Sep 5, 2017
Getting Through
Heather L. Clemons

A new educational program is arming high school athletes with knowledge about catastrophic injuries and spreading awareness about the sports medicine profession at the same time.

This article first appeared in the September 2017 issue of Training & Conditioning.

At first, it looked like a typical tough collision. It wasn’t.

It was spring 2009, and high school senior Tommy Mallon was playing in his final lacrosse game. While pursuing a ground ball, Mallon took a seemingly routine hit from an opponent and went down. He tried to get up and shake it off, but a teammate encouraged him to stay down while he called for the athletic trainer. Once she got to Mallon, she recognized the severity of the situation and insisted he remain on the ground. It was a good thing she did.

Mallon was later diagnosed with a potentially catastrophic cervical fracture and a dissected vertebral artery. Although the injury was devastating, two factors saved Mallon’s life that day on the lacrosse field: his teammate’s awareness and the on-site care provided by the athletic trainer. Those factors also helped shape his next move.

Inspired by the experience, Mallon created the nonprofit Advocates for Injured Athletes (A4IA) in 2010 with his mother, Beth Mallon. The group’s mission is to “promote sports safety and provide essential support, education, and resources to help keep athletes safe.”

A4IA accomplishes these goals primarily through its flagship program, Athletes Saving Athletes™ (ASA™), which was founded in 2012. This educational initiative enrolls athletic trainers to teach high school student-athletes how to recognize and respond to the signs and symptoms of potentially life-threatening sports-related injuries-just like Mallon’s teammate did. They are then encouraged to spread this knowledge to their teammates and coaches.

But ASA is about more than just finding a unique way to improve athletes’ understanding of sports injuries. Because Mallon’s athletic trainer was vital in keeping him alive, ASA is dedicated to raising awareness for the athletic training profession and the role these clinicians play in keeping athletes safe.

Based in San Diego and serving areas of Indiana and New Hampshire, ASA has touched the lives of 8,000 student-athletes so far. Its dual purpose makes it especially pertinent to the high school setting, and it’s a model that many athletic trainers can learn from.

THE PROGRAM

The core of ASA is a two-hour peer-to-peer education session taught by certified athletic trainers. It’s open to all schools in the San Diego area, as well as designated schools in both Indiana and New Hampshire. Certain medical organizations in these latter two states have signed agreements with A4IA to bring ASA to the schools for which they provide athletic training services.

Once a school reaches out to A4IA, co-founder Beth Mallon meets with its administrators to ensure they can support the tenets of ASA. Coaches and teachers from the school then nominate student-athletes to participate in the program, and most courses generally include 50 to 60 athletes.

The ASA curriculum focuses on four areas: head and neck injuries, concussions, exertional heat illness, and sudden cardiac arrest. These are highlighted because they are the most common life-threatening conditions athletes may face during competition and training.

In fact, according to 2012 data published by the Centers for Disease Control, 329,290 adolescent athletes visit the emergency department annually with a traumatic brain injury, concussion, or other head/neck injury. Meanwhile, some of the latest statistics indicate that the risk for sudden cardiac death is two to three times higher in athletes. And exertional heat illness can result in a spectrum of conditions-the most severe of which, exertional heat stroke, can be fatal. When athletes know how to recognize these conditions and tell an appropriate adult-ideally, an athletic trainer, but it can be a coach or parent-it can mean the difference between life and death.

During each ASA session, participants are educated about the four previously mentioned injuries through an interactive presentation that includes videos and group activities. Some of the group activities may involve athletes listing what they believe to be signs and symptoms of a concussion, sharing their personal experiences with a serious injury, or comparing glasses of lemonade and iced tea to learn about dehydration via urine color.

