Improving musculoskeletal injury surveillance methods in Special Operation Forces: A Delphi consensus study

Musculoskeletal injury mitigation is a priority in military organisations to protect personnel health and sustain a capable workforce. Despite efforts to prevent injury, inconsistencies exist in the evidence used to support these activities. There are many known limitations in the injury surveillance data reported in previous Special Operation Forces (SOF) research. Such studies often lack accurate, reliable, and complete data to inform and evaluate injury prevention activities. This research aimed to achieve expert consensus on injury surveillance methods in SOF to enhance the quality of data that could be used to inform injury prevention in this population. A Delphi study was conducted with various military injury surveillance stakeholders to seek agreement on improving surveillance methods in SOF. Iterative questionnaires using close and open-ended questions were used to collect views about surveillance methods related to injury case definitions and identifying essential and optional data requirements. Consensus was predefined as 75 % group agreement on an item. Sixteen participants completed two rounds of questionnaires required. Consensus was achieved for 17.9 % (n = 7) of questions in the first-round and 77.5 % (n = 38) of round two questions. Several challenges for surveillance were identified, including recording injury causation, SOF personnel’s injury reporting behaviours influencing accurate data collection, and surveillance system infrastructure limitations. Key military injury surveillance stakeholders support the need for improved data collection to enhance the evidence that underpins injury prevention efforts. The consensus process has resulted in preliminary recommendations to support future SOF injury surveillance

Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study

Introduction A voluntary State Government-led programme in Victoria, Australia ‘Defibrillators for Sporting Clubs and Facilities Program’ ran from 2015 to 2019, broadly aimed at increasing access to automated external defibrillators (AEDs), together with a greater number of community members trained for management of medical emergencies. This study aimed to understand whether participating sport clubs/facilities had successfully integrated an AED and medical planning with other club/facility safety practices, 12 months after delivery of the programme. Methods This was a qualitative case study of 14 sport clubs/facilities in Victoria, Australia in 2017, underpinned by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We conducted observational audits of facilities (to locate AED placement, signage and other relevant location-specific factors) and semi-structured, face-to-face interviews with representatives of the clubs/facilities. Interview questions were designed to determine if and how the related, mandated emergency management programme was adapted for the long term (embedding), whether this aligned to ongoing organisational mission (active engagement), and whether or not it was still ongoing 6 months postinitial implementation (sustainability). Data were evaluated using qualitative descriptive methodology. For reporting, descriptive summaries of the audit were combined with interview data to contextualise and visualise the sport club/facility setting and key results. Results Key issues identified were accessibility and visibility of the AED, with inadequate signage and challenges identifying an efficient location for access and storage. Most interviewees reported the AED and training were received with no further actions taken towards safety planning or integration with club/facility practice. Several challenges regarding remaining up to date with training and ensuring required routine checks of the AED take place were also raised. Conclusions This study identified several challenges for community sport clubs/facilities in the implementation of an AED and medical planning programme, including where to store the AED, how to make its presence known to the community and how to integrate changes alongside other club/facility practices

Injury deaths in Australian sport and recreation: Identifying and assessing priorities for prevention

Introduction Sport and recreation is beneficial for health and wellbeing but comes with a probability of loss, including occasional fatal injuries. Following high-profile injury deaths in Australia, concerns are raised regarding the safety of sport participation. To understand the scale and scope of injury deaths, and identify potential prevention opportunities, the aim of this investigation was to describe the number and nature of fatal injuries in Australian sport and recreation. Methods This is a retrospective cohort study of injury deaths reported between 1 July 2000 to 31 December 2019 using data from the National Coronial Information System, Australia. Unintentional deaths with an external cause, where the activity was recorded as sport and exercise during leisure time were included. Drowning deaths were excluded. Presented are the number and % of cases by age, sex, sport, broad cause and annual crude death rate (population). Results There were 1192 deaths, averaging 63 per year. Deaths were mostly in males (84.4%), with the largest proportion in people aged 15–24 years (23.1%). Wheeled motor (26.9%) and non-motor (16.2%) sports accounted for the highest proportion of cases. The primary mechanism of death was most commonly blunt force (85.4%), followed by piercing/penetrating force (5.0%). The years 2001 and 2005 recorded the highest crude injury death rate (2001, n = 92, 0.47 per 100,000 population; 2005, n = 95, 0.47 per 100,000 population). Conclusions On average, there is more than one injury death per week in a sport or recreation setting in Australia. Cases occurred in many sports and recreation activities, including those generally considered to be safe (e.g. individual athletic activities, team ball sports.) Detailed investigation of the coronial recommendations that are present within each case is now needed to understand and identify potential prevention opportunities

Prevention of sports injuries in Sri Lanka: What do we know about injuries in our athletes?

In terms of safeguarding the health and well-being of athletes in Sri Lanka, a primary focus has always been toward the treatment of injuries after they have occurred and promoting rehabilitation back into sport. There has been little attention towards the primary prevention of injuries in Sri Lankan sports. As a developing sporting nation, the benefits of injury prevention are immense: from a public health and financial perspective, through to individual benefits for athletes’ physical, psychological and social health. Understanding the reasons behind the lack of motive towards sports injury prevention in the country, and challenges in developing and implementing injury prevention measures in the field is useful so that these reasons can be addressed and overcome. Based on recent experience in conducting injury prevention research among Sri Lankan junior cricketers, this article discusses injury prevention principles in sport and provides directions for future sport injury prevention research in Sri Lanka

Heat and sun related medical concerns in Australian led outdoor activities: a three-year prospective study

