Lifesaving Medications Use By Athletic Trainers

The athletic trainer's (AT) emergency management skill set requires competency in the delivery of basic lifesaving medications. Some lifesaving medications have been a part of athletic training practice for decades, but that list has grown as ATs' practice setting has expanded - increasing the types of em ergent conditions that the AT may have to treat. The 2020 CAATE curricular standards require athletic training students be trained to administer the following: supplemental oxygen, nitroglycerine, low dose aspirin, bronchodilators, epinephrine using automated injection device, glucagon, and naloxone. Clinically, the conditions treated by these medications can be categorized as follows: cardiac, respiratory, hypoglycemia, or anaphylaxis. All ATs should know the indications, contraindications, administration methods, and the details of patient monitoring for each medication. Generally, these medications are safe, have clear indications for use, and few contraindications. While ATs are trained to administer these medications, they must consider state laws and local policies.

Age and Sex-Specific Joint Biomechanics in Response to Partial and Complete ACL Injury in the Porcine Model

Context: Pediatric anterior cruciate ligament (ACL) injury rates are increasing and are highest in adolescent females. Complete ACL tears are typically surgically reconstructed, but there are few guidelines and very limited data regarding the need for surgical reconstruction or rehabilitation for partial ACL tears in skeletally immature patients. Objective: To evaluate the impact of partial (anteromedial bundle) and complete ACL transection on joint laxity and tissue forces under anterior and rotational loads in male and female stifle joints throughout skeletal growth in the porcine model. Design: Descriptive Laboratory Study. Setting: Laboratory. Patients or Other Participants: Sixty male and female Yorkshire cross-breed pigs aged 1.5, 3, 4.5, 6, and 18 months (n=6/age/sex). Main Outcome Measure(s): Joint laxity was measured in intact, anteromedial bundle-transected, and ACL-transected joints under applied anterior-posterior drawer and varus-valgus torque using a robotic testing system. The loading of the soft tissues in the stifle joint was measured under each condition. Results: Anterior-posterior joint laxity increased by 13–50% (p<0.05) after anteromedial bundle transection and 75–178% (p<0.05) after ACL transection. Destabilizations after anteromedial bundle transection increased with age (p<0.05) and were greater in late adolescent females than late adolescent males (p<0.05). In anteromedial bundle-transected joints, the posterolateral bundle resisted the anterior load. In ACL-transected joints, the medial collateral ligament (MCL) contribution was largest, followed by the medial meniscus. MCL contribution was larger while medial meniscus contribution was smaller in males versus females. Conclusions: Partial ACL transection resulted in moderate increases in joint laxity, while the remaining bundle performed the primary ACL function. Destabilizations due to partial ACL transection were largest in late adolescent joints, indicating that operative treatment should be considered in active, late adolescent patients. Increased forces in the MCL and medial meniscus after ACL transection suggest that rehabilitation protocols may need to focus on protecting these tissues.

Proper Recognition and Management of Exertional Heat Stroke in a High School Cross Country Runner: A Validation Clinical Case Report

A 14-year-old female high school cross country runner (height = 154 cm, mass = 48.1 kg) with no history of exertional heat stroke (EHS) collapsed at the end of a race. An athletic trainer (AT) assessed the patient, who presented with difficulty breathing then other signs of EHS (i.e. confusion, agitation). The patient was taken to the medical area, draped with a towel, and a rectal temperature (Tre) of 106.9°F(41.6°C) was obtained. The emergency action plan was activated and emergency medical services (EMS) were called. The patient was submerged in a cold-water immersion tub until EMS arrived (~15 minutes; Tre = 100.1°F; cooling rate: 0.41°F·min−1[0.25°C·min−1]). At the hospital, the patient received intravenous fluids, and urine and blood tests were normal. The patient was not admitted and returned to running without sequelae. Following best practices, AT's in secondary schools can prevent death from EHS by properly recognizing EHS and providing rapid cooling before transport.

Epidemiology of overuse injuries in U.S. secondary school athletics from 2014–2015 to 2018–2019 using the National Athletic Treatment, Injury and Outcomes Network Surveillance Program.

