Enhancing Safety in Youth Sports: Exploring the Standard of Care. Gregg S. Heinzmann, Ed.M.

Transcription

1 Enhancing Safety in Youth Sports: Exploring the Standard of Care Gregg S. Heinzmann, Ed.M. Director, Youth Sports Research Council Rutgers, The State University of New Jersey

2 Educational Objective In view of recent, highly-publicized, media accounts of serious injuries/fatalities to young athletes, you will be able to describe the parameters which determine the standard of care for municipal recreation departments in New Jersey that sponsor youth sport programs.

3 Disclaimer This information is supplied with the permission of Gregg S. Heinzmann on behalf of Rutgers Youth Sports Research Council for educational purposes only and does not constitute, nor, is it a substitute for legal or medical advice. If legal or medical advice is required, the services of a competent professional should be sought.

4 Content Advisory During the course of this presentation, we will review medical research which involves the testing of laboratory animals and examine images of human autopsy. Some people might find this disturbing and objectionable. Audience discretion is advised.

5 YOUTH SPORTS RESEARCH COUNCIL Developing the Child Inside the Athlete

6 Youth Sports Research Council Established within Department of Recreation and Leisure Studies at Rutgers University Helped pass N.J. s Little League Law Partnered with NJRPA to disseminate applications of research Co-authored Minimum Standards for Coaches Assisted state Attorney General s s office with developing Model Code of Conduct Developed a Youth Sports Charter Trained more than 180,000 volunteer coaches via the Rutgers S.A.F.E.T.Y. Clinic

7 Outline N.J. s Youth Sport Safety Legislation Sudden Cardiac Arrest in Young Athletes Legislative Responses to SCA Commotio Cordis Preventive Measures/Empirical Research Standard of Care Strategies for Reducing Potential Liability Reflection & Discussion

8 N.J. s Youth Sport Safety Legislation

9 Little League Law (2A:62A-6 6 et. seq.) Passed 5/12/86; Amended 8/3/88; Volunteer coaches, managers, and officials; Links civil immunity protection to attendance at a safety orientation and training skills program ; Excludes willful, wanton, gross negligence

10 AED Users Immunity Law (2A:62A ) 25) Passed 3/8/99; Purpose: to encourage greater AED use Entity acquiring AED shall: Ensure users are certified by ARC, AHA, etc.; Ensure defibrillator is maintained and tested according to manufacturers guidelines; Notify EMS of acquisition and location; Provide prescribing licensed physician with protocol of compliance

11 AED Users Immunity Law (2A:62A-26) 26) Precludes use unless certified in CPR and AED administration Excludes licensed paramedics, EMT-D, or first responder-d Requires AED users to request EMS ASAP

12 AED Users Immunity Law (2A:62A-27) 27) Protects person or entity who acts in good faith including prescribing physician and CPR trainer Excludes gross negligence; willful or wanton misconduct Failure to use an AED is not considered gross negligence, in the absence of an otherwise preexisting duty to do so.

13 AED s in State Buildings Law (2A:62A et. seq.) Passed Jan. 8, 2002 HSS Commissioner shall establish guidelines, which the commissioner shall recommend for adoption by all State agencies, with respect to the placement of AED in state buildings.

14 AED s in Fitness Centers Law (2A:62A-30 et. seq.) Passed Jan. 12, 2006; binding 1/12/07 Health Club Owner/Operator shall: Acquire at least 1 AED; accessible location Maintain AED; notify EMS Pay for CPR/AED training of employees Ensure 1 trained empl.. on site during bus. hours Civil penalties for violators - $250, $500, $1,000 Immune from liability for malfunctioning AED

15 Protective Eyewear Law (5: et. seq.) Passed 1/11/06; Effective 7/11/06 Any child who wears corrective eyeglasses [shall] be required to wear protective eyewear that meets ASTM F803 frames standards and ANSI Z87.1 lens standards ; Includes programs sponsored by a school, community, or government agency; Provides immunity to [agency] for failure to administer of enforce provisions of this act.

16 Sudden Cardiac Arrest

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19 What is the most likely medical explanation for these incidents?

20 Commotio Cordis (CC) Commotion of the Heart

21 Commotio Cordis (CC) Commotion of the Heart Different than a heart attack Second leading cause of sudden death in young athletes (20%) to hypertrophic cardiomyopathy. Typically involves young, predominantly male athletes in whom a sudden, blunt, non-penetrating trauma to the anterior chest results in immediate cardiac arrest and sudden death from ventricular fibrillation (VF).