Active participation in the outdoors is beneficial for health and wellbeing. However, the impact of extreme weather, particularly heat, on safe participation is causing concern for organisations who lead these activities. Local mitigation strategies and acute management of heat- and sun-related illness (HSRI) are generally well understood by researchers and medical practitioners, however, cases continue to occur so further understanding of why this happens is required. This study aimed to identify the number, nature and contributory factors of HSRI in Australian led outdoor activities in order to seek opportunities for their prevention. This study presents a descriptive analysis of contributory factors to HSRI occurring during led outdoor activities. Cases were prospectively collected across 3 years (2014-2017) from a national Australian incident reporting system. Cases were included by identification of keywords linked with sun or heat exposure. From 2,015 incident cases, 48 cases were included: 25 termed heat stroke and 23 as “other adverse outcomes related to sun or heat.” One in three (35%) cases occurred during outdoor walking or running, and one in four occurred while camping. A total 146 contributory factors were identified. These factors were attributed to the activity participant (e.g. competence, decision making); equipment and resources (e.g. food/drink, dehydration); and environment (e.g. hot weather.). Mild to moderate HSRI was identifiable by signs/symptoms. Contributory factors were linked to the individual participant. Potentially, these factors could be mitigated through system focused approaches. Awareness of wider responsibility for preventing HSRI should be promoted across led outdoor activities

Medical-attention injuries in community cricket: A systematic review

Objectives: The aim was to identify and describe outcomes from original published studies that present the number, nature, mechanism and severity of medically treated injuries sustained in community-level cricket. Design: Systematic review. Methods: Nine databases were systematically searched to December 2019 using terms cricket∗ and injur∗ . Original, peer-reviewed studies reporting injury for at least one injury descriptor (body region, nature of injury and/or mechanism of injury) in community-level cricketers of all ages were included. Qualitative synthesis, critical appraisal and descriptive summary results are reported within the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: Six studies were included: five reported hospital-treated data and one reported insurance claims data. Two had a low risk of bias. In hospital-based studies, fractures were the most frequent injury type. Upper and lower limb injuries (age ≥ 15 years) and injuries to the head (age \u3c 15 years) were the most common body region injured. Being struck by the ball was the most common mechanism for injury presenting to hospitals. Children were also commonly struck by equipment. One study using insurance claims data reported soft tissue injuries as the main of injury type. Conclusion: Hospital treatment data were most prominent, which emphasised injuries of a more serious nature or requiring acute care. These injuries were primarily fractures, dislocation/sprain and strains, bruising and open wounds with the majority resulting from players being struck by the ball. Research into whether properly fitted protective equipment, at an approved standard, is worn and is effective, is recommended. © © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ

Reporting Multiple Individual Injuries in Studies of Team Ball Sports:A Systematic Review of Current Practice

Background To identify and prioritise targets for injury prevention efforts, injury incidence studies are widely reported. The accuracy and consistency in calculation and reporting of injury incidence is crucial. Many individuals experience more than one injury but multiple injuries are not consistently reported in sport injury incidence studies.Objective The aim of this systematic review was to evaluate current practice of how multiple injuries within individuals have been defined and reported in prospective, long-term, injury studies in team ball sports.Data Sources A systematic search of three online databases for articles published before 2016.Study Selection Publications were included if (1) they collected prospective data on musculoskeletal injuries in individual participants; (2) the study duration was &gt;1 consecutive calendar year/season; and (3) individuals were the unit of analysis.Data Extraction Key study features were summarised, including definitions of injury, how multiple individual injuries were reported and results relating to multiple injuries.Results Of the 71 publications included, half did not specifically indicate multiple individual injuries; those that did were largely limited to reporting recurrent injuries. Eight studies reported the number/proportion of athletes with more than one injury, and 11 studies presented the mean/number of injuries per athlete.Conclusions Despite it being relatively common to collect data on individuals across more than one season, the reporting of multiple injuries within individuals is much more limited. Ultimately, better addressing of multiple injuries will improve the accuracy of injury incidence studies and enable more precise targeting and monitoring of the effectiveness of preventive interventions.</p

Running marathons in high school: A 5-year review of injury in a structured training program

Objective: The aim in this study was to quantify the number, nature, and severity of injuries sustained by male and female high school students who took part in a running training program that culminated in the completion of a half or full marathon. Design: This study is a retrospective clinical audit. Methods: Injury reports from high school students (grades 9 – 12) who participated in a half or full marathon 30-week progressive training program comprising four training days per week (three running days and one cross-training day) were reviewed. The number of runners completing a marathon, together with the number, nature, severity of injuries, and treatment types, as reported to the program physiotherapist, were the main outcome measures. Results: Program completion was 96% (n = 448/469). Of all participants, 186 (39.6 %) were injured, with 14 withdrawing from the program due to injury. For those who completed a marathon, 172 (38 %) reported 205 musculoskeletal injuries (age of injured runners: 16.3 ± 1.1 years; 88 girls (51.2 %) and 84 boys (48.8 %)). More than half (n = 113, 55.1 %) of the reported injuries were soft tissue injuries. Most injuries were localized to the lower leg (n = 88, 42.9 %) and were of a minor nature (n = 181, 90 %), requiring only 1–2 treatments. Conclusions: There was a low number of relatively minor injuries for high school participants taking part in a graduated and supervised marathon training program. The injury definition was conservative (i.e., any attendance to physiotherapist) and the relative severity of injuries was minor (i.e., requiring 1 – 2 treatment sessions). Overall, these results do not support a need to restrict high school students from taking part in marathon running, though continued emphasis on graduated program development and close supervision of young participants is recommended