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NFHS Responds to Korey Stringer Institute Ranking of High School Associations Regarding Managing Injury Risk

By NFHS on August 08, 2017 nfhs news Print

In response to the Korey Stringer Institute’s ranking of state high school associations in the area of managing injury risk to high school student-athletes, NFHS Executive Director Bob Gardner has released the following statement and accompanying support information.



In order to provide the safest and most enjoyable experience for the 7.9 million participants in high school sports, it takes a concerted effort on the part of every organization connected to interscholastic athletics.

For a number of years, the NFHS and its member state associations have worked cooperatively with organizations such as the National Athletic Trainers’ Association (NATA) and the Korey Stringer Institute (KSI) to provide as much information as possible for the nation’s 19,000-plus high schools regarding heat illness awareness and prevention, as well as other safety issues related to the heart and head injuries.

Unfortunately, the Korey Stringer Institute has proclaimed itself as judge and jury of heat-illness prevention and other safety issues by ranking the 51 NFHS-member state high school associations – these very associations that have been promoting risk-minimization precautions in their schools’ athletic programs for many more years than the seven-year existence of the KSI.

The overall safety of student-athletes competing in high school sports is a key objective of the NFHS and all 51 state associations. Information on precautions related to heat and head issues is regularly shared with schools across the country. While the 19,000 high schools range in size from 50 students to 5,000, there has never been a time that coaches, athletic directors and school administrators were more focused on risk minimization.

 Very simply, a review of state association websites, such as the one employed by KSI, is an incomplete measurement of the efforts employed by states to assist their member schools with heat, heart and head issues. Providing more research data, as well as funds to enact more prevention programs, would be much more useful than giving grades to these associations.

For the past three years, the state high school associations have attended annual sports medicine meetings with KSI, the American Medical Society for Sports Medicine, and the National Athletic Trainers’ Association. The meetings have been entitled “Collaborative Solutions,” and they have been intended as an opportunity to share ideas about heat illness, cardiac problems and head injuries. The participating organizations have worked together, and the nation’s young athletes have benefited.

Now, KSI has utilized a new approach. By “grading” state high school associations based on a limited number of criteria, KSI has chosen to shine a light on certain areas, but it has left others in the dark. Thus, the information provided today gave an incomplete view. The full picture is much more positive. In fact, the state high school associations, and their respective sports medicine committees, post guidelines, speak at seminars, give warnings and alerts, and otherwise promote the health and well-being of young people. Certainly, there is room for improvement, and the American educational system will continue to be resource-challenged. Schools will need more funding, more defibrillators, more athletic trainers and more constructive legislation. With the assistance of everyone who cares about young athletes, including KSI, we can keep getting better.

The NFHS and its 51 member state associations are disappointed that KSI is, in essence, criticizing many states in this area rather than continuing to work with these groups in a collaborative relationship.

Protecting the health and safety of our nation’s high school student-athletes is an ongoing focus of all NFHS state associations. Following are some of the numerous initiatives undertaken by the NFHS in conjunction with its member state associations in the area of managing risk for the 7.9 million participants in high school sports.



Through the NFHS Learning Center at www.NFHSLearn.com, the NFHS offers a free course titled Heat Illness Prevention at https://nfhslearn.com/courses/34000/heat-illness-prevention as well as its core course First Aid, Health and Safety at https://nfhslearn.com/courses/26/first-aid-health-and-safety, which was developed with its partner, the American Red Cross.

In addition, the NFHS Sports Medicine Advisory Committee provides state associations and its member schools additional heat-related guidelines on the sports medicine page of its website at http://www.nfhs.org/resources/sports-medicine/ as well as the NFHS Heat Acclimatization and Heat Illness Prevention Position Statement at https://www.nfhs.org/media/1015653/heat-acclimatization-and-heat-illness-prevention-position-statement-2015.pdfand the NFHS Position Statement and Recommendations for Maintaining Hydration to Optimize Performance and Minimize the Risk for Exertional Heat Illness at http://www.nfhs.org/media/1014751/nfhs_smac_hydration_position_statement_october_2014.pdf.

The cover story of the May 2017 issue of High School Today – “Dangers of Heat Illness Reduced by Following Proper Guidelines” by David Csillan – offered some tremendous resources: http://www.nfhs.org/articles/dangers-of-heat-illness-reduced-by-following-proper-guidelines/.



In 2015, the NFHS provided the “Anyone Can Save a Life” emergency action plan toolkit originally developed by the Minnesota State High School League to member state associations for distribution to the nation’s schools. Through this program, schools have activated Emergency Action Plans, including the use of Automated External Defibrillators (AEDs). More information on the “Anyone Can Save a Life” program is available at http://www.anyonecansavealife.org/.