22 Ventricular Fibrillation (V-fiB, VF) Electrical system of the heart malfunctions leading to uncoordinated contraction of the cardiac muscles.

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25 How has the state legislature responded?

26 N.J. Legislative Session (The Torok Group, LLC) 8,423 bills introduced (23/day) 819 passed 1 st house 497 passed 2 nd house 480 bills passed both houses 473 signed into law 5.62% of total

27 Youth Coach CPR Bill (S. 2145) Sponsored by McNamara - 7/28/06 Precludes volunteers who lack CPR certification from coaching in youth sports leagues throughout New Jersey (includes interscholastic athletics). Status: Not filed for introduction in 2008 Session

28 Non-Wood Bat Ban Bill (A. 372) Steven s s Law Sponsored by Diegnan, Egan, and Russo - 6/26/06 Pre-filed for introduction in 2008 Session Unlawful to use a non-wood bat in any organized baseball game in which minors are participants.... Includes schools, nonprofit youth serving org., and county or municipal recreation depts. Excludes games involving non-n.j. teams Governing bodies shall ensure compliance

29 AED Bill (A. 640) Sponsored by Lampitt and Greenwald - 6/14/07 Pre-filed for introduction in 2008 Session Applies to schools, non-profit youth serving agencies, municipal and county rec. depts. [Agencies] shall ensure that there is available on site... at each baseball practice and game played on the department s s or organization s home field. Provides civil immunity to organizations, umpires, and coaches in the acquisition and use of a defibrillator.

30 AED Bill (A. 238) Janet s s Law Sponsored by Bramnick and Vas Pre-filed for 2008 Session; effective 9/1/08 Applies to public schools, recreation depts., nonprofit youth serving org., and youth camps Shall ensure [AED] is on-site at each youth athletic event and practice on home field Designate 1 official to ensure AED is available

31 Athletic Heart Protector Bill (A. 2136) Sponsored by Greenstein and Panter Introduced 1/9/07 as A Requires all children under 13 to wear AHP while playing organized baseball or softball. Applies to schools, non-profit youth serving agencies, municipal and county rec. depts. HSS Comm. establishes authorized list of AHP NJCPFS provide grants to low-income families Provides civil immunity to agencies for failure to administer or enforce provisions of the act.

32 Athletic Heart Protector Bill (A. 639) Sponsored by Lampitt and Diegnan Introduced 6/14/07 as A Requires youth baseball leagues to purchase AHP and make available to minors (under 18) Applies to schools, non-profit youth serving agencies, municipal and county rec. depts. HSS Comm. establishes authorized list of AHP and informational brochure about safety benefits Appropriates $2,500 to HSS for production costs

33 Pitch Count Limit Bill (A. 1353) Sponsored by Prieto 5/18/06 Pre-filed for introduction in 2008 Session Requires compliance w/ pitch count limits based upon players age: 9-10 year-olds: 50/game; 75/week; 1,000/season; 2,000/year year-olds: 75/game; 100/week; 1,000/season; 3,000/year Prohibits curveballs, sliders, and breaking pitches among year-olds

34 Period of Vulnerability to CC 15 ms (1 second = 1,000 ms)

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36 Elements of CC Precise timing 15 ms before peak of T wave Exact location Cardiac silhouette Force of collision Speed of projectile Mass of body part

37 Questions?

38 How prevalent is commotio cordis?

39 Spectrum of Commotio Cordis (U.S. Commotio Cordis Registry, 2001) Demographics 128 cases; 122 (95%) males; >180 cases (1/07) Mean age: 13.6 years; 100 (78%) under age 18 Event Setting 79 (62%) organized sports; 37 (29%) youth sport 46 (58%) baseball or softball 13 (16%) ice hockey 49 (38%) rec. activities (e.g., backyard)

40 Profile of Sports-Related Chest Blows (U.S. Commotio Cordis Registry, 2001) Of 107 events, 87 (81%) involved projectiles 53 baseball; 14 softball; 10 hockey puck; 5 lacrosse ball Baseball 13 batters; 11 pitchers; 20 base- runners/catchers hit by batted/thrown balls Ice hockey 10 defenders (including 1 goalie) struck by high-velocity slap-shot shot at close range Lacrosse 3 goalies; 2 others 20 (19%) physical contact with another person

