Best Practice Recommendations for Youth Sports

1) Read ONE of the following documents about emergency planning in sport. Choose the paper that is relevant to the population you are discussing (either youth or high school):

The Inter-Association Task Force Document on Emergency Health and Safety: Best-Practice Recommendations for Youth Sports Leagues (See Attachment)

You should read the Youth Sports Leagues statement above for any youth sports NOT occurring in a high school setting. This includes any non-school based leagues in the community (e.g., Little League baseball, youth soccer leagues, PAL, Babe Ruth, parks & recreation leagues, etc.).

All papers should be in the following format:

Submit a single document in Word
1″ margins
12-point font (Times New Roman or Arial)
Double-spaced
The document should be titled: LastnameFirst initial_317_Assn1 (e.g., SmithJ_317_Assn1)
Scenario #1

Scenario #1 (Coach): If you are a coach of a youth sport or high school sport, evaluate how prepared you are for an emergency at your primary practice location? Do you have an EAP? Are there trained responders on site? What steps should you take immediately to be more prepared to respond to a medical emergency? Submit a 3-5 page paper with an evaluation of your practice site and EAP, based on the document you read. After completing the evaluation of emergency preparation at the practice site, write a 1 page reflection about what you learned, and submit it as the final page in your assignment with the heading titled Reflection.

CITE the paper you read for the assignment.
You should NOT do additional research in order to complete the assignment.
Your paper should be based on how well your practice site meets the best practices criteria outlined in the position paper you read. Refer to specific criteria from the document.
NOTE: If you are not a coach or parent of child currently playing youth sports, it’s allowable to assess the practice site of a friend, neighbor or family member who is coaching or has a child playing

Journal of Athletic Training 2017;52(4):384400
doi: 10.4085/1062-6050-52.2.02
by the National Athletic Trainers Association, Inc
www.natajournals.org
consensus statement
The Inter-Association Task Force Document on
Emergency Health and Safety: Best-Practice
Recommendations for Youth Sports Leagues
Robert A. Huggins, PhD, ATC*; Samantha E. Scarneo, MS, ATC*;
Douglas J. Casa, PhD, ATC, FNATA, FACSM*; Luke N. Belval, MS, ATC,
CSCS*; Kate S. Carr; George Chiampas, DO; Michael Clayton, MS#;
Ryan M. Curtis, MS, ATC*; A. J. Duffy III, MS, PT, ATC*; Alexandra Flury;
Matthew Gammons, MD**; Yuri Hosokawa, PhD, ATC*; John F. Jardine, MD;
Cynthia R. LaBella, MD; Rachael Oats, CAE*; Jack W. Ransone, PhD, ATC,
FACSM*; Scott R. Sailor, EdD, ATC*; Katie Scott, MS, ATC*; Rebecca L. Stearns,
PhD, ATC*; Lesley W. Vandermark, PhD, ATC*; Timothy Weston, MEd, ATC*
*National Athletic Trainers Association; , University of Connecticut; ;
US Soccer Federation; Northwestern University; #USA Wrestling; **American Medical Society for Sports Medicine;
American Academy of Pediatrics; Co-Chair
Recent data from the Sports & Fitness Industry
Association1 on youth sport participation suggest
that 30 893 455 children ages 6 to 14 years
participated at least once in 1 or more reported activities
or sports during 2015. Many of these children participate in
sport programs that are governed by organizations known
as national governing bodies (NGBs) for youth sports.
These entities strive to promote fair play, increase physical
activity, and provide critical life lessons, values, and morals
to their members, all in a safe environment. Although many
NGBs meet these goals, the area of safety policies and best
practices offers room for improvement.
Data from emergency department visits by children ages
6 to 18 years indicated that 39% of life-threatening injuries
were sport related2
; however, few to no data regarding
sudden death during participation in youth sports are
available. Unpublished data on 34 youth (,14 years of age)
sport-related deaths from 2010 through 2014 collected by
the at the University of Connecticut demonstrated that 24% of these deaths (n 8) occurred
during participation in youth sport leagues. Cardiac
conditions, which are traditionally the most commonly
identified cause of death at all levels of sport, were
responsible for 47% (n 16). From 2000 through 2014,
baseball (n 5), soccer (n 4), football (n 3), basketball
(n 2), and lacrosse (n 1) accounted for all deaths in
youth athletes ,12 years of age. Given the large youth
sport participation rates1 and scarcity of published data
other than emergency roomdocumented sudden deaths in
youth sports,2 it is imperative to improve sport safety
policies and strive toward best practices. Catastrophic
injury is an obvious threat to this population. With
increased awareness of the potential causes of death and
implementation of preventive mechanisms, member organizations can improve the health and safety of these young
athletes.