The NFHS also offers its free course on Sudden Cardiac Arrest at https://nfhslearn.com/courses/61032/sudden-cardiac-arrest, which was developed with its partner, Simon’s Fund.  


  • 2005-present – Through the National High School Sports-Related Injury Surveillance System (High School RIO) http://www.ucdenver.edu/academics/colleges/PublicHealth/research/ResearchProjects/piper/projects/RIO/Pages/default.aspx and Dr. Dawn Comstock, the NFHS and its member associations have used comprehensive injury data as a resource in the rules-writing process to reduce risk of future injuries. High School RIO is a sports-injury surveillance system that has accumulated data from a large national sample of high schools annually since 2005-06. Since that time, High School RIO has captured information on nearly 80,000 injuries sustained during more than 40 million athlete exposures. The NFHS Sports Medicine Advisory Committee and individual NFHS rules committees use data from High School RIO to better understand which athletes are at risk of injury during various types of sports activities. As a result, evidence-based decisions can be made to limit risk. High School RIO data is used to monitor injury rates over time, to identify new concerns and to evaluate the effectiveness of rules changes.
  • Data from High School RIO during the 2015-16 season indicated that attempts by the NFHS and its member state associations to reduce the risk of head trauma and concussions in football have proven effective. Surveys from 2015-16 indicated that the rate of concussions during practice dropped below 5.0 per 1,000 athletic exposures (to 4.77) for the first time since 2010-11. Also, a 2015 study by the University of Wisconsin, Madison, revealed that the rate of concussions was reduced by more than 50 percent from the previous two seasons. These studies came on the heels of the 2014 NFHS Concussion Summit Task Force, which recommended that state associations adopt plans for limiting contact during football practices.  
  • In addition, The National Center for Catastrophic Sport Injury Research (NCCSIR) seeks to enhance the understanding of sports-related catastrophic injuries, illnesses and fatalities through active surveillance and research, with a focus on head/neck injuries, commotio cordis injuries, fatal/near-fatal cardiac conditions and fatal/near-fatal heat-related conditions. NCCSIR is committed to providing timely and useful information to the NFHS, its member state associations and high schools. The development of an online portal in 2015 enables state high school associations and their member schools to report the basic details surrounding catastrophic sports events (www.sportinjuryreport.org). Ongoing, active surveillance to monitor the incidence of catastrophic injuries, illnesses and fatalities is critical to identify areas for prevention and further study. Continued and improved efforts for detailed information and record-gathering is also critical to prevention.
  • 2008 – The NFHS Sports Medicine Advisory Committee advocated that a concussed athlete must be removed from play and not allowed to play on the same day.
  • 2009-present – All NFHS rules publications have contained guidelines for management of a student exhibiting signs, symptoms or behaviors consistent with a concussion. Such player shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health-care professional.
  • 2010 – The NFHS developed its “Concussion in Sport” online course at https://nfhslearn.com/courses/61064/concussion-in-sports. In addition, a related course specifically for high school students – “Concussion for Students” – is available at https://nfhslearn.com/courses/61059/concussion-for-students. More than three million courses have been taken since that time. In addition, a recent study indicated individuals who took the free course demonstrated a 40-percent higher level of understanding of concussions as compared to their pre-course knowledge base.
  • 2010-present – The “Suggested Guidelines for Management of Concussion” have been published in all NFHS rules books. That statement is available at http://www.nfhs.org/media/1018446/suggested_guidelines__management_concussion_april_2017.pdf.
  • 2011 – A six-page section on Concussions was added to the fourth edition of the NFHS Sports Medicine Handbook, which was distributed free to all high schools in the country.
  • 2011-2012 – The NFHS Football Rules Committee adopted “Concussions Related to Proper Use of the Helmet” as a Point of Emphasis.
  • 2014 – The NFHS Concussion Summit Task Force met in Indianapolis and adopted recommendations for reducing the amount of full contact in practices. State associations crafted their own policies based on these recommendations for implementation in the 2015 football season.
  • 2014 – By January 2014, all state governments had enacted concussion laws which established mandatory protocols.
  • 2014 – The NFHS Football Rules Committee adopted a definition and penalty for targeting aimed at preventing players from hitting an opponent – primarily with the helmet – above the shoulders.
  • The NFHS Sports Medicine Advisory Committee, which is composed of six medical experts, three certified athletic trainers, four administrators from state high school associations, as well as one high school coach and one official, has been invaluable in providing important information for NFHS rules committees and state association sports medicine committees in writing rules that minimize risk of injury for high school student-athletes. All member state associations have sports medicine committees that work with schools in their states to minimize risk of injury to student-athletes.