Helmetless Tackling Training Intervention and Preseason Self-efficacy Effects on Head Impacts in Hawai'i High School Football.

OBJECTIVE: To determine how football head impacts are influenced by self-efficacy (SE), helmetless tackling intervention participation (IP), and years of experience (YE) playing football. DESIGN: Cross-sectional. SETTING: Three high schools. PARTICIPANTS: 120 (male; n = 118, female; n = 2, 15.57 ± 1.23 years) participants were recruited from 5 high school teams (3 varsity and 2 junior-varsity). INDEPENDENT VARIABLES: SE, days of IP, and YE playing tackle football. MAIN OUTCOME MEASURES: SE was measured using a 53-question survey and categorized into 5 subscales. The accumulation of total head impacts (THI) was measured using Riddell InSite Speedflex helmets (Elyria, OH) throughout the season. Head impact exposure (HIE) was standardized as a ratio of impacts per session (games, scrimmages, and practices). Multiple regression analyses tested the relationship between THI or HIE with the predictor variables. RESULTS: For THI, 22.1% was explained by the predictors (r = 0.470, r2 = 0.221). Intervention participation had a negative correlation (B = -4.480, P = 0.019), whereas confidence in performing proper tackling and blocking (SE1) (B = 3.133, P = 0.010) and >8 YE (B = 135.9, P = 0.009) positively correlated with THI. For HIE, 25.4% was explained by the predictors (r = 0.504, r2 = 0.254). Intervention participation negatively correlated (B = -0.077, P = 0.007), whereas SE1 (B = 3.133, P = 0.010) and >8 YE (B = 2.735, P ≤ 0.001) correlated positively with HIE. CONCLUSIONS: Increased head impacts were associated with less helmetless tackling participation, more than 8 YE, and more self-confidence in tackling ability. Increasing the amount of time athletes spend practicing proper tackling and blocking techniques to reduce head first and risky play is warranted to reduce the amount of head impacts received over time.

Head Impact Exposure in Hawaiian High School Football: Influence of Adherence Rates on a Helmetless Tackling and Blocking Training Intervention.

CONTEXT: High school football remains a popular, physically demanding sport despite the known risks for acute brain and neck injury. Impacts to the head also raise concerns about their cumulative effects and long-term health consequences. OBJECTIVE: To examine the effectiveness of a helmetless tackling training program to reduce head impact exposure in football participants. DESIGN: A three-year, quasi-experimental, prospective cohort (clinicaltrials.gov #NCTXXX) study. SETTING: Honolulu (XXX, XXX) area public and private secondary schools with varsity and junior varsity football. PATIENTS OR OTHER PARTICIPANTS: Football participants (n=496) ages 14 to 18 years old. Intervention(s) Participants wore new football helmets furnished with head impact sensor technology. Teams employed a season-long helmetless tackling and blocking intervention in Years 2 and 3 consisting of a 3-phase, systematic progression of 10 instructional drills. MAIN OUTCOME MEASURE(S): Head impact frequency per athlete exposure (ImpAE), location, and impact magnitude per participant intervention adherence levels (60% and 80%). RESULTS: An overall regression analysis revealed a significant negative association between ImpAE and adherence (p=0.003, beta=-1.21, SE=0.41). In year 3, a longitudinal data analysis of weekly ImpAE data resulted in an overall difference between the adherent and non-adherent groups (p=0.040 at 80%; p=0.004 at 60%), mainly due to decreases in top and side impacts. Mean cumulative impact burden for the adherent group (n=131: 2,105.84g ± 219.76,) was significantly (p=0.020) less than the non-adherent group (n=90: 3,158.25g ± 434.80) at the 60% adherence level. CONCLUSIONS: Participants adhering to the intervention on at least a 60% level experienced a 34% to 37% significant reduction in the number of head impacts (per exposure) through the season. These results provide additional evidence that a helmetless tackling and blocking training intervention (utilizing the HuTT® program) reduces head impact exposure in high school football players. Adherence to an intervention is crucial for achieving intended outcomes.

National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players.

