2016, volume 2, issue 1
Personal Story - You Only Live Twice, by Rebecca Stearns
2nd Collaborative Solutions for Safety in Sports Meeting
Korey stringer Institute
The Stories of KSI
KOREY STRINGER INSTITUTE- Providing first-rate information, education, research, assistance and advocacy to protect athletes, soldiers, and laborers.
Dealing with Heat Stroke for the First Time by Michael Goldenberg
Douglas J. Casa, phd, atc, fascm, fnata cEo, korey stringer institute
now completely alive:
A Reflection from
30 years later
It is really ironic when you think about it. I toed the line at the University of Buffalo track in August 1985 for the New York State Championship at the Empire State Games (ESG). The race was a 10K. I was 16 years old and a few weeks shy of beginning my senior year of high school. This 10K final was the culmination of a trials process, where eight regions in New York State each sent two high school participants for each track race. I was one of the two runners representing Long Island for the boys high school division. For those a bit naïve to track and field, the 10K is a brutally boring 25 laps around a 400 meter track. The race began just before noon, on a day that was hot and humid.
When I stood at the start with the 15 other runners, I realized I had accomplished my biggest goal as a youth athlete. It had been my dream to qualify for the ESG. In the mid 1980’s the ESG were a huge deal for kids growing up on Long Island. We had incredible high school athletes in basketball, soccer, wrestling, lacrosse, track and field, and many other sports, all of which competed at these games. The kids who qualified wore their blue ESG jackets with pride, a symbol that they were one of the best on all of Long Island, a region with over 100 high schools.
When I first had this dream of qualifying for ESG, it was far-fetched. This created an opportunity for many to mock me for even considering the possibility. Only two people per event could compete! For all of Long Island!! For over 100 high schools!!!! I almost agreed with everyone. The chances would be slim, even potentially out-of-reach. But the less the odds seemed, the greater my motivation. I wanted to prove everyone wrong. Okay, maybe not my mom—she completely thought I could do it ever since the first time I mentioned it in my kitchen as a 14 year old. Moms are great for those kinds of things.
The journey to try to qualify for the ESGs was a comical one. I ran my first race as a 14 year old the summer before my sophomore year, and it yielded a last place finish, I think 18th. My second attempt fared a bit better with, if I remember correctly, a 6th place finish at age 15 the following summer. In my final and most successful attempt, as my senior year approached, I ran the race of my life and tied for 1st place. The rest is history—I would be heading to Buffalo for the ESG to represent Long Island in the 10K. I am certain that was the proudest moment of my entire atheletic career. To work for something for so long and then have the dream become a reality was a great lesson for me.
Here is where that irony I first mentioned comes in. As I toed the line for the race I had long dreamed of competing in, I had no idea that in just 45 minutes I would be in a hospital bed fighting for my life. On the 25th and final lap of the 10K race, I collapsed with 200 meters to go. I got back up to my feet then collapsed unconscious with about 50 meters to go. I had suffered an exertional heat stroke (EHS). A perfect storm of the intensity, heat, humidity, black track, and dehydration combined to cause me to have, the one and only time in my life, a difficult time exercising in the heat.
My intent of retelling this story is to make it understood that EHS is something that could afflict anyone exerting themselves in the heat, whether it is an athlete, soldier, or laborer. EHS does not pick on the weak, old, or sick. It can show its force against the strongest, fittest, and most determined among us. While much can be done to prevent EHS, sometimes even the most exhaustive efforts to prevent EHS cannot stop all cases of the condition. Sometimes people will just try harder than usual, and it will be too hot, or they were recently sick, or they are trying to reach some goal.
But the bottom line is to always be ready. Seriously, BE READY. EHS can happen at any time. When it does occur to a friend, child, parent, teammate, colleague, athlete, or patient—will you be prepared to rapidly notice something is wrong, immediately call for medical help (if you are not a medical provider), and quickly cool them down? The amount of minutes an EHS patient is hyperthermic will dictate if the EHS victim will live or die. Based on the available evidence, you have just 30 minutes to get them under 104⁰ F in order to assure survival and no long-term complications. EHS is an ever present risk, but there is no stopping intense exercise in the heat. People will continue exert themselves in these conditions, but you can always be ready to help.
In August 1985, I was thankful for my chance to compete in the ESG, but, looking back 3 decades later, I realize I was most fortunate for the incredible care provided by the athletic trainers, EMT’s, nurses, and physicians that helped me survive. Not a day goes by that I do not take a few moments to reflect on the fact that at the moment of my greatest athletic pride, I was a mere 45 minutes from the darkest memory of my life. For the past 30 years, I have tried to make my life a tribute to the myriad of emotions that emanated from my experience with EHS so that fewer athletes, soldiers, and laborers undergo what my 16 year-old self faced on that fateful day.
"...looking back 30 years later, I realize I was most fortunate for the incredible care provided by the athletic trainers, EMTs, nurses, and physicians that helped me survive."
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our mission and endeavours could not have been made possible without our corporate partners. we are greatly appreciative of your continued support.
National Football League: The National Football league is a founding partner of the Korey Stringer Institute. The NFL supports multiple player safety initiatives for athletes of all levels. For more information on the NFL’s Health and Safety Initiatives, visit NFL Evolution.
Gatorade: Gatorade is a founding partner of the Korey Stringer Institute. Gatorade and the Gatorade Sport Science Institute continue to search for and study new and innovative ways to help athletes improve performance by facilitating proper hydration and nutrition.
National Athletic Trainers' Association: The National Athletic Trainers' Association is the professional membership association for certified athletic trainers and others who support the athletic training profession. Its mission is to engage and foster the continued growth and development of the athletic training profession and athletic trainers as unique health care providers.
University of Connecticut: The Korey Stringer Institute is housed at the University of Connecticut. The Department of Kinesiology faculty are renowned for their research and expertise in the areas of heat and hydration, injury prevention, and strength and conditioning.
Camelbak: The mission of Camelbak is to continuously reinvent and forever change the way people hydrate and perform. Visit Hydrated for useful resources on hydration practice.
Kestrel Pocket Weather Meters by Nielsen-Kellerman: Nielsen-Kellerman is committed to ensuring that people know the weather and environmental conditions that impact their health, safety and bottom line. NK’s Kestrel meters are rugged, accurate, fully calibrated, portable, affordable and easy to use. KSI uses these wet bulb globe temperature thermometers to determine environmental conditions during research studies both inside the heat chamber and in field studies. Visit heatstress.com for resources on physical activity in heat stress.
One Beat CPR & AED: One Beat CPR + AED is one of the largest distributors of defibrillators and accessories in the United States. One Beat CPR + AED offers an expansive line of AED products and accessories.One Beat CPR + AED also offers American Heart Association (AHA) and American Safety Health Institute (ASHI) authorized training certifications. Be prepared to save the life of a teammate, fan, friend, or loved one.
Mission: Mission has a dual mission. While delivering world-class innovations that meet the unique needs of an athletic lifestyle, Mission also makes an impact off the field of play through the M Foundation, which promotes the health and safety of youth athletes, and simultaneously recognizes and awards high school athletes that give back to their community. Mission is currently running the Heat Safety Pledge initiative to advocate for heat safety awareness.
Official Partnership Between National Athletic Trainers' Association and the Korey Stringer Institute
2nd Collaborative Solutions for Safety in Sport National Meeting
Secondary School Value Model
2016 Spring, volume 2, issue 1
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My Experience Dealing with Heat Stroke for the First Time and What I Learned
SHAPE America Conference
Current Statistics: Heat Acclimatization Policies
Emergency Physicians' Meeting
KSI Lifesaving Awards
American Meteorological Society Meeting
Heat Safety Pledge: An Update
Youth Sport Safety Governing Bodies Meeting
Personal Story- You Only Live Twice
Back to Sports
ATs in the Secondary School Setting
Forged in the Furnace
the spotlight series will feature the people of the ksi, and those who share and represent the passion of the ksi.
Could you tell us about yourself?
My name is Katie Godfrey and I am the Kestrel Global Sales Account Executive at Nielsen Kellerman. I had always been involved in athletics throughout school and found a true passion in the sport of rowing in college. I was a varsity coxswain at Temple University. After college my love of the water continued through coaching high school and beginner adults in rowing. In 2004 I was introduced to dragon boating by a fellow rower and member of the USA Premier Dragon Boat team. Traveling with the team to World Championships in China and winning a Gold medal clinched it for me and I have been hooked ever since. To date I have been the drummer of both the premier open and mixed at 8 World Championships and have won 28 medals including 11 golds for the United Sates. I also have three kids who I encourage to stay healthy and active and spend as much time outside as possible. My hope is that with the work of KSI and the passion of the people involved we will keep our sports safe so that my kids and their kids can enjoy being a part of a team and feel the joy of competition.
Could you tell us about your first involvement/interaction with the Korey Stringer Institute?
My first involvement with KSI was meeting Dr. Casa and I was blown away by his passion and enthusiasm. It is contagious and we could see that he and his team were going to make a change. I was so excited to be able to be a part of something that could make a difference in so many lives. He did mention the best method of taking temperatures in our first meeting but even learning that fact did not deter me!
MEDICAL & SCIENCE ADVISORY BOARD
KOREY STRINGER INSTITUTE
BOARD OF ADVISORS
KOREY STRINGER INSTITUTE
Could you tell us about yourself?
