Preventing sudden death in youth sports
By Christianne Eason, PhD, ATC
Vice President of Sport Safety at the Korey Stringer Institute
It’s estimated that more than 30 million children between the ages of 6 to 14 participate in at least one sport each year. Data has indicated that 39 percent of life-threatening injuries treated in emergency departments involving children between the ages of 6 to 18 years old were sport related. Given the large number of children participating in youth sport and emergency room-documented serious sport injury data, it is imperative to improve sport safety policies and work towards implementation of best-practices.
Youth sport national governing bodies, member organizations and leagues, and member coaches play an essential role in supporting and prioritizing the health and safety of the young athletes participating in organized sport across the country. It is important to recognize that each organization is unique, which will require different strategies to successfully implement best practice policies. Many deaths in youth sports are preventable with appropriate planning and implementation of policies and procedures.
CATASTROPHIC ILLNESS AND INJURY IN SPORT
The 2019 National Center for Catastrophic Sport Injury Research annual report revealed that there were 88 catastrophic injuries and illnesses from July 1, 2018 to June 30, 2019 among high school and college organized sports participants. Of those that occurred during sport-related activities, the vast majority (78%) were at the high school level. Sudden cardiac arrest was the most common type of event, followed by heat-related injury, brain trauma, and spine fracture. Slightly more than half (51.2%) of exertional/medical (indirect) events were fatal. Though sudden death in sport is relatively rare in youth sport, these tragic events do happen. Data show that more than 90% of sport related deaths are due to cardiac arrest, exertional heat stroke, traumatic brain injuries, and exertional sickling. From 2000 through 2014, five sports (baseball, soccer, football, basketball, and lacrosse) accounted for all deaths in youth athletes.
RISK FACTORS FOR CHILDREN AND YOUNG ADULTS
While preexisting conditions and genetics are a large contributor to cases of sudden death in sport, there are numerous other external factors than can also contribute to catastrophic illness and injury. Environmental conditions, specifically heat and lightning, as well as lack of access to medical care, such as having an athletic trainer or other healthcare professional on site, are potential contributors and risk factors. Additionally, a lack of education specific to recognition of the common causes of sudden death in sport among coaches and a lack of emergency preparedness are all contributors to sudden death in sport.
IMPORTANCE OF EMERGENCY ACTION PLANS
Sport specific emergency action plans (EAPs) are concrete written plans that outline what should be done in the event of a catastrophic injury in sport. Similar to fire drills that can occur during the school day, EAPs are essential to reduce delays in care. These written documents should include healthcare professionals in the creation of the plan, EMS contact information, and be venue specific. The EAP should outline where emergency equipment (such as AEDs or cold-water immersion tubs) is located and should be updated, reviewed, and rehearsed annually.
IMPORTANCE OF COACHING EDUCATION
Coaches play an important role in helping to prevent catastrophic illness and injuries because they are present at all practices and games to observe their athletes and they can structure their practices and workouts in ways that can reduce risk. If coaches are educated on the signs and symptoms of the leading causes of sudden death in sport, trained in basic emergency care (CPR/AED), or they know how to respond in the case of an emergency, the chances of survival increase. Education is a crucial component of catastrophic illness and injury prevention. Whether a healthcare provider is on site at practices and games or not, it’s important for coaches to have education to help protect the health and well-being of youth athletes.
The following are examples of educational resources currently available for coaches:
IMPORTANT STEPS TO TAKE TO IMPLEMENT EMERGENCY HEALTH AND SAFETY BEST PRACTICES
In 2017 the inter-association task force document on emergency health and safety best practice recommendations for youth sports was published. The document was developed to serve as a road map for policy and procedure recommendations for youth sport organizations and was endorsed by the Korey Stringer Institute, National Athletic Trainers’ Association, Safe Kids Worldwide, and USA Wrestling.
The document recommends that youth sport national governing bodies should: 1) endorse the creation of emergency action plans and provide templates, 2) direct member organizations toward resources for appropriate emergency equipment and medical services, 3) develop a training structure to provide education related to emergency health and safety best practices for all members, including coaches, parents or guardians, and member leaders, 4) make training modules or educational content on best practices specific to emergency action plans, sudden cardiac arrest, brain and neck injury, exertional heat stroke, preexisting medical conditions, environmental conditions, and medical services available, 5) and develop a system to monitor educational training and certification of coaches.
