Athletic Administrators Report of Emergency Action Plan Adoption in Secondary School Athletics: The Influence of Athletic Training Services

This study describes the emergency action plan (EAP) adoption in secondary school athletics reported by athletic administrators in the United States. Utilizing best-practice criteria, a questionnaire assessed athletic administrators’ knowledge and adoption of an EAP in their athletics program. A majority of athletic administrators reported having an EAP; however, the EAP often lacked the necessary components to be compliant with best-practice guidelines. Further, access to an athletic trainer was associated with increased EAP adoption and adopting a venue specific EAP. Athletic administrators should utilize these data to facilitate improved policy adoption and management of athletics programs

The Precaution Adoption Process Model in Describing Emergency Action Plan Adoption

Purpose: The purpose of this study was to identify the ability of the Precaution Adoption Process Model (PAPM) to classify athletic trainers (ATs) and athletic directors (ADs) readiness to act with regards to adopting an emergency action plan (EAP), and describe factors influencing PAPM stages. Method: We used a cross-sectional questionnaire design to evaluate readiness to act for developing an EAP among ATs and ADs working in United States high schools. The PAPM is a participant-driven model to identify someone’s readiness to act or change and has seven stages: Unaware, Unengaged, Undecided, Decided not to Act, Decided to Act, Acting and Maintaining. Prevalence ratios (PRs) with 95% confidence intervals (95% CI) were calculated. Results: A majority of ATs and ADs reported maintaining an EAP in their secondary school (AT “Maintaining” = 84.4%, AD “Maintaining” = 68.7%). ADs were more likely to be staged as “Decided not to Act” (PR=0.14, 95% CI= 0.05, 0.41) for the development of an EAP compared to ATs. ATs were more likely to be staged as “Maintaining” (PR=1.23, 95% CI = 1.16, 1.30) for the development of an EAP compared to ADs. Conclusions: The PAPM appears to be able to classify AT and AD readiness to act with adoption of an EAP. However, statistical modeling struggles to identify predictors for the various stages. Future research should aim to use the PAPM stages in the development of tailored interventions

Characteristics of sports and recreation-related emergency department visits among school-age children and youth in North Carolina, 2010–2014

Abstract Background Sports and recreational activities are an important cause of injury among children and youth, with sports-related traumatic brain injuries (TBIs) being of particular concern given the developing brain. This paper reports the characteristics of sport and recreation-related (SR) emergency department (ED) visits among school-age children and youth in a statewide population. Methods This study included all injury-related visits made to all North Carolina 24/7 acute-care civilian hospital-affiliated EDs by school-age youth, 5–18 years of age, during 2010–2014 (N = 918,662). Population estimates were based on US decennial census data. Poisson regression methods were used to estimate incidence rates and rate ratios. Results During the five-year period, there were 767,075 unintentional injury-related ED visits among school-age youth, of which 213,518 (27.8%) were identified as SR injuries. The average annual absolute number and incidence rate (IR) of SR ED visits among school-age youth was 42,704 and 2374.5 ED visits per 100,000 person-years (95% confidence interval [CI], 2364.4–2384.6), respectively. In comparison to other unintentional injuries among school-age youth, SR ED visits were more likely to be diagnosed with an injury to the upper extremity (Injury Proportion Ratio [IPR] = 1.28; 95% CI, 1.27–1.29), the lower extremity (IPR = 1.14; 95% CI, 1.13–1.15), and a TBI or other head/neck/facial injury (IPR = 1.12; 95% CI, 1.11–1.13). Among ED visits made by school-age youth, the leading cause of SR injury was sports/athletics played as a group or team. The leading cause of team sports/athletics injury was American tackle football among boys and soccer among girls. The proportion of ED visits diagnosed with a TBI varied by age and sex, with 15–18 year-olds and boys having the highest population-based rates. Conclusions Sports and recreational activities are an important component of a healthy lifestyle, but they are also a major source of injury morbidity among school-age youth. Physical activity interventions should take into account sex and age differences in SR injury risk