I am a Professor in the Department of Family Medicine and Director of the Center for Sports Cardiology at the University of Washington (Seattle, WA). I’m honored to serve as the Team Physician for the Seattle Seahawks and the University of Washington Huskies, and am past-President of the American Medical Society for Sports Medicine (2012-13). My primary research focuses on the prevention of sudden cardiac death in athletes, cardiovascular screening and ECG interpretation in athletes, emergency response planning for sudden cardiac arrest, and the use of automated external defibrillators (AEDs) in the school and athletic settings.
Could you tell us about your first involvement/interaction with the Korey Stringer Institute?
It’s my privilege to serve on the KSI Medical and Science Advisory Board. KSI has emerged as a leader in the prevention of sudden death in athletes, and our missions and shared interests overlap considerably which sets the foundation for a productive collaboration. Both the UW Center for Sports Cardiology and KSI work closely with the National Center for Catastrophic Sports Injury Research (NCCSIR) in a consortium model for catastrophic sports injury prevention research. UW functions as the Division of Cardiac Injury in Sport, and KSI serves as the Division of Heat and Exertional Injury in Sport. Our combined efforts assist the NCCSIR to achieve and collect the most valid data on sudden death in athletes in order to guide policy and prevention strategies. I’ve also been privileged to work as co-chair with Dr. Doug Casa on the Collaborative Solutions for Safety in Sports (CSSS). This important meeting, co-sponsored by the NATA and AMSSM, brought representatives from all 50 state high school associations and the NFHS to discuss and establish best practices for the prevention of catastrophic injury in high school athletics. Having just completed the 2nd annual CSSS meeting, the momentum to improve sports safety is palpable and the KSI team has been instrumental in its success.
In what ways has KSI impacted you?
KSI is the model institute for catastrophic sports injury prevention. They have a dedicated team of visionary leaders and skilled researchers that have shaped heat acclimatization policy and heat injury prevention across the U.S. Their achievements over a relatively short timeframe, passion, and consistent work of the highest quality has inspired me to strive for similar success in the prevention of sudden cardiac death in athletes.
Jonathan drezner, md
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Could you tell us about yourself?
Hello! I am Alex Wafer, a senior athletic training student at the University of Connecticut about to graduate this May. The last four years have been an amazing experience here at UConn and I am truly grateful for the memories, friends, and connections I have developed along the way. During my time in the athletic training program, I have gained tremendous experience working with not only a variety of sports teams both on campus and in various areas of Connecticut, but also with the Korey Stringer Institute each year. I have also been fortunate to work as a summer athletic training intern with the Indianapolis Colts following my junior year. Following graduation, I will be attending SUNY Upstate Medical University in Syracuse, New York, to pursue my Doctor of Physical Therapy degree. Using my degrees and experience in sports medicine and rehabilitation, my goal is to work in collegiate or professional sports as an athletic trainer and rehabilitation coordinator.
Could you tell us about your first involvement/interaction with the Korey Stringer Institute?
In my first weeks at UConn, I had hopes of gaining experience in athletic training, although I did not know where or how. While I did reach out to the Korey Stringer Institute early in my first semester, it was surprisingly a family friend working in the medical field in Arkansas who suggested I contact Dr. Casa. This went to show how significant of an impact KSI was having even in the earliest years of their existence. Immediately, I wrote Dr. Casa in an email to introduce myself, the program I was interested in, and explain some of my goals and the experience I hoped to gain. When I first met with him, he was easily one of the most easy-going professors or teachers I had met, high school included. After talking about his love of UConn soccer, he excitedly introduced the CATCH-ON study, in which they were calling every public high school to assess the level of athletic trainer employment and coverage across the nation. From day one, working with the Korey Stringer Institute became an integral part of my education at UConn and continued through a range of studies and experiences over my four years.
In what ways has KSI impacted you?
Over my four years working with the Korey String Institute, I have had the pleasure of working with a phenomenal collection of professors and graduate students, as well as my fellow undergraduates, on a variety of projects. While I spent my first three semesters working primarily on the CATCH-ON study, I also assisted in data collection and analysis for wet-bulb globe thermometer accuracy on different athletic surfaces. During my junior year, I worked with Lesley Vandermark directly on the Mission Heat Safety Pledge project to evaluate and improve emergency and heat safety protocols for a number of high schools across the country. Most recently, I have assisted with the BrainScope project studying the efficacy of a wearable technology to help better diagnose and treat mild traumatic brain injury. From my first weeks as an undergraduate volunteer to my last semester as a senior athletic training student, the experience I have gained through working with the Korey Stringer Institute has been irreplaceable. Watching the institute expand over the last four years and playing a role in promoting and increasing athlete safety has been an honor I will never forget.
Korey Stringer Institute Volunteer
athletic training student, university of Connecticut
In what ways has KSI impacted you?
With the passion of the whole team at KSI I have greatly increased my awareness of the steps needed to stay safe in athletics for heat related injuries and have witnessed the difficulties that the team has hit in convincing the “right” people. The athletic trainers on the ground know what they need but we need to help them get the tools to properly do their job. As my kids get older and more involved in sports I know I will be looking out for all of the proper safety equipment. Right now, I just make sure that the 6 year-old Tee-ball team has water and shade during practice.
Athletic Trainers in the Secondary School Setting
Athletic Trainers are health care professionals who work under the direction of a licensed physician and who specialize in the prevention, recognition, emergency care, treatment, and rehabilitation of sports related injuries. A recent study reported that only 37% of high schools in the United States provide full-time athletic training services.1 However, on a positive side, seventy of the public secondary schools acknowledge the importance of athletic training services and provide some level of medical coverage.1 With the increasing sports participation and subsequent sports related injuries in the high school setting, it is essential that appropriate medical coverage is available. It is important to understand what services and coverage athletic trainers’ provide.
Athletic trainers do not just provide “coverage” during sporting events but provide quality health care to active individuals on and off the field. During emergencies, athletic trainers are on-site to provide immediate care to potentially life-threatening conditions and are trained to provide prompt treatment to help prevent sudden death (i.e., sudden cardiac arrest, exertional heat stroke). Furthermore, athletic trainers provide a link of communication between physicians, coaches, parents, and school nurses. Care of an athlete not only includes physical care but also psychosocial care. A safe environment is created which can result in an athlete confiding in the athletic trainer. Athlete trainers are trained to recognize potential problems (i.e., eating disorders) and can refer appropriate cases to medical or professional services. Additionally, athletic trainers work towards the prevention of injuries and sudden death. Before participation, athletes are screened using medical questionnaires and preparticipation physical examinations. Athletic trainers are skilled in identifying potential risk factors and can make appropriate
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"Athletic trainers do not just provide “coverage” during sporting events but provide quality health care to active individuals on and off the field."
referrals for further screening. The preparticipation screening also allows athletic trainers to identify at risk individuals (i.e., Sickle cell trait, asthma, diabetes). Risk mitigation can be accomplished through educating parents, coaches, athletes, and administrators, as well as, through injury prevention programs. Off the field athletic trainers develop, practice and implement Emergency Action Plans (EAPS) and Policy, and Procedure manuals. A few examples of the policies that athletic trainers develop are heat acclimatization, concussion, lightning, hydration, and environmental (i.e., cold and hot weather) policies. Athletic trainers are responsible for ensuring policies are implemented and followed.
Athletic trainers provide on and off field services to continually maintain health and safety in sports. Described above are
just a few of the many services athletic trainers provide at the high school level. For more information, visit the National Athletic Trainers’ Association (NATA) webpage for the Secondary School Setting.
1. Pryor RR, Casa DJ, Vandermark LW, et al. Athletic Training Services in Public Secondary Schools: A Benchmark Study. Journal of Athletic Training. 2015;50(2):156-162. doi:10.4085/1062-6050-50.2.03.
BY RACHEL VANSCOY, MS, ATC, ASSISTANT DIRECTOR OF SPORTS SAFETY POLICIES
BY Lesley Vandermark, ms, atc , director of reserach
Ryan curtis, ms, atc, cscs, ces, assistant director of elite athlete health and performance
KSI and Mission have been working together in efforts to streamline the application process for schools interested in pursuing the Heat Safety Pledge. Mission is set to roll out a new website for the pledge in the coming weeks. The new website is part of a series of changes to the pledge which will feature a more user-friendly document aimed at encouraging more schools to apply. In addition to ease of application, the new document will expedite KSI's review of applications, allowing for faster response rates and better overall processing. Mission has also been moving forward on a shortened preliminary application, which will be implemented during the AT Expo at this year's NATA Symposium in Baltimore, MD. The shortened application will allow athletic trainers to give some basic information on-site to start the process, and then complete the application at a later time.
Mission’s goal with the heat safety pledge has always been to supply schools who focus on heat safety with $1 million in product. Mission has decided to increase the size of the prize package to $2,500, a move which makes the pledge even more enticing. Look out for an article in the NATA News on the heat safety pledge. The article also includes a checklist to help athletic trainers evaluate whether or not their policies are meeting pledge standards, even before applying. This way, athletic trainers will be able to evaluate their policies and make appropriate changes based on best practices recommended by the NATA and other sport safety organizations.
As Dr. Casa said in the NATA News article, “the fact of the matter is that most schools don’t have all of these [pillars] in place – and that’s ok. We set it up to try to inspire people to meet the best practices for heat safety and heat illness prevention.”
