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.

_________________________________________________________________

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”]

RECOMMENDED SOLUTIONS FOR CHILD AND YOUTH ATHLETE SPORTS AND RECREATION SAFETY, A PUBLIC HEALTH CRISIS

ATHLETE INJURIES. DEATHS AND SEXUAL ABUSE ARE A GLOBAL CRISIS

THE FOLLOWING PUBLICATION IS ABOUT
• GROUND RULES AND ESSENTIAL PRINCIPLES FOR ATHLETE SAFETY 1ST
• RECOMMENDED SOLUTIONS FOR ATHLETE INJURIES, DEATHS AND SEXUAL ABUSE

I. AMATEUR ATHLETE HUMAN RIGHTS AND THE RIGHT TO SAFELY PLAY AND PARTICIPATE IN SPORTS AND RECREATION ARE RULES OF LAW. VIOLATIONS OF THOSE LAWS SHOULD BE REQUIRED EDUCATION.

“Human rights in the United States are legally protected by the Constitution of the United States and amendments, conferred by treaty, and enacted legislatively through Congress, state legislatures, and plebiscites (state referenda). Federal courts in the United States have jurisdiction over international human rights laws as a federal question, arising under international law, which is part of the law of the United States” [Wikipedia]

Child and Youth Protection was passed into Law by the enactment of the Child Abuse Prevention and Treatment Act 1974. It has been ammended and reauthorized several times; most recently Keeping Child and Families Safe Act of 2003, Public Law 108-36.

THE FUNDAMENTALS OF SPORTS AND RECREATION PLAY AND PARTICIPATION ARE THE PREVENTION OF CHILD AND YOUTH ATHLETE

• HUMAN RIGHTS VIOLATIONS
• PHYSICAL AND PSYCHOLOGICAL (EMOTIONAL) ENDANGERMENTS, MALTREAMENTS THAT CAUSE SERIOUS INJURIES AND/OR DEATHS
• SEXUAL ABUSE

The future development of Competitive Sports and the Positive effects of Child and Youth Sports and Recreation and positive impact on health disorders such as Childhood Obesity depend on the creation of Child-Centered Sports and Recreation Systems. This is a particular concern to Athlete Safety 1st.

Amateur Athlete Human Rights Disorders are secondary to Amateur Athlete Human Rights Violations (AAHRV). Child Athlete Abuse Syndrome is just one of the categories of AAHRV.

Child (<18) and Youth (15-24) Amateur Athletes are a Vulnerable, Global “Health Disparity Population.” Protection is mandatory from:

• Physical and Psychological (Emotional) Maltreatment and Endangerment
• Sexual Athlete Abuse
• Negligent Care Giving Supervision (Child Athlete Abuse Syndrome)
• Amateur Athlete Human Rights Disorders
• Other forms of Violence.

Children and Youth are to be Protected and properly Supervised while participating in Sports. Children are governed by Child Protection and Supervision State, National and International Laws.

“Human rights are standards that recognize and protect the dignity of all human beings. Human rights govern how individual human beings live in society and with each other, as well as their relationship with governments and the obligations that governments have towards them.”

“Human Rights Law mandates governments to accomplish missions, goals and objectives while preventing others. Individuals also have responsibilities: in using their Human Rights, they must respect the Rights of others. No government, group or individual person has the right to do anything that violates another’s Rights:

• Inherent: we are born with Human Rights
• Inalienable: individuals cannot give them up; other individuals cannot take them away
• Universal: they are held by all people, everywhere – regardless of age, sex, race, religion, nationality, income level or any other status or condition
[1989 Convention on Rights of the Child, UNICEF, United Nations International Children's Emergency Fund]

The Human Rights of Children and Youth have been recognized since the 1989 United Nations Convention on the Rights of the Child, ratified by 192 countries. Human Rights in Youth Sports by Paulo David published in 2005 is our bible.

A. AMATEUR ATHLETE SPORTS AND RECREATION MORBIDITY AND MORTALILTY ARE SECONDARY TO:

• Inadequate Safety, Health, Care, Welfare
• Failed Child and Youth Custodial Protection and Negligent Coaching Care-Giving Supervision
• Breach of Fiduciary-Athlete Responsibility
• Over Training
• Exploitation
• Human Growth and Development Deprivation
• Physical, Psychological (Emotional) and Sexual Abuse
• Doping and Medical Ethics
• Lack of Awareness and Education
• Child Labor
• Discrimination
• Human Rights Violations
• Poor Accountability of Governments, Criminal Justice Systems, Health and Human Rights Departments, National and International Sports Federations and Associations, Sports Medicine Departments
• Dysfunctional Sports Community: Poor Accountability of School Boards, School Officials, Athletic Directors, Coaches, Attorneys, Doctors, Entire and Parents.
• Drastically Different Environmental Conditions, Heat Waves, Global Warming, Air Pollution
• Obese Sedentary Indoor non-Acclimated Athletes

B. CHILD AND YOUTH AMATEUR ATHLETE AND RECREATION HUMAN RIGHTS:

• Right to non-discrimination 2
• Principles of the Best Interests of the Child 3
• Right to provide appropriate direction and guidance 5
• Right of Development 6
• Right to an identity and nationality 7
• Right not to be separated from their parents 9
• Right to have their views taken into account 12
• Freedom of Expression and Association 13 15
• Protection of privacy 16
• Right to access appropriate information 17
• Protection from Abuse and Neglect and other forms of Violence 19
• Right to Health 24
• Right to Education 28 29
• Right to rest, leisure, recreation and cultural activities 31
• Right to be protected from
1. economic exploitation 32
2. illegal drugs 33
3. sexual exploitation 34
4. abduction, trafficking, and sale 35
5. other forms of exploitation 36
6. Right to benefit from Rehabilitation Care 39
7. Right to Due and Fair Process 40
[Numbers refer to the Treaty Section 1989 United Nations Convention on the Rights of the Child]

