By Kim Smiley
Deaths and serious injuries of young athletes make headlines every year. So how do we ensure that participation in sports is as safe as possible? The first step is to determine what is causing the deaths and understanding the factors involved.
The serious health risks to young athletes can be analyzed by building a Cause Map, an intuitive format for performing a root cause analysis. A Cause Map visually lays out all the causes that contribute to an issue to show the cause-and-effect relationships to help illustrate the problem. According to experts, some of the serious health threats to young athletes are sudden cardiac arrest, heat stroke and concussions.
The potential for concussions, especially in the more physical contact sports, has been getting a lot of attention in the media lately, but the most common cause of death of young athletes is sudden cardiac arrest. Most cases of sudden cardiac arrest are caused by pre-existing heart conditions and the heart breaking part is that most of these are detectable and treatable. Most of the heart conditions that cause sudden, unexpected death have few symptoms and can’t be found by a typical sports physical done in the US. About two-thirds of the dangerous heart defects could be found by an electrocardiogram or EKG test, but these are not routinely done in the US. The main factor preventing EKGs is the cost, which is not always covered by insurance. Sudden cardiac arrest is also a risk that many people don’t know a lot about.
Concussions are also a risk for athletes of any age. Concussions can have long term health consequences and occur when brain cells are damaged. Concussions are mainly caused by impact to the head, but can also be caused by sudden jolts to the body that cause the brain to hit the inside of the skull. Impacts during contact sports are a well-known cause of concussions, but typical sports activities like heading a soccer ball can also cause concussions. Wearing the appropriate safety gear can help prevent concussions. The rules of some sports also limit the more dangerous plays like helmet to helmet tackles in football.
Another significant risk to young athletes is heat stroke. Heat stroke is usually preventable, but is still a significant risk and can cause death in extreme causes. Heat stroke occurs when the internal temperature of the body rises above safe levels. Young athletes are susceptible to heat stroke because many sports practice outside in hot weather. The typical modern, air conditioned life style increases the risk of heat stroke because athletes are generally less acclimated to the heat at the start of the season. Athletes are most likely to suffer from heat stroke during the first few days of practice in hot temperatures. Gradually increasing workouts in warm temperatures to allow athletes to acclimate to the weather has been very effective at preventing heat stroke. For example, heat stroke rates dramatically decreased after the NCAA limited practice to three hours once a day for the first five days.
How quickly treatment is administered can also dramatically change the outcomes if an athlete is injured. Quick action by trained personnel with the appropriate equipment can save lives. According to a recent New Times Times article, only about 40 percent of high schools in the United States have a certified athletic trainer on staff and only about 70 percent have an automatic external defibrillator (AED). AEDs are important because they can improve the chance for survival after sudden cardiac arrest by 60 percent or more.
So what is the best way to keep our young athletes safe? This is a matter of lively debate. Some people believe that the right answer is to require EKGs during pre-participation physicals, but the cost of performing EKGs on the 7.7 million high school athletes in the US is not trivial. There is also the issue that EKGs, like most diagnostic tests, are not perfect and produce some false positives that would require more testing that raises costs. Some believe the money could be better spent by hiring more trainers and buying more AEDs. The answers aren’t simple, but the better we understand the problem the more informed the decisions will be.