OBJECTIVE: To provide evidence-based recommendations for reducing the prevalence of head-first contact behavior in American football players with the aim of reducing the risk of head and neck injuries. BACKGROUND: In American football, using the head as the point of contact is a persistent, well-documented, and direct cause of catastrophic head and cervical spine injury. Equally concerning is that repeated head-impact exposures are likely to result from head-first contact behavior and may be associated with long-term neurocognitive conditions such as dementia, depression, and chronic traumatic encephalopathy. CONCLUSIONS: The National Athletic Trainers' Association proposes 14 recommendations to help the certified athletic trainer, allied health care provider, coach, player, parent, and broader community implement strategies for reducing the prevalence of head-first contact in American football.

Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury.

INTRODUCTION: Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. METHODS: A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique (NGT) meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. RESULTS: The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the NGT meeting created and refined conclusions and recommendations until consensus was achieved. CONCLUSIONS: These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.

Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury.

INTRODUCTION: Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. METHODS: A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. RESULTS: The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved. CONCLUSIONS: These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.

Implementation study of a 5-component pediatric early warning system (PEWS) in an emergency department in British Columbia, Canada, to inform provincial scale up.

BACKGROUND: The rapid identification of deterioration in the pediatric population is complex, particularly in the emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition of clinical deterioration and provide a structured process for the reassessment and escalation of care. The objective of the study was to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS implemented in the ED of an urban public general hospital in British Columbia, Canada, and to guide provincial scale up. METHODS: We used a before-and-after design to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS (pediatric assessment flowsheet, PEWS score, situational awareness, escalation aid, and communication framework). Sources of data included patient medical records, surveys of direct care staff, and key-informant interviews. Data were analyzed using mixed-methods approaches. RESULTS: The majority of medical records had documented PEWS scores at triage (80%) and first bedside assessment (81%), indicating that the intervention was implemented with high fidelity. The intervention was effective in increasing vital signs documentation, both at first beside assessment (84% increase) and throughout the ED stay (> 100% increase), in improving staff's self-perceived knowledge and confidence in providing pediatric care, and self-reported communication between staff. Satisfaction levels were high with the PEWS scoring system, flowsheet, escalation aid, and to a lesser extent with the situational awareness tool and communication framework. Reasons for dissatisfaction included increased paperwork and incidence of false-positives. Overall, the majority of providers indicated that implementation of PEWS and completing a PEWS score at triage alongside the Canadian Triage and Acuity Scale (CTAS) added value to pediatric care in the ED. Results also suggest that the intervention is aligned with current practice in the ED. CONCLUSION: Our study shows that high-fidelity implementation of PEWS in the ED is feasible. We also show that a multi-component PEWS can be effective in improving pediatric care and be well-accepted by staff. Results and lessons learned from this pilot study are being used to scale up implementation of PEWS in ED settings across the province of British Columbia.

A helmetless-tackling intervention in American football for decreasing head impact exposure: A randomized controlled trial.

OBJECTIVES: To evaluate a behavioral intervention to reduce head impact exposure in youth playing American football. DESIGN: Nested randomized controlled trial. METHODS: Participants, ages 14-17 years, wore head impact sensors (SIM-G™) during two seasons of play. Those randomized to the intervention group underwent weekly tackling/blocking drills performed without helmets (WoH) and shoulder pads while the control group trained as normal, matching frequency and duration. Research personnel provided daily oversight to maintain fidelity. Head impact frequency (≥10g) per athlete exposure (ImpAE) was analyzed over time (two 11-week seasons) using mixed effect models or ANCOVA. Secondary outcomes included exposure-type (training, game) and participation level (entry-level versus upper-level secondary education). RESULTS: One-hundred fifteen participants (59 WoH, 56 control) met compliance criteria, contributing 47,382 head impacts and 10,751 athlete exposures for analysis. WoH had fewer ImpAE during games compared to control participants at weeks 4 (p=0.0001 season 1, p=0.0005 season 2) and 7 (p=0.0001 both seasons). Upper-level WoH participants had less ImpAE during games than their matched controls at weeks 4 (p=0.017 and p=0.026) and 7 (p=0.037 and p=0.014) in both seasons, respectively. Upper-level WoH also had fewer ImpAE during training at week 7 (p=0.015) in season one. CONCLUSIONS: Tackling and blocking drills performed without a helmet during training reduced the frequency of head impacts during play, especially during games. However, these differences disappeared by the end of the season. Future research should explore the frequency of behavioral intervention and a dose-response relationship considering years of player experience. TRIAL REGISTRATION: ClinicalTrials.gov # NCT02519478.