Heat Safety Pledge: An Update
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By Yuri hosokawa, director of communication and education
On January 12th, 2016, Yuri Hosokawa, Director of Communication and Education, presented at the 96th Annual American Meteorological Society Meeting. Hosokawa presented on the prevalence of heat related fatalities in running and discussed the need for interdisciplinary work by exercise scientists, climatologists, and public health specialists to apply climate data to change human behaviors to ensure safety during physical activities in the heat. During the same session, Dr. Andrew Grundstein from the University of Georgia presented on the need for regional heat safety guidelines in athletics using the exertional heat stroke fatalities documented in football from 1991 to 2015, which Hosokawa, Casa, and Stearns from Korey Stringer Institute also co-authored. Grundstein and Hosokawa hope to further investigate the exertional heat stroke data with the climate data to further elucidate the association between environmental stress and athlete’s health and safety.
On April 6th – 8th, 2016, Rachel Katch, Assistant Director of Military and Occupational Safety, presented at the Society of Health and Physical Educators (SHAPE) America National Convention & Expo in Minneapolis, MN. The topics included exertional heat stroke and emergency cardiac care. The presentations were conducted in collaboration with Dr. David C. Berry, PhD, ATC, who is the Athletic Training Program Director at Saginaw Valley State University housed in University Center, MI. The presentation “Exertional Heat Stroke: Current Best Practice Recommendations and Guidelines,” focused on the new 2015 position statement titled, “National Athletic Trainers’ Association Position Statement: Exertional Heat Illnesses,” which notes a few key differences in the recognition of exertional heat stroke. This includes the updated diagnostic criteria of an internal temperature of >40.5°C (105°F; previously 40°C [104°F]), with accompanying central nervous system dysfunction. Additionally, the position statement discusses a new type of exertional heat illness termed, exertional heat injury. Exertional heat injury occurs when there is internal organ and tissue injury associated with a sustained elevated core body temperature (typically >40.5°C [105°F]); however, this exertional heat injury does not present with central nervous system dysfunction. For more information regarding the updated 2015 exertional heat illness recommendations and guidelines, please refer to the following: NATA Position Statement: Exertional Heat Illnesses
In the presentation “Understanding the New Emergency Cardiac Care and First Aid Guidelines,” multiple new
By: Rachel Katch, MS, ATC, Assistant Director of Military and Occupational Safety
Society of Health &
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emergency cardiac care guidelines by the American Red Cross were introduced. Some of the most robust changes include the rate and depth of compressions. Researchers have found that there is an increased chance of survival with an updated rate of 100-120 compressions per minute, with compressions being administered at a depth of at least 2 inches for adults; however, there is a new upper limit, and rescuers should not exceed 2.4 inches of compression. This upper limit of 2.4 inches was established due to researchers finding an increased chance of internal injury. For more information regarding the updated 2015 emergency cardiac care recommendations and guidelines, please refer to the following: Circulation - November 3, 2015, Volume 132, Issue 18 suppl 2
Resuscitation Outcomes Consortium
For any questions or concerns regarding updated evidence based practice recommendations and guidelines, please contact the Korey Stringer Institute at ksi.uconn.edu.
Education is an important link in the care of athletes. Including all personnel involved such as: coaches, athletes, administrators, and parents for many purposes that include injury prevention, awareness, and treatment can be helpful in providing top care for the student athletes in the secondary setting.
Academic success of student athletes that can include assessing student athletes on their well-being and educating on life skills.
By Andrea Fortunati, MS, ATC,
assistant Director of elite athlete health and performance
Rachel VanScoy, Ms, atc, LMT,
assistant director of sport safety policies
The National Athletic Trainers’ Association (NATA) has developed a model that depicts the “value” and “worth” of an athletic trainer in the secondary school setting. This model can be used by athletic trainers to articulate why they are vital to sports medicine team. So why does showing your worth and value matter? Following this model can lead to not only growth for our profession but also individual opportunities for growth. This can be a great occasion to educate administrators, schools, communities, and colleagues about the profession. In order to provide quality health care to student athletes one must first understand and utilize the best practices. In a high school setting, athletic trainers provide many services:
Best practices include but are not limited to documenting injury evaluations, communication, treatment logs, hours worked, and updating policies and procedures. Having proper documentation allows the athletic trainer to justify their position by showing outcome of services provided to the athletes.
A crucial piece to having an athletic trainer at the secondary school setting involves cost containment. These include insurance premiums, which by having an AT can potentially keep premiums low justifying AT services to the school. Managing budgets by seeking funding from outside sources such as physician groups and booster clubs, seeking competitive pricing utilizing bid process and cutting expenses whenever possible.
Not only will the MAB provide a link of communication within the school but also within the community. Specialist in various areas of health care can be included to ensure that an appropriate medical referral ensues. Developing a MAB also enables the athletic trainer to demonstrate worth.
Since athletic trainers work under the direction of a physician, Standard Operating Procedures (SOP) should be created that will outline the duties of the athletic trainer specific to the high school where employed. This can be done by consulting with the team physician and researching the current best practices within the profession.
Medical Advisory Board (MAB)
It is imperative for athletic trainers to utilize best practices, and to follow current evidence-based recommendations and guidelines in the secondary school setting.
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It is imperative for athletic trainers to utilize best practices, and to follow current evidence-based recommendations and guidelines in the secondary school setting. Athletic trainers are a vital part of the sports medicine team and we should continue to advocate #AT4ALL.
On and off field care which includes event and practice coverage.
Implement and educate all staff and students involved on medical emergencies and school protocols.
Treatment of acute and chronic injuries.
Rehabilitation of injuries and safe return to sport following and injuries or illness in the athletic population.
There is an inherent risk of injury when participating in sports and the injury can be minor to potentially life threatening. Best practices for the prevention of injury include developing and implementing: policies, procedure manuals, and Emergency Action Plans (EAP). EAPS This should be specific for each venue, and reviewed annually with EMS, coaches, AD, and all personal that would be in the chain of command in the event of an emergency situation.
Additionally, athletic trainers can educate coaches, athletes, administrators, and parents on the prevention of injury. Athletic trainers work to keep student athletes healthy and on the field. A few of the best practices for Injury prevention program (IPP) are through: education, strength and conditioning programs, safety equipment fitting, and maintenance.
Preparticipation medical examination (PPE) and a medical history questionnaire allows the athletic trainer to identify any individuals that are at risk for injury or to identify individuals that may need a medical referral for additional testing.
NATA Secondary School Athletic Trainers' Committee and NATA Committee on Revenue. (2015, June). National Athletic Trainers' Association. Retrieved April 4, 2016, from Secondary School Value Model: https://www.nata.org/sites/default/files/secondary_school_value_model.pdf
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BY Douglas casa, phd, atc
CEO, korey stringer institute
We are pleased to announce that the National Athletic Trainers’ Association (NATA) has come on board as our corporate partner. Korey Stringer Institute (KSI) saw evident synergy with NATA and felt it was only a matter of time before we formalized a partnership between the two entities. NATA and KSI have a shared goal to promote the athletic training profession and implement measures to ensure the safety of all physically active populations. Both organizations have made significant advances in athletic health care over the past few years, particularly in youth sports safety. From this partnership, we hope to continue the great work from recent years, such as the Athletic Training Locations and Services (ATLAS) project, Youth Sports Safety Governing Bodies Meeting and Collaborative Solutions for Safety in Sport (CSSS), among others. We will also expand to new collaborative initiatives, such as a Consumer Awareness study to examine overall perception of the AT’s impact on life, work and sport.
We are excited about formalizing this partnership and are confident NATA’s members will benefit from the athletic training knowledge, expertise and innovative ideas KSI brings to the table. Look for more information on these projects and others in the coming months.
Between National Athletic Trainers' Association and the Korey Stringer Institute
The Korey Stringer Institute is proud to announce the winners of the 2016 Lifesaving Awards. In 2012, the Korey Stringer Institute started recognizing three individuals annually who have made significant contributions in the realm of preventing sudden death in sport and physical activity. These individuals are leaders in their fields when it comes to making important policy changes in the prevention of sudden death. The three annual awards are the Lifesaving Research Award, Lifesaving Service Award, and the Lifesaving Education Award. Each award recognizes excellence in a given aspect of the Korey Stringer Institute’s mission of preventing sudden in sport and physical activity.
Lifesaving Education Award
Dr. Lawrence E. Armstrong, PhD, FACSM
Dr. Lawrence Armstrong is a Professor and Director of the Human Performance Laboratory at the University of Connecticut. Additionally, he is the current 2015-2016 President of the American College of Sports Medicine. Dr. Armstrong has a multitude of research specialties including: (1) exercising in the heat, (2) environmental physiology, (3) exercise and nutrition, (4) heat acclimatization, (5) exertional heat illness, (6) sports drinks, (7) fluid-electrolyte balance, (8) physical performance, and (9) hydration and dehydration. He presently teaches undergraduate and graduate courses in Exercise Metabolism, Thermal Physiology, Exercise Physiology, Scientific Presentations, and Physiological Responses to Stressful Environments. He is one of the leaders in the exercise science field of research, authoring/co-authoring over 145 peer-reviewed scientific articles, as well as publishing the book, “Performing in Extreme Environments,” and editing the book, “Exertional Heat Illnesses.” Through Dr. Armstrong’s dedication and enthusiasm for his profession, he has been an integral component to the evidence-based enhancement of safety in sport and physical activity.
