Korey Stringer Institute: Progress Made in High School Sports Safety Policies

Douglas Casa, CEO of the Korey Stringer Institute and professor of kinesiology.
Douglas Casa, CEO of the Korey Stringer Institute and professor of kinesiology. (Peter Morenus/UConn Photo)

In the three years since UConn’s Korey Stringer Institute published its initial report examining health and safety policies for high school athletes, 38 states have adopted legislative or State High School Athletic Association changes that make high school athletes safer in their respective states, according to its latest findings.

The update, released this month, reflects the notable progress states have made in the past year (August 2019-August 2020) in adopting important new policies to protect student athletes. States adopting policy changes that went into effect this year include Alabama, Arkansas, Colorado, Delaware, District of Columbia, Florida, Hawaii, Illinois, Iowa, Louisiana, Missouri, New Jersey, New Mexico, New York, Oklahoma, Tennessee, Texas, and Vermont.

These changes come as the NFL Foundation and the National Athletic Trainers’ Association, along with countless private donors, have announced their support of Team Up for Sports Safety (TUFSS), a KSI-led initiative with a goal to help propel the adoption of policies proven to reduce the incidence of catastrophic sports injuries.

As part of the TUFSS initiative, KSI hosts state meetings and invites local high school sports leaders and state legislatures to engage in conversation and help encourage the adoption of health and safety policies that benefit the wellbeing of high school student athletes. In the coming years, KSI will visit all 50 states, the District of Columbia, and Puerto Rico.

“One of the most important projects in the history of the Korey Stringer Institute is TUFSS,” KSI Chief Executive Officer and professor of kinesiology at UConn Douglas Casa says. “The project deeply reflects our core mission and provides an unbelievable opportunity to effect positive change that will influence so many youth athletes. Working with the state level policy leaders has been rewarding, but seeing the change in policies from the collective efforts of so many is truly inspirational- knowing that we are doing things that will literally allow more kids to arrive home for dinner instead of at a hospital or a morgue.”

Following KSI’s visit to Louisiana, a sweeping student athlete safety bill was signed into law by Gov. John Bel Edwards on June 15, 2020. It mandates emergency action plans, requires heat acclimatization and the use of wet bulb globe temperature (WBGT) to monitor environmental conditions.

“The Louisiana Project was a cooperative endeavor bringing the LA High School Coaches Association, LA Football Coaches Association, LA High School Athletic Association, LA High School Athletic Directors Association, LA Association of School Executives, and the LA Athletic Trainers’ Association together with one goal,” says Scott Arceneaux, Director of Athletic Training at St. Amant High School and President-elect of the Louisiana Athletic Trainers’ Association. “The goal…was to improve the health and safety of the student athletes in our great state. This was the key factor in Louisiana passing ACT 259 in the 2020 legislative session. Without the guidance and resources of the TUFSS program, this would not have been possible.”

Florida was another state visited by KSI that made legislative policy changes this year. The Zachary Martin Act requires Florida High School Athletic Association member schools to modify athletic activities based on heat stress guidelines and require emergency action plans to include procedures for onsite cooling before transporting a student for exertional heat stroke. Zachary Martin was a 16-year-old offensive lineman who collapsed during a hot summer football practice. His core temperature was 107°F, and he was taken off life support 11 days after his collapse. Zachary’s mother, Laurie Giordano, was instrumental in the passage of this bill.

“Sharing this tragedy with a room full of strangers was difficult, but I was encouraged by the heartfelt concern of Florida legislators and their commitment to ensuring the safety of our high school athletes,” she says. “KSI was instrumental in motivating lawmakers to address exertional heat illness safety through a state survey of high schools that included KSI’s High School Sports Safety Policy Review data for Florida. This survey highlighted inconsistent safety policies and revealed a shocking number of exertional heat illnesses along with a lack of Emergency Action Plans and heat safety equipment. As I spoke to each committee about losing Zach to exertional heat stroke, KSI’s recommendations became a clear path to athlete safety in Florida high schools. I am grateful for KSI’s influence in Florida and I am both humbled and proud that this law is named in honor of Zach.”

The new Florida law also requires Florida High School Athletic Association member schools to make automated external defibrillators available on school grounds in clearly marked, public locations. The Zachary Martin Act was signed by Gov. Ron DeSantis and went into effect July 1, 2020.

“We initially expected to have our policy changes enacted through our state high school athletic association but that did not occur,” said Dr. Michael Seth Smith, Clinical Associate Professor at the University of Florida Department of Orthopedics and Rehabilitation. “Ultimately, through the continued efforts of family members of athletes who have been affected by exertional heat stroke, like Laurie Giordano of the Zach Martin Memorial Foundation, athletic trainers like Bob Sefcik of the Jacksonville Sports Medicine Program, the Florida Alliance for Sports Medicine, the state of Florida Sports Medicine Advisory Committee, and countless other sports medicine professionals, administrators, and coaches along with the support of KSI, the Zachary Martin Act was signed into law on June 23, 2020. It is a great honor to see HB 7011 approved in the FL legislature, which hopefully ensures that our secondary school athletes can continue to participate in sports in a safer manner than in the past in regard to exertion heat illness, sudden cardiac death, and other sports medicine emergencies. I would encourage other state sports medicine groups, who are interested in policy changes, to explore the quickest way to get policy changes approved but not to be afraid to pivot to different paths if the initial one is obstructing their ability to approve mandatory policy changes to keep our young athletes safer while participating in sports.”

In New Jersey, two bills were signed by Gov. Phil Murphy on January 9, 2020, which mandate the use of accepted best practices in the state. The first requires the use of WBGT to monitor environmental conditions, and the second requires the establishment and implementation of emergency action plans. The KSI and TUFSS team has worked closely with New Jersey high school sports leaders over the last three years assisting in this policy change process.

“Both bills are the Athletic Trainers’ Society of New Jersey’s (ATSNJ) product of many years striving to keep New Jersey’s secondary school student athletes safe,” says David Csillan, MS, LAT, ATC, member of the NJSIAA Sports Medicine Advisory Committee. “S2443 mandates all New Jersey secondary schools to follow the New Jersey State Interscholastic Athletic Association’s (NJSIAA) Heat Participation Policy. The policy utilizes WBGT to access environmental conditions and, if safe, allows for activity to continue with the appropriate modifications of increased water breaks, removal of equipment and decreased intensity of activity. S2494 requires school districts to have an emergency action plan at the ready, should a serious or potentially life-threatening sports-related injury occur. According to the 2018/19 participation data from the National Federation of State High School Associations (NFHS), New Jersey had approximately 280,000 secondary school athletes participating in interscholastic sports and we have a responsibility to keep them safe while under our watch.”

More information about the current review from KSI’s high school sport safety study and details regarding each state’s assessment can be found online here.