Each NGB functions independently; therefore, implementing best-practice health and safety policies at the youth
sport level is challenging. Currently, no single entity
oversees governance for all youth sports. As a result,
uniformity in safety policies and procedures across
organizations is lacking. Governing bodies often encounter
difficulty enforcing current best-practice policies and may
only be able to recommend or create guidelines rather than
mandate change. Potential barriers NGBs encounter when
attempting to mandate policy include high rates of
participation, a wide range of age groups, budgetary
restrictions, diverse geographic locations, and a lack of
internal administration. These barriers were commonly
expressed by youth sport NGB leaders during the 2015 and
2016 Youth Sport Safety Governing Bodies meetings held
in New York, New York.4
In an effort to improve the emergency health and safety
best practices and policies in youth sport, this document
was developed to serve as a road map for policy and
procedure recommendations. It addresses the most common
conditions resulting in sudden death and outlines recommended policies and procedures designed to improve youth
sport safety. It serves as a call to action for youth sport
NGBs to provide support systems for member organizations
and to educate league leaders and their members about the
current best practices regarding emergency action plans
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(EAPs),57 sudden cardiac arrest (SCA),7 exertional heat
stroke (EHS),810 and brain and neck injury protocols.1113
The document also discusses preexisting medical conditions,14,15 environmental conditions,8,16 and emergency
medical care,5 such as the use of athletic training services.
These concerns were discussed at the January 21, 2016
Youth Sport Safety Governing Bodies Meeting in New
York, New York,4 in an effort to promote positive change
and assist with the strategic implementation and advancement of the best health and safety practices in youth sports.
Each organization is unique, and therefore each will need
to address policy and procedure recommendations differently to ensure successful implementation of best practices.
Furthermore, all best-practice policy and procedure recommendations may not be necessary for each sport (eg, a
lightning policy for most indoor sports). Many deaths in
youth sports are preventable. The goal of this document is
to support youth sport NGBs and provide them with the
structure and tools to prevent avoidable deaths.
RECOMMENDED YOUTH SPORT NGB SUPPORT
SYSTEM FOR MEMBER ORGANIZATIONS
The organizations that were invited to and participated in
the meetings and endorsed this document are listed in
Appendix A. Those organizations that have officially
endorsed the document are referred to throughout the
document as the Task Force. Other definitions used in this
document appear in the Table.
The Task Force recommends NGBs implement the
following:
1. Each NGB should endorse the creation of EAPs to be put in
place by all member organizations and provide templates for
and assistance in the development of the EAPs.
2. If a strategy to direct its member organizations toward
resources for appropriate emergency equipment and
medical services is not already in place, each NGB should
develop one.
3. Each NGB should develop a training structure to provide
education related to emergency health and safety best
practices for all members, including but not limited to
member leaders, member coaches, and parents or guardians of member athletes (see the Table for role definitions).
4. Each NGB should make available to all members training
modules or educational content on best practices related to
the following:
a. Emergency action plans
b. Sudden cardiac arrest
c. Brain and neck injury
d. Exertional heat stroke
e. Preexisting medical conditions
f. Environmental conditions
g. Medical services
5. Each NGB should recommend the development of an
educational training and certification reporting system for
member organizations and member coaches related to the
content areas listed in item 4.
6. Each NGB should recommend the development of a
reporting structure or system to monitor noncompliance as
each member organization moves toward the health and
safety best-practice policies recommended in this document.
7. Each NGB should recommend that an educational plan be
provided to train member organization leaders, who in turn
inform member coaches on how to organize and conduct
EAP training.
RECOMMENDED POLICIES FOR EAPs
The Task Force agrees that member organizations should
1. Establish venue-specific EAPs.6,15,17 (Strength of Recommendation [SOR] Taxonomy18: C; level of evidence
[LOE]: 3)
2. Provide access to emergency equipment at each athletic
venue as soon as possible.17,1921 (SOR: B; LOE: 2)
3. Recommend training for member leaders and member
coaches in first aid and cardiopulmonary resuscitation
(CPR), including the use of an automated external
defibrillator (AED). Training of officials, parents, and
athletes is also encouraged.2224 (SOR: B; LOE: 2)
4. Educate member coaches in recognizing emergency
situations and factors that increase the risk of catastrophic
injury or sudden death.6,15,17 (SOR: B; LOE: 3)
Table. Definitions
Term or Phrase Definition
Youth sport NGB An organization that has a regulatory or
sanctioning function over youth sports and
may be involved in the disciplinary action for
rule infractions and rule changes in the sport
it governs
Member organization
or league
An entity to which groups of sports teams or
individuals belong that operates under the
authority and rules and regulations set forth
by the NGB for the sport
Member leaders Those individuals who are members of the
NGB and are granted an official title of
authority, such as commissioner, event
organizer, safety coach, or director, by the
NGB
Member coaches Those individuals who are members of the
NGB and are granted the title coach by the
NGB; coaches may or may not receive
training and certification per the guidelines
set forth by the NGB
Members Those individuals who join or participate in the
NGB and are afforded membership benefits
including but not limited to educational
materials, trainings, certifications, and
coaching resources and tools
NGB-sanctioned
event
An event with authoritative permission or
approval provided by the NGB, which
accepts legal responsibility for those
participants involved
NGB-sponsored
event
An event that is financially supported by the
NGB for the purpose of increasing
awareness, building the brand, or generating
a commercial return
Policy A deliberate system of principles to guide
decisions and achieve rational outcomes; a
statement of intent that is implemented as a
procedure or protocol
Procedure An act or a manner of proceeding in any
action or process; conduct; for the purposes
of this document, a suggested process that
describes how each policy will be put into
action
Abbreviation: NGB, national governing body.