C. CHILD-CENTRED SPORTS AND RECREATION SYSTEMS HAVE 10 FUNDAMENTL PRINCIPLES:

• Equity, non-discrimination, fairness
• Best interest of the child, children first
• Evolving capacities of the child
• Subject of Rights, exercise of Rights
• Consultation, the child’s opinion, informed participation
• Appropriate direction and guidance
• Mutual respect, support and responsibility
• Highest attainable standard of health
• Transparency, accountability, monitoring
• Excellence
[Human Rights in Youth Sport by Paulo David, Secretary on Rights of the Child, Office of the High Commissioner for Human Rights, United Nation

II. CHILD AND YOUTH SPORTS INJURY STATISTICS ARE VITAL.

Improved Child and Youth Athlete Sports Injuries, Deaths, Morbidity and Mortality Statistics in high school, college and non-school amateur leagues and organizations, are vital.

III. SPORTS PARTICIAPTION HISTORY AND PHYSICAL EXAMINITION MUST BE AN APPROVED HEALTH BENEFIT OF MEDICAL INSURANCE COVERAGE.

The Sports Pre-Participation Physical Examination must be conducted by a Doctor or other competent health care professional. Ordinarily, the Pre-Participation Examination is not an Approved Health Care Benefit of medical insurance plans and coverage.

The Examination must become an Approved Health Care Benefit for Athlete Clients with medical insurance or provided free by school for those who don't have insurance. Heart Screenings must be included when Doctor ordered. If that occurs, the athlete's family Doctor, who knows the entire history and condition of the Athlete patient can more accurately evaluate the Athlete for participation and Death from Heart Disease will be prevented.

Currently, many Athletes are examined by Doctors, who have no knowledge of the past medical and faimily histories and have never examined that Athlete prior to Sports Participation. That Doctor might not examine that Athlete again.

IV. DOCTORS MUST BE EDUCATED AND BEGIN REPORTING CHILD ATHLETE PHYSICAL AND PSYCHOLOGICAL ATHLETE MALTREATMENTS AND ENDANGERMENTS THAT CAUSE SERIOUS INJURIES AND/OR DEATHS AND ATHLETE SEXUAL ABUSE. THAT IS LAW.

Doctors and Health Care Providers Awareness, Education and Risk Management campaigns are necessary. Doctor awareness and education will lead to improved reporting and the prevention and eradication of these disorders, morbidity and mortality.

DOCTORS ARE MANDATED TO REPORT ALL ABUSE

Physicians and Health Care Personnel risk criminal charges and malpractice claims themselves if they fail to Report Child Athlete and Adult Athlete Abuse. "Mandatory reporting and screening laws are proliferating. [64. Mandatory Reporting Laws and the Emergency Department.

[Forensic Emergency Medicine, Part II Topics in Emergency Medicine. 21(3):63-72,
September 1999. Mallon, William K. MD, FACEP, FAAEM; Kassinove, Andrew JD, MD ]

V. NO PRACTICES AND SPORTS “BOOT CAMPS” SHOULD BE “CLOSED”

NO ONE CAN INTERFERE WITH AN INVESTIGATION OF CHILD AND YOUTH ABUSE IN ANY SETTING, INCLUDING SPORTS, NO VENUE IS CLOSED TO THE INVESTIGATION CONCERNING IMPROPER CHILD AND YOUTH PROTECTION AND SUPERVISION.

Because closed “boot camp” training and conditioning practices are a major venue and setting for Injury, Deaths and Abuse, from the very beginning, Governments must forbid all child and youth Sports closed practices.

No Custodial Protection and Care-Giving Supervision should be conducted behind closed doors. Coaches have Custiodial Protection and Care-Giving Supervidion Duty Most Coaches are Not Aware of the Duty.

Furthermore, what parent in his or her right mind would allow their Child to be taken behind closed doors and potentially mistreated?

VI. CHILD AND YOUTH ATHLETES PLAY, PRACTICE AND CONDITIONING WEATHER LIMITATIONS AND OTHER RESTRICTIONS

A. NEVER PLAY OR PRACTICE OUTSIDE DURING SEVERE WEATHER. RESTRICTIONS ARE:
• Thunder, Lightning and Electrical Storms
• Heat Index greater than 95
• Air Quality Index 100 and greater

B. OVERUSE INJURIES LIMITATIONS

“There appear to be increasing numbers of children who specialize in a sport at an early age. They train year-round for a sport, and/or compete on an “elite” level. Specialization is the reason for overtraining.

“To be competitive at a high level requires training regimens for children that could be considered extreme even for adults.

“Adverse consequences from intense training and competition have been reported in the lay and medical literature.

