ATHLETE SAFETY MEDICINE

DOCTORS CAN AND SHOULD TAKE CONTROL OF THE PRE-SPORTS-PARTICIPATION PHYSICAL EXAMINATION

Doctors should only approve clearance for Athlete Sports Participation and Play with stipulations i.e. the Athlete is “Only cleared for Sports Participation, when Coaches and All Responsible Parties, implement Athlete Standard Protection, Supervision and Duty of Care.”

What’s a Doctor to do? Let me tell you, “think outside the little box you check with your pen that says “Cleared to Play”.

Following Pre-Sports-Participation Physical Examinations currently, Doctors are routinely checking the box entitled “Cleared to Play” if the Athlete passes the examination. Presently, Doctors do not detail their clearance to play.

Unbeknown Doctors clear athletes to participate in Sports, consequently, with both proper and unsafe playing and sports participation conditions. Unprotected, exposed, vulnerable Athlete Clearance to play by Doctors with routine form completion habits about Athletes participation in potentially harmful circumstances, must cease.

What’s a school to do? Lauran Neergaard of the Associated Press provided one suggestion that University of Georgia Director of Sports Medicine Ron Courson called “the most important thing”:

“The American Heart Association recommends a thorough physical exam and detailed family and personal medical history for every athlete, but not an automatic EKG. The idea is to look for red flags—like fainting episodes, a heart murmur or whether a relative died young of a heart problem—that would prompt the doctor to order further cardiac testing.”

“There’s no doubt that a detailed medical history for all student-athletes should be schools’ logical, low-cost first step……after all, ensuring student-athlete safety should be schools’ highest priority in athletics.” [Trainers: States Dragging Feet on Student-Athlete Safety Laws, By Bryan Toporek April 6, 2011, Education Week]

Why would any meticulous Doctor do such a detailed examination and then toss the Athlete into Maltreatment and Harms Way? That doesn’t make sense.

After a throughly complete Pr-Participation Physical Examination, Every Doctor should do their Duty and add to their physical examinations a clearance provision, for their own and the Athletes protection, a proviso over their signature for clearance: “Only cleared to participate in Sports, when Coaches and All Responsible Parties, implement Athlete Standard Protection, Supervision and Duty of Care.”

Doctors should forbid the heretofore clearance of Limitless, Unrestricted Athlete Sports Participation where Athletes have Risks of being Pushed and Punished beyond their Physical and Emotional Limits and/or Sexually Abused, after the Doctor naively checks the box provided on the Pre-Participation form provided by the school, athlete association or other non-medical group.

Doctors, take Control! Think Athlete Safety 1st!
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WORLD HEALTH ORGANIZATION RANKS NATIONS

The World Health Organization Ranks nations based on different Categories. The Category of interest for this publication is Child and Youth Safety, Protection, Health, Welfare, Growth and Development.

The questins are:
1. How well do we take care of our Children in the U.S.?
2. How well do we take care of Child and Youth Athletes?

The World Health Organization (WHO) Represents United Nations and its 193 Member States. the following rankins reveal we do not take very good care of our U.S. Children.

Why then would anyone expect the U.S. to take good care of Child and Youth Athletes?

• WHO World ranked the United States 37th among World Health Systems 37/193
• U.S. ranks 34th in Children’s Index (condition and well being of Children) 34/193
• 12th in human development,
• 47th in infant survival
• 10th in bullied teenage females
• 14th in college graduation
• 21st in Children’s Accidental Deaths
• U.S. 3rd in juvenile crime suspects
• 15th in literacy 15/193
• 20th in Childhood Obesity
• 31st in quality of living
• 10th in per capita rape suspects
• 18th in reading
• Students rank 17th in the world
• 13th in age of first sex encounter
• Only ~21 percent of children in the United States who need mental health services receive them. (AJP, Sept. 2002)
• ~ every two hours, a young person commits suicide. (AAS, 2002)
• U.S. 3 Million Teenagers considered suicide / attempted suicide. (SAMHSA, 2002)
• Suicide 3rd leading cause of death among people < 24 YO • 1st accidents, 2nd homicide. (CDC, 2002) • Suicide Rate males ages 15 to 24 has 4X over last 60 years • Suicide Rate females ages 15 to 24 has 2X (CDC, 2002) • 5 to 9 percent U.S. children have serious emotional disturbance. (USSG, 1999) • ~13% of children 9 to 17 YO have an anxiety disorder. (USSG, 1999) • U.S. ~4.1 percent school-age children have attention-deficit hyperactivity disorder. (NIMH, 1999) • Early-childhood trauma > memory problems, ↓mental and ↓cognitive ability later in life
• Early Emotional Stress > slow decline Brain Neuron Activity, Region associated with learning, memory, recall (JN, 2005)
• ~4 % boys and > 6 % girls have PTSD symptoms caused by violence they have endured or witnessed. (JCCP, 2003)
• ~ 2/3 boys and3/4 girls in juvenile detention centers have a psychiatric disorder. (AGP, Dec. 2002) [Child and Adolescent Fast Facts]