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5. Review the general EAP annually or as needed.5,7,15 (SOR:
C; LOE: 3)
RECOMMENDATIONS FOR EAP PROCEDURE
IMPLEMENTATION
The EAP should be implemented in concert with local
emergency medical service (EMS) providers by the
member leader (ie, league safety officer, commissioner, or
director) within the youth sport organization who oversees
safety responsibilities under the direction of the NGB.
1. Components of the EAP6,15,17
a. Contact information for EMS and other pertinent
emergency numbers
b. Facility address, locations or maps (or both), specific
directions, global positioning system coordinates
c. Personnel names, contact information, and responsibilities
d. Emergency equipment needs, including the specific
location of each item
e. Follow-up emergency documentation and reporting
actions
Important note: These components should be presented in
a clear and logical manner (ideally on 1 sheet of paper) with
step-by-step directions for the individual(s) at the event or
venue with the assistance of the local EMS.
2. Procedures to establish efficient and effective communication6,15,17
a. Implement and routinely practice the EAP to be in
concert with local EMS.
b. Provide all member coaches and EMS with copies of
the general EAP.
c. Post the EAP at each venue in an easily visible location
(if possible).
d. Activate the EAP quickly and at the first sign of distress.
e. Alert any on-site responders to the emergency and its
location.
f. Alert other individuals on-site so they can assist in
guiding EMS to the scene.
3. Emergency equipment location and maintenance6,7,15,17,1921,25
a. Develop a plan to locate the nearest accessible AED and
other emergency equipment. Ideally, an AED is present
on-site in a central location so that the device can be
immediately retrieved and applied to the individual in
need. However, the nearest AED may be located with
EMS or in a nearby building. Use of the AED within 1
to 3 minutes of collapse results in the best chance of
survival from a cardiac-related, shockable rhythm.1921
b. Recommend that member leaders and member coaches
perform and document on-site readiness checks of
equipment and maintenance of emergency equipment
on a regular basis if applicable. This includes battery
and lead replacement for AEDs according to manufacturer specifications.7,25
c. Recommend that any AEDs be registered (according to
local ordinances) with EMS so EMS is aware of the
community-wide strategic placement, make, model, and
type of pads needed before arriving on the scene.20
4. Training and education for member leaders and member
coaches23,2629
a. Plan in-person or online training sessions to educate
member coaches on how to recognize life-threatening
situations. Ideally, these sessions should include scenario-based practice with health care professionals22 or
a voice advisory manikin.23,26,27
b. Advise member leaders and member coaches to
document their completed competencies and trainings
and submit these to the appropriate personnel if required
by the NGB.
RECOMMENDATIONS FOR SCA POLICIES
The Task Force agrees that member organizations should
1. Have in place a comprehensive cardiac emergency policy
in accordance with the recommendations of the
NGB.7,19,21,30 (SOR: C; LOE: 2)
2. Recommend that athletes undergo cardiovascular screening before participating in sport.14,20,3034 (SOR: B; LOE:
2)
3. Recommend moving toward having an AED on-site and
readily available within an appropriate amount of time for
all organized events or developing a strategic plan to
reduce the time to AED application.1921,29 (SOR: A; LOE:
2)
4. Educate, on a biannual basis at minimum, member leaders
and member coaches on the proper steps for managing
SCA.15,19,20,24,29,30 (SOR: B; LOE: 3)
RECOMMENDATIONS FOR SCA PROCEDURE
IMPLEMENTATION
1. Components of the comprehensive cardiac policy7,14,21,30,33,34
a. Cardiac-screening procedures
b. Procedures to properly manage SCA
c. Emergency equipment (ie, AED) location and logistics
d. Education, training, and certification recommendations
e. Return-to-participation protocol
2. Screening procedure14,3036
The Task Force supports recommendations from the
American Academy of Family Physicians and American
Academy of Pediatrics33 and American Medical Society for
Sport Medicine30 as the minimum standards for screening
using the comprehensive personal history, family history,
and physical examination.
3. Procedures for proper management of SCA7,17,19,20,25,28,29
Note: Any youth athlete who has collapsed and is
unresponsive should be assumed to be in SCA until proven
otherwise or another cause of the collapse is identified.
a. Prompt recognition of SCA (ie, collapse, brief seizurelike activity, difficulty breathing or gasps, chest pain)
b. Early activation of EMS via the EAP (ie, call 911)
c. Early CPR and retrieval and application of the AED (if
shock is advised) for a witnessed collapse
i. If no shock is advised, continue CPR and life-support
measures until either the athlete responds or EMS
arrives.
ii. If others are available to assist, have them call 911
and retrieve the AED while CPR continues.