Cervical spine trauma: prevention strategies.

Participation in any sport activity carries risk of cervical spine trauma, but certain activities have a higher risk than others, and hence, demand concerted efforts in developing prevention strategies. Prevention often includes efforts surrounding education of stakeholders, creating or modifying rules, and specific policies adopted for decreasing such risk. Stakeholders include sport clinicians, participants, coaches, parents, league administrators, officials, and the public. Thus, both athlete-specific and setting-specific factors must be considered and controlled to the extent possible for a multipronged approach for decreasing cervical spine injury risk. The effectiveness of certain strategies put into place in collision sports, such as American football, rugby, and ice hockey, is reviewed to illustrate this approach. Some research evidence exists that either has informed a strategy, or validated its effectiveness after the fact. More research of a higher level needs to be conducted in all sports to continue to contain the risk of cervical spine trauma to the fullest extent possible.

Delivering Chest Compressions and Ventilations With and Without Men's Lacrosse Equipment.

CONTEXT: Current management recommendations for equipment-laden athletes in sudden cardiac arrest regarding whether to remove protective sports equipment before delivering cardiopulmonary resuscitation are unclear. OBJECTIVE: To determine the effect of men's lacrosse equipment on chest compression and ventilation quality on patient simulators. DESIGN: Cross-sectional study. SETTING: Controlled laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-six licensed athletic trainers (18 women, 8 men; age = 25 ± 7 years; experience = 2.1 ± 1.6 years). INTERVENTION(S): In a single 2-hour session, participants were block randomized to 3 equipment conditions for compressions and 6 conditions for ventilations on human patient simulators. MAIN OUTCOME MEASURE(S): Data for chest compressions (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of optimal compressions) and ventilations (ventilation rate, mean ventilation volume, and percentage of ventilations delivering optimal volume) were analyzed within participants across equipment conditions. RESULTS: Keeping the shoulder pads in place reduced mean compression depth (all P values < .001, effect size = 0.835) and lowered the percentages of both correctly released compressions ( P = .02, effect size = 0.579) and optimal-depth compressions (all P values < .003, effect size = 0.900). For both the bag-valve and pocket masks, keeping the chinstrap in place reduced mean ventilation volume (all P values < .001, effect size = 1.323) and lowered the percentage of optimal-volume ventilations (all P values < .006, effect size = 1.038). Regardless of equipment, using a bag-valve versus a pocket mask increased the ventilation rate (all P values < .003, effect size = 0.575), the percentage of optimal ventilations (all P values < .002, effect size = 0.671), and the mean volume ( P = .002, effect size = 0.598) across all equipment conditions. CONCLUSIONS: For a men's lacrosse athlete who requires cardiopulmonary resuscitation, the shoulder pads should be lifted or removed to deliver chest compressions. The facemask and chinstrap, or the entire helmet, should be removed to deliver ventilations, preferably with a bag-valve mask.

Prehospital Cervical Spine Motion: Immobilization Versus Spine Motion Restriction.

OBJECTIVE: This study aims to evaluate the efficacy of two different spinal immobilization techniques on cervical spine movement in a simulated prehospital ground transport setting. METHODS: A counterbalanced crossover design was used to evaluate two different spinal immobilization techniques in a standardized environment. Twenty healthy male volunteers (age = 20.9 ± 2.2 yr) underwent ambulance transport from a simulated scene to a simulated emergency department setting in two separate conditions: utilizing traditional spinal immobilization (TSI) and spinal motion restriction (SMR). During both transport scenarios, participants underwent the same simulated scenario. The main outcome measures were cervical spine motion (cumulative integrated motion and peak range of motion), vital signs (heart rate, blood pressure, oxygen saturation), and self-reported pain. Vital signs and pain were collected at six consistent points throughout each scenario. RESULTS: Participants experienced greater transverse plane cumulative integrated motion during TSI compared to SMR (F1,57 = 4.05; P = 0.049), and greater transverse peak range of motion during participant loading/unloading in TSI condition compared to SMR (F1,57 = 17.32; P < 0.001). Pain was reported by 40% of our participants during TSI compared to 25% of participants during SMR (χ2 = 1.29; P = 0.453). CONCLUSIONS: Spinal motion restriction controlled cervical motion at least as well as traditional spinal immobilization in a simulated prehospital ground transport setting. Given these results, along with well-documented potential complications of TSI in the literature, SMR is supported as an alternative to TSI. Future research should involve a true patient population.

