Automated External Defibrillators

The Korey Stringer Institute has taken the existing literature and consolidated it to create 8 key points when considering state policy on automated external defibrillators (AEDs) in secondary schools.  These devices can be the difference between life and death for athletes who experience sudden cardiac arrest or commotio cordis.  In terms of treatment of sudden cardiac arrest or commotio cordis, use of an AED with cardiopulmonary resuscitation (CPR) is the gold standard.  With EMS an average of 7-8 minutes away from the scene, the responsibility of initiating pre-hospital care falls to the on-site medical staff, coaches, athletes, administrators, or other bystanders.

The rate of survival from sudden cardiac arrest falls 7-10% for each minute without CPR. That would mean that if CPR was delayed even 3 minutes, the injured person now has a 70% chance of survival.

Coaching Education

When allowing a child to play sports parents are trusting coaches to be someone their child can look up to, instill a love for the sport, but most importantly someone who has the best interest of the child in mind.   It is the coaches’ responsibility to plan and conduct practices that keep their athletes safe.

Particularly at the high school level, all schools should have access to a certified athletic trainer. A coach should not be the primary medical provider at any level of athletics, but should be educated on emergency care and methods used to protect their athletes. As a result the Korey Stringer Institute has devised the following 6 coaching education requirements that should be implemented by each states’ high school athletic associations.

Heat Acclimatization

Heat acclimation or acclimatization plays a large part in the body’s physical responses and overall ability to cope with heat exposure. Heat acclimation is a broad term that can be loosely defined as a complex series of changes or adaptations that occur in response to heat stress in a controlled environment over the course of 7 to 14 days. These adaptations are beneficial to exercise in the heat and allow the body to better cope with heat stress. Heat acclimatization describes the same process, but happens in a natural environment.


Monitoring hydration status before, during and after exercise is essential for both performance and safety during physical activity.  Maintaining an appropriate level of hydration (a euhydrated state) has been shown to increase performance (aerobic exercise, anaerobic exercise, strength, power), allows athletes to exercise at lower body temperatures and heart rates, improves cognitive function, and has been shown to enhance immunological function.

Dehydration is influenced by exercise intensity, environmental conditions (temperature and humidity), and availability of fluids during exercise. Once an individual loses 2% of their body mass from fluid losses impairments in performance are noticeable and these impairments become more extreme with greater levels of dehydration. Also, it has been shown that with increasing levels of dehydration body temperature and heart rate increases over and above the levels of someone who is hydrated, which can increase the risk of heat illness in dehydrated exercising individuals.

Medical Time Out

While it is imperative to have an Emergency Action Plan, it is equally important that the EAP be practiced and understood by all involved. A medical timeout is designed to prepare athletic trainers, emergency medical services, team physicians and anyone designated as responsible for the medical well-being of athletes or spectators on game day to be aware, prepared and educated. Communication between these individuals can make the difference between a positive outcome and a negative experience should an injury or incident occur. Following a medical timeout procedure reduces, and in most cases, eliminates chaos and confusion because these professionals simply took the time to be prepared.

Pre-Participation Examinations

The Pre-Participation Exam otherwise known as the (PPE) has become a critical aspect in both sport and recreation, however currently there is no standardized instrumentation. The PPE is designed to screen for injuries, illnesses, or other factors that increase an athlete’s risk for injury or illness. Experts in the field of athletic training, sports medicine, orthopaedics, family medicine, pediatrics, and osteopathics all agree that the identification of predisposing factors that threaten one’s safety are vital to participation in sport and will serve to improve the health and safety of athletes and active individuals.

Protective Equipment

Protective gear is a key element of injury prevention in sport. However, even the best gear is ineffective when the fit is improper. It is essential to understand and follow proper fit guidelines for all styles of equipment. Equipment should be utilized in the way that it was designed, with no modifications, to gain the full protective effects.

Sports Medicine Policies & Procedures

Policies and procedures are a critical component of a risk management plan. They are documents that aid in carrying out clear expectations (policies) and instructions (procedures) on various sports medicine topics. By implementing written policies & procedures, organizations are able to communicate desired outcomes to employees, clarify roles and responsibilities and set a foundation for the delivery of safe and effective healthcare.

Wet Bulb Globe Temperature Monitoring

A WBGT device is a measurement tool that uses ambient temperature, relative humidity, wind, and solar radiation from the sun to get a measure that can be used to monitor environmental conditions during exercise. Establishing WBGT guidelines that dictate modifications in activity (work:rest ratios, hydration breaks, equipment worn, length of practice) at given WBGT temperatures play a huge factor in helping to prevent EHS.

As environmental temperature and humidity increase, there is an increase in the heat stress that is placed on the exercising individual. Exercise in the heat causes athletes to rely on evaporation of sweat from the skin as the primary method of dissipating heat that is produced by the working muscles. As humidity increases, the ability to dissipate heat through evaporation is further hindered, thus causing the body to have an increased body temperature, which increases the risk of EHS.