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iii. If only 1 person is present, he or she should call 911,
retrieve the AED (if readily available on-site), and
administer CPR.
iv. If no AED is available, call 911 and administer CPR
until help arrives.
d. Transportation to a hospital with advanced life-support
capability
e. Emergency equipment location and logistics
i. On-site AED
a. Should be readily available (ideally within 13
minutes)
b. Should be in a central location for large-scale
events, especially for NGB-sanctioned or
-sponsored events. For events located more than
3 minutes from an AED, a separate AED should
be available or a plan to obtain the nearest AED
should be implemented.
ii. No AED on-site
a. Activate EMS and call 911.
b. Continue CPR and life-support measures until
either the athlete responds or EMS arrives.
c. If others are available to assist, begin 2-person
CPR and life-support measures.
4. Education and training or certification5,7,15,30
Member leaders and member coaches should be
a. Educated at least biannually about the location,
function, and use of AEDs.
b. Educated on prompt recognition of SCA, early activation of EMS, early CPR and defibrillation, and transport
of the athlete to the hospital.
c. Informed of proper clearance and return-to-participation
procedures for an athlete who has experienced or is
experiencing a cardiac-related condition.
5. Recommended return-to-participation protocol7,19,30,34,37
a. Youth athletes who experience cardiac problems such as
chest pain, fainting or near-fainting episodes, skipped
heartbeats, shortness of breath, or excessive fatigue
should be evaluated by a physician before return to
participation is considered.
b. A physician should discuss clearance decisions with the
appropriate consultants and the parents or guardians of
youth athletes to make prudent decisions.
c. Clearance for youth athletes with cardiac disorders
should be based on physician recommendations and
should take into consideration the guidelines from the
American Heart Association and American College of
Cardiology Task Force.34
RECOMMENDATIONS FOR BRAIN AND NECK
INJURY POLICIES
The Task Force agrees that member organizations should
1. Have a comprehensive medical management plan and
policy in accordance with state laws for athletes with a
brain or neck injury, including concussion.1113,15,38 (SOR:
C; LOE: 3)
2. Educate member coaches, athletes, parents, and other
pertinent members regarding the plan and policy on a
regular basis.11,3841 (SOR: C; LOE: 3)
3. Recommend the proper use, fit, and wear of protective
equipment.11,38,41,42 (SOR: B; LOE: 2)
4. Advise that the management of any athletes with brain or
neck injuries, including those who do not require
emergency medical treatment, be directed by appropriate
medical personnel.11,38,41,43 (SOR: B; LOE: 2)
5. Never permit member coaches to return an athlete to play
who is suspected of having a brain or neck injury,
including concussion.11,38,41,43 (SOR: B; LOE: 3)
RECOMMENDATIONS FOR BRAIN AND NECK
INJURY PROCEDURE IMPLEMENTATION
1. Components of a comprehensive brain and neck injury
policy1113,15,38,41
a. Procedures for management and care of patients with
brain or neck injury
b. Educational information related to the prevention,
recognition, treatment, and return-to-play procedures
for athletes with brain or neck injuries, including
concussion
c. Appropriate evaluation protocols for when medical
personnel are and are not present
d. Protocols for return to play after brain or neck injury
2. Procedures for proper management and care of brain and
neck injury11,13,38,41
a. Activate the on-field care and management of the
patient with a brain or neck injury.
b. The brain or neck injury plan should be implemented
for an athlete who experienced, complains of, or was
suspected of receiving a hit to the head or neck.
c. If only nonmedical personnel (ie, coach, teammates,
parents, game officials) are present, a patient with a
suspected brain or neck injury should not be touched
or moved by anyone and the EAP and EMS should
be activated. The only time an athlete with a head or
neck injury should be moved is if he or she is not
breathing or has no pulse and requires compression-only
CPR, CPR and AED, or rescue breathing.
d. If appropriate medical personnel (ie, physician,
athletic trainer, health care provider trained in
emergency evaluation of the brain and neck) are
present, an athlete with a suspected brain or neck
injury should be properly stabilized under the
direction of the medical personnel. When a brain or
neck injury results in the patients loss of pulse or
respiration, CPR should be initiated and an AED
applied if appropriate. If the patient is face down,
medical personnel should consider and determine the
most appropriate mechanism for maintaining stabilization when rolling the patient to a supine position.
e. The EMS should be activated and transfer procedures
consistent with local protocols should be implemented.