U.S. CHILDREN’S HEALTH STATUS GAP

There is a gap between the current U.S. Level of Children’s Health and What It Should Be.

• Unrealized Health Potential = difference between – ‘WHAT IS’ (What is Actual Current Level Children’s Health) and – ‘WHAT IS ATTAINABLE’ (What is Level of Health That Would Occur)

UNREALIZED HEALTH POTENTIAL = WHAT IS ATTAINABLE – WHAT IT ACTUALLY IS

• There is a Large Unrealized Health Potential Among U.S. Children
[2008 Robert Wood Johnson Foundation, Comm .to Build a Healthier America]

WHAT ABOUT CHILD and YOUTH ATHLETES WHO PARTICIPATE IN COMPETITIVE AMATEUR SPORTS? This is where ATHLETE SAFETY MEDICINE comes in to play.

ATHLETE SAFETY MEDICINE (ASM) DEFINITION

Branch of Medicine for the Examination, Treatment and Holistic Health Care of Child and Youth Amateur Athletes

• Promotes the Advancement of Athlete Safety, Protection, Security, Supervision
• Promotes Education and Awareness about Athlete Health-Care, Well-Being, Growth and Development
• Promotes the Prevention of Athlete Diseases, Injuries, Catastrophic Injuries and Deaths
• Motto: “Play with Athlete Safety 1st”

ATHLETE SAFETY MEDICINE SPECIALIST (ASMS) PROFESSIONAL OBJECTIVES AND DUTIES

• Doctors can Begin Study for Athlete Safety Medical Specialists:

1. http://www.cappaa.com
2. http://www.athletesafety1st.com
3. http://www.athletesafety1st.org
4. Find Additional Study Resources

• Perform Examinations and Treatment of Athlete Injuries
• Expert Pre-participation History and Physical Examination
• Provide Sports 911 Emergency Action Plan Consultation and Implementation
• Perform Examinations/Treatment of Athlete Injuries with Medical-Legal, Endangerment, Maltreatment and Abuse Assessment
• Release Athletes to Play Following Successful Injury Treatment and Rehabilitation
• Intervention on Athletes behalf when Athlete Safaeaty Medical Specialist (ASMS) has knowledge that Coach is Exercising and Punishing Athletes Beyond Physical and Emotional Limitations
• Promote Child Athlete Abuse Recognition Education (C.A.A.R.E.)
• Promote Child and Youth Athlete Human Rigfts Education
• Provide Instruction on the Implementation of both Primary and Child and Youth Abuse Modifier ICD-9 Diagnostic Injury Codes for Medical Service Reimbursement.
• Testimony Medical Witness and Expert when necessary
• Forensic Assessment of Sports-Participation-Related Injuries and/or Death to the Athlete
• Forensic Assessment for Child and Youth Endangerment, Maltreatment and Abuse Injuries and/or Death
• Properly Reporting Child Athlete Abuse And Negligent Coaching Supervision to authorities
• Instructing others about Proper Reporting
• Educate others about the Recognition of Child and Youth Athlete Endangerment, Maltreatment and Abuse.
• Provide information Links for CME Category I and II Credits for Athlete Safety Medical Specialists
• Strive to Prevent and Eradicate Preventable, Non-Accidental Sports Injuries and Deaths by eliminating Sports Related Determinants, Risks, Reasons and Causes that are not Inherent to the Games Children Play
• Act to Reduce the human, social and financial burdens from Preventable, Non-Accidental Child Sports Injuries and Deaths
• Initiate Reduction Global Health Care Burden from Preventable, Non-Accidental Child Sports Injuries and Deaths
• Ensure the Protection of Child and Youth Athlete’s Human Rights, Health and Welfare in Sports
• Provide training, education, experience and expertise to the medical profession will optimize Athlete enjoyment, positive outcomes of sports and Athlete safety, protection, Physical and Emotional Fitness during and after sports participation.