One of the program’s most compelling elements involves participants hearing the personal accounts of three athletes who survived potentially catastrophic injuries: Tommy Mallon (head and neck injury), Brittan Sutphin (a swimmer who suffered sudden cardiac arrest), and William James (a football player who experienced exertional heat stroke). Each of these athletes has worked closely with A4IA to develop a video that tells their story and highlights the key facts about recognizing their condition. While ASA is always taught with a positive lens, participants are reminded of how dangerous these injuries can be by also hearing about student-athletes who did not survive them, such as Matthew Alan Gfeller (a football player who suffered second impact syndrome), Eric Paredes (a wrestler who succumbed to sudden cardiac arrest), and Tyler Davenport (a football player who died from exertional heat illness).

The concussion discussion is usually one of the livelier portions of the ASA program. Given the press regarding head injuries in sports, there is often a long conversation about what really constitutes a concussion, myths surrounding head injuries, and the falsehood that “getting your bell rung” is not a concussion.

While athletes are engaged with this topic, we use this opportunity to promote ASA’s “Speak Up” campaign, which encourages athletes to report concussion symptoms. From this, student-athletes learn that concussions are serious injuries and often ask thoughtful questions about how to deal with friends and teammates who may be hiding symptoms of a head injury. In the end, many come to the difficult conclusion that it’s much more important to report a friend’s symptoms and protect them from a potentially severe injury than to keep silent.

After the educational session, there is an interactive portion of ASA that includes teaching participants Hands-Only CPR and how to use an automated external defibrillator (AED). In addition, athletes are informed of the emergency action plan details for their school so they can be more effective during a crisis. This includes knowing the athletic trainer’s hours, where their school’s AED is located, and where to find emergency supplies.

ATHLETIC TRAINERS IN CHARGE

A hallmark of ASA-and part of what sets it apart from other athlete education initiatives-is that it’s only taught by certified athletic trainers. These clinicians were tapped for ASA because of their specific training and expertise in prevention, recognition, and management of sports-related injuries.

Currently, we have a designated group of athletic trainers who facilitate ASA in San Diego, Indiana, and New Hampshire. Many of them were approached to teach ASA because they were already very active in educating their local community about athlete safety. Others were recommended to A4IA as faculty for the program.

Once selected, athletic trainers in the San Diego area spend time learning the ASA curriculum. Then, for their first few courses, they are paired with another athletic trainer who has previously taught the material. After that, they can teach the content alone and mentor others who are just becoming involved in the program. Our athletic trainer facilitators in New Hampshire and Indiana are trained via an online meeting that includes a review of the curriculum, as well as tips on how to teach the course.

Whenever possible, athletic trainers at participating schools are present during ASA sessions, even if they are not facilitating them. This improves the trust between the athletes and the athletic trainer, making it easier for athletes to report symptoms of injury when necessary. If the school’s athletic trainer is not familiar with the ASA curriculum, we give them a copy prior to the course so they can prepare.

All in all, the ASA program serves to supplement what most athletic trainers are already doing to educate athletes. The key difference is the use of a peer-to-peer education model. It’s not just an expert teaching athletes-it’s athletes learning together from the powerful stories of people who are just like them. This makes the lessons more meaningful and effective.

SPREADING THE KNOWLEDGE

Once a student-athlete completes the ASA course, they are designated as an ASA Ambassador. Then, they can educate others within their school community about sports safety and help athletic trainers by recognizing the signs and symptoms of serious injuries.

To make this easier, A4IA provides the Ambassadors with information cards and posters to share. A4IA also typically follows up with the school’s athletic trainer, if available, to ensure coaches have provided Ambassadors the time they need to meet with teams.

The ongoing education provided by ASA has resulted in a safer athletics community and is slowly changing the “tough it out” culture of sports. These are a few examples of the positive impacts ASA Ambassadors have had:

• Two different San Diego Ambassadors have utilized Hands-Only CPR on community members in distress, helping save their lives.

• Under the direction of an athletic trainer, ASA Ambassadors retrieved an AED to help a teacher at a San Diego high school who went into cardiac arrest at an athletic event.

• After completing the ASA program, a San Diego high school quarterback reported concussion symptoms that he had been hiding to his school’s athletic trainer.

