The Korey Stringer Institute (KSI) has published its most recent report that provides a snapshot of state-level policies concerning sudden death and catastrophic injuries in high school sports. Since their robust efforts to strengthen these policies across the country, 38 states have adopted legislative or State High School Athletic Association changes improving on that baseline. This remarkable progress is chronicled in KSI's latest policy paper published in The American Journal of Sports Medicine in August 2021.
It's no coincidence that three-quarters of states have adopted changes in just three years. This nationwide movement towards stronger safety rules has been driven by the work of Team Up for Sports Safety (TUFSS), a KSI-led initiative aiming to propel the adoption of high school athletic policies proven to reduce the incidence of catastrophic sports injuries. The rapid, widespread success of TUFSS has been fueled by support from the National Football League Foundation and the National Athletic Trainers' Association along with numerous private donors.
A State-By-State Approach
As part of the TUFSS initiative, KSI hosts meetings within states and invites local high school sports leaders, health care providers, medical professionals and policy makers to engage in conversation aimed as fueling the adoption of health and safety policies that enhance the wellbeing of high school student athletes. Through the implementation of TUFSS-recommended policies and procedures, schools can be well prepared in the unfortunate event of a catastrophic injury, helping to reduce risk of athlete fatality from sudden cardiac arrest, traumatic head injuries, exertional heat stroke, and exertional sickling.
"We decided to do a state-based approach and make it a really targeted, individualized approach for the states," said Rebecca Stearns, Chief Operating Officer of KSI and Director of TUFSS.
The goal of each meeting is to leave with a policy document which decision makers can use to guide the implementation of new regulations – changes that may take the form of legislation, executive actions, rules changes, or other organizational reforms.
"In the last three years, the top five scoring states were all states that TUFSS visited," said Stearns. "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."
Research, Advocacy and Education
The Korey Stringer Institute draws its name and inspiration from Korey Stringer, a Minnesota Vikings offensive lineman who passed away from exertional heat stroke in 2001. In an effort to prevent additional exertional heat stroke deaths, Stringer's widow, Kelci, joined forces with exertional heat stroke expert Dr. Douglas Casa at the University of Connecticut to form KSI, which launched in April 2010. KSI's mission is to provide research, education, advocacy and consultation to maximize performance, optimize safety and prevent sudden death for the athlete, warfighter and laborer.
The NFL and the NFL Foundation have been strong advocates for the work of KSI since its founding, providing funding and support for various initiatives including the Athletic Trainer Grant Program, which provided funding to public high schools with football programs with limited or no access to an athletic trainer.
Looking ahead, TUFSS will visit all 50 states, the District of Columbia, and Puerto Rico in an effort to ensure that common sense guidelines to protect the health of high school athletes are in place in each American jurisdiction. As standards continue to be raised across the country, KSI hopes that additional states will follow the example of governments that have already implemented changes.
KSI's recent policy paper found that the following five states improved the most when it came to implementing policies to protect high school athletes: Florida, Louisiana, New Jersey, Delaware and Georgia.
In Florida, for example, both houses of the state legislature unanimously passed the Zachary Martin Act, which took effect July 1, 2020. Under the provisions of the bill, Florida High School Athletic Association (FHSAA) member schools must modify athletic activities based on heat stress guidelines and require emergency action plans to include procedures for onsite cooling before transporting a student for exertional heat stroke. The law also requires FHSAA member schools to make automated external defibrillators (AEDs) available on school grounds in clearly marked, public locations.
"I was encouraged by the heartfelt concern of Florida legislators and their commitment to ensuring the safety of our high school athletes," said Zachary Martin's mother, Laurie Giordano. "KSI was instrumental in motivating lawmakers to address exertional heat illness safety."
Louisiana also passed sweeping legislation as the result of KSI's organizing efforts, as governor John Bel Edwards signed a bill in June mandating emergency action plans, requiring heat acclimatization and the use of wet bulb globe temperature (WBGT) to monitor environmental conditions during high school athletic activity in the state.
In New Jersey, two bills were signed into law on January 9, 2020 requiring high schools to follow best practices guidelines. One bill requires the use of WBGT to monitor environmental conditions, while the other requires the establishment and implementation of emergency action plans. The TUFSS team has worked closely with New Jersey high school sports leaders over the last three years assisting in this policy change process.
An Unrelenting Effort
Though the progress of KSI and TUFSS over the past three years has been remarkable, there is still a lot more work to do. Dozens of states can still act to make their policies stronger to mitigate risk for high school athletes.
"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," said Stearns. "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. Bringing attention to it and getting parents in the local community to kind of push for this and support it and start asking questions, I think it goes a long way."
The NFL will continue to stand alongside Korey Stringer Institute in their unrelenting effort to make high school sports safer each year than they were before.