Pedestrian Safety Among High School Runners: a Case Series

Background: Participation in high school cross-country and track has increased over the last few decades. At the same time, the rate of pedestrian-involved motor vehicle crashes (MVCs) has also increased. In the context of organized sport, pedestrian safety among runners is often not highlighted, despite the risk of catastrophic injury. Purpose: To describe incidents of pedestrian-involved MVCs involving student athletes captured by the National Center for Catastrophic Sport Injury Research (NCCSIR) at the University of North Carolina at Chapel Hill. Study Design: Case series. Level of Evidence: Level 5. Methods: This study utilized surveillance data from the NCCSIR from 2011 to 2020. It presents descriptive statistics, including frequencies and percentages, detailed summaries, and a Haddon Matrix. Results: There were 8 incidents involving 11 student athletes, resulting in 9 fatalities. Of these, 5 cases occurred in the afternoon or early evening, 4 occurred in the Fall, and 6 occurred in a rural area. Haddon Matrix analyses of case descriptions indicate schools should implement a runner safety program for all new runners and ensure that runner safety measures are included in emergency action plans. Conclusion: Runner-related MVCs are relatively rare, but tragic, incidents. Pedestrian safety measures should be incorporated into school-sponsored practices and training runs. Clinical Relevance: Pedestrian safety should be incorporated into runner safety and injury prevention efforts

Adoption of Lightning Safety Best-Practices Policies in the Secondary School Setting

CONTEXT: Lightning-related injuries are among the top 10 causes of sport-related death at all levels of sport, including the nearly 8 million athletes participating in US secondary school sports. OBJECTIVE: To investigate the adoption of lightning safety policies and the factors that influence the development of comprehensive lightning safety policies in United States secondary schools. DESIGN: Cross-sectional study. SETTING: Secondary school. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers (ATs). MAIN OUTCOME MEASURE(S): An online questionnaire was developed based on the “National Athletic Trainers' Association Position Statement: Lightning Safety for Athletics and Recreation” using a health behavior model, the precaution adoption process model, along with facilitators of and barriers to the current adoption of lightning-related policies and factors that influence the adoption of lightning policies. Precaution adoption process model stage (unaware for need, unaware if have, unengaged, undecided, decided not to act, decided to act, acting, maintaining) responses are presented as frequencies. Chi-square tests of associations and prevalence ratios with 95% CIs were calculated to compare respondents in higher and lower vulnerability states, based on data regarding lightning-related deaths. RESULTS: The response rate for this questionnaire was 13.43% (n = 365), with additional questionnaires completed via social media (n = 56). A majority of ATs reported maintaining (69%, n = 287) and acting (6.5%, n = 27) a comprehensive lightning safety policy. Approximately 1 in 4 ATs (25.1%, n = 106) described using flash to bang as an evacuation criterion. Athletic trainers practicing in more vulnerable states were more likely to adopt a lightning policy than those in less vulnerable states (57.4% versus 42.6%, prevalence ratio [95% CI] = 1.16 [1.03, 1.30]; P = .009). The most commonly cited facilitator and barrier were a requirement from a state high school athletics association and financial limitations, respectively. CONCLUSIONS: A majority of ATs related adopting (eg, maintaining and acting) the best practices for lightning safety. However, many ATs also indicated continued use of outdated methods (eg, flash to bang)

Traumatic brain and spinal cord fatalities among high school and college football players — United States, 2005–2014

Summary What is already known about this topic? Fatalities resulting from catastrophic brain and spinal cord injuries occur infrequently among high school and college football players. What is added by this report? During 2005–2014, a total of 28 traumatic brain and spinal cord injury deaths in high school and college football were identified (2.8 deaths per year). The most common playing positions of those fatally injured were running back and linebacker. Approximately 18% of identified high school brain injury deaths were preceded by an earlier concussion, which might have led to second impact syndrome. What are the implications for public health practice? Implementing enhanced safety measures to prevent fatalities from catastrophic brain and spinal cord injuries among high school and college football players has the potential to reduce the number of these fatalities. Continued surveillance is important to monitor the circumstances of these deaths and develop risk scenarios to improve prevention measures

Managing concussion in the real world: Stakeholder perspectives of New Zealand Rugby's concussion management pathway