Lifesaving Service Award
Rachael Oats, CAE
As the Associate Executive Director of the National Athletic Trainers’ Association (NATA), Rachael has been an invaluable asset to the athletic training profession. Rachael holds the vision and foresight to consider many different angles and ideas, which help promote and develop our profession. She truly understands and appreciates the value of an athletic trainer and this is evident through her work with the NATA. Rachael brings a positive attitude, intellect, and passion to her work.
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Lifesaving Research Award
Dr. Fred Mueller, PhD
Dr. Frederick Mueller is the former director of the National Center for Catastrophic Sports Injury Research (NCCSIR), which is based on the University of North Carolina, Chapel Hill campus. Since 1965, Dr. Mueller and the NCCSIR have tracked deaths and brain or spinal cord injuries at various levels of football and later expanded data collection and analysis of other sports. The numerous years collecting data and analyzing sports injuries were to help minimize the risk during participation. Dr. Mueller has co-authored multiple reports on catastrophic sports injuries that have helped various sports organizations develop health and safety policies. His passion, dedication, and effort have improved sports safety in various sports such as football, pole vaulting, and cheerleading.
Simple Modifications in pre-season practice
Costs no money to implement
In states that followed heat acclimatization recommendations
By WILLIAM ADAMS, MS, ATC, Director of SPORT SAFETY POLICIES
Samantha scarneo, ms, atc , director of youth sport safety
Current Statistics on Heat Acclimatization Policies at the Secondary School Level
Mandate minimum best practice recommendations for heat acclimatization during pre-season august practices
Heat acclimatization is a term that is defined as a series of physiological changes or adaptations that occur in response to heat stress over the course of 7 to 14 days. These adaptations are beneficial to exercise in the heat and allow the body to better cope with heat stress and can be used to mitigate the risk of exertional heat stroke and enhance performance. The positive adaptations that occur include reductions in:
Exercising body temperature
Skin temperature responses
As well as increase in:
Sweat onset (sweating starts earlier)
Plasma volume (water volume of blood)
Overall ability to perform in the heat
Other changes include decreased salt losses in sweat and urine as well as an improved blood pressure response. All of these changes improve an athletes’ ability to handle heat stress during exercise. Acclimatization is also known to depend on volume of exercise, intensity, and maintenance of an elevated body temperature during exercise.
When preparing to acclimatize to the heat, athletes should gain a base level of fitness in a cooler environment prior to heat exposure. Fit individuals already have some of the physical advantages that are gained with acclimation—for example, an increased sweat rate. Guidelines have been introduced for the high school population for the purpose of gradual heat acclimatization during preseason practices. At the secondary school level, there are 15 states that mandate all schools follow minimum best practice recommendations for heat acclimatization during pre-season August practices. Since implementation of mandated heat acclimatization policies in these states, there has not been an exertional heat stroke (EHS) death at the secondary school level (these states accounted for 50% of all EHS deaths at the secondary school level from 1980-2009).
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Figure. Representation of the number of states and the year in which they mandated evidence-based practice policies for heat acclimatization policies in secondary schools.
Days 1-5 are the first formal practices. No more than 1 practice occurs per day.
Total practice time should not exceed 3 hours in any 1 day.
1-hour maximum walk-through is permitted on days 1-5, however there must be a 3 hour minimum between practice and walk-through (vice versa)
During days 1-2 of first formal practices, a helmet should be the only protective equipment permitted (if applicable). During days 3-5, only helmets and shoulder pads should be worn. Beginning on day 6, all protective equipment may be worn and full contact may begin.
Football only: on days 3-5, contact with blocking sleds and tackling dummies may be initiated.
Full-contact sports: 100% life contact drills should begin no earlier then day 6.
Day 6-14, double practice days must be followed by a single-practice day. On single-practice days, 1 walk-through is permitted, separated from the practice by at least 3 hours of continuous rest. When a double-practice day is followed by a rest day, another double practice day is permitted after the rest day.
On a double-practice day, neither practice day should exceed 3 hours in duration, and no more than 5 total hours of practice in the day. Warm-up, stretching, cool-down, walk-through, conditioning, and weight-room activities are included as part of the practice time. The 2 practices should be separated by at least 3 continuous hours in a cool environment.
Because the risk of exertional heat illness during the preseason heat-acclimatization period is high, we strongly recommend that an athletic trainer be on site before, during and after all practices.
The National Football League (NFL) and the American Heart Association (AHA) have teamed up on Back to Sports, a program designed to promote physical activity and safe sport participation among youth.
The Back to Sports program is geared toward parents and guardians of upper elementary, middle and high school aged students who participate or are considering participating in sports. The sports safety topics covered in the program include concussion awareness, heat and hydration, cardiac arrest and proper response, and the prevention of overuse injuries.
Back to Sports provides sports safety information and resources for athletic trainers, parents, coaches and supporters of youth sports.
Only athletic trainers are eligible to facilitate a Back to Sports meeting. Other medical professionals, such as a team physician, CPR course instructor, or school nurse, can volunteer to provide assistance and present sports safety content, should the athletic trainer desire.
AHA provides digital turn-key resources for any meeting facilitator (both non-grant and mini-grant recipients) to implement Back to Sports meetings. The Back to Sports Toolkit includes access to customizable invitations, promotional posters, presentation slides and video content. Required equipment includes a computer with internet access, projector, and screen.
Are you an Athletic Trainer? Want to bring Back to Sports to your school or community?
Check out more information from www.heart.org or search AHA Back to Sports Program.
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By rebecca stearns, phd, atc
coo, korey stringer institute
Youth Sport Safety Governing Bodies Meeting
By Samantha Scarneo, MS, ATC, Director of Youth Sport Safety
In January, KSI had the honor of hosting the second annual Youth Sport Safety Governing Bodies meeting with the National Athletic Trainers’ Association, Jones & Bartlett Learning, and Kestrel, at the National Football League Headquarters, in New York, NY. The goal of this meeting was to improve health and safety standards at the youth sport level. In last years’ meeting the goal was to educate the youth sport governing bodies on top causes of sudden death in sport This years goal was to create a best practices document for all governing bodies and its members to strive towards. This consensus document touches on the top causes of sudden death in sport and polices & procedures of how to improve these safety standards. The attendees of this years meeting included: Michael Clayton (USA Wrestling), George Chiampas, DO (US Soccer), Elizabeth Chaffin, DPT, ATC and Alexis Colvin, MD (USTA), Lynn Moskovitz-Thompson (USA Gymnastics), Bruce Griffin, PhD (US Lacrosse), Kevin Margarucci, ATC (USA Hockey), Steve Alic (USA Football), and Jack Ransone, Phd, ATC (USA Track and Field).
We also had the honor of having key representatives from the American Medical Society of Sports Medicine (Matthew Gammons, MD), National Athletic Trainers' Association (Scott Sailor EdD, ATC, Tim Weston Med, ATC, AJ Duffy MS, ATC, PT, Rachael Oats CAE, Katie Scott, MS, ATC), American Academy of Pediatrics (Cynthia LaBella, MD) and Safe Kids Worldwide (Kate Carr, Ali Flury). The meeting was moderated by some of the KSI staff (including Robert Huggins, PhD, ATC, Doug Casa, PhD, ATC, Rebecca Stearns, PhD, ATC, Samm Scarneo, MS, ATC, Yuri Hosokawa, MAT, ATC, Lesley Vandermark, MS, ATC, Luke Belval, BS, ATC, and Ryan Curtis, MS, ATC) and was largely discussion based to create a best practice consensus. The first day of the meeting focused on cardiac conditions, emergency action plans, and
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exertional heat stroke. The second day focused on head injuries, medical personnel and other conditions (asthma, anaphylaxis, and lightning). One of the unique aspects of this meeting is that all of the governing bodies have strong and weak points in different areas. For example, one organization may have extraordinary policies in place for heat acclimatization yet may be very weak in an area of emergency action plans. However, despite the various levels of safety attained by each organization, all attendees had a strong will to improve standards across the board. Dr. Huggins called this meeting “one of the most important meetings that he has been to in his career.” We are hopeful that consensus document will provide a template for all leaders of youth organizations, and their members, to expand health and safety standards for the athletes. “If you want to go fast, go alone; if you want to go far, go together.” -African proverb
On March 1st, KSI gathered influential members of the emergency medicine community to better our efforts of providing care to exertional heat stroke patients throughout the country. The meeting, Pre-hospital Care of Exertional Heat Stroke, was convened at the University of Connecticut to help disseminate information to emergency medical services and emergency departments across the country regarding best practices for the care of exertional heat stroke.
Along with representatives from the American College of Emergency Physicians, the American Academy of Pediatrics, the American Medical Society for Sports Medicine, and several branches of the military, KSI is working to change the way exertional heat stroke is cared for by emergency medical services. While many in the sports medicine and athletic training communities have embraced the mantra of “Cool First, Transport Second,” the clinicians that work in ambulances and emergency departments face unique obstacles when responding to heat stroke patients. Furthermore, for many EMTs and paramedics, their training still teaches that a patient needs to be cooled slowly or that ice packs in the armpits and groin are adequate, despite clear evidence that rapid cooling is necessary to reduce poor outcomes.