3. Educational information related to brain and neck
injuries1113,38,41,43
Member leaders and member coaches should receive
education focusing on the prevention, recognition, and
management of athletes with brain or neck injury, such as
the Centers for Disease Control and Preventions Brain
Injury Safety Tips and Prevention from HEADS UP to
Youth Sports44
USA Footballs Heads Up Football program45
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USA Soccers Recognize to Recover, Head and Brain
Conditions information46
a. Education should also include the following information:
i. The fact that helmets do not prevent concussions in
helmeted sports
ii. The importance of enforcing the rules of the sport
and instruction on the safest techniques for playerto-player contact
iii. How to ensure the safety of the playing surface and
surroundings (ie, boards, nets, posts, fences)
iv. Proper fit, wear, and maintenance of protective
equipment specific to the sport
v. Proper reconditioning and recertifying of equipment
(when appropriate) based on manufacturer guidelines
b. Education should also cover each states laws related to
concussion management and reporting.
4. Appropriate evaluation protocol for brain-related injury
(specifically concussion)11,38,41
a. If appropriate medical personnel (licensed or certified health care provider trained in the assessment
and diagnosis of brain-related injury) are not on-site,
the athlete should be removed from the activity and
referred for medical evaluation. An athlete with a
suspected concussion or neck injury should be evaluated
by an appropriate health care provider (not a member
coach or parent unless medically qualified) and should
not be returned to participation until medically cleared.
b. If appropriate medical personnel are present,
evaluation for concussion at the discretion of the
medical provider should be conducted. The athlete
may return to play after evaluation only if the trained
medical professional deems that the athlete does not
have a concussion; however, the athlete may not return
to play if the medical professionals impression is that
he or she has sustained a concussion.
c. Initial treatment recommendations for concussion, including educating the athlete and his or her parents on the need
for cognitive and physical rest until follow-up assessment
determines otherwise, should be provided.
d. Management of the concussion should be in accordance
with state laws.
5. Recommended return-to-participation protocol after a
brain or neck injury11,38,41
a. To prevent a premature return to participation and avoid
placing the athlete at risk for a catastrophic injury, a
graduated return-to-participation progression should be
implemented and closely managed by an appropriate
medical provider.
b. Athletes returning to participation after a brain or neck
injury should be required to obtain written clearance
from an appropriate medical provider specifically
trained in the management of such injury.
c. Suggested return-to-play process (concussion only)11,38,41
The return-to-play process may begin once symptoms
have resolved (unless otherwise directed by a medical
provider) and the athlete is cleared by appropriate medical
personnel.
Step 1: No activity until complete symptom resolution for at
least 24 hours
Step 2: Light aerobic exercise for 20 minutes
Step 3: Sport-specific exercise, which may include interval
aerobic exercise and body-weight resistance exercise
Step 4: Noncontact training drills, which may include shuttle
runs, plyometrics, and noncontact sport-specific drills (eg,
kicking, ball handling)
Step 5: Limited, controlled, and gradual return to full-contact
practice
Step 6: Return to full participation, including games and
competitions
Note: As directed by an appropriate medical professional,
the athlete should not advance to the next step unless he or
she is symptom free at the current step (unless otherwise
specified by appropriate medical personnel) and a minimum
of 24 hours has elapsed between steps.
RECOMMENDATIONS FOR EHS POLICIES
The Task Force agrees that member organizations should
1. Have a heat-acclimatization program and how-to guide in
place before training for sport when applicable (ie,
preseason in hot environments, nonclimate-controlled
conditions, or new environments in unfamiliar regions).8,9,15,47 (SOR: B; LOE: 2)
2. Have a medical management plan for the care of athletes
with EHS.8,15 (SOR: C; LOE: 2)
3. Provide education for member leaders, coaches, athletes,
parents, and staff on a periodic basis.810,48 (SOR: C; LOE: 3)
4. Have a plan for assessing environmental conditions to prevent
heat-related illnesses including EHS.8,9,15 (SOR: B; LOE: 2)
5. Have a return-to-play plan for athletes who have
experienced EHS.4952 (SOR: C; LOE: 3)
RECOMMENDATIONS FOR EHS PROCEDURE
IMPLEMENTATION
1. Components of a comprehensive EHS policy8,9,15
a. Guidelines for environmental monitoring
b. Protocol for heat acclimatization
c. Procedures for proper emergency management of EHS
d. Emergency equipment and logistics
e. Education and training
f. Return-to-play protocol
2. Guidelines for reducing the risk of heat illness8,9,15
a. Monitor the environment using a wet-bulb globe
temperature device, prediction chart, heat index, or
information from a local weather station to assess if it is
safe to exercise, practice, or play in the heat.
b. The threshold for activity modification should be
determined using an on-site environmental monitor and
geographic regionspecific guidelines. (See Grundstein et
al53 for region-specific guidelines, and see US Soccer
heat guidelines.54) Predicted wet-bulb globe temperature
calculated from ambient temperature and humidity and
the heat index can provide estimated values, but
interpretation should be done with caution.
c. The methods and expectations for providing hydration
should be established by member coaches with their
athletes. Depending on the sport, event, and size, a
sufficient quantity of water or sports drinks should be
brought by the athlete, made available, or placed at various
stations around the athletic venue. Member leaders and
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member coaches should ensure that athletes can hydrate
quickly and freely but also take regular hydration breaks.