The potential adverse consequences associated with poor concussion management highlights the need to improve the translation of concussion guidelines into consistent use in real-world sport settings. To facilitate this process, New Zealand Rugby developed a community concussion management pathway to support concussion recognition, diagnosis, and management. This study adopted a pragmatic, descriptive qualitative approach to explore key stakeholders’ perceptions of the concussion management pathway, with the aim to inform policy and practice. Interviews were conducted with 123 participants, including players, parents, coaches, healthcare professionals, and school and provincial union representatives. The framework method was used to analyze data. Themes were organized according to the principles of realist process evaluation that considers contextual factors and mechanisms influencing a program's operation to produce specific outcomes. Contextual factors influencing the concussion management pathway's implementation included governing bodies’ support, existing local resources, general concussion attitudes, or concussion severity. The optimal functioning of the concussion management pathway (mechanism) was influenced by (i) pathway resources, (ii) roles and relationships, (iii) buy-in and support towards the concussion management pathway, and (iv) diligence and communication. Outcomes identified included (i) hitting the target (optimally managed and enhanced awareness) or (ii) missing the mark (dissatisfaction or management gaps). Overall, participants found the concussion management pathway valuable. However, the acceptability of certain policy-related aspects and the underlying attitudes associated with these perceptions, are some areas requiring further investigation and support. Tailoring programs according to end-users’ perceptions is crucial in developing context-sensitive interventions appropriate for a specific setting. These findings may act as a foundation for investigations of concussion management in other settings

Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System

There is a growing concern around concussions in rugby union, at all levels of the game. These concerns highlight the need to better manage and care for players. However, consistency around concussion-related responsibilities of stakeholders across the community rugby system remains challenging. Taking a systems thinking approach, this pragmatic, qualitative descriptive study explored key stakeholder groups within New Zealand’s community rugby system’s perceptions of their own and others’ concussion-related responsibilities. Participants included players from schools and clubs, coaches, parents, team leads and representatives from four provincial unions. A total of 155 participants (67 females and 88 males) were included in the study. Focus groups and individual interviews were conducted. Thematic content analysis was used to analyse data. Thirty concussion-related responsibilities were identified. These responsibilities were contained within four themes: (1) policies and support (responsibilities which influence policy, infrastructure, human or financial resources); (2) rugby culture and general management (responsibilities impacting players’ welfare and safety, attitudes and behaviour, including education, injury reporting and communication); (3) individual capabilities (responsibilities demonstrating knowledge and confidence managing concussion, leadership or role/task shifting) and (4) intervention following a suspected concussion (immediate responsibilities as a consequence of a suspected concussion). The need for role clarity was a prominent finding across themes. Additionally, injury management initiatives should prioritise communication between stakeholders and consider task-shifting opportunities for stakeholders with multiple responsibilities. How concussions will realistically be managed in a real-world sports setting and by whom needs to be clearly defined and accepted by each stakeholder group. A ‘framework of responsibilities’ may act as a starting point for discussion within different individual community rugby contexts on how these responsibilities translate to their context and how these responsibilities can be approached and assigned among available stakeholders

Factors and expectations influencing concussion disclosure within NCAA Division I athletes: A mixed methodological approach

Background: Participation in sports is associated with many benefits to all aspects of health; however, it also comes with the risk of injury, particularly concussions. Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms. Although recent research has explored factors affecting concussion disclosure, use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs. Therefore, the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association (NCAA) athletes that may influence concussion disclosure. Methods: This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports, all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview. Eligible athletes were at least 18 years old and on an NCAA roster. The surveys focused on previous concussion-related disclosure behaviors, knowledge, attitudes, beliefs, norms, and intentions about disclosing concussion. Interviews focused on the athletes’ experiences related to concussion disclosure. Survey data were analyzed using descriptive statistics and Mann-Whitney U tests. Interviews were analyzed using a Consensual Qualitative Research tradition. Results: Participants had good concussion knowledge (median = 46.0), positive attitudes (median = 38.0), strong beliefs (median = 13.0), and strong intentions to disclose concussion symptoms (median = 7.0). None of the constructs differed by participants’ gender. Although quantitative findings were mostly positive, interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult. Educational efforts, sport culture, and medical professional presence were the primary facilitators discussed by participants. Stigma, pressure, and a lack of team support were perceived as disclosure barriers. Conclusion: The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions. Interventions must prioritize stakeholder- and team-based perspectives on concussion to establish a network supportive to disclosure