Coaches/ Staff Ensure proper education, experience, and Read and understand the NATA position credentialling of strength and conditioning statements and NCAA/ NFHS guidelines. staff Legal responsibility? Moral responsibility? Provide for appropriate medical coverage. What is/ are the role each individual plays in Watch for outward S & S of distress- each situation? Develop and practice Emergency Action Plans. Standing, breathing normally. Cognizant of key medical conditions. Establish safety of the scene and immediate care of Standing, bent at waist, hands on the knees. 1. the victim. Kneeling on one knee. Administration of strength and conditioning EMS activation- program by proper staff. 2. On all fours. On- campus vs. off- campus phones? Information to Partnership of recognized professional Lying on the ground. provide (critical). Directions. organizations. Full disclosure, I have in the past, ignored these Equipment retrieval. 3. Ensure proper continuing education S & S, and am thankful that I never had to deal EMS coordination (direct to the scene). 4. opportunities for the entire coaching and with a tragedy. medical team. 4
11/20/2012 cthompso@princeton.edu 5
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