Asymmetry of lower extremity force and muscle activation during knee extension and functional tasks.

INTRODUCTION: Strength and power asymmetries of >10% may negatively impact physical function. METHODS: Twenty-four healthy participants, 30-60 years of age, were assessed for muscle power asymmetry during isokinetic knee extension and ground reaction force asymmetry during chair-rise and vertical jump tasks. Neuromuscular activation asymmetry and coactivation of vastus lateralis (VL) and biceps femoris (BF) were assessed in each condition. Symmetric (SG) and asymmetric (AG) groups were identified using a 10% knee extension power asymmetry criterion. RESULTS: The AG had greater chair-rise rate of force development asymmetry (P = 0.003, d = 1.29), but a similar chair-rise and vertical jump peak force asymmetry as the SG. Large group effects were found for VL activation asymmetry during knee extension (P = 0.047, d = 0.87), BF activation asymmetry during vertical jump (P = 0.015, d = 1.12), and strong leg coactivation during vertical jump (P = 0.028, d = 0.96). CONCLUSIONS: Compensation for muscle power asymmetry may occur during functional tasks, potentially through differential activation of strong and weak leg muscles. Muscle Nerve 56: 495-504, 2017.

Football Equipment Removal Improves Chest Compression and Ventilation Efficacy.

OBJECTIVE: Airway access recommendations in potential catastrophic spine injury scenarios advocate for facemask removal, while keeping the helmet and shoulder pads in place for ensuing emergency transport. The anecdotal evidence to support these recommendations assumes that maintaining the helmet and shoulder pads assists inline cervical stabilization and that facial access guarantees adequate airway access. Our objective was to determine the effect of football equipment interference on performing chest compressions and delivering adequate ventilations on patient simulators. We hypothesized that conditions with more football equipment would decrease chest compression and ventilation efficacy. METHODS: Thirty-two certified athletic trainers were block randomized to participate in six different compression conditions and six different ventilation conditions using human patient simulators. Data for chest compression (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of adequate compressions) and ventilation (total ventilations, mean ventilation volume, and percentage of ventilations delivering adequate volume) conditions were analyzed across all conditions. RESULTS: The fully equipped athlete resulted in the lowest mean compression depth (F5,154 = 22.82; P < 0.001; Effect Size = 0.98) and delivery of adequate compressions (F5,154 = 15.06; P < 0.001; Effect Size = 1.09) compared to all other conditions. Bag-valve mask conditions resulted in delivery of significantly higher mean ventilation volumes compared to all 1- or 2-person pocketmask conditions (F5,150 = 40.05; P < 0.001; Effect Size = 1.47). Two-responder ventilation scenarios resulted in delivery of a greater number of total ventilations (F5,153 = 3.99; P = 0.002; Effect Size = 0.26) and percentage of adequate ventilations (F5,150 = 5.44; P < 0.001; Effect Size = 0.89) compared to one-responder scenarios. Non-chinstrap conditions permitted greater ventilation volumes (F3,28 = 35.17; P < 0.001; Effect Size = 1.78) and a greater percentage of adequate volume (F3,28 = 4.85; P = 0.008; Effect Size = 1.12) compared to conditions with the chinstrap buckled or with the chinstrap in place but not buckled. CONCLUSIONS: Chest compression and ventilation delivery are compromised in equipment-intense conditions when compared to conditions whereby equipment was mostly or entirely removed. Emergency medical personnel should remove the helmet and shoulder pads from all football athletes who require cardiopulmonary resuscitation, while maintaining appropriate cervical spine stabilization when injury is suspected. Further research is needed to confirm our findings supporting full equipment removal for chest compression and ventilation delivery.

Head and Trunk Acceleration During Intermediate Transport on Medical Utility Vehicles.

