Athletic trainer Christa Finney helps a Bryant Hornet football player cool down during an August practice.

State attacks heat illnesses, concussions in athletes

The high-profile death of an Arkansas high school football player during last year’s August practices helped pave the way for an increased focus on heat-related illnesses as well as a law that requires coaches to undergo training in player safety.

Sixteen-year-old Tyler Hamilton died October 12, 2010, at Arkansas Children’s Hospital, two months after collapsing in the locker room following an August football practice at Lamar High School in north Arkansas.

Act 1214, passed by the Legislature this year, requires coaches to undergo training to prevent and treat heat illnesses, concussions, and dangerous environmental issues and communicable diseases every three years. It also requires districts to develop procedures for dealing with these issues.

The Arkansas Activities Association, the state’s governing body over high school sports, has expanded on that theme by creating seminars and online courses for heat illnesses and concussions. A third course is being developed for MRSA, the methicillin-resistant Staphylococcus aureus bacteria.

This also was the first year of a AAA-enforced policy that ended consecutive two-a-day practices in August and limited practices to five hours a day when teams hold two practices and three hours a day when practicing only once.

According to Dr. Joey Walters, the association also required schools to hold meetings to discuss heat-related illnesses with athletes and their parents prior to the start of football season, and it required school districts to create emergency action plans to respond to injuries at all venues.

AAA and the Arkansas Athletic Trainers Association have been trying to educate the high school athletic community both about the dangers of heat illnesses and the proper treatment. “It has been a blitz campaign to get the coaches educated along that line,” said Doug Killgore, athletic director at Central Arkansas Christian and president of the Arkansas High School Athletic Administrators Association.

A big focus: rapidly cooling a heat-exhausted athlete to under 104 degrees Fahrenheit before transporting him or her to a medical facility. Christa Finney, an athletic trainer at Bryant High School who works for OrthoArkansas, said the ideal method is very simple: a shaded tub of water covered with a layer of ice along with a paddle to circulate the water so that it isn’t warmed by the athlete’s own body heat.

According to a checklist provided by Todd Ross, athletic trainer and Bill Hefley, MD, with OrthoSurgeons, it’s not enough for an athlete simply to be in shape and well-hydrated in order to withstand the rigors of summer football practice. Ross and Hefley recommend seven to 14 days of exercise in the hot outdoors to acclimatize a young body to a hot summer practice and say that it may take two months for full acclimatization.

Ideally, every school would have an athletic trainer like Finney, but fewer than 40 do. Finney is responsible for helping keep student-athletes safe at all venues in games and practices, and to watch for safety issues that coaches might miss.

“Especially if you are out there every day with the same team, you get to know these kids,” she said. “You know what’s normal and what’s not with them.”

Two-a-day football practices are an Arkansas tradition, but Finney said that coaches have been willing participants in the drive to help student-athletes avoid heat-related injuries. “No coach wants to be the one on the news whose kid is going to the hospital in MedFlight,” she said. “It’s about keeping the kids safe. It’s about keeping them hydrated, and it’s about taking care of them.”

In fact, according to Kilgore, most of the resistance is coming from parents and members of the community who themselves went through two-a-days.

AAA has also tightened rules on concussions. Although these can occur in any sport, the most obvious place is football, and recent research by Purdue University and others is indicating that head injuries may be more common than earlier thought. Under new AAA guidelines, student-athletes cannot return to play within 24 hours of a concussion, and only then after being cleared to play by a medical professional.

“Back in the day, a kid would get what we would call a ‘ding,’ which is a concussion, they would rub some dirt on it and (have them) walk it off,” said Tom Cantwell, an athletic trainer with OrthoArkansas. “Now that individual, that student-athlete has to be evaluated and released to return to play by a healthcare provider.”

Arkansas Children’s Hospital operates a concussion clinic two days a week. According to Darrell Nesmith, MD, associate professor of pediatrics, concussion injuries have been rising in recent years. They primarily occur in football but also happen in other sports, in both genders.

Nesmith said that, despite the AAA’s guidelines, there is no set time period for returning an athlete to play and each has to be treated individually. About half require a gradual return of about a week; half require more as physicians evaluate their progress.

“The general principle is that we can start them back to their sport when all of their symptoms have gone away at rest and at exertion,” he said.

The clinic received a grant from Arkansas Blue Cross Blue Shield allowing participating schools to have a free one-year license to use ImPACT, a 20-minute computerized test administered to athletes that measures attention span, working memory, and other cognitive performance. Ideally, schools will use the software at the beginning of the year on all athletes to set a baseline for measurement when head injuries occur.

For more information, contact Arkansas Children’s Hospital’s concussion clinic at 501-364-1601.

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