To this end, the task force assembled at the meeting resolved to release a statement that overviews the current best practices in pre-hospital care of exertional heat stroke. This forthcoming publication will help to not only shape the practices of current practitioners, but also help revise the training of students, such that best practices are enforced.
By Luke Belval, MS, ATC
Director of military and occupational safety
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Cindy Chang, MD, Associate Professor, Primary Care Sports Medicine Department of Orthopaedic Surgery, University of California, San Francisco.
Francis O'Connor, MD, MPH, Professor, Military and Emergency Medicine, Uniformed Services University of the Health Sciences.
Scott Sailor, EdD, ATC, President, National Athletic Trainers' Association.
David Csillan, MS, ATC, Ewing Hish School, NJ.
Brian Hainline, MD, Chief Medical Officer of the National Collegiat Athletic Association.
National Athletic Trainers’ Association (NATA) President, Scott Sailor, EdD, ATC, kicked off the 2nd Collaborative Solutions for Safety in Sport (CSSS) Meeting with a powerful statement. “Nearly all deaths and serious injuries can be avoided when proper steps are taken.” A continuation of last year’s inaugural meeting in New York City, the NATA and American Medical Society for Sports Medicine (AMSSM), with assistance from the Korey Stringer Institute, brought together each state’s High School Athletic Association Executive Director and Sports Medicine Advisory Committee Chair for the second year in a row to discuss proactive sport policy changes and states’ progress on various health and safety initiatives at the secondary school level.
On March 22, 2016, Dr. Brian Hainline, Chief Medical Officer of the NCAA, opened the meeting with the keynote address, speaking on the challenges of change. The session that followed, titled “Where are we now?” facilitated by Douglas Casa, PhD, ATC, Robert Huggins, PhD, ATC, Larry Cooper MS, ATC, and Thomas Dompier, PhD, ATC focused on progress made in policy change, athletic training coverage across the nation, proper injury prevention strategies specific to Heads-Up Football, and an overview of data from the Datalys Center for Sports Injury Research and Prevention. The meeting portion of day one concluded with small group breakout sessions, quite valuable for those in attendance, as they spoke candidly with one another about successes and barriers pertaining to sport safety policy implementation.
Day two began with a keynote address from Martha Lopez-Anderson, Chair of the Board of Directors for Parent Heart Watch. Turning tragedy into triumph, Martha shared her heartbreaking personal story that led to her involvement in this organization, and advocated for the implementation of prevention strategies for sudden cardiac arrest in the youth population, including placing AED’s in all locations, cardiac screening, and getting appropriate personnel trained in
BY ALICIA PIKE, MS, ATC
ASSISTANT DIRECTOR OF YOUTH SPORT SAFETY
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2nd Collaborative Solutions for Safety in Sports
Following her keynote, a session dedicated to mental health issues in student-athletes ensued. Although not directly in the spotlight, mental health is a true problem. Dr. Brian Hainline stressed the importance of having an emergency action plan in place for mental health issues, similar to the ones implemented to manage various incidents such as cervical spine or head injuries. Alongside Dr. Hainline, John Reynolds, Dr. Cindy Chang, and Dr. Francis O’Connor also facilitated this session. From sharing success stories on the promotion of mental wellness in a school district, to discussions on the prevalence and consequences of disordered eating and performance-enhancing drug use, attendees were informed of proper strategies to take in limiting and managing mental health issues in student-athletes.
Taking a different approach this year, attendees were allowed to choose from three different breakout sessions, providing opportunities to promote discussion in small groups about personal experiences, struggles, and successes with cardiac and heat policy implementation, and employing athletic trainers in secondary schools. This created an environment of close collaboration, with states getting feedback for themselves while simultaneously helping each other. NATA President, Scott Sailor, said it best when he addressed the attendees; “With your collaborative support we will make a difference. We will save lives, reduce injuries, and create a playing environment that ensures health and safety first.” It was another incredibly successful CSSS Meeting, and we anticipate the next to result in even greater strides towards improving sport safety in the secondary school setting.
From left: Brian Hainline, MD, Chief Medical Officer of the National Collegiat Athletic Association; Douglas Casa, PhD, ATC, COO Korey Stringer Institute; Jonathan Drezner, MD, Associate Professor and Team Physician, University of Washington.
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""YOU ONLY LIVE TWICE: ONCE WHEN YOU'RE BORN AND ONCE WHEN YOU LOOK DEATH IN THE FACE"" - IAN FLEMING
Fans of James Bond may recognize this quote from Ian Fleming’s 12th book on his now infamous fictional spy hero. However, while created for a fictional character, this sentiment rings far too true for those who have overcome life threatening medical conditions. Such is the case for two college football athletes we have worked closely with this past year: Gavin Class and Hunter Knighton.
Exertional Heat Stroke Strikes: Both of these athletes were around 6’4” tall and 300 pounds on the day of the exertional heat stroke (EHS). Gavin’s occurred during the 2013 summer pre-season while Hunter succumbed to his during a 2014 spring football training session, both spent weeks in the hospital and had multiple complications from their injuries. But both ultimately survived…
KSI Involvement: KSI was first notified about each of these cases following their release from the hospital. Both players had one very clear goal in mind, get back to football. As a first step, we discussed the option of performing heat tolerance tests in our lab, an established test done as part of the return to play progression for any complicated case of exertional heat stroke as supported by the NATA, ACSM, US Army and Navy. Both athletes were cleared by their physicians, came to our labs, and both quickly failed their first heat tolerance tests.
While this outcome was by all means devastating to these players, it was not with a finality that these results were delivered, but rather as an objective starting point.
As with any athlete coming back from a severe injury, we took this as a starting point by which to measure future progress with their rehabilitation. We provided a plan and recommendations for their exercise regime over the course of the next 2-3 months to help improve modifiable factors that would ultimately assist with their exercise heat tolerance, primarily by boosting their base aerobic fitness.
Ultimately both athletes showed significant improvement on subsequent heat tolerance tests and passed the test.
Returning to life: While the outcome from this example may seem clear, it is at this point these two stories take vastly different paths.
BY Rebecca stearns, Phd, atc
COO, korey stringer institute
YOU ONLY LIVE TWICE
Hunter Knighton – Hunter and his medical staff team worked incredibly closely with KSI following his heat tolerance testing, even hosting myself for a few days to work one on one with him (monitoring his body temperature the whole time) as he progressed his training and assimilation back to the team. On September 3, 2015 Hunter took his first steps back onto the game field, returning fully back to the life he had before it was almost taken too prematurely.
Gavin Class – Gavin was cleared by his liver surgeon and demonstrated a similar and remarkable improvement in his physical ability to recover and improve following his heat stroke. Following his successful heat tolerance test, KSI also cleared him to begin a return to play progression with the suggestion that his body temperature be monitored during his initial return to football (at a minimum). However, his team physician refused to clear him for football. Her main reason was cited as the inability to ensure he would not have another heat stroke. The University stated that it could not manage his risk for heat stroke “with any reasonable restriction or accommodation.” This inability to accommodate Gavin’s rehabilitation also stemmed from the team physician’s belief that the athletic trainers were not qualified to monitor body temperature, nor did the physician believe that athletic trainers were medical professionals. Unfortunately we will never know if Gavin could have returned to football because, unlike Hunter, he was never given the chance.
Unfortunately Gavin’s team physician never consulted with KSI regarding her decision. We believe that, if given the opportunity, we could have at a minimum agreed upon and supplied a potential path forward for Gavin’s rehabilitation, which would have provided an opportunity to assess his readiness to return. This could have been done similarly to how Hunter’s case was progressed with consultations from topic area experts and onsite monitoring by KSI.
Our hope by sharing this story with you is not to say that there is a 50% chance of return from heat stroke despite a successful heat tolerance test. Rather that 100% survival has resulted when
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#03: Rebecca stearns, coo, korey stringer institute, shares the stories of hunter knighton and gavin class from her perspective and calls for an attention to follow the best practice of exertional heat stroke care.
Gavin Class (top and middle) and Hunter Knighton (left and bottom) .
aggressive whole body immersion is implemented within 10 minutes; when this life saving modality is not applied, we see deaths or lingering complications as in these two cases. Without immediate cold water immersion, the path to recovery becomes complicated and requires specialized assessment for lingering complications, which also places future potential for healthy, safe, full sport participation at risk. For this reason, KSI offers support and resources for the implementation of best practices at all levels of sport and physical activity.
WITHOUT IMMEDIATE COLD WATER IMMERSION, THE PATH TO RECOVERY BECOMES COMPLICATED AND REQUIRES SPECIALIZED ASSESSMENT...
ONLINE COURSE UPDATE!
In July we released our online Evidence Based Practice continuing education course on Preventing Sudden Death in Sport. We are pleased that we have provided CEU credits for over 350 athletic trainers to date! If you would like to know more about this interactive online program please visit: go.jblearning.com/KSIOnlineCEU
SECOND EDITION OF PREVENTING SUDDEN DEATH BOOK RELEASED!
Our CEO Douglas Casa and COO Rebecca Stearns, have released the second edition of this lifesaving book!
Published in cooperation with the American College of Sports Medicine (ACSM), Preventing Sudden Death in Sport and Physical Activity, examines the etiology, prevention, recognition, treatment, and return-to-play protocol of the common causes of sudden death in sport. Chapters are written by content area experts, offering a blend of clinical, scientific, and research expertise regarding each medical condition that is discussed.