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Health Services are vital to young people, Children and Youth.

“Healthy development presupposes the availability and accessibility of health care at primary, secondary, and tertiary levels.” Medical care is classified into primary, secondary, and tertiary care categories. [Wikipedia]

“Primary care medical services are provided by physicians, physician assistants, nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care.”

“Secondary care medical services are provided for a patient referred by a primary care provider who first diagnosed or treated the patient.”

“Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation oncology, etc.”

Patient Records, Medical and Forensic Information, Education and Awareness are still delivered in many health care settings on paper records, but nowadays electronic delivery systems are rapidly proliferating.

“Modern medical care” depends nowadays on patient, educational and other information, records, reports, publications by electronic, cyber, virtual pod, computer-generated health delivery systems.

In addition to the advancements in health care technology, informatics and their applications and stored locations, health care is provided by other important institutions, organizations and communities in other settings. Health care is not provided exclusively by or in the health care community. Examples of other Health Care Venues are:

• Sport
• Education
• Labor
• Culture
• Religion

Sport is a universal language. Everyone understands the language of Sport. U.N. Secretary-General Kofi Annan, “Year 2005 was declared the International year of Sport and Physical Education” by the U.N. Sport was advanced for the development and peace among nations and all diverse people.

The Right To Play and Participation-In and the Access-To Sport and Recreation have long been recognised in a number of U.N. international conventions and treaties. In 1978, UNESCO described sport and physical education as a “fundamental Right for all”.

Services for health needs must be coordinated among all sectors that offer Health Care. Consultation connecting the sectors should be proper and timely. Services must endeavor to Promote Health by providing reliable information directly to the young people with whom they are in contact and indirectly through adults who deal with young people.

Health Risks must be identified completely in early stages and deliver current care and treatment for injury and disease in all sectors that offer Health Care, including Sports.

Many countries do not have the health services resources to meet these objectives. Furthermore, since Children and Youth are automatically perceived as being relatively healthy, all countries, even the more advanced industrialized countries, such as the U.S.. are not knowledgeable or accustomed to their special needs.

While young people are relatively disease-free, they have other health problems that often arise from their own Risks or other peoples’ Risks. The other people are usually adults who have Custodial Protection and Supervision Responsibilities and who engage in abnormal and harmful behavior in environments affected with Injury and Death Risks.

Children and Youth have particular sensitivities and health care providers must have special training if the available services are to be used to their fullest extent. Athletes must be carefully observed, protected and supervised, for example.

Disease Free, healthy young people can be seriously injured and succumb, when carelessly and recklessly exposed to harmful behaviors and environmental dangers.
During Sports Participation health care providers and everyone, including parents, must be especially attuned to Abnormal Coaching Behaviors that create Negative Determinants, Risks, Reasons and Causes for Children and Youth Preventable, Not-Accidental Injuries and Death.

“Excessive competitiveness with the emphasis on winning rnay place enormous psychological pressure on the young adolescent, for whom the approval of peers and parents is important.” Win-at-all-costs is extremely detrimental to Athletes and an Athlete Centered Sports and Rights System.

During sports participation excessive stress placed on bones, ligaments, tendons, joints and every other part of Child and Youth human anatomyl including emotional centers in the brain are adverse to Human Growth and Development. Coaches who Cross the Line by Pushing and Punishing Athletes beyond their Physical and Psychological Limits can Risk severe irreversible damage.

Policies and Legislation

“Policies relevant to the health of Children and Youth cut across virtually all sectors of both government and many non-governmental organizations.”

“Laws relating to sports, education, employment, social welfare, population, defense, religion, culture and women, as well as those dealing specifically with youth, have major implications for young people.”

Now that specific public health measures, such as improved sanitation, clean water supplies and immunization programs, have succeeded to some degree in controlling disease, more attention is being paid to health problems characteristic of Children and Youth in which behavior plays a major role.

Abnormal Coaching Behaviors are an example of behaviors that play a major role in self inflicted and perpetrated Serious Injuries and/or Deaths and Sexual Abuse.
Policies and legislation have too often been impromptu, off the cuff responses to health problems that have captured public attention, rather than action taken before the problem has become widespread.

