Active Voice: Navigating Health and Safety Policy Changes -- It Doesn’t Always Have to be in Response to Tragedy

By Kelly D. Pagnotta, M.A., ATC, PES and Douglas J. Casa, Ph.D., ATC, FACSM, FNATA

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.


Kelly D. Pagnotta, M.A., ATC, PES is an athletic trainer at Bloomfield High School in Bloomfield, CT. She also is a doctoral student in the Neag School of Education and Chief Information Officer for the Korey Stringer Institute at the University of Connecticut in Storrs. Her research interests include preventing sudden death in sport through education and policy development. In addition to the secondary school setting, she has also worked at various mass-event medical tents.

Douglas J. Casa, Ph.D., ATC, FACSM, FNATA, is professor in the Department of Kinesiology, the University of Connecticut at Storrs. He also is Director of Athletic Training Education and Chief Operating Officer of the Korey Stringer Institute at the University of Connecticut.

This commentary presents Ms. Pagnotta’s and Dr. Casa’s views on the topic of the article which they and their colleagues published in the September/October 2013 issue of ACSM's
Current Sports Medicine Reports (CSMR).

Health and safety policies for athletics are a hot topic within the medical community, media and public. Concussion assessment and return-to-play, AED availability, coaching education, availability of athletic trainers (ATs), sickle cell testing, pre-participation exams and heat acclimatization are only some of the policies that could be used to reduce the risk associated with athletic participation. While heat acclimatization is one example, currently only 12 of 50 states have adopted heat acclimatization guidelines for high school sports (for details, see Korey Stringer Institute website) that follow Inter-Association Task Force Pre-Season guidelines (see NATA website). In the professional or collegiate level, one central governing body can initiate and mandate policies (e.g., NFL, FIFA or NCAA). At the secondary school level it is much different; instead, it is up to each state to regulate policies. The National Federation of State High School Associations (NFHS) certainly has the best interest of high school athletes at heart, but do not have authority to impose those rules across all 50 states. The recommendations that NFHS endorses are an important starting point to direct the individual state high school athletic associations. Each state can regulate policy changes by two primary mechanisms: 1) a state law or mandate; or 2) by enacting policy through action of the high school athletic association, with advice from a sports medicine advisory committee. One potential problem is that coaches, athletic directors and administrators, with little if any medical training, often direct these organizations, and utilize their sports medicine advisory committee to various degrees. Medical professionals (physicians, AT’s, etc.) who wish to embark on the change process often encounter difficulties in the complex process of securing approvals for needed policies when they engage in this process with little guidance or advice. Cooperation between these various stakeholders is necessary for the successful development and implementation of policies.

A series of events in Arkansas during the summer of 2011, as described in our recently published article (September/October 2013 issue of ACSM’s CSMR), prompted major health and safety changes for high school athletes. Stakeholders, including athletic trainers, physicians, coaches and administrators, embarked on the process after this tragedy. Three student-athletes were hospitalized after suffering exertional heat stroke during the same time period; two survived, but sadly one passed away. Media attention and increased public awareness led to the state high school athletic association joining discussions with ambulance services and hospitals to create solutions that could prevent another tragedy. While the changes in Arkansas were extensive and grounded in current best practices, we hope that other states and organizations can initiate similar changes without a tragedy as a catalyst for change. Arkansas was able to successfully initiate and manage the change process due to a combination of factors. Ambrose’s Requirements for Change was used to explain their change process and because the stakeholders had all the components of Ambrose’s Requirements for Change (vision, skills, incentives, resources, and an action plan), the development and implementation of the new policies was successful.

Unfortunately, it is after tragedies that many organizations begin to reevaluate their current practices and policies. We have the knowledge and mechanisms, motivation, and power to proactively make policy changes that we know are protective for the student-athletes we supervise. While heat acclimatization, emergency action plans, AED’s and coaching education are four domains we need to immediately act upon in the sports setting, many other simple and relatively low-cost issues need to be addressed in an aggressive manner. As other organizations explore ways to also implement new health and safety policies, we hope Ambrose’s Requirements for Change can help facilitate this process.