Below you can find a brief overview of some of the recommended policies and procedures for three of the leading causes of sudden death in sport.
RECOMMENDATIONS FOR SUDDEN CARDIAC ARREST POLICIES AND PROCEDURE IMPLEMENTATION
- Have an AED onsite and readily available for all organized events or develop a strategic plan to reduce the time to AED application
- Educate coaches and member leaders on the proper steps for managing a sudden cardiac arrest
- Have written procedures for the proper management of a sudden cardiac arrest to include:
- Prompt recognition (Assume any youth who has collapsed and is unresponsive is in sudden cardiac arrest until proven otherwise or another cause can be identified.)
- Early activation of EMS following steps in the emergency action plan
- Early CPR and retrieval and application of an AED (if shock is advised)
- If no AED on site activate EMS and continue chest compressions until athlete responds or EMS arrives
- Transportation to a hospital with advanced life-support capability
- Any youth athlete with cardiac problems (chest pain, fainting or near fainting, skipped heartbeats, shortness of breath, and/or excessive fatigue) should be evaluated by a physician before return to sport
RECOMMENDATIONS FOR BRAIN AND NECK INJURY POLICIES AND PROCEDURE IMPLEMENTATION
- Advise management of any athlete with a brain or neck injury, including those who do not require emergency medical treatment, be directed by appropriate medical personnel
- Never permit coaches to return an athlete to play who is suspected of having a brain or neck injury, including concussion
- If only non-medical personnel are present, a patient with a suspected brain or neck injury should not be touched or moved by anyone and the emergency action plan and EMS should be activated
- If an athlete with a head or neck injury is not breathing or has no pulse this requires CPR, CPR and AED, or rescue breathing. In this situation care should be given to prioritize circulation and breathing
- If appropriate medical personnel are present, an athlete with a suspected brain or neck injury should be properly stabilized under the direction of the medical personnel
- Member leaders and member coaches should receive education focused on the prevention, recognition, and management of athletes with brain or neck injury
- Develop appropriate evaluation protocol for suspected concussions
- If appropriate medical personnel are not on-site the athlete should be removed from the activity and referred for medical evaluation
- If appropriate medical personnel are on-site, evaluation for concussion at the discretion of the medical provider should be conducted
- Recommend return-to-participation protocol after brain or neck injury that includes written clearance from an appropriate medical provider and a graduated return-to-participation progression.
RECOMMENDATIONS FOR EXERTIONAL HEATSTROKE POLICIES AND PROCEDURE IMPLEMENTATION
- Have a heat acclimatization program and how-to-guide in place before training for sport when applicable (i.e., non-climate-controlled conditions, preseason in hot environments, new environments in unfamiliar regions)
- Have a plan for assessing environmental conditions to help prevent heat-related illnesses
- Monitor the environment using a wet-bulb globe temperature device, prediction chart, heat index, or information from local weather station to assess if it’s safe to exercise, practice, or play in the heat
- The threshold for activity modification should be determined using an on-site environmental monitor and geographic region-specific guidelines
- Set clear methods and expectations for providing hydration
- Coaches should ensure that athletes can hydrate quickly and freely and should also take regular hydration breaks
- Develop a medical management plan for the care of athletes with exertional heat stroke
- Athletes who demonstrate confusion, nausea, dizziness, altered consciousness, combativeness, other unusual behavior, or staggering during walking or running or collapse while exercising should be suspected of having a heat-related injury
- An athlete with a suspected heat illness who has collapsed or is unresponsive but is breathing and has a heartbeat should be immediately cooled via cold water immersion in a tub of ice water or the rotation of ice towels over the entire body while 911 is called
- Excess clothing and equipment should be removed from the athlete to help with the dissipation of heat
- If medical personnel are not on-site call 911 while simultaneously pursuing rapid colling
- If medical personnel are on-site and equipment are on-site, “cool-first, transport-second” should be implemented and cooling should continue uninterrupted until the athlete’s core body temperature is less than 102F
- Athletes returning to participation after exertional heat stroke should be required to obtain written clearance from an appropriate medical provider specifically trained in heat illness and a graduated return-to-participation progression tailored for the severity of the illness should be implemented
Additional recommendations and checklists can be found in the 2017 inter-association document. Visit the Korey Stringer Institute website for more information.
Korey Stringer Institute
Emergency Action Plan
Sudden Cardiac Arrest
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