As they settle into a new school year, student-athletes don’t just have to protect themselves from COVID-19. They also have to protect themselves from the heat, cardiac arrests, traumatic brain injuries and several other catastrophic injuries.

West Virginia University researcher Samantha Scarneo-Miller and her colleagues at the University of Connecticut investigated the policies that high schools across the country use to protect their student-athletes from the most common safety threats. They also are traveling from state to state to meet with policymakers to ensure that life-saving policies are adopted nationwide.

“It’s really a scary time,” said Scarneo-Miller, an assistant professor in the School of Medicine’s Department of Human Performance – Athletic Training and director of the Master of Science in Athletic Training Program. “Because of COVID-19, a lot of student-athletes haven’t prepared their bodies to return to sports this summer. We know that coaches have been very frustrated for the past year, and they have not thought about safety as much as they thought about getting back on the field.”

The National Football League Foundation and the National Athletic Trainers Association, along with several private donors, provided $1.4 million for the effort.

The project is part of the Team Up for Sports Safety initiative, which propels the adoption of policies that make catastrophic sport injuries less likely among high school athletes.

In support of TUFSS, Scarneo-Miller and her team members at UConn’s Korey Stringer Institute began publishing annual reports—and bi-annual updates—on secondary schools’ health and safety policies in 2017.

They considered schools in every state and the District of Columbia.

The evaluations took into account safety measures such as having an emergency action plan, having automatic external defibrillators on site, training coaches to look for signs of severe traumatic brain injuries, treating exertional heat stroke and gradually phasing in activity in the heat.

Based on the results of the evaluations, the researchers assigned each state and D.C. a score. Then they ranked them.

Florida currently sits at the top of the list, with a score of 87.67%. California is last, scoring 30.8%.

West Virginia—with a score of 58.53%—placed 19th.

“We want to make sure that when we’re evaluating these policies, we’re being as objective as possible,” Scarneo-Miller said. “We go through a five-step process to make sure we’re removing as much subjectivity as we can.”

In their latest publication, the researchers report that 38 states have adopted legislative or State High School Athletic Association changes that improve safety for student-athletes.

West Virginia is among them. Last year, the state began requiring high schools to have emergency action plans that include several components considered best practices.

“In the last three years, the top five states were all states that TUFSS visited,” said Rebecca Stearns, KSI’s chief operating officer, the director of TUFSS and an assistant professor of kinesiology at UConn. “We’re proud of the fact that those are the states making the biggest score increase in the last three years. Also, none of the states ranked in the bottom five have had a TUFSS meeting yet. In terms of the impact, the mean score increases by 10% after we’ve worked with states.”

The policies that TUFSS and state representatives pursue focus on what Scarneo-Miller, Stearns and their colleagues call “the four H’s”: heart, head, heat and hemoglobin.

That “translates to cardiac arrest, head injuries, heat stroke and sickle cell trait,” Stearns said. “Those four conditions make up 90% of the deaths that we see, so that’s why we target those when we go to the state meetings.”

Policies take time to implement, but TUFSS strives to expedite the process by meeting with key individuals from each state to help identify areas for swift change. The process involves scheduling meetings with policymakers to present policies and measures tailored to that state, addressing areas of improvement.

TUFSS first visited West Virginia policymakers in February 2020. They plan to return in October 2021.

One challenge that West Virginia faces is a dearth of athletic trainers in its secondary schools. In fact, nearly 60% of West Virginia high schools don’t have access to one. But the state isn’t alone in lacking access to athletic trainers. NATA reports that the problem is nationwide. And according to the Bureau of Labor Statistics, the occupation is expected to grow much faster than average—by 16%—until the end of the decade, as people become more aware of the effects of sports-related injuries.

The World Health Organization says that, around the world, extreme-heat events appear to be occurring more frequently, lasting longer and spiking temperatures higher.

“We know that climate change has increased our temperatures, so this summer might be one of our hottest summers ever,” Scarneo-Miller said.

“I think a lot of parents have this underlying assumption and kind of a false sense of security that you send your kids to practice that there’s guidelines and rules in place that are going to protect them when we know that that’s definitely not the case,” Stearns said. “Unfortunately, in the last five years, we’ve seen over 300 sport-related deaths at the high school level alone, so we are just trying to curb that. Parents should be asking things like ‘Do you have an athletic trainer? Do you have an emergency action plan? Where is the nearest AED?’ Because those could all be things that save your child’s life.”

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