ABSTRACT Context: With 8 million annual participants in the United States, the epidemiology of sports-related injuries in high school athletics has garnered significant interest. The most recent studies examining overuse injury rates in high school sports reported data from 2012–2013 and therefore may not reflect current overuse injury rates in high school sports. Objective: To 1) to determine overuse time-loss (TL) and non-time-loss (NTL) injury rates among high school student athletes using NATION-SP data collected from 2014–2015 to 2018–2019 and 2) compare overuse injury rates based on student-athlete gender defined by sport, sport, and injury location. Design: Descriptive epidemiology study. Setting: Online injury surveillance from 211 high schools (345 individual years of high school data). Patients or Other Participants: Athletes participating in secondary school-sponsored boys' and girls' sports. Main Outcome Measures: Boys' and girls' overuse injury data from the National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) from the 2014–2015 to 2018–2019 school years were analyzed. Overuse injuries were identified using a combination of reported injury mechanism and diagnosis. TL injuries resulted in restriction from participation beyond the day of injury; a NTL injury did not result in restriction from participation beyond the day of injury or lost no time due to the injury. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs). Results: The overall overuse injury rate was 5.3/10,000 AEs (95%CI=5.1, 5.7), the NTL overuse injury rate was 3.4/10,000 AEs (95%CI=3.1, 3.6), and the TL overuse injury rate was 2.0/10,000 AEs (95%CI=1.8, 2.2). The overuse injury rate was greater in girls' sports compared to boys' sports (IRR=1.9; 95%CI=1.7, 2.1). The highest rates of overuse injury were reported in girls' cross-country (19.2/10,000 AEs; 95%CI=15.0, 24.2), girls' track and field (16.0/10,000 AEs; 95%CI=13.5, 18.8), and girls' field hockey (15.1/10,000 AEs; 95%CI=10.2, 21.6). Overuse injury rates were highest for the lower extremity compared to the upper extremity (IRR=5.7; 95%CI=4.9, 6.7) and for the lower extremity compared to the trunk and spine (IRR=8.9; 95%CI=7.3, 10.8). Conclusions: Awareness of overuse injury risk as well as prevention and intervention recommendations are necessary and should be specifically targeted towards cross-country, field hockey, and track and field athletes.

Talar Cartilage Deformation and Spatiotemporal Gait Patterns in Individuals with and without Chronic Ankle Instability.

ABSTRACT Context: Research has demonstrated individuals with chronic ankle instability (CAI) present with alterations in the compositional structure of the talar articular cartilage. These alterations likely influence how the talar cartilage responds to loading associated with activities of daily living, such as walking. Ultrasonography has emerged as an alternative imaging modality to assess the amount of cartilage deformation in response to loading because it can be clinically accessible and cost-effective for routine measurements. Objective: To compare talar cartilage deformation in response to a standardized exercise protocol between those with and without chronic ankle instability. Secondly, to examine the association between spatiotemporal walking gait parameters and cartilage deformation. Design: Case-control. Setting: Research Laboratory. Patients or Other Participants: A volunteer sample of 24 participants with self-reported CAI (age = 23.2 ± 3.9 years; BMI = 25.1 ± 3.7 kg/m2) and 24 un-injured controls (age = 24.3 ± 2.9 years; BMI = 22.9 ± 2.8 kg/m2). Main Outcome Measure(s): Spatiotemporal walking gait was first assessed from five self-selected trials using an electronic walkway with data sampled at 120Hz. An 8-to-13MHz linear-array ultrasound transducer placed transversely in line with the medial and lateral malleoli captured three images before and after a standardized loading protocol consisting of 30 single and double-limb squats, 2-minute single-limb balance and 10 single-leg drops from a 40cm height box. Results: After controlling for body mass index, participants with chronic ankle instability had greater deformation compared to the un-injured controls (p=0.034). No other significant between group differences were observed (p>0.05). No significant partial correlations were observed between talar cartilage deformation and spatiotemporal gait parameters when controlling for body mass index (p>0.05). Conclusions: Individuals with CAI had greater talar cartilage deformation in response to a standardized exercise protocol than controls. The amount of talar cartilage deformation was not associated with spatiotemporal walking gait.

Factorial Validity and Invariance of an Adolescent Depression Symptom Screening Tool