New & Key Features of the Second Edition:
NEW! - Includes two new chapters, Developing Safety Policies for Organized Sports and Sports Law
NEW! - Recently released NATA position statements have been incorporated into their four respective chapters: Heat Illness, Cervical Spine Injuries, Lightning, and Brain Injuries.
EXPANDED! - The traumatic injuries chapter has been extensively expanded, and now includes greater discussion on hemothorax, pulmonary embolism, and considerations for returning athletes who have sustained abdominal injuries. The new edition includes access to the Navigate 2 interactive online learning environment, which arms readers with the knowledge and skills they need to make the correct decision when confronted with an emergency situation.
Navigate 2 Advantage Access includes:
An interactive ebook, Interactive video scenarios, Learning Modules, Skill Drill Case Study Assessments, Prepopulated tests and quizzes, Instructor resources, and learning analytics reporting tools. To learn more or purchase a copy, visit: http://www.jblearning.com/catalog/9781284077360/
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BY Michael Goldenberg, Ms, atc
lawrenceville school, nj
I have been an athletic trainer for more than 30 years and in that time I have not seen nor treated any athletes that had true heat stroke. I have been the primary provider for athletes suffering from heat exhaustion and other lesser heat illness issues, but nothing as serious as exertional heat stroke. As an athletic trainer, I would say this a great thing not to experience, but I know someday, with the way the weather patterns are changing in the northeast, that I will eventually have to give care to an athlete in serious heat distress. Before preseason football camp starts in August, I always review the literature on heat illnesses and other life threatening situations such as cardiac and exertional sickling.
In March 2015, I attended a function that KSI was holding at the NFL Headquarters in New York City. During the gathering I was talking with KSI’s Rebecca Stearns about my lack of practical experience in this particular area. I mentioned that I have only seen videos on how to use cooling tubs for heat stroke during conferences or online, all of which were staged. As we continued our conversation, Rebecca was nice enough to invite me to work with KSI at an event that has a history of having a high number of runners that suffer from heat stroke. This being the famous Falmouth Road Race, which is, held annually the third week in August in Falmouth, MA, boasting a course that runs along the beach. This seven mile race
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draws almost 13,000 individual runners with a wide range of fitness backgrounds. They range from elite runners from all around the country to the weekend warriors who have not done much training. I was grateful for the invite and accepted her offer. Rebecca then introduced me to one of the co-medical directors of the race who was also at the function and was similarly supportive of my interests.
This was the first ever road race that I worked, and throughout the summer I received emails regarding my duties and responsibilities. I found the organizational skills of Chris Troyanos ATC and the other members of the medical committee to be outstanding. Chris also happens to be one of the medical directors for the Boston Marathon. Two days prior to the event, there was an optional seminar for all medical volunteers. There were three relevant presentations offered; Preventing Hyponatremia, Sudden Cardiac Arrest and of course, Exertional Heat Stroke. These talks were given by KSI staff that did a great job focusing on the relevance of each of these areas with regard to this particular race. A fourth presentation given by the co-medical director, spelled out what to expect on race day for those of us who had not experienced it before. I was quite impressed with how much respect the medical organizers had for KSI. They reiterated numerous times that for all heat illness cases, the protocols to be used were set up by KSI. In the event of heat stroke, cool first and if needed, transport second. It was also pointed out that in the past 18 years, this race has averaged 2.5 incidences of heat stroke per 1000 athletes. After quickly doing the math, my first thought was that I’d definitely be assisting with some heat stroke cases this weekend. It was both scary and exciting. Throughout my career as an athletic trainer I have always stayed updated with the latest
trends in treating heat and other illnesses, but wondered what it would be like to finally put my book knowledge into practice. After our first meeting in New York City, the medical director knew I needed a place to sleep prior to the race and graciously invited me to stay at his family home, along with the rest of the KSI staff. This too wound up being an amazing experience and one I will never forget. Besides talking about the profession of athletic training before, during and after dinner, I was able to sit down in an informal environment and pick the brains of the leading experts who were conducting the latest research on heat illness. They kindly answered my many questions, none of which I could ever have gotten from books. Not all members of the KSI staff, however, were there to assist in the medical tent. A number of them were participating in a very interesting research project involving some of the runners. I look forward to seeing the results of this study as it could be ground-breaking in the area of heat illness. I was also most impressed with the camaraderie of this group and how much of a family atmosphere was present. The positive energy was very refreshing and made my experience even better. After dinner it was time to get to business. There was a meeting where we discussed everyone’s roles for the race and the research project, and made sure everyone had a ride to the race in the morning, including me!!
Race day began at 4am when we woke up, had breakfast and headed out to set up for the research project. The head researcher was very impressive as she had everything well organized, down to the finest detail. Once that was up and running, I went to sign in at the medical tent. After that, I had the opportunity to meet and talk with other athletic trainers and healthcare providers. I felt very welcomed considering it was my first time working amongst volunteers who have known each other for years from working this event. I was also excited to see a few athletic trainers that I knew from the Eastern Athletic Trainers’
Association’s annual meetings. As I walked around, I was amazed at the size of the two tents that were set up side-by-side, not to mention the vast quantity of medical supplies that were well organized on large portable shelving units. I counted 25 immersion tubs, dozens of recovery cots lined up in the back of one tent, a table with the fanciest AEDs I had ever seen, a triage area, padded tables for orthopedic evaluations and a registration/check in area. I observed students filling the tubs with cold water, EMTs demonstrating the new AEDs to the doctors, and someone was hanging up two oversized clocks in the center of the tent. I did not realize the importance of the clocks until we started to treat patients. Approximately one hour before the race began, we gathered at one end of the tent to unload a truck full of large bags of ice. We arranged the ice so that there were three bags per immersion tub. Next, came a group meeting where Chris Troyanos offered a few encouraging words, followed by Doug Casa from KSI, who reviewed and demonstrated the protocols that were being used for runners suffering from heat stroke and heat exhaustion. Lastly, the co-medical directors addressed the volunteers and thanked us for our service. We were then assigned to our treatment teams. I was assigned to a physician who had been working the race for over thirty years, along with a nurse and another athletic trainer. We also had a student on our team who would function as our scribe.
Representatives from Kestrel Meters were
present to set up one of their latest devices that would provide instant feedback on weather conditions throughout the race. This was also their first time at an event like this and I was impressed that they were not only there to share their device, but signed up to help in the medical tent in any capacity that they could. Looking at the readings prior to race time, it warned us that the weather conditionings were close to favorable for heat stroke cases.
As the start of the race drew closer, we could hear the announcer over the speakers at the finish line describe the excitement at the starting line. A few minutes later, the wheelchair race had officially begun. Soon after, the elite runners were off, and then the rest of the pack shortly after that. In our briefing we were given estimated times of when the first individuals from each group would cross the finish line. Within thirty to forty minutes, we had our first patient. This runner was wheeled in by a volunteer, checked in and taken to the triage area.
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Here, they were laid onto a type of canvas stretcher that I had never seen before, while all the volunteers crowded around to watch the triage team at work. The doctor questioned the patient, and then the nurse took their rectal temperature, which were 106.5. This was the first time I had witnessed an adult getting their rectal temperature taken. (Having three kids of my own, like most parents, I have taken rectal temperatures numerous times!) This was done in a discreet way and all that was exposed was the person’s buttock. (I was very interested in seeing how this was done, as this vital sign is one that many secondary school administrators and school physicians are reluctant to have performed on their athletes for a variety of reasons. One being that the genitals of a minor might be exposed.) The patient was then moved over to the first immersion tub where team one then took over.
In less than two minutes, there were multiple runners getting wheeled into the tent. Now, all of a sudden, things were getting busy. I soon heard my name being called from the triage area. Help was needed carrying the next patient who was going to be at our station. I ran over quickly to assist with bringing the patient to our tub. We used the unique stretcher which could be immersed directly into the tub with the patient still on it. After placing our patient into the tub, I found myself stationed at his head with a wet towel for his head in one hand and the readout of the rectal thermometer in the other. At this point, my book knowledge was being tested. I knew that the rate of cooling was one degree every three minutes, and my job was to call out the patient’s temperature every few minutes so the team would know his status. It was important not to overshoot when he needed to be removed from the tub. We were instructed to take individuals out of the tub when their core temperature was at 102 degrees. When I looked at the digital thermometer for my first reading, I had to check it twice, as it read 107.9. After the physician talked with our patient about allergies and other medical history questions, I then engage him in conversation to keep him focused on what we were doing and to make sure he remained alert and coherent. The scribe took notes of the conversation with the physician and then started to track the time and temperature as I called it out. Within two minutes, our patient’s temperature began to drop and quickly. The other members of the team used pitchers to circulate the water in the tub, pouring it over areas of the body that were not immersed. Our patient was tall and thus his lower legs were not fully in the tub, so we put wet towels on them and continued to re-soak and re-apply them. Within ten to twelve minutes our patient was at 102 degrees and as we started to remove him from the tub, his temperature continued to drop rapidly. It then registered at 95-96 degrees as we brought him over to the recovery area. During this time, he still had his rectal temperature probe in and was now being warmed to return his temperature to normal. Once we returned from the recovery area, another patient was
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carried over to our tub and the process started all over again. This happened multiple times over the next two hours.