“It is important to make efforts to assist young athletes in avoiding potential risks from early excessive training and competition. The following guidelines are suggested keeping in mind

• 1. Import to assure safe and healthy sports play for children
• 2. Must provide practical and realistic guidelines
• 3) Increased guideline research

[1. Committee on Sports Medicine and Fitness, 1999–2000]
[2. Ryan J. Little Girls in Pretty Boxes: The Making and Breaking of Elite Gymnasts and Figure Skaters. New York, NY: Warner Books; 1996]
[3. Tofler IR, Stryer BK, Micheli LJ, Herman LR. Physical and emotional problems of elite female gymnasts. N Engl J Med. 1996;25:335:281–283]

Overuse injuries can be caused and aggravated by the following. Limit and/or Omit:

• Overuse and Overtraining: because there are growth spurts, an imbalance between strength and flexibility
• Excessive activity (for example, increased intensity, duration, or Frequency of playing and/or training)
• Playing the same sport year-round or multiple sports during the same season
• Inadequate warm-up
• Improper technique (for example, overextending on a pitch)
• Bad and Faulty Equipment (for example; bad fitting helmet)
• Re-injury can be avoided by allowing an injury to completely heal.
• Once the Doctor has approved a return to the sport, make sure that your child properly warms up and cools down before and after exercise

The US Department of Health and Human Services Recommend Key Physical Activity Guidelines for Children and Adolescents during Sports and Recreation. Implement the following:

• Children and adolescents should do 60 minutes (1 hour) or more of physical activity daily.
• Aerobic: Most of the 60 or more minutes a day should be either moderate- or vigorous-intensity aerobic physical activity, and should include vigorous-intensity physical activity at least 3 days a week.
• Muscle-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days of the week.
• Bone-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days of the week.
• Children and Adolescents should participate in physical activities that are appropriate for their age

VII. BALANCED DIET, NUTRITION AND INTAKE

Centers for Disease Control [CDC]: Basic Food Groups required for a balanced Diet:
Grains
Fruits
Vegetables
Milk Products
Lean Meat, Beef, Poultry, Fish
Nuts, Seeds, Beans

Committee on Sports Medicine and Fitness, 1999–2000, Am Academy of Pediatrics

“Proper nutrition is critical for both good health and optimal sports performance. For child athletes, an adequate diet is critical because nutritional needs are increased by both training and the growth process. Young athletes and their parents are frequently unaware of the appropriate components of a training diet. The following 4 areas are of particular concern.

Total Caloric Intake

Athletic training creates a need for increased caloric intake, and requirements relative to body size are higher in growing children and adolescents than at any other time in life. In child athletes, the energy intake must be increased beyond the needs of training to maintain adequate growth. Children who engage in sports in which slenderness is considered important for optimizing performance (ie, gymnastics, ballet dancing) may be at risk for compromising their growth. A risk for pathologic eating behaviors also may be increased in children participating in sports where leanness is rewarded.

Balanced Diet

Balance, moderation, and a variety of food choices should be promoted. The Food Guide Pyramid can be used to plan a diet that is balanced and provides sufficient nutrients and calories for both growth and training needs. Athletes who focus on particular dietary constituents (such as carbohydrates) at the expense of a well-rounded diet may potentially compromise their performance as well as their health.

Iron

The body’s requirement for iron is greater during the growing years than at any other time in life. Adequate iron stores are important to the athlete to provide adequate oxygen transport (hemoglobin), muscle aerobic metabolism (Krebs’ cycle enzymes), and cognitive function. However, athletes often avoid eating red meat and other iron-containing foods. Moreover, sports training itself may increase body iron losses.

Calcium

Inadequate calcium intake is common in athletes, presumably because of their concern about the fat content in dairy foods. Normal bone growth, and possibly, prevention and healing of stress fractures, are contingent on sufficient dietary calcium.”

PRE-PARTICIPATION EXAMINATION

Most Pre-Participation Examinations are finalized when the Doctor checks the statement ☑☒ “Cleared to Play”. A Lesser number of Examinations end with ☑☒ Full & Unlimited Participation.

In either case the clearing an Athlete to Play or Participate must be qualified from this day forward.

☑☒ “Cleared to Play only during–Standard Care+Protection+Supervision.” should be the qualification. This provision should be printed (or stamped) above the Doctor’s signature on the Pre-Participation Examination Forms thereby qualifying approval to Participate in Sports after the Pre-Participation Examination only when Safety Standards are to be obeyed by the Coach and supervisor.

“On June 16, 2011 U.S. Surgeon General Regina Benjamin and members of the National Prevention Council released the first ever National Prevention Strategy at a news conference in Washington, D.C.”

“On June 10, 2010 President Obama signed an Executive Order creating the National Prevention, Health Promotion, and Public Health Council. The National Prevention Council, chaired by Surgeon General Regina Benjamin, is charged with providing coordination and leadership at the federal level and among all executive departments and agencies with respect to prevention, wellness and health promotion practices.”

“With input from the public and interested stakeholders, the National Prevention Council is charged with developing a National Prevention and Health Promotion Strategy (National Prevention Strategy).[HealthCare.gov]

After Private Sector Publilc Health Advocacy and input such as this post, U.S. Amateur Athlete Pre-Participation Examination Provisions can be recommended and enacted by congress as part of National Prevention Law by

• The Surgeon General, who directs the Office of the Surgeon General which is part of the Office of the Assistant Secretary for Health in the Office of the Secretary, The Office is in the U.S. Department of Health and Human Services.
• And The National Prevention Council.

The Surgeon General serves as America’s Doctor by providing Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury. Dr. Regina M. Benjamin is the current Surgeon General. [U.S. Dept of Health and Human Services]

Doctors, including the Surgeon General, are in the center of the Comprehensive Model of Athlete Safety, Health, Care, Protection, Supervision and Human Rights and Treatment Compliance. Without Doctors, Sports would not continue to operate.

