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Sport Science Institute distributes recommendations to prevent catastrophic injury and death in college sports

During the summer, schools received a document crafted to help prevent catastrophic injuries and deaths in college sports. The document was reviewed by NCAA members, endorsed by a slew of leading sports medicine organizations and relevant NCAA committees in all divisions and, ultimately, recommended as Association-wide policy by the NCAA Board of Governors.

Catalyzed by discussions at the 2016 Safety in College Football Summit, the 21-page interassociation recommendations are designed to arm athletics departments and sports medicine personnel with the information needed to curtail incidences of heatstroke, rhabdomyolysis and other exertional maladies.

The guidelines focus on athletics department culture, structure and best practices. Excerpts of the recommendations, which are organized into six areas of emphasis, follow:


The head and helmet should not be used as a weapon, and unsportsmanlike efforts to deliberately injure an opponent are outside the boundaries of fair and legal play. Given this commitment to sportsmanship, coupled with the considerable safety implications of its violation, the following recommendations regarding deliberate injury to an opponent should be considered in all sports:

  • A player should be ejected immediately from competition for a first infraction.  
  • Video replay after the competition can verify missed calls and could lead to suspension from the next competition. Conferences play a crucial role in this process and should commit themselves to this responsibility. 
  • Officials who fail to call such infractions should be educated and/or disciplined appropriately. 
  • In helmeted sports, rules should be further developed to prohibit and penalize the initiation of contact with the head/helmet and should be uniformly enforced.

Protective equipment

Protective equipment typically must be manufactured and maintained according to performance and safety standards promulgated by standards organizations such as the National Operating Committee on Standards for Athletic Equipment and ASTM International. When sport playing rules require equipment to comply with existing standards, the legality of the equipment is dependent on compliance, certification or both, under existing standards.

Every member school should establish policies to ensure annual certification, recertification and compliance, as appropriate, with all protective equipment standards.

Acclimatization and conditioning  

Many nontraumatic deaths take place during the first week of activity of a transition period (the first seven days of any new conditioning cycle) in training. Given this fact, it is imperative to recognize the vulnerability of student-athletes during these periods and to ensure that proper exercise and heat acclimatization are implemented. A minimum expectation is that all strength and conditioning sessions, regardless of when in the year they occur, should be evidence- or consensus-based; sport-specific; intentionally administered; appropriately monitored, regardless of the phase of training; and not punitive in nature. For acclimatization and conditioning, the following direction should be considered for all sports and by any individual responsible for the planning and/or implementation of training and conditioning sessions, whether that be a strength and conditioning professional or a sport coach:

  • Training and conditioning sessions should be introduced intentionally, gradually and progressively to encourage proper exercise acclimatization and to minimize the risk of adverse effects on health. This is especially important during the first seven days of any new conditioning cycle, which should be considered a transition period.
  • Training and conditioning sessions should be based on exercise science principles and physiologically representative of the sport and its performance components.
  • Collegiate athletes are especially vulnerable to exertional injuries during the first four days of transition periods, and the data supports that modifications in these periods can greatly decrease the risk of catastrophic events.
  • All training and conditioning sessions should be documented.
  • A disciplinary system should be developed and applied to strength and conditioning professionals and sport coaches who fail to follow these recommendations. Such penalties could include suspension and/or termination by the member school.

Emergency action plans

There is broad agreement that the most effective way to prevent catastrophic fatalities and manage nonfatal catastrophic events is through a sound and well-rehearsed emergency action plan. Venue-specific plans are a cornerstone of emergency readiness for campus and athletics health care providers. At a minimum, well-rehearsed and venue-specific emergency plans should be developed for the following nontraumatic catastrophic events: 

  • Head and neck injury. 
  • Cardiac arrest. 
  • Heat illness and heatstroke. 
  • Exertional rhabdomyolysis. 
  • Exertional collapse associated with sickle cell trait. 
  • Any exertional or nonexertional collapse. 
  • Asthma. 
  • Diabetic emergency. 
  • Mental health emergency.

Responsibilities of athletics personnel

Physical activity should never be used for punitive purposes. All athletics personnel, including both sport and strength and conditioning professionals, as well as primary athletics health care providers, should intervene when they suspect that physical activity is being used as punishment. 

All strength and conditioning professionals should have a reporting line into the sports medicine or sport performance lines of the institution. This includes sport coaches who have responsibility for providing strength and conditioning services across all sport teams.

The following questions about the strength and conditioning credential should be considered when hiring a strength and conditioning professional: 

  • Is the strength and conditioning credential one that reflects attaining relevant competencies in the delivery of strength and conditioning services to college athletes and teams? 
  • Is the credential conferred by a certification program/process that is nationally accredited?
  • What are the educational standards required for certification eligibility and the continuing education standards required by the certification program? 
  • Does the certification require CPR and AED certification? 
  • Does the certification require a bachelor’s degree or higher, and is it in a degree field with relevance to the provision of strength and conditioning services?

Education and training

Beyond strength and conditioning professionals, each institution should adopt requirements for the education and training of athletics personnel. Education should focus on preventing catastrophic injury and sudden death in sport and should occur annually. Education and prevention strategies should be customized for the unique learning needs of relevant stakeholders and their roles on the athletics team. Such training should include the following: 

  • Foundational information regarding emergency action plans.  
  • Environmental monitoring (heat/humidity, lightning). 
  • Head and neck injuries. 
  • Cardiac arrest. 
  • Heat illness and heatstroke. 
  • Exertional rhabdomyolysis. 
  • Exertional collapse associated with sickle cell trait. 
  • Any exertional or nonexertional collapse. 
  • Asthma. 
  • Diabetic emergency. 
  • Mental health emergency. 
  • Proper training principles/principles of periodization.
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