• Two Ambassadors in New Hampshire recognized a potential catastrophic injury and ensured the athletes involved received proper care.

The athlete-focused ASA programs have been so successful that there have been cases where coaches, parents, and other community members have requested to participate in a course. This typically happens when adults who sit in on the initial ASA session realize they could benefit from the education, too.

The curriculum for adult groups is the same as the one used for student-athletes. Most often, the adults want to know how they can be better prepared for sports-related emergencies and respond properly if they do occur. In addition, for those who don’t work regularly with an athletic trainer, the ASA session provides a clear understanding of the value athletic trainers can bring.

EMPHASIS ON ADVOCACY

This latter benefit of the adult-oriented ASA courses points to an important overarching goal of the program: promoting and expanding the athletic training profession. According to the latest research published by the Journal of Athletic Training, nearly 70 percent of public high schools and 58 percent of private schools provide some level of sports medicine coverage at practices and games, but only 37 percent and 28 percent have at least one full-time athletic trainer. Through ASA, A4IA is hoping to change that.

Bringing ASA to a school is a powerful tool because it raises the community’s awareness of the athletic training profession and gives athletic trainers the chance to show how their education and experience makes schools safer. After all, athletic trainers are their own best advocates. They are intimately familiar with the needs of their schools and have a keen understanding of barriers that can prevent them from providing a more complete sports medicine program.

A4IA fights for athletic trainers, as well. Through ASA and other programming, the organization pushes to make athletic administrators, league organizers, parents, coaches, and athletes aware of the important role athletic trainers play in improving overall sports safety.

In addition, A4IA has brought ASA to the students in San Diego State University’s Athletic Training Education Program. They learned what A4IA is doing to support the sports medicine profession and can now spread awareness of ASA once they became professionals.

Co-founder Beth Mallon has found other avenues for advocacy. She has spoken through various outlets about the importance of athletic trainers, including an appearance in front of the California state legislature to support efforts for athletic trainer licensure. She’s also served as a guest speaker at various sports safety educational and policy conferences. Her work continues with local organizations, such as the University of California, San Diego sports medicine program and concussion clinic. UCSD serves as the group’s local hospital partner and provides funding for the take-home materials that ASA Ambassadors receive after they complete the course.

Looking to the future, A4IA will continue to promote athlete safety and support the athletic training profession via the ASA program. In turn, athletic trainers can embrace these efforts by being outspoken advocates for sports safety with their own athletes, in their local communities, and across the country.

To learn more about ASA or to find out how to bring the program to your school, contact A4IA at [email protected] or 858-361-6553.

To view the references for this article, go to Training-Conditioning.com/References.

CLOSE TO HOME

The Athletes Saving Athletes™ (ASA™) program from Advocates for Injured Athletes (A4IA) has fostered a growing community of people who value sports safety and advocate for the availability of licensed athletic trainers at all high schools. This has been particularly important in the organization’s home state of California, which is the only state without licensure for athletic trainers.

According to Jason Bennett, DA, ATC, President of the California Athletic Trainers’ Association, over 750 schools in the state do not have athletic trainers. Of those that do, the California Interscholastic Federation has identified 145 schools that employ an athletic trainer who does not hold the ATC credential, potentially jeopardizing the health and safety of 80,000 student-athletes.

However, efforts are underway to see this changed. Assembly Bill 1510, currently under consideration, would require every athletic trainer in the state to hold a license.

The improved awareness provided by A4IA and the ASA program has helped pressure California legislators to act in the best interest of student-athletes across the state by passing this bill. Beyond pushing for the legislation, A4IA is hoping to mediate the significant safety risk for California high school athletes through the ASA program, its athletic trainer advocates, and its student Ambassadors.


Heather L. Clemons, MS, MBA, ATC, is a member of the Outreach Advisory Board for Advocates for Injured Athletes and serves as the Lead CME Associate for Sharp HealthCare in San Diego. Previously, she spent eight years as the Clinical Coordinator for Hofstra University's Athletic Training Education Program. She can be reached at: [email protected]
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