Until such time of legal enactment of this suggested change in policy, however, every Doctor who does Pre-Participation Examinations should have a self-inking rubber stamp made-up and used for Pre-Participation Examinations stateing ☑☒ “Cleared to Play only during–Standard Care+Protection+Supervision.”

DOCTORS CAN AND SHOULD TAKE CONTROL OF THE SPORTS PRE-PARTICIPATION EXAMINATION AUTHORIZATION WHEN ATHLETES ARE “CLEARED” TO PARTICIPATE

Doctors should only approve clearance for Athlete Sports Participation and Play with the Above stipulations and provisions.

Every Doctor who does examinations should have a self-inking rubber stamp made-up for Pre-Participation Examinations that says the above to be stamped above the Doctor signature,

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

The Doctor does not perform a Pre-Particpation Examination on the Coach for his/her Coaching Conduct and Methods. Coaching Dynamics might be dangerous and unknown by the Doctor, yet the Coach’s behavior is destined for the Athletes’ encounter.

Unbeknown Doctors clear athletes to participate in Sports potentially with both proper and unsafe playing and sports participation conditions. Unprotected, exposed, vulnerable Athlete Clearance and Approval 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 wouldn’t make sense.

Child and Youth Sports Pre-Participation Examinations are analogous to the Doctor taking his or herChild or Youth’s car in for a Tune-Up.

The Doctor’s Child’s automobile is taken to the service department for Safety 1st and foremost, Child Care, Protection and Supervision before the car is driven any further.

The oil is changed, tires rotated, brakes checked and engine is tuned-up for the prevention of an engine blow-up, tire blow-out, brake loss, a wreck, serious damage, injury and/or death to the Child.

The Doctor doesn’t service his Child’s car with the intention of the Child entering a Demolition Derby, a damaging sport participation that has no rules, where cars are required to crash into another vehicle every 2 minutes, have required head-to-head hits at the close of the event and the last car running wins the sporting event. That is not the Doctor’s intention for the Child’s car check-up.

The automobile check-up, before the Child drives, is for safe driving and the prevention of Preventable, Not-Accidental Injuries and/or Deaths, where all authorities have implemented Standard Driving Protection, Supervision and Duty of Care on the road.

Accidents are guaranteed in a Demolition Derby. They are Not-Accidental. If the Doctor believed his Child would enter a Demolition Derby, after the automobile safety check-up, the Doctor would take-away the Keys.

The same attitude should be for Doctors, after a Pre-Participation Examination. The Doctor should take control, take-away the Cleared to Participate Key and NOT allow the Child or Youth Athlete to participate in Harmful Sports, if there is any indication that Athlete Safety Rules will not be strictly enforced by the Coach and/or other safe-keepers during Sports Participation.

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

☑☒ “Cleared to Play” Doesn’t mean the Child and Youth Athletes are worthiness, unprotected Gladiators, who after Doctor approval will be forced to perform in Dangerous Heat, Air Pollution, with Faulty Equipment, Over Exercise, Over Training, after Concussion, beyond Exhaustion and so forth with total Inhumanity and Cruelty.

After a thoroughly complete Pre-Participation Physical Examination, every Doctor should do their Duty and add to their physical examinations a clearance and approval provision, for their own and the Athletes protection, a proviso ink-stamped over the Doctor’s signature for clearance, until our Government mandates changes on the examinatin form:

☑☒ Cleared to Play only “during–Standard Care+Protection+Supervision.” applied with the self-inking pen.

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

Doctors must take Control of the Clearance and Approval of Child and Youth Athletes to Participate-in and Play Sports, just like they would protect, care-for and supervise their own child driving the car after a tune-up.

Control of the Clearance and Approval of Child and Youth Athletes to Participate-in and Play Sports is a Public Health Innovation by Doctors, as called for in 2005 by the Surgeon General to make Child Abuse a Priority in all venues and settings including the Sports.

So you ask, “Where is the Doctor’s Authority to make such a change in Sports’ Pre-Participation Examination policy by his ownmeans, method, device or instrumentality?”

Enactments of Law: Kentucky Revised Statutes, KRS 311.550 Definitions for KRS 311.530 to 311.620 and KRS 311.990(4) to (6). As used in KRS 311.530 to 311.620 and KRS 311.990(4) to (6):

The “practice of medicine or osteopathy” means the diagnosis, treatment, or correction of any and all human conditions, ailments, diseases, injuries, or infirmities BY ANY AND ALL MEANS, METHODS, DEVICES, OR INSTRUMENTALITIES.

• The Doctor has 2 primary Duties to Child and Youth Athletes in regard to the Pre-Participation Examination:

1. Implementation of the aforementioned proviso ink-stamped over the Doctor’s signature for clearance, until our Government mandates changes on the examinatin form:

☑☒ Cleared to Play only “during–Standard Care+Protection+Supervision.” applied with the self-inking pen.

• If the Doctor has any knowledge after a Forensic History during follow-up Examination about Dangerous, Harmful, Substandard Protection and Failed Athlete Safety during Sports Participation of an Athlete whom he has performed Pre-Participation examination and stipulated the participation conditions, the Doctor:

2. Report the suspected Maltreatments and Endangerments to the County Attorney and Child Protective Services (CPS) as Mandated by Child and Youth Protection Federal and State Laws
3. Assist the Forensic Investigation
4. Close-down the Sport until the investigation has been completed and Dangers entirely removed

• In accordance with State Law “The Practice of Medicine” for the “Correction of any and all human conditions, ailments, diseases, injuries, or infirmities BY ANY AND ALL MEANS, METHODS, DEVICES, OR INSTRUMENTALITIES.”

