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Youth Sports - Is your child safe? Are you really sure about that?

“… high school football on a national level is at a critical juncture.” —Roger Blake, executive director of the California Interscholastic Federation, the governing body for California high school sports (Ref)

What is "the most vital and important subject" and the "top priority" of the California Interscholastic Federation? Sports Safety! (Ref)

The reality of sports safety today

While reading this article, please keep this statement by Dr. Doug Casa in mind:

"Nearly all of the causes of death in sport are influenced by the care [provided] in the first five to seven minutes."

The likelihood of having trained medical personnel at practices and games was called an “overwhelming challenge” by the National Federation of State High School Sports Associations (NFHS) (Ref). The National Athletic Trainer’s Association states that 63% of all high schools do not have even one full time athletic trainer (ATC) and 30% of all high schools have no athletic training services whatsoever (Ref).

There are about 8 – 12 sports per season in high school, so even if the school has one ATC, which sport gets the ATC?

And who takes care of the other sports? "In those situations where a full-time trainer is not an option, schools must assign those duties to other individuals and develop an alternate plan for dealing with catastrophic injuries. (Ref)”

What is this “alternate plan?” "Secondary schools without AT[C] services rely on sports coaches and administrators, such as athletic directors, to determine proper medical treatment when injuries and emergencies arise during a practice or competition.” Not surprisingly, many Athletic Directors “believed the secondary school coach had sufficient knowledge and training to address the medical needs of student-athletes without an AT.” (Ref)

This belief is at odds with the NATA’s finding that “most coaches do not have the proper medical education to treat injuries or recognize the common causes of life-threatening medical conditions, which puts the lives of athletes in jeopardy. Moreover, if coaches do recognize a medical emergency is present, they are not trained to treat life-threatening conditions, and it should not be their responsibility to do so." (Ref, p.156)

Even the most highly trained person, an orthopedic surgeon, made the wrong on-the-field decision. Read here (Case 1).

So, if there are not enough athletic trainers to cover all the school sports and the coaches do not have the training or education to either recognize or treat injuries, who is caring for our children?


This disconnect is even more disturbing when it comes to concussions. The Zurich 2012 Consensus Statement states, Concussion is considered to be among the most complex injuries in sports medicine to diagnose, assess and manage.” Yet, we think that an annual 30 minute CDC educational program is sufficient to educate coaches on emergency head injury management.

The statement goes on to say, “At present, there is no perfect diagnostic test or marker that clinicians can rely on for an immediate diagnosis of concussion in the sporting environment. Because of this evolving process, it is not possible to rule out concussion when an injury event occurs associated with a transient neurological symptom.”

And even for the trained medical professional, “The on-field evaluation of sports-related concussion is often a challenge given the elusiveness and variability of presentation, difficulty in making a timely diagnosis, specificity and sensitivity of sideline assessment tools, and the reliance on symptoms.”

"If your ask me how to diagnose a concussion with 100% accuracy, I will tell you I have no idea." Dan Garza, MD, Assistant Professor, Stanford School of Medicine, Assistant Director of Sports Medicine, Medical Director, San Francisco 49ers.

A helmet sensor went off in a high school player’s helmet. He was evaluated for a concussion. He was returned to the game. Read more here.

The first state concussion law, the Zachary Lystedt Law, was a REACTIVE (read not proactive!) response to a horrible injury. “Zach’s injury was preventable. If Zach had just been taken out of the game and remained out, he’d be like every other kid …

Sudden Cardiac Death

The disconnect continues with regard to Sudden Cardiac Death. “The National Institute of Health states that rapid treatment of sudden cardiac arrest with an AED "can be lifesaving." (Ref) Yet, just “19 states in the U.S. require that at least some of their schools have automated external defibrillators.” (Ref)

At least some schools systems are attempting to educate coaches with biannual CPR certification and a CDC concussion video. This is certainly better than nothing. But, is that training even close to enough to prepare that coach for an on the field emergency? Or to recognize an injury on the sidelines? The NATA says it is not.

The scariest part of this story - League Sports

What I have just discussed applies ONLY to the kids that play high school sports. What about league sports? Twice as many kids participate in league sports as compared to high school sports.

By and large, league sports have no sports safety training requirements for coaches. NONE! No ATCs, no education for coaches, and not even a sports physical is required for participation.

Here is a story about a youth soccer player who was saved thanks to several bystanders in the stands. Neither coach knew what to do! There was no plan and neither coach was properly trained or prepared! Read here.

Virtually no league implements an Emergency Action Plan. Some schools have one on a webpage or in a manual, but where is it when the coach needs it?

  • Does the coach know the field address?

  • Who runs onto the field to care for the athlete?

  • Who calls 9-1-1?

  • What do you tell the operator?

  • Do you have the child's emergency medical information and contact information immediately available?

  • Who cares for the rest of the team, who meets the ambulance?

  • Who travels with the child in the ambulance?

  • When the coach runs onto the field to care for the injured athlete, what does he/she do?

  • Is the injured child responsive or unresponsive, face up or face down, breathing or not breathing? Do they have a helmet on? Do you take it off?

  • Are you able to remove the facemask? How?

Parents are left to hope: "I sort of just sit there, secretly hoping at the end of every game that they walk of the field in one piece" Watch the video (11:24) here.

Parents are left to pray: “you try and you pray for the kids every game like we do, to be safe, to be healthy” (Ref)

When hoping and praying is simply not enough

The NFHS says, "We wish we would not have to report another death in high school sports. That goal starts with continuing our efforts to minimize risk for the 12 million participants in high school activity programs." (Ref)

As Zach Lystadt’s dad says, “if there is no accountability, then there is no responsibility.” (Ref)

So, mom and dad, are you really willing to let a completely untrained, unprepared coach make a determination as to whether or not your child should go back into the game? In other words, would you EVER drop your kids off at a public pool knowing there was no lifeguard on duty? No!

Then why do you drop off your kids at the sports fields without the knowledge that someone could take care of them if they got injured?

"...many parents don't realize how under-resourced the medical care is for their child's team until they're facing an injured child and a dearth of options." James Andrews, MD

"Playing safe and being able to continue to enjoy your sport for the rest of your life is ultimately what's the most important." Dr. Naomi Albertson

What is the solution? Is our approach simply going to remain a reactive response? Are we going to continue along the path of horrible injury which begets a lawsuit which begets a new law?

Read about the class action lawsuit against FIFA and US Soccer.

A solution is right around the corner. Stay tuned....

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