Alliance for Youth Sports Safety: A Call to Action

By Terry Zeigler, EdD, ATC 

Nearly seven million high school students participate in school sports every year. Because most high school athletes do not have access to trained sports medicine professionals on site (58%) and most high school coaches are not well trained in the recognition and provision of emergency treatment for catastrophic injuries and/or illness, death and/or lifelong disabilities have increased in recent years. Specifically, concussion, heat illness, and sudden cardiac arrest have increased.

With the release of data confirming that there were 120 documented sports-related deaths in young athletes in the United States during the past two years, 30 leading health care and sports organizations recently joined together and formed the Alliance for Youth Sports Safety for the purpose of preventing and reducing catastrophic injuries in youth sports. Some of the Alliance members include the American Academy of Orthopedic Surgeons, American Academy of Pediatricians, National Athletic Trainers’ Association, National Association of Secondary School Principals, National Center for Sports Safety, and National Center for Catastrophic Sports Injury Research (National Athletic Trainers’ Association, 2010).

The statistics are getting the attention of many in the medical and sports communities with the message that something needs to change in providing medical care for athletes participating in youth sports (National Athletic Trainers’ Association, 2010). The statistics include:

• Approximately 8,000 children are treated in emergency rooms each day for sports-related injuries.
• Among children, those aged 15-17 experience the highest emergency room visits for sports injuries.
• 50% of “second impact syndrome” incidents – brain injury caused from a premature return to activity after suffering initial injury (concussion) – result in death.
• The CDC reports that high school athletes suffer 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations each year.
• 400,000 brain injuries (concussions) occurred in high school athletics during the 2008-2009 school year.
• There are five times as many catastrophic football injuries among high school athletes as college athletes.
• Only 42% of high schools have access to athletic training services (allied health professional specializing in sports medicine).

Earlier this year, representatives from the 30 organizations in the Alliance for Youth Sports Safety met together in Sacramento, California for the “Summit on the Youth Sports Safety Crisis in America”. This was a half-day event focused on increasing the awareness of catastrophic injuries in youth sports. The Summit focused on how to prevent the three top causes of catastrophic injuries and death in youth sports including concussions, exertional heat illness, and sudden cardiac arrest (Popke, M., 2010).

One of the outcomes of the Alliance was a seven-point “Call to Action” to educate and bring awareness to all those who are involved in youth sports including high school athletic directors, coaches, teachers, parents, and certified athletic trainers. The seven points include the following:

1. Ensure that young athletes have access to healthcare professionals who are qualified to make medical assessments and decisions.
2. Educate your family about the symptoms of musculoskeletal (ACL injury, sprains) and neurological (concussion, heat illness) injuries.
3. Ensure effective pre-participation physical exams before play begins.
4. Ensure that sports equipment and playing surfaces are checked for safety and best conditions prior to activity.
5. Encourage state lawmakers to introduce legislation that would make high school sports participation safer.
6. Support additional research of youth sports injuries and their effects.
7. Eliminate the culture of playing through pain without assessment (specifically related to heat illness and concussion).

Assisting with the push for national and state legislation is the Zachery Lystedt Brain Project. The project was named after a young high school football player. Zachery Lystedt was a 16 year old athlete competing on a high school football team in the state of Washington. He suffered a concussion towards the end of the first half of a football game, was removed, but returned to play in the third quarter and played for most of the second half of the game (Popke, 2009).

The young athlete collapsed at the end of the game and lapsed into a coma from a brain hemorrhage. He remained in a comatose state for one month. Although he survived and recovered from the coma, Lystedt remains paralyzed on his right side and is confined to a wheelchair. Lystedt suffered from a brain injury called “second impact syndrome”.

Second impact syndrome occurs when an athlete is returned too early to play after suffering from a concussion. Second impact syndrome is completely preventable with the proper initial assessment and proper management of an athlete with a concussion.

The goal of the Zachery Lystedt Brain Project is to increase public awareness, training, and legislation while encouraging further research on brain injuries. Because of Lystedt’s brain injury, Washington state passed what is considered one of the toughest pieces of legislation to protect young athletes from returning to play too early from a concussion. The legislation took two years to pass, but other states are following its lead and passing similar legislation.

The law stipulates that “only licensed healthcare providers can make return-to-play decisions and that they be trained in the evaluation and management of concussions” (Popke, M., 2009). The licensed healthcare providers approved so far to make return-to-play decisions include medical doctors, osteopaths, physician’s assistants, nurse practitioners, and certified athletic trainers.

The law also “mandates that school districts work with the Washington Interscholastic Activities Association to educate coaches, players and parents about the nature and risk of concussions, and stipulates that student-athletes and their parents sign an information sheet about concussions and head injuries prior to each season” (Popke, M., 2009).

Other states with pending legislation modeled after the Lystedt Law include the states of California, Florida, Massachusetts, New Jersey, New York, Pennsylvania, and Virginia.

Taking sports safety even further, the state of California currently has two bills pending. Both were introduced by Democratic Assemblymember Mary Hayashi and require not only a medical clearance after concussions for return-to play, but also include:

• Expanding coaches’ first aid and CPR requirements by the end of 2011 to include specific education regarding recognition of and reaction to catastrophic injuries.
• Mandating automated external defibrillators at all high school games and practices by 2014.
• Requiring the adoption of a statewide heat acclimatization program (to prevent catastrophic illness/death from heat illness)

As state and national attention continues to increase on awareness, education, and prevention of catastrophic injuries in youth sports, both health care and sports organization advocates are stepping up and making a difference. Becoming educated on sports injuries is a good first step. Advocating for access to better medical care at the high school level is also an important step. Last, protecting young athletes from further injury by getting athletes’ injuries assessed by medical professionals and teaching our children not to “play through pain” together will all begin to help reduce the incidence of catastrophic injuries.

National Athletic Trainers’ Association (January, 12, 2010). “Alliance to Address the Youth Sports Safety Crisis in America” Summit Raises Awareness of Health Care and Safety of Youth Athletes.

National Athletic Trainers’ Association (2010). Summit on Youth Sports Safety Crisis in America.

Popke, M. (April, 2010). Curtailing Catastrophe. Athletic Business.

Popke, M. (December, 2009). Hit Hard. Athletic Business.

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