3. Suggested heat-acclimatization protocol8,9,15,55,56
Specific guidelines outlining equipment use, intensity and
duration of exercise, rest breaks, hydration, and total
practice time, such as those outlined in the heat-acclimatization guidelines for secondary school athletics,55 should
be followed.
Procedures for proper management of EHS:
a. Activate the on-field exertional heat-stroke care and
management plan.
b. Athletes who demonstrate confusion, nausea, dizziness,
altered consciousness, combativeness, other unusual
behavior, or staggering during walking or running or
collapse while exercising should be suspected of having
a heat-related injury.
c. The athlete with a suspected heat illness who has
collapsed or is unresponsive but is breathing and has
a heartbeat should be immediately cooled via coldwater immersion in a tub of ice water or the rotation
of ice towels over the entire body while 911 is called.
(Activate EAP.)
d. Excess clothing and equipment should be removed from
the athlete to help with the dissipation of heat. During
cooling, the athlete should be moved from direct
sunlight into shade if possible.
e. If medical personnel are NOT on site, call 911
(activate EAP) while simultaneously pursuing rapid
cooling (see items c and d). Until medical personnel
arrive, continue to cool and monitor the athlete.
f. If medical personnel (physician, athletic trainer, or
other medical personnel trained in heat illnesses) and
equipment (ie, rectal thermometer, cold tub, plastic
tarp, kiddie pool, shower, access to water and ice,
towels) are on-site, cool first, transport second
should be implemented and cooling should continue
uninterrupted until the athletes core body temperature is
less than 1028F (38.98C).
4. Equipment required for rapid cooling and body temperature assessment8,9,15,52
a. A large tub, plastic tarp, kiddie pool, or empty trash
barrel are all options to hold ice and water for the athlete
who needs rapid and immediate cooling.
b. A water source, extra water cooler(s), access to a locker
room with shower, ice chest(s), and towels or sheets are
recommended to assist in the rapid cooling of the
athlete.
c. If a rectal thermometer is not available and EHS is
suspected, rapid cooling should ensue. A rectal
thermometer is required for the accurate assessment of
core body temperature (for use by medical personnel
only). All other on-field temperature assessment techniques (mouth, ear, forehead, armpit) are inaccurate and
should be avoided.
5. Education and training recommendations for member
leaders and member coaches8,9,15,56
a. Educate annually regarding the factors that place
athletes at risk and strategies to prevent heat illness.
b. Educate on the prompt recognition of EHS, activation of
EMS, importance of immediate cooling, and transport
of the athlete to the hospital.
c. Inform about proper clearance and return-to-participation procedures for an athlete who has experienced
EHS.
6. Return to participation after EHS8,9,49,51,57
a. To prevent a premature return to participation after
EHS, the athletes medical provider should implement a
graduated return-to-participation progression tailored
for the severity of the illness.
b. Athletes returning to participation after EHS should be
required to obtain written clearance from an appropriate
medical provider specifically trained in heat illness.
RECOMMENDATIONS FOR POTENTIALLY LIFETHREATENING MEDICAL CONDITIONS POLICIES
The Task Force agrees that member organizations should
1. Consider the importance of education about disclosing
potentially threatening medical conditions (eg, asthma,
anaphylaxis, sickle cell trait, diabetes, epilepsy) to member
coaches.14,15,5862 (SOR: B; LOE: 3)
2. Encourage parents or guardians to disclose member
athletes potentially life-threatening medical conditions.15,33,5961,6365 (SOR: B; LOE: 3)
3. Encourage parents or guardians of athletes with potentially
life-threatening conditions to provide the players with
appropriate self-administering medication (eg, inhaler,
epinephrine injector) as indicated by each athletes
physician.60,61,63,64,66 (SOR: A; LOE: 1)
RECOMMENDATIONS FOR POTENTIALLY LIFETHREATENING MEDICAL CONDITIONS
PROCEDURE IMPLEMENTATION
1. Components of a comprehensive life-threatening medical
conditions plan14,15,5862
a. Educate others on the signs and symptoms related to
these conditions.
b. Establish procedures for managing these conditions.
c. Communicate the plan to parents or guardians.
2. Procedures for the proper management of a potentially lifethreatening asthma attack60,61
a. If medical personnel are NOT on-site, retrieve the
athletes medication (eg, inhaler) and provide it to the
athlete for self-administration. Successful administration of the medication requires the athlete to remain
calm and concentrate on breathing correctly. If
requested by the athlete, other individuals may assist
with administration of the inhaler. The athlete may
administer up to 3 times before medical transport is
required. If no improvement occurs after treatment or
the condition becomes worse, activate EMS (activate
EAP and call 911) immediately.
b. If medical personnel are on-site, retrieve the athletes
medication and assist in the proper administration of the
medication. The athlete should be monitored by a
medical professional knowledgeable about asthma
emergencies until breathing returns to normal, and
follow-up or referral should be at the discretion of the
medical provider.
