That’s right, I believe the real problem is much deeper seated.  There is a growing concern today for the number of deaths taking place in non-football related activities.  Football players – especially in the Football Bowl Subdivision, are being driven harder and harder today.

Scott Anderson, a past-president of the College Athletic Trainers Society (CATS) sounded the alarm in college athletics in January 2011 with his comment to senior writer Dennis Dodd on CBSSports.com.  “The way we’re training college football players in this day and age is putting them at risk,” Anderson said.  “Twenty-one dead football players and we’re still today training them the same way as we did dating back to at least January, February of 2000.”

Is conditioning the problem, or is something else going on?  Several years ago, we were alarmed from the incidence of sudden cardiac death, as related to those student-athletes falling out with no reported medical history of cardiac issues.

One underlying principle athletic trainers must deal with today is the concept of “care” versus “coverage.” Care involves a hands-on, comprehensive service including the prevention, care, and rehabilitation of athletic injuries.  Care is what we have tried to provide for years.  However, today administrators are more interested in having coverage as this is much less expensive and requires less institutional commitment.  Health care providers need to fight for care, and administrators with any prudent understanding will embrace and support care over coverage.  The problem is, health care is not glitzy like shiny uniforms or JumboTron scoreboards or expansive facilities.

The first known case of sickle-cell trait causing a death at the NCAA level was discovered at Colorado in 1974.  More recently, Florida State player Devaughn Darling died in 2001 during “mat drills.”(Wikipedia, 2002) His family settled with Florida State for $2 million.  There remains disagreement about Darling’s cause of death, but both Devaughn and surviving brother Devard, who transferred from Florida State to Washington State after the death, were found to have the sickle-cell trait.  Also, there was Dale Lloyd II, who died a day after he collapsed during a conditioning workout in 2006 at Rice University.  Lloyd’s family requested in its suit settlement with Rice that the NCAA mandate member institutions to test for the sickle-cell condition.  The list continues . . . Central Florida’s University of Central Florida freshman student-athlete Eric Plancher died in March, 2008.  There was some question about whether adequate staffing was provided to Central Florida student-athletes.  Plancher was another in a line of student-athletes who have died from conditioning-related activities in Division I football.  The offseason workout was determined to have triggered his sickle cell trait.  The case received a great deal of attention.

Following Plancher’s death, the University of Central Florida commissioned a high-profile investigator, Michael Glazier, to review the Knights’ football athletic training practices, policies, etc.  The report compiled by Glazier (Glazier, 2009), a former NCAA investigator and attorney based in Kansas City, Missouri recommended that Central Florida improve communication between its athletic training staff and athletic department administrators, consider adding a fourth certified athletic trainer exclusively devoted to football, and enhance its nutrition education and support for players.  The report addressed staffing at Central Florida, and referenced like institutions in Division I.

The University of Central Florida eventually lost the $10 million dollar law suit.  Other colleges and universities are waiting their day in court including the University of Mississippi and Western Carolina University.

Sadly, I am not certain larger staffs equate to a higher quality of athletic training care.  The UCF report from Glazier specifically addressed staffing.  What we have today at many institutions is coverage with minimal or little health care being provided.  Why else would student-athletes with sickle cell trait be expiring in cases where the health care team knows the student-athlete is positive? There is a duty to educate the student-athlete, coach, strength coach, and to communicate all this to the student-athlete’s parents or guardians.

Any death is a concern, so the number of non-practice field deaths should alarm everyone.  Many of these deaths have been sickle-cell trait related.

As I visit with institutions and athletic trainers, the number of sickle-cell trait positive deaths concerns me.  There are identified steps to be taken for these cases and excellent education and information is provided by NATA, the American Medical Society for Sports Medicine, the American Orthopedic Society for Sports Medicine as well as other groups.  The NCAA also includes information, but I prefer to obtain my medical information from medical organizations, not a membership or sanctioning organization.

The education of the health care team and coaches over the recent years has certainly grown.  My fear and constant concern is with all the testing and education that is being mandated by the NCAA and other organizations – we still are having deaths to student-athletes known to be Sickle Cell Trait positive! The bottom line is we are not adhering to the guidelines which have been established.

Somewhere, somehow, something is wrong.  In my book Tape, I-C-E, and Sound Advice, I reflect on my twenty-seven year career in college athletics – reflecting on guiding principles and policies I was exposed to . . . and how they impacted the care of student-athletes.

The second part of this example is that the student-athlete gave you the insurance card and it was never really an active card to start with. Therefore any injury that occurs will result in you paying more than you had planned on paying. If you are a school that requires coverage in order to play, you should be immediately verifying those cards each time you are given one and should also be checking all cards on a regular basis to look for any loss in coverage. There are companies that can do this for you. The cost of doing this step could save you thousands of dollars each time you catch a case where coverage is lost or no longer valid. By taking this step you will know what your exposures are and what next steps to take. Learning after the fact is the worst way to find out this information. Remember, bad news never gets better with time, so find out early.

Contact us if we can assist you and your institution in partnering with companies that provide such services.

How many times have you had a Student-athlete show up on campus with an insurance card in hand and come to find out that the card is no longer valid after an injury occurs? In most cases you will find the card was once active, but the student-athlete lost coverage at some point and the card is no longer valid. When this happens, a step you could take to control expenses is to elect COBRA (Consolidated Omnibus Budget Reconciliation Act) on that student-athlete. COBRA is a continuation of coverage benefit enacted by the federal government in 1985. This act allows for continuation of coverage on a group medical plan should coverage be lost due to a qualifying event. By electing COBRA, you could take a large claim and have the costs picked up under primary coverage rather than having all the cost gone toward your secondary insurance. There are specific rules and timeframes as to when this can be done, but the bottom-line is that anyone person can elect COBRA for anyone. The cost of electing COBRA on a large claim and paying for the premiums for the duration of the injury will be far less expensive than paying for the entire injury and having the claim go against your loss runs.

We have to be diligent in our work today to contain costs!

during a game.
Today there is lots of emphasis on hydration with physically active patients. Now it’s water, water, water . . . you can’t get too much! The more . . . the better. Actually, you can get too much water, and a combination of electrolytes and water are best.

We know now that dehydration can contribute to heat exhaustion and even heat stroke. Fluids will protect the body from dehydrating, overheating, and cramping. In a given practice—one of our offensive or defensive linemen may lose up to 15 pounds of fluid. We require them to return to within 4% of their pre-practice weight prior to leaving the locker room—Athletic Trjaining Room area and return to within 2% prior to subsequent workouts! Thus, heat illness is prevented as the greatest way to have a heat related death would be to exercise in a dehydrated state.
It’s important to remember that thirst is not a good indicator of dehydration. In fact, when you feel thirsty . . . you’re probably already a quart low! That’s good information whether you’re an athlete or not . . . drink, drink, drink.
The National Athletic Trainers Association recommends that athletes take drink breaks at least every 45 minutes during practice and play . . . many coaches and athletic trainers demand even more frequent breaks. Drink selection needs to be less than 8% concentration of sugar in order to avoid a slow down in gastric emptying. Basically, no caffeinated drinks.
The night before the big game or event, athletes need to drink Gatorade to help the body store fluid and reduce the risk of dehydration the following day. Athletic Trainers and Physicians know they can prevent a lot of heat-related events by proper hydration. Once athletes understand and comprehend this, we are well on our way to preventing heat related illness. If we rely on our thirst as a guide for fluid replacement – we are way behind. Remember the guide for weight charts and effective prevention of dehydration of your patients. This plan helps prevents fluid loss and subsequent predisposing patient to heat related events.