Guidelines Issued to Prevent Sudden Death in College Athletes

New guidelines introduced Wednesday by leading health care professionals are designed to provide athletes, coaches, athletic trainers and physicians with best practices for preventing sudden death in college student-athletes. They particularly target cardiac conditions. Since 2000, 21 NCAA football players have died during conditioning workouts; 75 percent of these fatalities were Division I players. Eleven out of the 21 deaths occurred during the first or second day of workouts.

"Preventing Sudden Death in Collegiate Conditioning Sessions: Best Practices Recommendations," presented at the National Athletic Trainers' Association's 63rd Annual Meeting & Clinical Symposia in St. Louis, will be published in the July/August issue of the Journal of Athletic Training. A copy of the complete statement is available here. (Earlier this year, NATA published guidelines to prevent sudden death in athletes playing youth sports.)

The task force to develop the collegiate guidelines was spearheaded by the NATA, in collaboration with the National Strength and Conditioning Association. Members represented numerous organizations including the NCAA, the American College of Emergency Physicians, the American Medical Society for Sports Medicine, the American Orthopaedic Society for Sports Medicine, the Canadian Athletic Therapists Association, the Collegiate Strength and Conditioning Coaches Association and the United States Olympic Committee. "Strength and conditioning sessions have become fundamental to success in collegiate sports," task force chair Douglas Casa, director of athletic training at the University of Connecticut's Neag School of Education and chief operating officer of the Korey Stringer Institute, said at a press conference announcing the guidelines. "However, the athletes' development, health and safety are sometimes overshadowed by a culture that values making athletes tough, instilling discipline and focusing on success at all costs. This ill-conceived philosophy has been a contributor to the alarming increase in collegiate athlete deaths and serious injuries during conditioning sessions." To combat injuries and deaths, the task force developed the following guidelines:1. Progressive acclimatization is the cornerstone of safety.2. Introduce new conditioning activities gradually.3. Do not use exercise and conditioning activities as punishment.4. Strength and conditioning coaches require proper education, experience and credentialing.5. Provide appropriate medical coverage, including a strength and conditioning coach and an athletic trainer.6. Develop and practice emergency action plans.7. Be cognizant of athletes' medical conditions.8. Administer strength and conditioning programs to manage health- and safety-related concerns.9. Establish a close working partnership of recognized professional organizations, including athletic, coaching, sports medicine, and strength and conditioning organizations.10. Require adequate continuing education for the entire coaching and medical teams. "Inadequate emergency preparation leading to sudden deaths in athletes also carries with it the real risk of major liability to the school or organization's administrators, teams and coaches," said Richard Adler, a founding principal partner of the Seattle law firm Adler Giersch and chairman of the executive board of the Brain Injury Association of Washington. "These guidelines are a great resource to prevent easily preventable tragic and catastrophic deaths, reduce financial and legal risks, and make sports more enjoyable for participants, their families and fans."

The NCAA has policies echoing some of the recommendations and is evaluating the others, David Klossner, the association's director of health safety, told NPR.org. "We're supportive of the effort to address these issues that they raise," he said.

The guidelines challenge "the old athletic mentality that if a little bit is good, a lot must be better," added Jim Thornton, president of the NATA and head athletic trainer at Clarion University. Last year, a University of Iowa investigation into the January 2011 hospitalization of 13 football players determined that an intense exercise regimen on the heels of a three-week layoff from supervised workouts was the cause of the players' rhabdomyolysis, a potentially fatal breakdown of muscle fibers into the bloodstream, where excess proteins can clog the kidneys and cause renal failure. What's more, the 18-page report revealed that Iowa strength and conditioning coaches apparently had no prior knowledge of rhabdomyolysis as a medical condition.

Thornton also said the new recommendations highlight the need for better oversight at the high school level, where certified athletic trainers are often absent. In August 2010, approximately two dozen McMinnville (Ore.) High School football players complaining of extreme pain and swelling in various muscles were hospitalized after participating in the football program's "immersion camp." Those players - three of whom required surgery - also were diagnosed with rhabdomyolysis attributed to an overly strenuous workout in a hot environment with inadequate hydration.

Working athletes longer and harder, concluded Jolie Holsche, a Chicago emergency medicine and sports medicine specialist and co-author of the new guidelines, "is not exercising smart."

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