• In accordance with the Doctor’s duty to Public Health: “As well as seeking to improve population health through the implementation of specific population-level interventions, Public Health contributes to medical care by identifying and assessing population needs for health care services, including:
1. Assessing current services and evaluating whether they are meeting the objectives of the health care system
2. Ascertaining requirements as expressed by health professionals, the public and other stakeholders
3. Identifying the most appropriate interventions
4. Considering the effect on resources for proposed interventions and assessing their cost-effectiveness

Doctor, think Athlete Safety 1st! Do your Duty, If Danger lurks, Take the Keys!

References:
^ WHO Definition of Health Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, 1946
^ The Solid Facts: Social Determinants of Health edited by Richard Wilkinson and Michael Marmot, WHO, 2003
^ Brandt, A. M., and M. Gardner. 2000. Antagonism and Accommodation: Interpreting the Relationship Between Public Health and Medicine in the United States During the Twentieth Century. American Journal of Public Health 90:707 – 715

^ Gillam Stephen; Yates, Jan; Badrinath, Padmanabhan. Essential Public Health. Cambridge University Press 2007.
^ Pencheon, David; Guest, Charles; Melzer, David; Gray, JA Muir. Oxford Handbook of Public Health Practice. Oxford University Press 2001.
^ Smith, Sarah; Sinclair, Don; Raine, Rosalind; Reeves, Barnarby. Health Care Evaluation (Understanding Public Health). Open University Press 2006.
^ Sanderson, Colin; Gruen, Reinhold. Analytical Models for Decision Making (Understanding Public Health). Open University Press 2006.

WHOSE RESPONSIBLE FOR SPORTS SAFETY? INJURY PREVENTION?

U.S. society depends mightily on excellent Athlete Competition, Competent Coaching and “Win-At-All-Costs”, particularly costs to the Young Athlete.

But systems in crisis according to the Surgeon General [^Workshop 2005] regarding Child Protection, including the Government’s duty to Young Athletes, have failed to stress Coaching Child and Youth Athlete Custodial Protection, Supervision and Safety.
Who or what has the most authority and regulation capacity to affect Child and youth Athlete Safety improvement?

Each state has clearly defined Child Abuse and Neglect Legal Statutes and Regulations that govern the care of Children and Youth. These are Standards of Care for Children and Youth and govern their care. They follow Ffederal Child Protection guidelines.[2011 Society for Social Work Leadership in Health Care]

Human rights of Children and Youth in the United States are legally protected, like adults, by the Constitution of the United States and amendments conferred by treaty, and enacted legislatively through Congress, state legislatures, and plebiscites (state referenda).[ Lauren, Paul Gordon (2007). "A Human Rights Lens on U.S. History: Human Rights at Home and Human Rights Abroad". In Soohoo, Cynthia; Albisa, Catherine; Davis, Martha F.. Bringing Human Rights Home: Portraits of the Movement. III. Praeger Publishers. p. 4. ISBN 0275988244] [Brennan, William, J., ed. Schwartz, Bernard, The Burger Court: counter-revolution or confirmation?, Oxford University Press US, 1998,ISBN 0-19-512259-3, page 10] These too are Standards of Care for Children and Youth and govern their care.

Q. WHY DOES the U.S. HAVE An ATHLETE INJURY CRISIS DURING SPORTS PARTICIPATION? WHY DOES CHILD AND YOUTH ATHLETE CRUELTY EXIST AT AN ALARMING RATE? WHY ARE STATNDARS OF CARE VIOLATED?

A. BECAUSE PEOPLE and SYSTEMS ARE NOT DOING THEIR JOB and DUTY FOR THE PREVENTION OF CHILD and YOUTH ATHLETE AMATEUR HUMAN RIGHTS VIOLATIONS AND PROTECTION AND SUPERVISION AGAINST PHYSICAL, PSYCHOLOGICAL MALTREATMENT AND ENDANGERMENT AND SEXUAL ABUSE.

Q. QUESTION AND SOLUTION: DESCRIBE WHO OR WHAT HAS THE MOST AUTHORITY AND CONTROL CAPACITY TO AFFECT THE IMPROVENMENT IN CHILD AND YOUTH SPORT SAFETY AND THE PREVENTION OF CHILD AND YOUTH ATHLETE CRUELTY AND INJURIES AND SPORTS HUMAN RIGHTS VIOLATIONS

The most responsible for Athlete Safety enjoys the most Criminal and Civil Immunity, until the hierarchy of responsibility for Young Athletes’ Safety fumbles down to the Coach who can suffer punishment.

The most responsible and powerful are the most immune. The General Deterrence for Criminal Behavior Principle for Athlete Safety doesn’t apply to those immune. The most responsible can only rely on their moral fibers and obligation.

All the following are immune to Criminal and Civil Litigation except the Coach, Teacher, Parent and Athlete. The Heirachy Responsibililty for Young Athlete Safety. in descending order and who’s not doing their duty to Young Athletes:

I. FEDERAL GOVERNMENT HAS THE GREATEST AUTHORITY AND CONTROL CAPACITY TO AFFECT IMPROVENMENT IN CHILD AND YOUTH SPORT SAFETY

► “The Bill of Rights were introduced by James Madison to the 1st United States Congress as a series of legislative articles. They were adopted by the House of Representatives on August 21, 1789, formally proposed by joint resolution of Congress on September 25, 1789, and came into effect as Constitutional Amendments on December 15, 1791, through the process of ratification by three-fourths of the States.