3. Procedures for the proper management of a potentially lifethreatening anaphylactic reaction61,66
a. Personnel (medical or nonmedical) should simultaneously call 911 (and activate the EAP) while retrieving
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the athletes medication (eg, epinephrine injector) and
providing it to the athlete for immediate self-administration in the thigh. The injector should be provided to
EMS when they arrive. If medical personnel are present,
they may assist the athlete with administration of the
injection, especially if the athlete demonstrates signs of
anaphylaxis and becomes unconscious; however, state
laws pertaining to the administration of lifesaving
medications and Good Samaritan laws should dictate
proper procedures.
b. After the anaphylactic reaction is treated with epinephrine injection, transport to the hospital for observation is
recommended, as the athlete may have a rebound
reaction. The EMS protocols will include this direction.
4. Education recommendations60,61
a. Member leaders and member coaches should be educated
on the major signs and symptoms of asthma, such as
shortness of breath, wheezing, chest tightness, and
recurrent coughing. In an athlete with asthma, these
symptoms likely represent an asthma exacerbation
(attack). In severe cases of asthma, the athlete may
become less responsive or lose consciousness.
b. Member leaders and member coaches should be
educated on the major signs and symptoms of
anaphylaxis, such as quickly developing rash, hives,
swollen lips or tongue, shortness of breath, wheezing,
reduced blood pressure, and fainting or collapsing after
being exposed to a likely or known allergen.
5. Communication plan
The parents or guardians of all member athletes should be
encouraged to complete a form that discloses all known
medical conditions. This form should also include a
treatment plan for these individuals, consisting of the
medications used as well as who will be responsible for
ensuring these medications are present during practices and
competitions. Furthermore, member organizations should
educate parents and guardians on the dangers of not
disclosing such conditions.
RECOMMENDATIONS FOR LIGHTNING POLICIES
The Task Force agrees that member organizations should
1. Create and enforce a comprehensive lightning safety
policy.16,6771 (SOR: B; LOE: 3)
2. Enforce the slogans supported by the National Weather
Service72:
a. When thunder roars, go indoors.
b. No place outside is safe when thunderstorms are in the
area.
c. Half an hour since thunder roars, now its safe to go
outdoors!
3. Stop practice or competition immediately and find a safer
location when thunder is heard.16,67,73 (SOR: B; LOE: 2)
4. Identify the nearest appropriate and safe secure structure in
the EAP.16,67,73 (SOR: B; LOE: 2)
RECOMMENDATIONS FOR LIGHTNING PROCEDURE
IMPLEMENTATION16,6775
1. Components of a comprehensive lightning safety policy16,67,69,74,75
a. Guidelines for weather monitoring
b. Protocol for lightning-strike prevention
c. Proper emergency management of a lightning strike
d. Education and training recommendations
e. Criteria for cancellation and resumption of activity
2. Guidelines for successful weather monitoring67,73,75
a. Instill and promote awareness about lightning and
changing or unstable weather conditions and determine
a reliable weather source.
b. Establish a chain of command and identify the person(s)
responsible for suspending activity.
c. When appropriate, cancel or postpone activity before
the event begins and prevent athletes or spectators from
entering the venue.
3. Protocol for lightning-strike prevention16
a. Promote lightning safety slogans such as When
thunder roars, go indoors.
b. Identify safe locations. A safe location is a fully
enclosed building with wiring and plumbing or a fully
enclosed vehicle, such as a school bus, car, or van.
c. Identify and avoid unsafe locations, such as picnic or park
shelters, tents, dugouts, press boxes, porches, open
garages, and storage sheds. Tall objects such as trees,
poles, towers, or other elevated areas are potential
lightning targets and should also be avoided. Being inside
a building with plumbing or wiring in close proximity to
showers, sinks, locker rooms, indoor pool, appliances, and
electronics connected to a power source can be unsafe.
4. Procedures for proper emergency management of a
lightning strike16,71,72,75
a. If an athlete or multiple athletes are struck by lightning,
ensure your personal safety before assisting others.
b. Carefully move the injured athlete(s) to a safer location,
call 911 (activate EAP), and provide appropriate care
within the scope of training, which may include CPR,
AED use, and rescue breathing.
c. Depending on the severity and number of athletes
involved, provide care to those with the most lifethreatening injuries while waiting for EMS to arrive.
5. Education recommendations16,73,75
a. Member leaders and member coaches should be
educated on proper prevention strategies and safe
locations to use when lightning is in the area.
b. Member leaders and member coaches should be
educated on managing an athlete who is struck by
lightning.
c. Member leaders and member coaches should be
educated as to when the event should be postponed
because of lightning and when it is safe to resume
activity.