When our team finally had a down period, I was able to observe other teams in action. Everything I was told was going to happen, I indeed witnessed firsthand. Some patients were completely incoherent and one actually tried to bite the person who was stationed at the head. It took eight volunteers to hold down another patient as they attempted to get out of the tub before they were cooled. Yet another patient that was being carried over to a tub was as white as a bed sheet. At one point, our team was cooling a 60 year-old patient who was saying some strange things to me and was holding mine and another team members hand while we were circulating the water. He was definitely nervous and somewhat incoherent. While he was in recovery, I paid him a visit to see how he was doing. I could tell he did not remember much of what had happened in the tub. When I told him some of the things he had said earlier, he apologized and just shook his head. I continued to talk with him for a few minutes while the recovery nurse tried to reach his family. Soon he was giving me some great tips on local restaurants to take my wife to the next time we were in town.
I learned quite a bit in those two hours of dealing with patients with heat stroke. I saw almost everything I read regarding the treatment of heat stroke. I saw patients with temperatures over 107 degrees, which was hard for me to comprehend, and then to see how they looked and acted in this state was educational. I can still remember a test question in college about the differences between heat stroke and heat exhaustion; and the answer was “dry skin” for people who were suffering from heat stroke. We now know that is not necessarily true. Some of the runners that came to our station with heat stroke were sweating but were not clammy or sweating profusely, as you might see with someone with heat exhaustion. Not everyone presented with the same signs and symptoms. Some had minimal if any central nervous system dysfunctions. Some of the changes that I witnessed were disorientation, confusion, dizziness, irritability, aggressiveness, and hysteria. One team looked like they were dealing with a patient who was going in and out of consciousness. I also saw what happens if an individual’s temperature drops below 98.6 and the process used to rewarm them.
In closing, I cannot thank Rebecca Stearns and the rest of the KSI staff enough for the great learning experience this past summer. These groups of athletic trainers that make up KSI are first class professionals who represent our profession extremely well through education, research and clinical work. They are forward thinkers who are doing many great things to help prevent sudden death in athletics. Thank you again for a great experience!
KSI has allowed me to realize my goals as an
athletic trainer in ways that i never imagined i could.
director of Research
korey stringer institute
Lesley Vandermark ms, atc
Could you tell us about yourself?
I am the Director of Research for KSI, and currently a doctoral candidate in the last year of my doctoral studies at the University of Connecticut. My Doctor of Philosophy degree will be in Kinesiology, and I have the opportunity to do my dissertation research with KSI on a more practically applicable way of assessing hydration during sport or labor activity. I received my bachelors of science in athletic training from California University of Pennsylvania in 2010, and came straight to UConn to work with Dr. Casa and KSI. I received my Master of Science degree in Kinesiology from the University of Connecticut in 2012. As Director of Research, I have my hands in several of our research projects, trying to provide better evidence for heat safety, hydration, and more generally sport safety. Additionally, I work with one of our corporate partners, Mission, in research, education, and community outreach in the realm of heat safety.
Could you tell us about your first involvement/interaction with the Korey Stringer Institute?
My first interaction with KSI was as a graduate assistant, during the institute’s first full year of operation. At that time, the court case involving Max Gilpin, a high school football athlete who died of exertional heat stroke, and his coach Jason Stinson was freshly finished. We wanted to learn from this case to prepare ourselves for the future, and a lot of my time was spent listening to courtroom testimony and deciphering the main points which lead to the verdict. We use this information now to describe the importance of heat stroke education and care for coaches and athletes at all levels of play. About a year later, the Collaboration for Athletic Training Coverage in High Schools- an Ongoing National Survey (CATCH-ON) with the NATA was just getting started. I started by calling high schools, asking about athletic trainers, and getting to interact with athletic directors and principals around the country.
In what ways has KSI impacted you?
KSI has allowed me to realize my goals as an athletic trainer in ways that I never imagined I could. My motivation has always been to impact the lives of athletes I work with. KSI has given me the opportunity to work with athletic trainers, coaches, athletes, parents, and other medical professionals to further advance their knowledge. I see through my work with KSI that we can work in both big pictures and small details, and that both are meaningful ways of changing the world.
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korey stringer institute
University of connecticut alum
Could you tell us about yourself?
I am originally from Pittsburgh, PA where I lived for most of my life before moving to Connecticut in 2007. I was very lucky to be introduced to athletic training in high school by one of my mentors, Larry Cooper, which ultimately led me to pursue this profession. I graduated from Duquesne University in 2006 with a Bachelor of Science degree in Athletic Training, and moved to Connecticut shortly after to begin my graduate work at UCONN. During that time, I worked in various capacities within athletic training, including clinical practice, research, and teaching. I completed my PhD in 2013, and currently work at Sacred Heart University in Fairfield, CT as an assistant professor in the Athletic Training Education Program. In addition, I currently serve on the Medical and Science Advisory Board for KSI and am also the Chair of the Research and Education Committee for the Connecticut Athletic Trainers’ Association.
Could you tell us about your first involvement/interaction with the Korey Stringer Institute?
My first involvement with KSI was during my graduate work at UCONN. While at UCONN, I was fortunate enough to not only study under Doug Casa, but to also be a part of the Founders Council for KSI. I can remember sitting in our very first meeting where our only agenda item was to brainstorm on how to get the word out that we even existed (easier said than done)! To see what exceptional growth has taken place since that day is truly remarkable and I am grateful to have the opportunity to continue working with KSI.
In what ways has KSI impacted you?
KSI has impacted me both on a personal and a professional level. To see the success that KSI has had in such a short time is extraordinary. In addition to the lives they have saved through education, advocacy, and policy changes, they have also encouraged countless others to actively promote sport safety. I remember working the first year at the KSI exhibit booth at the NATA national symposium where only a handful of people visited the booth and even fewer knew what KSI was. Now, those interactions have been replaced by people inquiring about the latest information, thanking the staff for their work, and even asking how they can be involved in making changes in their school, community, and even at the state level. To see the profound impact that KSI has had is inspiring and I am excited to see what their future endeavors hold.
5th Annual KSI Gala
May 5th, 2016
NFL Headquarters, New York, NY
Air Force Research Laboratory
May 16-18th, 2016
Connecticut Athletic Trainers' Association Annual Meeting
May 19th, 2016
Quinnipiac University, Hamden, CT
White House National Security Council and CDC
May 26th, 2016
Webinar; Extreme Heat Week
ACSM Annual Meeting
June 1-4th, 2016
University of British Columbia
June 13-14th, 2016
British Columbia, Canada
NATA Clinical Symposia and AT Expo
June 22-25th, 2016
Washington State Athletic Trainers' Association Annual Meeting
July 16th, 2016
University of Washington, Seattle, WA
IRONMAN Lake Placid
July 24th, 2016
Lake Placid, NY
Falmouth Road Race and Medical Symposium
August 21st, 2016
Ragnar Trail Team KSI Sponsored By Mission
August 26-27th, 2016
Northfield Mountain, MA
September 15-16th, 2016
University of Connecticut, Storrs, CT
September 23-24th, 2016
NEACSM Fall Meeting
October 13-14th, 2016
Marine Corps Marathon and Medical Symposium
October 30th, 2016
SPRING 2016 45
Korey Stringer Institute staffs and members of the medicine and science advisory board are leading researchers and expert in Exercise Science, Athletic Training, and Sports Medicine. Listed here are some of the key publications from recent months.
1. ACSM’s Research Methods. Wolters Kluwer Health; 2015.
2. Nutrition for Elite Athletes. CRC Press; 2015.
3. Fluid Balance, Hydration, and Athletic Performance. CRC Press; 2015.
4. The Sports Medicine Field Manual. American Academy of Orthopaedic Surgeons. iBooks; 2015.
5. Quick Questions in Heat-Related Illness and Hydration: Expert Advice in Sports Medicine. Slack Books; 2015.
6. Athletic Training Case Scenarios: Domain-Based Situations and Solutions. Slack Books; 2015.
7. O’Connor FG, Casa DJ. Exertional heat illness in adolescents and adults: Epidemiology, thermoregulation, risk factors, and diagnosis.
8. Epidemiology for Athletic Trainers: Integrating Evidence Based Practice. Slack Books; 2016.
9. Adams WM, Casa DJ, Drezner JA. Sport Safety Policy Changes: Saving Lives and Protecting Athletes. J Athl Train. March 2016.
10. VanScoy RM, DeMartini JK, Casa DJ. National Athletic Trainers’ Association Releases New Guidelines for Exertional Heat Illnesses: What School Nurses Need to Know. NASN Sch Nurse Print. March 2016.
11. Webber BJ, Casa DJ, Beutler AI, Nye NS, Trueblood WE, O’Connor FG. Preventing Exertional Death in Military Trainees: Recommendations and Treatment Algorithms From a Multidisciplinary Working Group. Mil Med. 2016;181(4):311-318.
12. Adams WM, Hosokawa Y, Adams EL, Belval LN, Huggins RA, Casa DJ. Reduction in body temperature using hand cooling versus passive rest after exercise in the heat. J Sci Med Sport. 2016;0(0)
13. Stearns RL, Casa DJ, O’Connor FG, Lopez RM. A Tale of Two Heat Strokes: A Comparative Case Study. Curr Sports Med Rep. 2016;15(2):94-97.