• The Bill of Rights is the collective name for the first ten amendments to the United States Constitution, which limit the power of the U.S. federal government. These limitations serve to protect the natural rights of liberty and property including freedoms of religion, speech, a free press, free assembly, and free association, as well as the right to keep and bear arms.

• Originally, the Bill of Rights included legal protection for white men only, excluding most Americans and all women. It took additional Constitutional Amendments and numerous Supreme Court cases to extend the same rights to all U.S. citizens.

• The Bill of Rights plays a key role in American law and government, and remains a vital symbol of the freedoms and culture of the nation. One of the first fourteen copies of the Bill of Rights is on public display at the National Archives in Washington, D.C.

• Defines citizenship, contains the Privileges or Immunities Clause, the Due Process Clause, the Equal Protection Clause, and deals with post-Civil War issues

• 14th Amendment: The Equal Protection Clause of the Fourteenth Amendment to the United States Constitution, provides that “no state shall … deny to any person within its jurisdiction the equal protection of the laws”. The Equal Protection Clause can be seen as an attempt to secure the promise of the United States’ professed commitment to the proposition that “all men are created equal”[2] by empowering the judiciary to enforce that principle against the states.[3] As written it applied only to state governments, but it has since been interpreted to apply to the federal government of the United States as well.

• More concretely, the Equal Protection Clause, along with the rest of the Fourteenth Amendment, marked a great shift in American constitutionalism. After the Fourteenth Amendment was enacted, the Constitution also protected rights from states could not, deprive people of the equal protection of the laws. What exactly such a requirement means has been the subject of much debate, and the story of the Equal Protection Clause is the gradual clarification of its meaning.” [Wikipedia]

►United States Congress and Federal Government, have enacted Child Protection Laws

• 1974 Federal Law, Child Abuse Prevention and Treatment Act (CAPTA), amended several tiemes but last amended to the Keeping Children and Famillies Safe Act in 2003, Public Law 108-36
• Title I— Child abuse Prevention and Treatment Act
• Sec. 101. Failed Subtitle A. General Program
• Sec. 111. Failed Child Abuse Information Exchange
• All categories of Child Abuse are illegal, including Child and Youth Physical and Psychological (Emotional) Endangerment and Maltreatment and Sexual Abuse.
• Criminal Codes have been enacted.
• Therefore, Child Athlete Abuse Syndrome has been Illegalized.

► Powers Reserved for the Federal Government

• “The U.S. government is federal in form. The states and national government share powers, which are wholly derived from the Constitution.
• From the Constitution, the national government derives express powers, implied powers, inherent powers
• Article I, Section 10 of the Constitution of the United States puts limits on the powers of the states. States cannot form alliances with foreign governments, declare war, coin money, or impose duties on imports or exports.

► United States Federal Government Mandates

• States must also administer mandates set by the federal government. Generally these mandates contain rules which the states wouldn’t normally carry out. For example, the federal government may require states to reduce air pollution, provide services for the handicapped, or require that public transportation must meet certain safety standards. The federal government is prohibited by law from setting unfunded mandates. In other words, the federal government must provide funding for programs it mandates.
• The federal government pays for its mandates through grants-in-aid. The government distributes categorical grants to be used for specific programs. In 1995, federal grant money totaled $229 billion.
• Block grants give the states access to large sums of money with few specific limitations. The state must only meet the federal goals and standards. The national government can give the states either formula grants or project grants (most commonly issued).
• Mandates can also pass from the state to local levels. For example, the state can set certain education standards that the local school districts must abide by. Or, states could set rules calling for specific administration of local landfills.” [Project Vote Smart]
• The Responsibility for Child Welfare Services Rests with each State
• Every United State receives Federal Grants for Child Abuse
• Federal Guidelines Must Be Followed For States to Receive Federal Child Abuse Funds
• The Administration for Children and Families (ACF) is a federal agency funding state, territory, local, and tribal organizations to provide family assistance (welfare), child support, child care, Head Start, child welfare, and other programs relating to children and families.
• Actual services are provided by state, county, city and tribal governments, and public and private local agencies. ACF assists these organizations through funding, policy direction, and information services

II. STATE GOVERNMENT HAS THE 2ND HIGHEST AUTHORITY AND CONTROL CAPACITY TO AFFECT IMPROVENMENT IN CHILD AND YOUTH SPORT SAFETY

• Every United State receives Federal Grants for Child Abuse and Human Rights
• Every United State must serve the Rules of Law for Amateur Athlete Human Rights and for Child Athlete Abuse Syndrome Violations.
• Each state has its own constitution which it uses as the basis for laws. All state constitutions must abide by the framework set up under the U.S. National Federal Constitution.
• The basic structure state constitutions much resemble the U.S. Constitution. They contain a preamble, a bill of rights, articles that describe separation of powers between the executive, legislative and judicial branches, and a framework for setting up local governments.