6. Criteria for cancellation or resumption of activity16,67,73
a. Postpone or suspend activities if a thunderstorm is
expected before or during the event.
b. Activities should be suspended until 30 minutes after
the last strike of lightning is seen and the last sound of
thunder is heard.
c. The 30-minute clock restarts for each lightning flash
within 6 miles (9.7 km) and each time thunder is heard.
RECOMMENDATIONS FOR MEDICAL SERVICES
POLICIES
The Task Force agrees that member organizations should
1. Establish a plan to provide access to appropriate medical
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services such as athletic trainers or other emergency
services for NGB-sponsored or -sanctioned events and
events at which NGB staff are present.6,15,55,76,77
2. Implement a plan to access appropriate and adequate
medical services, such as athletic trainers or other
emergency services, for activities including practices,
competitions, and large-scale events (eg, tournaments).6,15,78,79
SUMMARY
This document is intended to serve as a call to action for all
youth sport NGBs to provide support systems for member
organizations through the education of league leaders and
their members on the current policy and procedure best
practices regarding EAPs, SCA, brain and neck injury, EHS,
and other potentially threatening medical conditions (Appendix B). This document also discusses preexisting medical
conditions, environmental conditions, and emergency medical
care, such as athletic training services. The Task Force
recognizes that each organization is unique and, therefore, will
need to address policy and procedure recommendations
differently to ensure the implementation of best practices.
Furthermore, the Task Force recognizes that all best-practice
policy and procedure recommendations may not be necessary
for each sport (eg, lightning policy for indoor sports). Many of
the deaths in youth sports are preventable, and it is the goal of
the Task Force to support youth sport NGBs in this mission of
prevention.
DISCLAIMER
The National Athletic Trainers Association (NATA)
and this Inter-Association Task Force advise individuals,
national youth sport governing bodies, staff, organization
member leaders, member coaches, and member players to
carefully and independently consider each of the recommendations. The information contained in these recommendations is neither exhaustive nor inclusive of all
circumstances or individuals. Variables such as institutional human resource guidelines, state or federal statutes,
rules, or regulations, as well as regional environmental
conditions, may affect the relevance and implementation
of these recommendations. The NATA and the InterAssociation Task Force advise their members and others
to carefully and independently consider each of the
recommendations (including the applicability of some to
any particular circumstance or individual). The foregoing
statement should not be relied upon as an independent
basis for management and care but rather as a resource
available to NATA members, national youth sport
governing body members, and others. Moreover, no
opinion is expressed herein regarding the quality of care
that adheres to or differs from NATAs position
statements. The NATA and the Inter-Association Task
Force reserve the right to rescind or modify their position
statements at any time.
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Address correspondence to Robert A. Huggins, PhD, ATC, Department of Kinesiology, Korey Stringer Institute, University of
Connecticut, 2095 Hillside Road, Box U-1110, Storrs, CT 06269. Address e-mail to [email protected]
Appendix A. The 2016 Youth Sport Safety Governing Bodies Meeting: Invitees, Participants, and Statement Endorsers
Invitees Participants Statement Endorsers
Korey Stringer Institute Korey Stringer Institute Korey Stringer Institute
National Athletic Trainers Association National Athletic Trainers Association National Athletic Trainers Association
Safe Kids Worldwide Safe Kids Worldwide Safe Kids Worldwide
USA Wrestling USA Wrestling USA Wrestling
American Academy of Pediatrics American Academy of Pediatrics
American Medical Society for Sports Medicine American Medical Society for Sports Medicine
US Lacrosse US Lacrosse
US Soccer Federation US Soccer Federation
USA Football USA Football
USA Gymnastics USA Gymnastics
USA Hockey USA Hockey
US Tennis Association US Tennis Association
USA Track and Field USA Track and Field
Amateur Athletic Union Basketball
Little League
USA Softball
US Olympic Committee
USA Field Hockey
Journal of Athletic Training 393
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Appendix B. Emergency health and safety recommendations for national governing bodies. Part 1, Overall. Part 2, Emergency action
plan. Part 3, Sudden cardiac arrest. Part 4, Brain and neck injury. Part 5, Exertional heat stroke. Part 6, Potentially life-threatening medical
conditions. Part 7, Lightning. Abbreviations: AED, automated external defibrillator; CPR, cardiopulmonary resuscitation; EAP, emergency
action plan; EMS, emergency medical services; SCA, sudden cardiac arrest.
394 Volume 52 Number 4 April 2017
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Appendix B. Continued from previous page.
Journal of Athletic Training 395
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Appendix B. Continued from previous page.
396 Volume 52
Number 4
April 2017
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Appendix B. Continued from previous page.
Journal of Athletic Training 397
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Appendix B. Continued from previous page.
398 Volume 52
Number 4
April 2017
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Appendix B. Continued from previous page.
Journal of Athletic Training 399
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Appendix B. Continued from previous page.
400 Volume 52
Number 4
April 2017
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