OBJECTIVE: To compare head and trunk acceleration during transport on 2 medical utility vehicles. DESIGN: Within subject. SETTING: Controlled laboratory. PARTICIPANTS: Nineteen male volunteers (21.8 ± 1.4 years, 176.5 ± 5.5 cm, 90.3 ± 16.1 kg). INTERVENTIONS: Participants were secured to a spineboard and stretcher on the Husqvarna HUV 4421DXL ambulance (HUV) and modified John Deere Gator TH (Gator) and driven over synthetic field turf transitioning to concrete slab (interval 1) and concrete slab transitioning to natural grass (interval 2). Three-dimensional (x, y, and z) accelerometers recorded head and trunk acceleration. At each data point, acceleration of the trunk was subtracted from the acceleration of the head and the peak acceleration difference was determined. Independent variables were vehicle (HUV, Gator) and interval (interval 1, interval 2). MAIN OUTCOME MEASURES: The average peak acceleration differences in 3 directions (x, y, z) were analyzed using a 2-factor within analysis of variance (P ≤ 0.05). RESULTS: For x, Gator in interval 2 (28.34 ± 7.45 m/s/s) was greater than HUV in interval 2 (21.87 ± 6.28 m/s/s), and HUV (11.05 ± 3.29 m/s/s) and Gator (12.56 ± 4.32 m/s/s) in interval 1. The HUV in interval 2 was greater than HUV and Gator in interval 1. For z, Gator in interval 2 (22.12 ± 4.8 m/s/s) was greater than HUV in interval 2 (15.21 ± 2.84 m/s/s), and HUV (9.51 ± 3.01 m/s/s) and Gator (12.5 ± 3.78 m/s/s) in interval 1. The HUV in interval 2 was greater than HUV and Gator in interval 1. Gator in interval 1 was greater than HUV in interval 1. CONCLUSIONS: Varying head and trunk accelerations exist in healthy spine-boarded participants during transport on medical utility vehicles dependent on surface and vehicle type. CLINICAL RELEVANCE: Intermediate transport vehicles vary in their ability to mitigate perturbations conveyed to the patient from the terrain travelled over.

Early Results of a Helmetless-Tackling Intervention to Decrease Head Impacts in Football Players.

OBJECTIVE: To test a helmetless-tackling behavioral intervention for reducing head impacts in National Collegiate Athletic Association Division I football players. DESIGN: Randomized controlled clinical trial. SETTING: Football field. PATIENTS OR OTHER PARTICIPANTS: Fifty collegiate football players (intervention = 25, control = 25). INTERVENTION(S): The intervention group participated in a 5-minute tackling drill without their helmets and shoulder pads twice per week in the preseason and once per week through the season. During this time, the control group performed noncontact football skills. MAIN OUTCOME MEASURE(S): Frequency of head impacts was recorded by an impact sensor for each athlete-exposure (AE). Data were tested with a 2 × 3 (group and time) repeated-measures analysis of variance. Significant interactions and main effects (P < .05) were followed with t tests. RESULTS: Head impacts/AE decreased for the intervention group compared with the control group by the end of the season (9.99 ± 6.10 versus 13.84 ± 7.27, respectively). The intervention group had 30% fewer impacts/AE than the control group by season's end (9.99 ± 6.10 versus 14.32 ± 8.45, respectively). CONCLUSION: A helmetless-tackling training intervention reduced head impacts in collegiate football players within 1 season.

Cold-Water Immersion for Hyperthermic Humans Wearing American Football Uniforms.

