Catastrophic Injury Figures Decline in 2005-06

By Bob Herman

Injuries are unfortunately inevitable at every level of athletics, and the perpetual scare of a life-threatening injury looms in every field, court and sporting venue.

The National Center for Catastrophic Sports Injury (NCCSI) Research, which was created in 1982 to monitor injury trends in high school and collegiate athletics, released its 24th annual catastrophic sports injury report.

"When you look at this report, you're looking to see if there are trends," said Bob Colgate, NFHS assistant director and liaison to the NFHS Sports Medicine Advisory Committee. "Are we seeing the same catastrophic numbers? We want to see zero, but we know it's not going to happen. We're looking at this and are trying to decrease the risks of participation when writing the playing rules."

The NFHS Sports Medicine Advisory Committee also aims to educate the medical and the athletic community about safety protocols and appropriate return-to-play scenarios.

"The goal has been to minimize risk for our athletes while maintaining the integrity of each sport, protecting participation equity for offense and defense and being aware of the scientific data and the potential for unintended consequences of changes in equipment and rules," said Vito Perriello, M.D., and chair of the NFHS Sports Medicine Advisory Committee.

The catastrophic injury numbers for the 2005-06 school year were some of the lowest in the history of the research study.

"Coaches and certified athletic trainers are more aware of the possibility of a catastrophic injury," said Frederick O. Mueller, Ph.D. "I definitely think there's better medical care in the field and in the emergency rooms with AEDs [automated external defibrillators]."

Mueller is the director of the NCCSI while Robert C. Cantu, M.D., is the medical director. Both men headed the report and have created guidelines to categorize a catastrophic sports injury.

Catastrophic sports injuries are defined as "a death, a permanent disability injury or injuries such as a head or neck injury with a full recovery," Mueller said.

These injuries are either considered to be direct, which result from actual participation in the skills of the sport, or indirect, which could involve a systemic body failure on the athletic location such as heatstroke or a heart attack.

There are three main categories of catastrophic sports injuries: fatalities, non-fatal (a permanent severe functional disability) and serious (no permanent functional disability, but a severe injury exists, such as a torn ACL).

Fall sports in 2005 had 11 direct and 10 indirect catastrophic injuries, the most of any season. Soccer accounted for one direct and two indirect deaths, but all of the others occurred in football.

Ten direct catastrophic injuries (two fatalities, five non-fatal and three serious) and eight fatalities came during the 2005 football season. However, the direct catastrophic injury number was still the lowest since the research began.

Although football players record more injuries than any other group of athletes, there are also many more football players than any other high school sport. In 2006, more than 1.1 million high school boys and girls participated in 11-player football, and the injury rate per 100,000 participants was still less than one for each catastrophic injury category.

Many preventative measures have been taken to ensure a safer football environment, such as newer helmet safety and improved coaching techniques that keep the head out of blocking and tackling.

"The NFHS participated in an information packet, 'Heads Up,' developed by the Centers for Disease Control and Prevention (CDC) on a coach's proper role in concussion management," Perriello said. "This is an example of the type of information we are sending out."

A big concern, though, is the number of indirect football deaths and injuries -- mainly from heat stroke -- that could be avoided.

"Any time you have that many heat stroke stats, it's a concern," Mueller said. "Part of the problem has always been [teams] starting so early in the heat. You have to be really careful to follow the guidelines."

Two direct and 10 indirect catastrophic injuries occurred during the 2005-06 winter season, which are nearly identical from last year's figures.

Wrestling accounted for one direct and one indirect fatality, while basketball accounted for six indirect fatalities.

One serious ice hockey injury was the only other direct catastrophic injury during the winter. Swimming had one indirect death, while volleyball experienced one indirect, non-fatal injury.

Although there have been 118 direct and 146 indirect catastrophic injuries during winter sports from 1983 to 2006, many winter sports still maintain an injury rate of less than one per 100,000 participants.

It was noted, though, that a close eye must be kept on wrestling, men's and women's gymnastics and ice hockey since those three sports are associated with higher injury rates.

High school spring sports only had one direct catastrophic injury (a serious track injury), and not a single indirect catastrophic injury was recorded.

"Collision sports (football, lacrosse and ice hockey) certainly have the highest incidence of major injury, which is not surprising based on the nature of the games," Perriello said. "However, several years ago, pole vault hit our radar screen because of the high incidence per athlete participating with a catastrophic injury."

Even though there were only 14 direct and 20 indirect catastrophic injuries during the 2005-06 school year, relatively nominal figures compared with past years, preventative measures still can and need be taken to keep the numbers low and to maintain the safety and integrity of the sports.

"[Coaches and parents] have to understand what sport their athletes or children are participating in and the risks involved," Colgate said. "One of our goals is trying to make all sports that the NFHS writes playing rules for as risk-free as possible. They need to know their risks and the rules of the sport, but accidents do happen. There are a lot of things we don't control."

The NCCSI Research included some recommendations to help reduce catastrophic injuries:

1. Mandatory medical examinations and a medical history taken before allowing an athlete to participate.
2. All personnel concerned with training athletes should emphasize proper, gradual and complete physical conditioning in order to provide the athlete with optimal readiness for the rigors of the sport.
3. Every school should strive to have a certified athletic trainer who is a regular member of the faculty and is adequately prepared and qualified.There should be a written emergency procedure plan to deal with the possibility of a catastrophic injury.
4. There should be an emphasis on employing well-trained athletic personnel, providing excellent facilities and securing the safest and best equipment available.
5. There should be strict enforcement of game rules, and administrative regulations shouldbe enforced to protect the health of the athlete. Coaches and school officials must support the game officials in their conduct of the athletic contests.
6. Coaches should know and have the ability to teach the proper fundamental skills of thesport. This recommendation includes all sports and not only football. The proper fundamentals of blocking and tackling should be emphasized to help reduce head andneck injuries in football.Keep the head out of football.
7. There should be continued safety research in athletics (rules, facilities and equipment).
8. Strict enforcement of the rules of the game by both coaches and game officials will help reduce serious injuries.
9. When an athlete has experienced or shown signs of head trauma (loss of consciousness, visual disturbance, headache, inability to walk correctly, obvious disorientation, memory loss), he/she should receive immediate medical attention and should not be allowed to return to practice or game without permission from the proper medical authorities.It is important for a physician to observe the head injured athlete for several days following the injury.
10. Athletes and their parents should be warned of the risks of injuries.
11. Coaches should not be hired if they do not have the training and experience needed to teach the skills of the sport and to properly train and develop the athletes for competition.
12. Weight loss in wrestling to make weight for a match can be dangerous and cause serious injury or death. Coaches should be aware of safety precautions and rules associated with this practice.

"The knowledge, scientific data and specific recommendations for management are growing by leaps and bounds in sports medicine," Perriello said. "Awareness of new diseases and injuries, statistics on certain injuries and better documented guidelines for return-to-play all allow us to make better informed and substantiated recommendations for sports, athletes and programs."

Herman is a fall semester intern in the NFHS Publications/Communications Department. He is a junior at Butler (Indiana) University majoring in journalism (news editorial) and minoring in Spanish.