Context: Depression is among the most common mental health disorder in youth, results in significant impairment, and is associated with a higher risk of suicide. Screening is essential but assessment tools may not be appropriate across races or do not account for the complex interrelatedness of various demographics including gender, socio-economic status and race. Objectives: (1) To determine the factor structure of the Patient Health Questionnaire-Adolescent (PHQ-A) for measuring depression in a group of adolescent athletes; and (2) to determine measurement invariance between Blacks and Whites on the PHQ-A. Design: Retrospective cohort design. Setting: Data obtained from a secure database collected at a free, comprehensive, mass pre-participation physical exam (PPE) event hosted by a large health care system. Participants: Participants included 683 high school athletes (Black n=416; White n=267). Independent variables included somatic and affective factors contributing to the construct of depression measured by the PHQ-A and participant race (Black and White). Main Outcome Measures : (1) Factors upon which the construct of depression is measured and (2) measurement invariance between Blacks and Whites. Results: A two-factor model, including affective and somatic components, was specified and exhibited an adequate fit to the data (CFI> .90). All items exhibited moderate to high squared multiple correlation values (R2 = .10–.65), suggesting that these items resonated relatively well with participants. The two-factor model demonstrated noninvariance Black and White participants (RMSEA = .06-.08). Conclusions: Overall, the structure of the PHQ-A is supported by a two-factor model in adolescent athletes, measuring both affective and somatic symptoms of depression. A two factor PHQ-A structure is not fully invariant for the adolescents sampled across participant groups, implying that the model functions differently between Blacks and Whites sampled.

Trends in College Student-Athlete Mental Health in the National College Health Assessment (NCHA), 2011–2019

ABSTRACT Context: Recently the athletic training community has paid increased attention to college student-athlete mental health, treatment-seeking, and impacts on athletic and academic performance. Ongoing efforts to better-educate and equip athletic trainers to help student-athletes in this regard should result in improved mental health-related outcomes. Objective: Examine changes in student-athlete mental health over the past decade compared to non-athlete students. Design: Cross-sectional study. Setting: United States colleges and universities. Patients or Other Participants: Varsity athletes (n=54,479) and non-athlete students (n=448,301) who completed the National College Health Assessment (NCHA) between 2011 and 2019. Main Outcome Measures: Survey responses (self-report) to questions in five mental health-related domains: symptoms, diagnoses, treatment-seeking, institutional information distribution, and academic impacts. Results: Student-athletes consistently reported significantly lower symptom and diagnose rates than non-athletes, except for attempted suicide, substance abuse, and eating disorders. Diagnoses increased over time in both groups, but remained lower in athletes. Treatment-seeking and openness to future treatment increased over time in both groups, but remained lower in athletes. Student-athletes received more information on stress reduction, substance abuse, eating disorders, and handling distress/violence than non-athletes. Both groups received information more frequently over time. Athletes reported lower academic impacts, especially for depression and anxiety, but impacts grew over time in both groups. Impacts of injuries and extracurricular activities on academic performance were higher in athletes than in non-athletes. Conclusions: Athletes reported overall lower levels of symptoms, diagnoses, and academic impacts than non-athletes. While non-athlete rates climbed over the past decade, athletes' rates broadly remained flat or climbed less rapidly. Increasingly positive attitudes toward treatment are encouraging, but the deficit relative to non-athletes remains. Ongoing efforts of athletic trainers to educate athletes and guide them to mental health resources are needed in order to continue (or, better yet, accelerate) the observed positive trends in information dissemination and treatment-seeking.

Quantification method influences training load change in high school cross-country runners across a competitive season

Context: Running programs traditionally monitor external loads (e.g., time, distance). There has been a recent movement to encompass a more comprehensive approach to also monitor training loads that account for internal loads (e.g., intensity, measured as session rating of perceived exertion [sRPE]). The combination of an external and internal load accounts for the potential interaction between these loads. While differences in weekly change in training loads have been reported between external loads and the combination of an external and internal load during 2- and 4-week training cycles, there are no reports whether these differences are apparent during an entire cross-country season in high school runners. Objective: To compare change in training loads, as measured by external loads and combinations of an external and internal load, in high school runners during an interscholastic cross-country season. Design: Case-series. Setting: Community-based with daily online surveys. Participants: Twenty-four high school cross-country runners (female=14, male=10, age=15.9±1.1 years, running experience=9.9±3.2 years). Main Outcome Measure(s): Week-to-week percent change in training load when measured by external loads (time, distance) and the combination of an external and internal load (timeRPE, distanceRPE). Results: Overall, the average weekly change was 7.1% greater for distanceRPE compared to distance (p=.04, d=0.18). When decreasing weekly running duration, the average weekly change was 5.2% greater for distanceRPE compared to timeRPE (p=.03, d=0.24). When maintaining or increasing weekly running duration, the average weekly change was 10–15% greater when an external load was combined with an internal load compared to external loads alone, but these differences were non- significant (p=.11–.22, d=0.19–0.34). Conclusions: Our results demonstrate that progression in training load may be underestimated when relying solely on external loads. The interaction between internal loads (sRPE) and external loads (distance or time) appears to provide a different measure of training stresses experienced by runners than external loads alone.