CONTEXT: Current treatment recommendations for American football players with exertional heatstroke are to remove clothing and equipment and immerse the body in cold water. It is unknown if wearing a full American football uniform during cold-water immersion (CWI) impairs rectal temperature (Trec) cooling or exacerbates hypothermic afterdrop. OBJECTIVE: To determine the time to cool Trec from 39.5°C to 38.0°C while participants wore a full American football uniform or control uniform during CWI and to determine the uniform's effect on Trec recovery postimmersion. DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 18 hydrated, physically active, unacclimated men (age = 22 ± 3 years, height = 178.8 ± 6.8 cm, mass = 82.3 ± 12.6 kg, body fat = 13% ± 4%, body surface area = 2.0 ± 0.2 m(2)). INTERVENTION(S): Participants wore the control uniform (undergarments, shorts, crew socks, tennis shoes) or full uniform (control plus T-shirt; tennis shoes; jersey; game pants; padding over knees, thighs, and tailbone; helmet; and shoulder pads). They exercised (temperature approximately 40°C, relative humidity approximately 35%) until Trec reached 39.5°C. They removed their T-shirts and shoes and were then immersed in water (approximately 10°C) while wearing each uniform configuration; time to cool Trec to 38.0°C (in minutes) was recorded. We measured Trec (°C) every 5 minutes for 30 minutes after immersion. MAIN OUTCOME MEASURE(S): Time to cool from 39.5°C to 38.0°C and Trec. RESULTS: The Trec cooled to 38.0°C in 6.19 ± 2.02 minutes in full uniform and 8.49 ± 4.78 minutes in control uniform (t17 = -2.1, P = .03; effect size = 0.48) corresponding to cooling rates of 0.28°C·min(-1) ± 0.12°C·min(-1) in full uniform and 0.23°C·min(-1) ± 0.11°C·min(-1) in control uniform (t17 = 1.6, P = .07, effect size = 0.44). The Trec postimmersion recovery did not differ between conditions over time (F1,17 = 0.6, P = .59). CONCLUSIONS: We speculate that higher skin temperatures before CWI, less shivering, and greater conductive cooling explained the faster cooling in full uniform. Cooling rates were considered ideal when the full uniform was worn during CWI, and wearing the full uniform did not cause a greater postimmersion hypothermic afterdrop. Clinicians may immerse football athletes with hyperthermia wearing a full uniform without concern for negatively affecting body-core cooling.

Emergent Access to the Airway and Chest in American Football Players.

CONTEXT: American football has the highest rate of fatalities and catastrophic injuries of any US sport. The equipment designed to protect athletes from these catastrophic events challenges the ability of medical personnel to obtain neutral spine alignment and immobilization during airway and chest access for emergency life-support delivery. OBJECTIVE: To compare motion, time, and difficulty during removal of American football helmets, face masks, and shoulder pads. DESIGN: Quasi-experimental, crossover study. SETTING: Controlled laboratory. PATIENTS OR OTHER PARTICIPANTS: We recruited 40 athletic trainers (21 men, 19 women; age = 33.7 ± 11.2 years, height = 173.1 ± 9.2 cm, mass = 80.7 ± 17.1 kg, experience = 10.6 ± 10.4 years). INTERVENTION(S): Paired participants conducted 16 trials in random order for each of 4 helmet, face-mask, and shoulder-pad combinations. An 8-camera, 3-dimensional motion-capture system was used to record head motion in live models wearing properly fitted helmets and shoulder pads. MAIN OUTCOME MEASURE(S): Time and perceived difficulty (modified Borg CR-10). RESULTS: Helmet removal resulted in greater motion than face-mask removal, respectively, in the sagittal (14.88°, 95% confidence interval [CI] = 13.72°, 16.04° versus 7.04°, 95% CI = 6.20°, 7.88°; F(1,19) = 187.27, P < .001), frontal (7.00°, 95% CI = 6.47°, 7.53° versus 4.73°, 95% CI = 4.20°, 5.27°; F1,19 = 65.34, P < .001), and transverse (7.00°, 95% CI = 6.49°, 7.50° versus 4.49°, 95% CI = 4.07°, 4.90°; F(1,19) = 68.36, P < .001) planes. Face-mask removal from Riddell 360 helmets took longer (31.22 seconds, 95% CI = 27.52, 34.91 seconds) than from Schutt ION 4D helmets (20.45 seconds, 95% CI = 18.77, 22.12 seconds) or complete ION 4D helmet removal (26.40 seconds, 95% CI = 23.46, 29.35 seconds). Athletic trainers required less time to remove the Riddell Power with RipKord (21.96 seconds, 95% CI = 20.61°, 23.31° seconds) than traditional shoulder pads (29.22 seconds, 95% CI = 27.27, 31.17 seconds; t(19) = 9.80, P < .001). CONCLUSIONS: Protective equipment worn by American football players must eventually be removed for imaging and medical treatment. Our results fill a gap in the evidence to support current recommendations for prehospital emergent management in patients wearing protective football equipment. Helmet face masks and shoulder pads with quick-release designs allow for clinically acceptable removal times without inducing additional motion or difficulty.

