Athletic trainers and coaches bear major responsibility for preventing deaths

Colleges and high schools must follow an active strategy to preventing deaths among student athletes from exertional heat stroke (EHS) and other causes, according to an editorial in a recent issue of The Journal of Strength and Conditioning Research, official research journal of the National Strength and Conditioning Association (NSCA). The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"[I]nstead of school and university administrators, sport coaches, and strength and conditioning coaches merely hoping that these stories will not become a reality to their athletes, schools must start actively assuming the responsibility of reducing risk factors associated with these conditions," write Julie K. Demartini, MA, ATC, and Douglas J. Casa, PhD, ATC, of the Korey Stringer Institute at Neag School of Education, University Connecticut, Storrs.

Despite the availability of effective prevention strategies, many types of preventable deaths in athletes have become more common in recent years. In addition to EHS, these include exertional sickling, which may occur in patients with sickle cell disease; and sudden cardiac death, often related to previously unsuspected genetic conditions. Korey Stringer, for whom the Korey Stringer Institute was named, was a National Football League player who died of EHS in 2001.

Why do these preventable deaths continue to occur? Because of lack of awareness and a passive approach to dealing with the problem, Demartini and Casa believe. In their editorial, they outline and strongly advocate for a series of active steps that schools and coaches can take to reduce the risk of preventable deaths in athletes.

First and foremost, an emergency action plan (EAP) should be in place wherever athletic practices, conditioning sessions, and competitions are held. The EAP provides a blueprint for handling emergencies while establishing accountability.

Certified athletic trainers (ATCs) play a critical role in designing and following the EAP. Demartini and Casa recommend that high schools hire an ATC, while universities should ensure that they have an adequate number of trainers for their athletic programs. If an ATC is not present, athletic directors and coaches must assume responsibility for the EAP.

The authors also call for mandatory training in cardiopulmonary resuscitation and automated external defibrillator use for all coaches. While coaches can't be held to the same expectations as ATCs, they do need to be aware of the conditions that can cause sudden death, be able to recognize those conditions, and initiate life-saving first aid.

Perhaps most importantly, coaches must be willing to alter their usual practice routine to prevent EHS and other causes of sudden death from occurring. Especially in hot weather, coaches must be responsible for safe practice regimens including rest breaks, hydration, heat acclimatization, time of day, and intensity of drills.

Coaches must also be aware of which athletes may be at risk of sudden death and be willing to alter conditioning drills and practices to avoid those risks. As part of the active strategy to prevent deaths, Demartini and Casa believe that administrators must "aggressively penalize" coaches who endanger the health and safety of athletes.

Finally, the authors also recommend that all college and high school strength and conditioning coaches be certified by the NSCA. As an organization, the NSCA places a top priority on health and safety issues and is working to demand that all Certified Strength and Conditioning Specialist (CSCS)-credentialed coaches follow minimum health and safety standards.