► UNFORTUNATELY, ENFORCEMENT OF THE LAW AND THE WILL TO ENFORCE THE LAW ARE THE MOST EFFECTIVE DETERRENTS TO ATHLETE AMATEUR HUMAN RIGHTS AND CHILD AND YOUTH AHTLETE ABUSE SYNDROME VIOLATIONS

► CHILD (<18) and YOUTH (15-24) AMATEUR ATHLETES ARE A GLOBAL, VULNERABLE, “HEALTH DISPARITY POPULATION” IN NEED OF ENFORCEMENTO OF

• UNIVERSAL, INHERENT, INALIENABLE HUMAN RIGHTS
• CHILD AND YOUTH ATHLETE CUSTODIAL PROTECTION AND SUPERVISION

► ATHLETE AMATEUR HUMAN RIGHTS DISORDERS ARE SECONDARY TO ATHLETE AMATEUR HUMAN RIGHTS VIOLATIONS

► CHILD ATHLETE ABUSE SYNDROME, “A NEW DISEASE” IS SECONDARY TO THE FOLLOWING BY DEFINITION:

• Child (<18) or Youth (15 to 24) Athlete
• With Serious Injury and/or Death sustained by
• Physical Endangerment and/or Maltreatment
• Psychological (Emotional) Endangerment and/or Maltreatment
• And/or Sexual Athlete Abuse
• Failed Improper Child Custodial Protection
• Negligent Coaching Care-Giving Supervision
• That was Inflicted, Caused, Created,
• or Allowed To Be Inflicted, Caused, Created,
• Directly or Indirectly
• By the Coach

III. 3rd in the Hiearchy of Responsibilty: THE OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH IN THE OFFICE OF THE SECRETARY U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

• America's Doctor, the Surgeon General
• “The Office of the Surgeon General, under the direction of the Surgeon General, oversees the operations of the 6,500-member Commissioned Corps of the U.S. Public Health Service and provides support for the Surgeon General in the accomplishment of her other duties.
• The Surgeon General serves as America's Doctor by providing Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury” [Office of the Surgeon General)

► CHILD ATHLETE ABUSE SYNDROME IS “MEDICALIZED”

• Medicalized: To identify or categorize a condition or behavior as being a disorder requiring medical treatment or intervention [Online-Dictionary]

• CAAS IS LEGITIMATE DIANOSIS WITH ICD-9 CODES because all child abuse is Medicalized. (ICD-9) "International Classification of Disease, 9th edition, Clinical Modification is a standardized classification of disease, injuries, and causes of death, by etiology and anatomic localization and codified into a 6-digit number, which allows clinicians, statisticians, politicians, health planners, health insurance and others to speak a common language, both US and internationally". ICD-9s are used to bill medical insurance by Doctors.

IV. 4th in the Hiearchy of Responsibilty: Community based Sports Medicine, Family Medicine, Pediatric Doctors and Emergency Doctors need to familarize themselves with modifer codes

• Child Abuse Codes are in International Classification of Disease, 9th Edition
• Child Abuse is “On The Books”
• Doctors Need To Step-Up, Code Child Athlete Abuse Syndrome and receive increaed reimbursement
For Instance on the 3rd Party Insurance Claim
1. ICD-9 Code – Fractures
2. ICD-9 Code - Modifiers
3. T74.12 CPA Child Abuse Confirmed by the Doctor
4. YO7 Perpetrator of the Child Abuse is Known
• Proper Reporting of Amateur Athlete Human Rights Violations and Child Athlete Abuse Syndrome
• Direct Intervention when the Doctor discovers Abnormal Coaching Behaviors resulting in Injuries and Deaths
• Preventing the return to play and practice after injury until the injury is completely healed
• Through Pre-Participation History and Physical Examinations including EKG, Echo Cardiogram, Concussion Baseline Neuropsychological Testing
• Honest, forthright, free expert witness or treating doctor witness testimony, not tainted by employment to testify as a source of income
• Some Sports Medicine Doctors Have Sold Their Souls To The Coach. They Don’t Take Helmets after Concussion, Sneakers after a knee injury etc.

V. 5th in the Hiearchy of Responsibilty: STATE, FEDERAL AND NATIONAL ATHLETIC ASSOCIATIONS AND ORGANIZATION

• Athletic Associations Not Closed Societies
• Athletic Association Not Impervious > Rule of Law
• The Federal Government has faile to Direct The State Process of Child Athlete Protection
• The Federal Government has Failed to Approve Funding Directly for Child Athlete Safety
• Failed to Inform States Must Comply with Federal Requirements
• Altlhough Federal our Government has directed Child Abuse Grants to States for Child Abuse in general
• “NCAA legislation provides practice opportunities during which institutions can conduct workouts,”
• “Determination of the content of those workouts are best handled by the local athletics staff to meet the individual needs of student-athletes.”
• “[An institution is] responsible for establishing a safe environment for its student-athletes to participate in its intercollegiate athletics program.”
• Acording to the NCAA Athlete Safety is the Responsibility of the College and Coach

VI. 6th in the Hiearchy of Responsibilty: COACH/TEACHER
• Coaches and Teachers are not immunie to Criminal Prosecution and Civil Adjudication for for Athlete Amateur Human Rights Viloations and failed Child and Youth Custodial Protection and Supervision
• Coaches and Teachers catch the brunt of the Legal System for Athlete Amateur Human Rights Viloations and failed Child and Youth Custodial Protection and Supervision
• Coaches and Teachers are the first in the responsibility hierarchy to be at Risk for for Athlete Amateur Human Rights Viloations and failed Child and Youth Custodial Protection and Supervision
• All others above Coaches and Teachers in the responsibility hierarchy are not as vulnlerable to the Risk for Criminal Prosecution and Civil Adjudication for Athlete Amateur Human Rights Viloations and failed Child and Youth Custodial Protection and Supervision
• Coaches and Teachers are directly Responsible to Unlawful Behavior
• Coaches and others were targeted as potential Abusers and Perpetrators by the Surgeon General
• Chaches and Teachers in this scenario are like the Football player who scores a Touchdown. The player who crosses the goal line with the football gets credit for the TD.
• The Coach who crosses the line by pushing and punishing Athletes beyond their Physical and Emotional Limits or initiates Sexual Athlete Abuse whether the Coach ignored, overlooked Rules of Law or did not know the Rules of Law or the violations were intentional or willful gets the blame for the Unlawful Behavior.
• When the Coach crosses the line with Bad Behavior, the Coach gets liability for the Risk.

