Should schools provide trainers?
When Georgia public high schools were asked five years ago to devise a policy to govern sports activities during periods of high heat and humidity, one school's proposal stood out: It pledged to scale back workouts when the heat index reached 140.
Those who understood the heat index, a formula that uses air temperature and humidity to calculate how hot it feels, weren't sure whether to be appalled or amused. "If you hit a heat index of 140," said Bud Cooper, a sports medicine researcher at the University of Georgia who examined all the proposed policies, "you'd basically be sitting in the Sahara Desert."
The policy reflected an old-school, "no pain, no gain" philosophy, a view that athletes need to be pushed to their physical limits -- or beyond them -- if they and their teams are to realize their full potential.
In some places, state, school and sports officials are recognizing that the zeal of coaches, players and parents must be subordinated to safety. Increasingly, they are adopting measures to protect student-athletes from serious, even catastrophic injuries or illnesses that can result from a blinkered focus on competitiveness.
Since 2009, every state and the District of Columbia have enacted laws mandating that athletes who are in high school or younger be removed from games or practices when it is suspected they have sustained a concussion. Such laws also lay out the process for determining when a concussed athlete can safely resume sports activities.
In addition, more than a third of the states now require that at least some schools have on hand an automated external defibrillator (AED) for the treatment of sudden cardiac arrest, a leading cause of death in young athletes. Thirteen states have adopted stringent rules conforming with guidelines from the National Athletic Trainers' Association to avoid heat-related illnesses and deaths.
And some school systems or individual schools have implemented policies to prevent overuse injuries -- those caused by a repeated motion, such as pitching a baseball.
But no state has enacted the provision that many sports medicine experts argue is key: a requirement that every high school employ at least one full-time athletic trainer.
According to a survey conducted by the Korey Stringer Institute, a research center concerned with the safety of student-athletes, only 39 percent of public high schools that responded had full-time athletic trainers on staff. Many schools do have nurses, but they usually leave at the close of the school day, just as games and practices commence.
"Without question, all of these policies on heat, concussion and so forth, they all make sense," said Doug Casa, the institute's chief operating officer. "As we move toward having more policies in place to protect these kids, the most important thing you can do is have an athletic trainer on staff."
The institute, based at the University of Connecticut, is named for a Minnesota Vikings offensive lineman who died of heat stroke during summer training camp in 2001. Stringer's death brought attention to the issue of heat-related illnesses experienced by athletes, but it took more than a decade before policies started filtering down to high schools. The full list of states with policies can be found at ksi.uconn.edu. Illinois is listed as "deficient, but working with KSI on guidelines."
The trainers' association guidelines were not the result of legislation, but were adopted by state athletic associations that oversee scholastic athletics. Unlike the NCAA, which governs collegiate athletics, there is no national sports association presiding over all high school sports.
In 2011, Ralph Swearngin, then head of the Georgia High School Association, commissioned a group of sports medicine researchers at the University of Georgia, including Cooper, to study the effect of heat on high school football players.
"I was really concerned we weren't making data-driven decisions, but relying on best guesses and assumptions and copying what other people were doing," Swearngin said.
The group's study of 25 Georgia high schools found that players were particularly prone to heat-related illnesses in the first days of practice. Clearly, Cooper said, any new policy had to mandate a graduated start to football activities to allow players to get used to the weather.
Cooper said his team knew that using the heat index to determine heat policy was not sufficient because it ignored an important factor: the radiant temperature, or temperature on the ground. Certain surfaces, such as concrete or a football field, retain and intensify the heat on the ground. That is why the military, the NCAA and other organizations use the Wet Bulb Globe Temperature (WBGT) calculator, which measures air temperature, humidity and radiant temperature.
In accordance with the research team's recommendations, the new GHSA policy, implemented in 2012, requires all Georgia high schools to use a WBGT calculator. A reading above 82 requires coaches to provide at least three breaks of four minutes or longer every hour. Higher readings require more precautions, such as shortening practice sessions and allowing players to wear shorts instead of football pants. For readings above 92, outdoor practices are prohibited.
The GHSA has now commissioned Cooper's team to conduct another study to gauge the effect of the new policy.
There was no WBGT calculator on hand when Don'Terio Searcy, a rising junior at Fitzgerald High School near the Florida border, collapsed on Aug. 2, 2011. "D.J." Searcy was a speedy, 280-pound tackle who had been scouted by some big-time college football powers. That summer, his coaches had taken the football team to a camp in Lake City, Fla., to practice.
According to his father, Carlton Searcy, an Army captain who trains soldiers at Fort Jackson in South Carolina, his son collapsed on the second day of practice. He went to bed that night without receiving medical attention.
The next morning, D.J. told his coaches he was still dizzy and nauseated and in no condition to practice. They insisted he participate. He began the drills in full gear and with limited access to water. Mid-morning, he collapsed again. He was pronounced dead at a nearby hospital several hours later. The maximum temperature in Lake City that day was 93 degrees, according to the Web site Weathersource.com.
As the tragedy was unfolding in Florida, Carlton Searcy was at Fort Jackson, where the temperature was already 85 degrees by 7:30 a.m. After taking a WBGT reading, Searcy determined that his soldiers should drill without helmets and body armor and be given frequent water breaks.
"For us, above 90 degrees, you're putting people's lives at risk," he said.
An autopsy determined that D.J.'s death was caused by a previously undiagnosed heart ailment, but his family insists he would not have died if the coaches had taken heat-related precautions. The Searcys have gone to court seeking damages against the school district and the camp where D.J. collapsed. In May, a federal court found that the coaches' actions that day didn't rise to the required level of "conscience-shocking" -- a higher standard than negligent -- and dismissed the case. The Searcys are deciding whether to pursue the case in state courts.
"If one of my recruits died under these circumstances, I'd be thrown in military prison," Carlton Searcy said.
While Southern states have taken the lead in adopting statewide heat policies, Cooper warns that temperatures in the North are also high when football players begin practicing. He pointed out that Korey Stringer died of heat stroke in Minnesota, on a day the heat index hit 110.
Concussions and extreme heat are not the only dangers facing young athletes. The Sudden Cardiac Arrest Foundation says that 19 states have laws either requiring or urging schools to have automatic external defibrillators on hand. That's a good step, said Judy Pulice of the National Athletic Trainers' Association. But, she noted, "a lot of time, after 3 p.m. the AED is locked up in the principal's office."
Overuse injuries also are receiving more attention. The growing number of student-athletes who specialize in particular sports risk serious injury from overused joints and muscles. For pitchers, there are elbow and shoulder injuries. In soccer, players are subject to knee and growth-plate injuries. In volleyball and swimming, it's often the shoulder.
States have largely left it to individual schools and school districts to adopt policies regarding overuse. Many limit the number of pitches baseball and softball pitchers are allowed to throw. Some schools try to mandate training breaks in the calendar in some sports. But many young athletes play on travel or recreation league teams that are not covered by school policies.
Mark Hyman, a sports journalist and teaching assistant professor in the sports management program at George Washington University, whose book "Until It Hurts" chronicles the rise in kids' sports injuries, said the irony is that as more adults have become increasingly involved in youth sports, more injuries have occurred.
"Before, when kids played sports and they knew their elbow or knee hurt, they stopped playing," Hyman said. "With adult involvement, parents and coaches have been the ones to push them beyond physical limits."
If limits are going to be re-established, it will be up to the adults to do so, he said.