A novel sensorimotor movement and walking intervention to improve balance and gait in women.

PURPOSE: This study evaluated the effectiveness of a 5-day mind-body exercise (MBE) program on measures of quality of life, balance, balance confidence, mobility and gait in community-dwelling women. METHODS: The MBE program was a 5-day retreat where multiple sessions of Feldenkrais(®)-based sensorimotor movement training and walking were performed daily. Forty-six women aged 40-80 years old participated in either the MBE program or maintained normal daily activity. Two-footed eyes-closed balance, gait characteristics, mobility via the Timed Up and Go test, balance confidence and quality of life were assessed before and after the intervention. RESULTS: Women in the MBE group experienced improvements in mobility (6%; p = 0.01), stride length (3%; p = 0.008), single limb support time (1.3%; 0.006), balance confidence (5.2%; p < 0.001) and quality of life (p < 0.05) while the control group did not change. CONCLUSION: This short-term intensive program may be beneficial to women at risk of mobility limitations.

Face mask removal is safer than helmet removal for emergent airway access in American football.

BACKGROUND CONTEXT: In cases of possible cervical spine injury, medical professionals must be prepared to achieve rapid airway access while concurrently restricting cervical spine motion. Face mask removal (FMR), rather than helmet removal (HR), is recommended to achieve this. However, no studies have been reported that compare FMR directly with HR. PURPOSE: The purpose of this study was to compare motion, time, and perceived difficulty in two commonly used American football helmets between FMR and HR techniques, and when helmet air bladders were deflated before HR compared with inflated scenarios. STUDY DESIGN/SETTING: The study incorporated a repeated measures design and was performed in a controlled laboratory setting. PARTICIPANTS: Participants included 22 certified athletic trainers (15 men and seven women; mean age, 33.9±10.5 years; mean experience, 11.4±10.0 years; mean height, 172±9.4 cm; mean mass, 76.7±14.9 kg). All participants were free from upper extremity or central nervous system pathology for 6 months and provided informed consent. OUTCOME MEASURES: Dependent variables included head excursion in degrees (computed by subtracting the minimum position from the maximum position) in each of the three planes (sagittal, frontal, transverse), time to complete the required task, and ratings of perceived exertion. To address our study purposes, we used two-by-two repeated-measures analysis of variance (removal technique×helmet type, helmet type×deflation status) for each dependent variable. METHODS: Independent variables consisted of removal technique (FMR and HR), helmet type (Riddell Revolution IQ [RIQ] and VSR4), and helmet deflation status (deflated [D], inflated, [I]). After familiarization, participants conducted two successful trials for each of six conditions in random order (RIQ-FMR, VSR4-FMR, RIQ-HR-D, VSR4-HR-D, RIQ-HR-I, and VSR4-HR-I). Face masks, helmets, and shoulder pads were removed from a live model wearing a properly fitted helmet and shoulder pads. The participant and an investigator stabilized the model's head. A six-camera three-dimensional motion system and a three-point one-segment marker set were used to record motion of the head. RESULTS: Face mask removal resulted in less motion in all three planes, required less completion time, and was easier to perform than HR. The RIQ helmet resulted in less frontal plane motion and less time to task completion, and was easier to remove than VSR4 helmets. Inflated helmets-regardless of helmet type-required less removal time but did not result in greater cervical spine motion or difficulty. CONCLUSIONS: It is safer to remove the face mask in the prehospital setting for the potential spine-injured American football player than to remove the helmet, based on results from both a traditional and newer football helmet designs. Deflating the air bladder inside the helmet does not provide an advantage.

National athletic trainers' association position statement: preventing sudden death in sports.

OBJECTIVE: To present recommendations for the prevention and screening, recognition, and treatment of the most common conditions resulting in sudden death in organized sports. BACKGROUND: Cardiac conditions, head injuries, neck injuries, exertional heat stroke, exertional sickling, asthma, and other factors (eg, lightning, diabetes) are the most common causes of death in athletes. RECOMMENDATIONS: These guidelines are intended to provide relevant information on preventing sudden death in sports and to give specific recommendations for certified athletic trainers and others participating in athletic health care.