VII. 7th in the Hiearchy of Responsibilty: Criminal Justice System
Lack of Attorney Practice Guidelines and Standards in Child Protection Proceedings
acording to the NATIONAL ASSOCIATION of COUNSEL for CHILDREN / NACC and
AMERICAN BAR ASSOCIATION / ABA

VIII. 8th in the Hiearchy of Responsibilty:Social and Child Welfare Services

IX. 9th in the Hiearchy of Responsibilty: Education / Awareness services
Failure Coach Education by High School and University Athletic Associations Concerning Child and Youth Athlete Protection Law

X. 10th in the Hiearchy of Responsibilty:PARENT

XI. 11th in the Hiearchy of Responsibilty: THE CHILD AND YOUTH ATHLETE HAVE THE LEAST AUTHORITY AND CONTROL CAPACITY TO AFFECT IMPROVENMENT IN CHILD AND YOUTH SPORT SAFETY AND THE PREVENTION OF INJURY

__________________________________________________________________

WHO IS RESPONSIBLE FOR SPORTS SAFETY? INJURY PREVENTION?

Injury Prevention in Child and Adolescent Sport: Whose Responsibility Is It? Carolyn A. Emery, PhD,* Brent Hagel, PhD,† and Barbara A. Morrongiello, PhD‡Clin J Sport Med _ Volume 16, Number 6, November 2006

Dr. Barbara A. Morrongiello has researched extensively supervision and sports injuries. She is a world’s authority on those subjects. From the article several excellent lines of reasoning were reported.

Abstract
Objective: Sport and recreational injuries are a leading cause of morbidity in youth. There is a significant body of literature on risk factors for sport-related injuries and a growing body of research supporting the effectiveness of sport-specific prevention strategies in youth. Given the predictability and preventability of injuries in youth sport, the purpose of this article is to develop a model that considers societal responsibility for injury prevention in youth sport, and to discuss the evidence that supports this model.

Data Sources/Synthesis: Previously published papers have provided a basis for expert opinion to discuss an approach to examining the shared societal responsibility for implementing countermeasures to reduce the risk of injury to youth during sports.

Results: Based on a historical perspective, broad conceptual framework, and specific evidence for prevention strategies in youth sport, the authors have developed and supported a theoretical model that defines a responsibility hierarchy in preventing injuries in youth sport. An argument has been made for a hierarchy of responsibility, with the lowest level of responsibility assigned to the child, and the highest level to those organizations or groups with the potential to effect the most change.

The justification for this approach has been discussed in the context of the desirability of passive prevention strategies, the limited evidence for the effectiveness of strategies relying solely on behavior change in children and parents, and the level of perceptual and cognitive development in children that inadequately prepares them to take primary responsibility for their own safety in sport.

Conclusions: The development of effective programs to reduce the burden of sport injury among youth necessitates a scientific approach, the identification of key risk factors for injury, a thorough examination of how factors interact to affect risk, and the identification of potential barriers to the effectiveness of injury-prevention programs

The History surrounding events of an injury are extremely important. “The first axis of injury and its prevention comprises the temporal phase:

 pre-event
 event
 post-event.

“The second axis describes factors that may bear on the likelihood or severity of injury, including host (human) factors, agent factors (equipment), and physical and social environmental conditions.” 26.

In Figure 2 of this excellent article, was presented “a model of risk that can aid in intervention planning.

As can be seen in the model, some factors are quite amenable to policy initiatives to improve safety (eg, physical environment factors), whereas others (eg, social environment factors, psychological host factors) are not.”

From Article’s Figure 2.
I. HUMAN FACTORS

 GENDER
 AGE Cognitive and Perceptual Development
 HEALTH AND FITNESS
 SKILL AND EXPERIENCE
 KNOWLEDGE AND UNDERSTANDING OF RISKS AND HAZARDS
 PERSONALITY / TEMPERMENT

Sensation Seeking, impulsiveness, over-activity

Inhibitory control

II. PSYCHOLOGICAL FACTORS

 Beliefs About Injury Vulnerability and Severity
 Tolerance for Risk Taking, Estimation of Ability,
 Perception of Risk, Motivation to Excel,
 Motivation to Avoid Injury etc.
III. ENVIRONMENTAL FACTORS

 PHYSICAL ENVIRONMENT

a, Environmental Conditions
b. Equipment

 INSTITUTIONAL ENVIRONMENT

a. Policies
b. Procedures
c. Behavior, Attitudes and Training of Coaches, Referees, Umpires etc.
d. Communications About Safety

 SOCIAL ENVIRONMENT

a, Behaviors of Family Members, Peers, Friends, Team b. Members Opponents, Observing Fans, Social Norms, c; Media
d. Communications

From figure 1.
“Increasing Responsibility for Child Sport Injury Prevention Based on Influence Potential”. The Increase begins with the Child who has the least Responsibility for their Injury and progressively increases until its summit, the Government/Law/Public Health

MOST INFLUENCE POTENTIAL
► GOVERNMENT/LAW GREATEST INFLUENCE POTENTIAL
► COACH/TEACHER
► SPORTS ORGANIZATION
► PARENT
► CHILD LEAST INFLUENCE POTENTIAL

___end of reference___________________________