14. Pryor RR, Bennett BL, O’Connor FG, Young JMJ, Asplund CA. Medical Evaluation for Exposure Extremes: Heat. Wilderness Environ Med. 2015;26(4 Suppl):S69-S75.
15. Adams WM, Hosokawa Y, Huggins RA, Mazerolle SM, Casa DJ. An Exertional Heat Stroke Survivor’s Return to Running: An Integrated Approach on the Treatment, Recovery, and Return-to-Activity. J Sport Rehabil. October 2015.
The Korey Stringer Institute
Department of Allied Health Sciences student, Abby Colburn, poses with her KSI bottle at the Table Mountain in Cape Town, South Africa.
K.. S.. Indy! #DreamTeam #Strive2Protect
Apply for the Heat Safety Pledge and receive Mission products for your team.
UConn Kinesiology alumna, Lindsay Ellis hiked the Appalachian Trail with her KSI/Mission towel. She is currently pursuing her doctorate at the University of British Columbia, investigating the physiology of high altitude stress.
Robert Huggins, Will Adams, and Yuri Hosokawa volunteered at the 120th Boston Marathon.
Ryan Curtis and Robert Huggins worked with professional boxer, Chris Algieri to perform elite athlete testing at his training site.
SPRING 2016 47
korey stringer institute
making changes everywhere...!
John Jardine, MD Chairman, Chief Medical Advisor, Korey Stringer Institute Our Lady of Fatima Hospital, North Providence, RI , Co- Medical Director, Falmouth Road Race
Lawrence Armstrong, PhD Professor, Department of Kinesiology, University of Connecticut President, American College of Sports Medicine
Lindsay Baker, PhD R&D Principal Scientist, Gatorade Sports Science Institute
Mike Carroll, MEd, ATC, LAT Head Athletic Trainer and Assistant Athletic Director for Stephenville High School, Stephenville, TX
Jason Cates, ATC, LAT Head Athletic Trainer, Cabot Public Schools, Cabot, AR
Cindy Chang, MD Associate Professor, Primary Care Sports Medicine Department of Orthopaedic Surgery, University of California, San Francisco
Ronald Courson, PT, ATC, EMT Director of Sports Medicine, University of Georgia Athletic Association
David Csillan, MS, ATC, LAT Athletic Trainer, Ewing High School, Ewing Township, NJ
Robert Davis, MD Diplomat, American Board of Emergency Medicine, Medical Director Emergency Department at Falmouth Hospital, Medical Director, Falmouth Road Race
Julie DeMartini, PhD, ATC Assistant Professor, Athletic Training Education Program, Sacred Heart University
board of advisors
medical and science advisory board
Kelci Stringer Founder and Spokesperson
James Gould Chairman
Mitch Berger Teammate and Friend of Korey
Scott Birnbaum Chief Marketing Officer, Mission
Heberto Calves Senior Vice President of Marketing & Product Development, Sports Division, EB Brands
George Chiampas, DO Assistant Professor in Emergency Medicine and Orthopedic Surgery Feinberg School of Medicine, Northwestern University
Maxine Clark Founder, Chief Executive Bear, and Chairman, Build-A-Bear Workshop
Jeremy Galten Vice President of Research and Development, CamelBak Products LLC
Philip Guarascio Chairman, Arbitron, Inc.
Adam Gurian Executive Vice President of Global Sales and Merchandising, Frederick Goldman Inc.
Nick Inzerello Senior Director, Football Operations, USA Football
Katie Godfrey Senior Global Account Executive, Kestrel Meters
Jeff Kearney Senior Director of Sports Marketing, Gatorade
Jeff Miller Senior Vice President for Health and Safety Policy, National Football League
Josh Newton President, CEO, UConn Foundation
Rachael Oats Associate Execuitve Director, National Athletic Trainers' Association
Scott Paddock President, Chicago Speedway
Jeff Petak National Sales Director, One Beat CPR & AED
Scott Sailor President, National Athletic Trainers' Association
Josh Shaw Founder and CEO, Mission
John Shea Managing Director, Teneo Sports
Lindsay Distefano, PhD, ATC Associate Professor, University of Connecticut
Jonathan Drezner, MD Associate Professor, Department of Family Medicine, University of Washington Associate Director, Sports Medicine Fellowship, University of Washington Team Physician, Seattle Seahawks & UW Huskies, University of Washington
Michael Ferrara, PhD, ATC Dean, College of Health and Human Services, University of New Hampshire
Matthew Ganio, PhD, FACSM Chief Statistical Advisor, Korey Stringer Institute Associate Professor, University of Arkansas, Director, Human Performance Laboratory, University of Arkansas
Kevin Guskiewicz, PhD, ATC Distinguished Professor, University of North Carolina Co-Director, Matthew Gfeller Sport Related TBI Research Center Director, Center for the Study of Retired Athletes
Jay Hoffman, Ph.D., CSCS, FNSCA, FACSM Department Chair, Education and Health Sciences Professor, Dual Appointment in Sport and Exercise Science and Burnett School of Biomedical Science, Director, Institute of Exercise Physiology and Wellness University of Central Florida
John Jefferies, MD Director of Cardiomyopathy and Advanced Heart Failure, The Heart Institute Cincinnati Children’s Hospital Medical Center
Stavros Kavouras, PhD, FACSM, FECSS Associate Professor, University of Arkansas
Glen Kenny, PhD Professor, University of Ottawa
Zachary Kerr, PhD Professor, University of North Carolina
Lisa Larkin, MD, NCMP, FACP Associate Professor of Obstetrics and Gynecology University of Cincinnati College of Medicine, Director of Division Midlife Women’s Health and Primary Care, Director of UC Health Women’s Center
Elaine Choung-Hee Lee, PhD Assistant Professor, University of Connecticut
Rebecca Lopez, PhD, ATC, CSCS Assistant Professor, University of South Florida
Thom Mayer, M.D., FACEP, FAAP Medical Director, NFL Players Association
Stephanie Mazerolle, PhD, ATC, FNATA Assistant Professor, Director of the Professional Bachelors Athletic Training Program, Department of Kinesiology, University of Connecticut
Brendon McDermott, PhD, ATC Associate Professor, University of Arkansas
Francis O’Connor, MD, MPH Professor, Military and Emergency Medicine, Uniformed Services University Medical Director, Consortium on Health and Military Performance
Margot Putukian, MD Director of Athletic Medicine, Head Team Physician, Princeton University Associate Clinical Professor, Robert Wood Johnson, University of Medicine and Dentistry of New Jersey, Past President American Medical Society for Sports Medicine Chair, US Lacrosse Sports Science & Safety Committee, NFL, Head, Neck & Spine Committee
Michael Ryan, MS, ATC, PT Head Athletic Trainer/Physical Therapist, Jacksonville Jaguars- Retired
Paul Sparling, MS, ATC Head Athletic Trainer, Cincinnati Bengals
Erik Swartz, PhD, ATC, FNATA Professor and Department Chair, University of New Hampshire
Mark Verstegen, MS, CSCS Founder, EXOS
Susan Yeargin, PhD, ATC Assistant Professor, University of South Carolina
Jill Livingston Research Service Librarian
SPRING 2016 49
lesley vandermark, ms, atc
rebecca stearns, phd, atc
Ryan curtis, ms, atc, cscs, ces
Director of Youth Sport Safety
Assistant Director of Sport Safety Policies
Chief Operating Officer
Chief Executive Officer
samantha scarneo, ms, atc
SARAH ATTANASIO, BS, ATC
Rachel Katch, MS, ATC
Director of Military and Occupational Safety
Director of Sport Safety Policies
william adams, ms, atc
Luke belval, MS, ATC
Assistant Director of Elite Athlete Health
and Performance- Individual Sports
Director of Research
Assistant Director of Military and Occupational Safety
Andrea fortunati, MS, ATC
Director of Communication and Education
Assistant Director of Youth Sport Safety
douglas Casa, Phd, atc, facsm, fnata
Photo credit: Rebecca Stearns
Alicia Pike, MS, atC
Rachel vanscoy, MS, ATC
Vice President of Research and
Elite Athlete Health and Performance
Assistant Director of Elite Athlete Health and Performance- Team Sports
robert huggins, phd, atc
Yuri hosokawa, mat, atc
Our Lady of Fatima Hospital, North Providence, RI
Co- Medical Director, Falmouth Road Race
Co-Founder and spokesperson of the KSI
James Gould, co-founder and chairman of the board of advisors
SPRING 2016 51
John jardine, md, chief medical advisor and chairman of medical & science advisory board
Pertinacity- The Stories of KSI
Volume 2, Issue 1
Edited by Yuri Hosokawa
Cover photo credit to Savannah Knighton
Visit Our Website: ksi.uconn.edu
Chairman, Management One
Korey's NFL Agent
kelci stringer, co-founder and spokesperson
show your support, please visit the UConn Foundation web page to make donations. #Proud2SupportKSI
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The Korey Stringer Institute (KSI) is a not-for-profit 501(c)3 organization housed in the Department of Kinesiology, College of agriculture, health & natural resources, at the University of Connecticut under the UConn Foundation.
KSI serves the needs of active individuals and athletes at all levels- youth, high school, college, professional, laborers, soliders, recreational athletes- and those who supervise and care for these individuals. Our services include consultations, advocacy, education, research, athlete testing, and mass-market outreach.