Volume 54: Issue 7

Objective

To present the appropriate medical care standards for organizations that sponsor athletic activities for secondary school–aged athletes.

Data Sources

To develop the current standards and identify current best-practices evidence, the task force used a multistep process that included reviewing the existing 2004 Appropriate Medical Care for Secondary School–Aged Athletes consensus points and cross-referencing of National Athletic Trainers' Association (NATA) statements and official documents from the strategic alliance (the NATA, NATA Foundation, Board of Certification, and Commission on Accreditation of Athletic Training Education). Gaps in the recommendations from the 2004 Appropriate Medical Care for Secondary School–Aged Athletes document were identified by the task force, and the new appropriate medical care standards were developed and refined.

Conclusions and Recommendations

Twelve standards, with supporting substandards, were developed that encompassed readiness to participate in activity; facilities; equipment; protective materials; environmental policies; nutrition, hydration, and dietary supplementation; wellness and long-term health; comprehensive emergency action plans; on-site immediate care; on-site therapeutic interventions; psychological concerns; and athletic health care administration. Collectively, these standards describe a comprehensive approach to providing appropriate health care to secondary school–aged athletes and should serve as a framework with which organizations can evaluate and improve the medical care supplied to adolescent athletes.

Context

In 2009, the National Athletic Trainers' Association Inter-Association Task Force (NATA-IATF) released preseason heat-acclimatization guidelines for gradually acclimatizing high school (HS) athletes to the environment during the first 2 weeks of the preseason and reducing the risk of exertional heat illness. However, researchers who studied the 2011 preseason found a low level of overall compliance.

Objective

To assess compliance with the NATA-IATF guidelines during the 2017 preseason and compare the findings with 2011 preseason data and between states mandating and not mandating the guidelines.

Design

Cross-sectional study.

Setting

Preseason HS football, 2017.

Patients or Other Participants

A total of 1023 athletic trainers working with HS football (14.2% response rate).

Main Outcome Measure(s)

Using a survey, we acquired information from athletic trainers on their HS football programs, including location and compliance with 17 NATA-IATF guidelines during the 2017 football preseason. The outcome measures were full compliance with all 17 NATA-IATF guidelines and compliance with ≥10 NATA-IATF guidelines. Prevalence ratios (PRs) with 95% confidence intervals (CIs) compared findings between (1) the 2017 and 2011 preseasons and (2) states whose HS athletic associations imposed a full or partial or no mandate to follow the NATA-IATF guidelines.

Results

Overall, 3.9% reported full compliance with NATA-IATF guidelines; 73.9% complied with ≥10 guidelines. The proportion reporting full compliance was higher in 2017 than in 2011 but not statistically different (3.9% versus 2.5%; PR = 1.54; 95% CI = 0.96, 2.46). However, the proportion reporting compliance with ≥10 guidelines was higher in 2017 (73.9% versus 57.9%; PR = 1.28; 95% CI = 1.20, 1.36). The proportion of respondents reporting their HSs were fully compliant was highest among the with-mandate group (9.4%), followed by the partial-mandate group (4.6%) and the without-mandate group (0.6%). Group differences retained significance when we examined compliance with ≥10 guidelines.

Conclusions

Although full compliance with NATA-IATF guidelines remained low, many HS football programs complied with ≥10 guidelines.

Context

Exertional heatstroke is one of the leading causes of death in American football players. Precooling (PC) with whole-body cold-water immersion (CWI) may prevent severe hyperthermia and, possibly, exertional heatstroke. However, it is unknown how much PC delays severe hyperthermia when participants wear American football uniforms during exercise in the heat. Does PC alter the effectiveness of CWI once participants become hyperthermic or affect perceptual variables during exercise?

Objectives

We asked 3 questions: (1) Does PC affect how quickly participants become hyperthermic during exercise in the heat? (2) Does PC before exercise affect rectal temperature (T_rec) cooling rates once participants become hyperthermic? (3) Does PC affect perceptual variables such as rating of perceived exertion (RPE), thermal sensation, and environmental symptoms questionnaire (ESQ) responses?

Design

Crossover study.

Setting

Laboratory.

Patients or Other Participants

Twelve physically active males (age = 24 ± 4 years, height = 181.8 ± 8.4 cm, mass = 79.9 ± 10.3 kg).

Intervention(s)

On PC days, participants completed 15 minutes of CWI (9.98°C ± 0.04°C). They donned American football uniforms and exercised in the heat (temperature = 39.1°C ± 0.3°C, relative humidity = 36% ± 2%) until T_rec was 39.5°C. While wearing equipment, they then underwent CWI until T_rec was 38°C. Control-day procedures were the same except for the PC intervention.

Main Outcome Measure(s)

Rectal temperature, heart rate, thermal sensation, RPE, and ESQ responses were measured throughout testing. The duration of cold-water immersion was used in conjunction with T_rec to calculate cooling rates.

Results

Precooling allowed participants to exercise 17.6 ± 3.6 minutes longer before reaching 39.5°C (t₁₁ = 17.0, P < .001). Precooling did not affect postexercise CWI T_rec cooling rates (PC = 0.18°C/min ± 0.06°C/min, control = 0.20°C/min ± 0.09°C/min; t₁₁ = 0.9, P = .17); ESQ responses (F_2,24 = 1.3, P = .3); or RPE (F_2,22 = 2.9, P = .07). Precooling temporarily lowered thermal sensation (F_3,26 = 21.7, P < .001) and heart rate (F_3,29 = 21.0, P < .001) during exercise.

Conclusions

Because PC delayed hyperthermia without negatively affecting perceptual variables or CWI effectiveness, clinicians may consider implementing PC along with other proven strategies for preventing heat illness (eg, acclimatization).

Dear Editor:

How accurate are secondary school injury data?

Published secondary school injury data are generally based on large multi-institutional studies. Although the High School Reporting Information Online (HS RIO) injury-reporting system is the primary vehicle for collecting secondary school sport injury data, it is also an example of the problems that plague any such systems.

With a standard definition and defined reporting guidelines, individuals collecting and reporting the data are often the weak link. It is the duty of the primary investigator to verify the accuracy and validity of the submitted data before they are made available to the

Dear Editor:

I appreciate the opportunity to respond to the concerns raised by Mr Beachy in his letter to the editor regarding our recently published article, “The first decade of Web-based sports injury surveillance: descriptive epidemiology of injuries in United States high school football (2005–2006 through 2013–2014) and National Collegiate Athletic Association football (2004–2005 through 2013–2014).”¹ Although more than 100 peer-reviewed papers reporting data captured by the High School Reporting Information Online (HS RIO) surveillance study have been published to date, many in the Journal of Athletic Training, journal-mandated word counts rarely provide the opportunity to

Reliability and Validity of the Functional Assessment of Neurocognition in Sport (FANS): A Paradigm Shift in Post-Concussion Return-to-Sport Decision-Making

Landon B. LempkePhD, ATC,

Benjamin L. BrettPhD, and

Douglas P. TerryPhD,ABPP