41 What is the likelihood of survival?

42 Resuscitation Probability (U.S. Commotio Cordis Registry, 2001) 128 victims, 107 (84%) died 106 received CPR; 41 were defibrillated 21 (16%) survived 7 years on average: 15 recovered completely; 6 residual disability 17 CPR; 2 AED; 2 responded spontaneously Response Time: < 3 minutes: 17 of 68 (25%) survived > 3 minutes: 1 of 38 (3%) survived

43 Were any of the victims wearing chest protectors?

44 Chest Wall Protection (U.S. Commotio Cordis Registry, 2001) 79 victims involved in organized athletics 22 (28%) wearing chest protectors 12 hockey (2 goalies); 5 football; 3 lacrosse; and 2 baseball players (catchers) Unlikely padding covered chest at impact In 7 cases, projectile probably contacted protective padding directly

45 Preventive Measures Chest protectors Softer baseballs Wood vs. Aluminum Bats

46 Would wearing chest protectors help minimize the risk of commotio cordis?

47 Empirical Research

48 Experimental Animal Model of CC (Pediatrics, Vol. 17, No. 4, April, 2006)

49 Conclusion (Pediatrics, Vol. 17, No. 4, April, 2006) In our experimental animal model of commotio cordis, commercially available baseball and lacrosse chest wall protectors were ineffective in protecting against VF that was triggered by chest blows and, by inference, sudden cardiac arrest.

50 How about modifying the equipment, such as using softer balls?

51 Experimental Animal Model of CC (NEJM, Vol. 338, No. 25, 1998)

52 Conclusion (NEJM, Vol. 338, No. 25, 1998).... In this model, the use of safety baseballs decreased the incidence of ventricular fibrillation, suggesting that their use in the community may reduce the risk of commotio cordis....

53 Conclusion (Journal of Cardiovascular Electrophysiology Vol 18, No. 1, January, 2007).... While softer-than than-standard safety baseballs reduce the risk of commotio cordis,... More widespread use of automated external defibrillators at youth sporting events are needed.

54 What about banning aluminum bats?

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56 Dr. Richard Greenwald Comment.... The notion of limiting the use of bats to wood only is reasonable if a governing body wants to control some aspects of the game such as run production or game time based on the fact that non- wood bats often outperform wood bats. However, I would oppose any statement that linked such a limitation on using non-wood bats to injury, simply because there are no scientific data to support this contention....

57 CPSC Ruling on Limiting Non-Wood Bat Performance April 5, 2002 Available incident data are not sufficient to indicate that non-wood bats may pose an unreasonable risk of injury. [The Commission is unaware of any information] indicating that injuries produced by balls batted with non-wood bats are more severe than those involving wood bats. Based on its review of all the available information, the Commission concluded that a mandatory standard is not reasonably necessary to address an unreasonable risk of injury posed by non-wood bats.

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59 Standard of Care

60 Risk vs. Safety (Feigley, 1987) Risk Measurable What is the probability of harm? Safety Value judgment Is the risk acceptable?

61 Risk Management (Dougherty, 2007) Understanding those circumstances in which losses are most likely to occur. Designing and implementing policies to minimize the likelihood of their occurrence. Taking appropriate steps to minimize the impact of those losses that cannot be avoided.

62 Sources of Professional Standards and Guidelines (Dougherty, 2007) Rules of the sport Professional associations Learned treatises Statutes, codes and administrative law Codes of ethics Case analysis and court decisions Common practice

63 Examples LLB Statement on Non-Wood Bats NATA Official Statement on CC AMA - AED Clinical Benefits/Legal Liability AHA - AED Programs Q & A

64 Relevant Case Law Rotolo v. San Jose Sports, LLC Ingram v. Busch Gardens Fajardo v. Alayon

65 Strategies for Reducing Potential Liability (Adapted from Dougherty, 2007) Adhere to professional standards Maintain adequate records Practice good public relations Implement a Youth Sports Charter

66 Elements of a Youth Sport Charter 1. Formal Mission Statement 2. Organization & Administration 3. Staff and/or Volunteer Recruitment 4. Coach Development and Training 5. Coordination of Allied Community Groups 6. Equipment & Facilities 7. Evaluation & Recognition 8. Parent Education Orientation Program 9. Discipline/Grievance Process 10. Recruitment, Training and Credentialing of Officials 11. Finance

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68 Reflection & Discussion

69 YOUTH SPORTS RESEARCH COUNCIL Developing the Child Inside the Athlete