Preventable, Not-Accidental Athlete Injuries and/or Deaths and Sexual Abuse are prime examples. For example, Concussion is now the Injury du jour.

• Enacting One Law At A Time for Most Popular Disease, Injury, Death of the Day is a Disservice to All Child/Youth Athletes with other Pathologies
• Cherry Picking is Not Enforcement of Coexisting Child Athlete Abuse Pathologies
• Doesn’t Address the Entire Syndrome
• Aims To Silence the Cannons for the least amount of Government Combat
• Spares the Crime, Spoils the Law
• Federal Control Over Child Athlete Abuse would be “Eviscerated” Gutless when Cherry Picked
• No Abused Child Athlete Should Be Left Behind the Cherry Tree

The Federal Government has not examined Child and Youth Athlete Safety as a whole for ways in which the enactment of laws might reinforce Prevention and Awareness, rather than eviscerate the advocacy and opposition by piecemeal legislation.

The Law and Public Health

“Many laws deal with public health generally and are not directed specifically at young people, although legislation, particularly in developed countries, covering health education and fluoridation of water supplies to prevent dental caries is of special relevance to the young.”

“Laws that protect the environment and the safety of food, water and medication, provide for health services generally, and foster the necessary conditions for education, family welfare, employment, housing, Sport, culture, religion and recreation all have an impact on the health of young people.”

A key element in the tertiary prevention of disease and disorders in young people is the availability and accessibility of treatment and rehabilitation services for catastrophic illness and injury.

Young people are particularly vulnerable to disabilities arising from accidents on the road, in Sport, at work and in the home. Spinal-cord injuries that result in paralysis or other impairment are particularly devastating for young people. Cheerleading Injuries are an example. Rehabilitation needs must be directed at the whole individual so that he or she is able to develop physically, psychologically and socially to the fullest extent possible.

But here is the rub. Many disabilities in Sports are Preventable and Not-Accidental. Many catastrophic Child and Youth Athlete Injuries and/or Deaths are not natural or inherent to the game that was played and NOT “just part of the game”. They result form careless, reckless mistreatment and endangerment and sexual abuse of Athletes by Coaches.

Prevention and eradication of Preventable, Not-Accidental Child and Youth Athlete Injuries and/or Deaths and Sexual Abuse requires excellent co-operation between the sectors, particularly between health, education, labor, youth and social services, and the involvement of community and non-governmental organizations.

“Schools usually provide an opportunity to learn Sports. They are important not only for physical fitness, but also for learning about teamwork and the constructive use of leisure time.”

Youth associations are another major source of health care for young people. Sport organizations and associations are designed primarily to encourage interest in sport, recreation or community service. All include a health component.

“Youth organizations sometimes require some form of health screening before accepting a person for membership, and they often provide information, education or training in such health-related subjects as fitness, eating habits, personal hygiene and Sport.”

“Because of the variety of activities commonly available, and because the atmosphere is much more one of participation than in school or the health services, it is often easier for a young person to raise sensitive subjects. Youth organizations also provide training in leadership and conduct campaigns for public health that both promote the social development of their members and provide education and training in public health issues.”

In many societies, including the Sports Community, important groups are likely to include policy-makers, program managers and administrators, community leaders, adult family members and, crucially, young people themselves. A multisectoral approach is essential, seeking the active collaboration of health workers and those working in the sectors of youth, education, social welfare, religious affairs, sport, culture and criminal justice, among others for Medical-Legal Health and Welfare of young people.

“The need to achieve such a multisectoral, interdisciplinary and multiagency approach to the relatively neglected subject of adolescent health, (including Athletes in Sports) and make it effective in all cultures, has stimulated the development and adaptation of a number of methodologies.”

“They are participatory and qualitative in nature, using the Socratic principle of eliciting knowledge and action from the resources which people already have within themselves, while at the sarne time providing systematic frameworks that can be used in any setting. They are directed to planning action, setting priorities, behavioral and attitudinal research, training in interpersonal skills, evaluation of work with young people, and advocacy for policy and programs.”

References:
[Health of Young People, World Health Organization, Geneva, Switzerland 1993]
[Chapter: Health Problems and Behavior]
[Chapter – Policies and legislation]
[United Nations, Press Release, 05/11/2004]
[Child Athlete Abuse Syndrome, “A New Disease”]

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