Child Athlete Abuse Syndrome is a Short Title for a Clustering of Child (<18) or Youth (15-18) Athlete Serious Injury, Disease and/or Death secondary to: ► Physical endangerment, maltreatment and/or abuse ► Psychological (Emotional) endangerment, maltreatment and/or abuse ► Sexual Abuse ► Failed child custodial protection ► Negligent care giving supervision ► Human rights violations ► That were inflicted, caused, created, or allowed to be inflicted, caused, created, directly or indirectly by the Problematic Coach, including the Strength Training, Conditioning and other specialty Coach, Problematic Parent or other Problematic Caretaker Person who has Child and Youth Athlete custodial protection, supervision, care and control during Sports, Recreation and Exercise Participation ► Failure to report the morbidity and mortality to Authorities is Illegal. [1.] [6.] ► In most United States, Children are minors when less than 18 years of age. ► The United Nations define Youth as persons between the ages of 15-24. ________________________________________________________________________ Research on Child and Youth Athlete Abuse began in 2007 as our 1961-1962 University of Kentucky Wildcat Football team began the organization of our first Football Class Reunion scheduled for June 14, 2008, about one year after the publication of The Thin Thirty. The Thin Thirty is a remarkable book written by Shannon Ragland and published by Set Shot Press in 2007. It is an historical book about the University of Kentucky Football tragedy in 1962, untold and hushed until this book’s publication. As we organized our first 1961-1962 University of Kentucky Wildcat Football Class Reunion, we began gathering information. Questionnaires were mailed to our teammates and information gathering began. Concerns about teammates reported experiences 50 Years Ago began to accumulate as teammates returned information for the Reunion. We realized our teammates suffered morbidity and mortality from the reports submitted. That prompted us to survey our 1961-1962 University of Kentucky Football Team. Frank Deford, Sports Illustrated reporter, said from his recollection, it was the “first study of its kind”. The result was “A Longitudinal and Retrospective Study of The Impact of Coaching Behaviors on the 1961-1962 University of Kentucky Football Wildcats”, Kay Collier McLaughlin, Ph.D., Micheal B. Minix Sr. M.D., Twila Minix, R.N., Jim Overman, Scott Brogdon. Thus began our research group’s mission to discover the circumstances and pathology that compelled Charlie Bradshaw and his assistants to the vile, tyrannical, brutal, abusive, abnormal Coaching Behaviors that they manifest during 1962. Child Athlete Abuse was first authored by Micheal B. Minix, SR., M.D. in 2009. Permission for use was granted for the Cheer Safety and Risk Management Guide. (3537 words) by Micheal B. Minix, Sr., M.D. cc Sept. 2009 with copyright restrictions on "changes, alterations and other uses such as redistribution and sale of this document are not to be made without my permission."* CAPPAA, (Child and Adult Physical and Psychological [Emotional] Athlete Abuse), a Public Health Crisis, was prepared for Presentation to Deputy Secretary Steven Nunn, the Kentucky Cabinet for Health and Family Services April 24, 2010 by mbmsrmd and the CAPPAA Team. Child Athlete Abuse Syndrome, A New Disease was further described November 15, 2010. “As sport is a highly child-populated domain, the establishment of child-protection measures to reduce the potential for child maltreatment in sport is critical.” “Concern for the protection of children in sport has a history that is as old as modern sport itself; however, it is only recently that concern has been established about children's experiences of relational forms of abuse and neglect in this domain.” [45.] Violations of Child Protection Laws in the Sport, Recreation and Exercise (SRE) domains and the offenders and perpetrators necessitate new definitions moving forward with the new developments in SRE. U.S. CHILD ATHLETE POPULATION STATISTICS • There were 75,200,000 U.S. Children <18 YO in 2010. [46.] ~20,000,000 U.S. Children 6 -18 played organized, Non-School Amateur Sport ~25,000,000 played organized School Amateur Sports ~45,000,000 (~60%) U.S. Children played one School or Non-School Amateur Sport 2010. [47.] CHILD ATHLETES ARE A HEALTH DISPARITY POPULATION STATISTICS • “A health disparity is a particular type of difference in health or one of the most important influences on health that could potentially be shaped by policies. It is a difference in which disadvantaged social groups have persistently experienced social disadvantage or discrimination and systematically experience worse health or greater health risks than more advantaged social groups.” [25.] • Defined in US Public Health Safety Act: “A population is a ‘Health Disparity Population’ if there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population. In addition to the meaning so given, the Director may determine that such term includes populations for which there is a significant disparity in the quality, outcomes, cost, or use of health care services or access to or satisfaction with such services as compared to the general population.” [26.] • An estimated 50% of Child Athletes Sports Injuries are secondary to Child Athlete Abuses Syndrome (CAAS) • “About 3.5 million children age 14 and under are treated for sports-related injuries annually, and half may be preventable, Safe Kids USA officials say.” [27.] • “According to the CDC, more than half of all sports injuries in children are preventable.” [ 28.] • “According to the Centers for Disease Control and Prevention, nearly 30 million children and adolescents are participating in youth sports and nearly 3.5 million children under the age of 14 receive some sort of medical treatment for sports injuries each year. An estimated half of these injuries are preventable ”. [29.] • There were 120 sports-related deaths of young athletes in 2008–2009; 50 in 2010; and 40 in 2011. • Approximately 8,000 children are treated in emergency rooms each day for sports-related injuries. • Among children, those aged 15–17 experience the highest emergency room visits for sports injuries.  • Rates of sports injury visits to ERs were highest in remote rural settings.  • High school athletes suffer 2 million injuries, 500,000 doctor visits and 30,000 hospitalizations each year.  • There are three times as many catastrophic football injuries among high school athletes as college athletes.  • History of injury is often a risk factor for future injury, making prevention critical. - [48.] • Emergency department visits for concussions sustained during organized team sports doubled among 8–13 year olds between 1997 and 2007 and nearly tripled among older youth.  • Concussion rates more than doubled among students age 8–19 participating in sports like basketball, soccer and football between 1997 and 2007, even as participation in those sports declined.  • A 2011 study of U.S. high schools with at least one athletic trainer on staff found that concussions accounted for nearly 15% of all sports-related injuries reported to ATs. [32[ • High school athletes who have been concussed are 3 times more likely to suffer another concussion the same season.  • Females aged 10–19 years sustained sports- and recreation-related TBIs most often while playing soccer or basketball or while bicycling.  • More than 248,000 children visited hospital emergency departments in 2009 for concussions and other traumatic brain injuries related to sports and recreation.  - [48.] • 31 high school players died of heat stroke complications between 1995 and 2009.  • 64.7% of football players sustaining a heat illness were either overweight or obese.  • The number of heat-related injuries from 1997 to 2006 increased 133 percent. Youth accounted for the largest proportion of heat-related injuries or 47.6 percent.  - [48.] The incidence of out-of-hospital sudden cardiac arrest in high school athletes ranges from .28 to 1 death per 100,000 high school athletes annually in the U.S. - [48.] Child Athlete Abuse Syndrome is a Short Title for a Clustering of Child (<18) or Youth (15-18) Athlete Serious Injury, Disease and/or Death secondary to: ► Physical endangerment, maltreatment and/or abuse ► Psychological (Emotional) endangerment, maltreatment and/or abuse ► Sexual Abuse ► Failed child custodial protection ► Negligent care giving supervision ► Human rights violations ► That were inflicted, caused, created, or allowed to be inflicted, caused, created, directly or indirectly by the Problematic Coach, including the Strength Training, Conditioning and other specialty Coach, Problematic Parent or other Problematic Caretaker Person who has Child and Youth Athlete custodial protection, supervision, care and control during Sports, Recreation and Exercise Participation ► Failure to report the morbidity and mortality to Authorities is Illegal. [1.] [6.] ► In most United States, Children are minors when less than 18 years of age. ► The United Nations define Youth as persons between the ages of 15-24. Child Athlete Abuse Syndrome and Cruelty to Children in Sports, Recreation and Exercise (SRE) are matters of importance to Doctors and Health Care Personnel. They summons all Doctors and Health Care Personnel into action for the Awareness and Prevention of these Child Athlete Preventable, Not-Accidental morbidities and mortalities. The practice of medicine, in part, involves documentation and analysis of medical and surgical objective information about preventable, not-accidental morbidity and mortality. Forensic Medicine is the utilization of these objective facts by the legal system as evidence, following their reqresition and obtainment. Medical jurisprudence is concerned with a broad range of medical, legal and ethical issues and human rights disorders. CAAS IS MEDICALIZED Child Athlete Abuse Syndrome is “medicalized” which means that CAAS is identified and categorized as a condition, disorder or behavior requiring medical treatment or intervention [2.] CAAS is a legitimate Diagnosis with International Classification of Disease-9 Codes (ICD-9). Every classification of Child Abuse in every venue is Medicalized. The “International Classification of Disease, 9th edition, (ICD-9) Clinical Modification is a standardized classification of disease, injuries, and causes of death, by etiology and anatomic localization, 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” and ICD-9s are used for data analysis, medical insurance billing by physicians and many other purposes. [3.] USE OF ICD-9 CODE EXAMPLE If the Coach strikes a Child Athlete in the left eye with his fist during sport participation and fractures the left orbaital floor. The Medical Erergency Department Chart is tendered with: • Impression (Initial Diagnosis): 1. Left Orbital Floor Fractures 2. Child Physical Abuse (CPA) Hospital and Physicians' office Charts should have recorded the following codes and the Insurance Claim to 3rd Party Payor, or Medical Insurance, should be billed with the following codes: • ICD-9 Code – Fractures 1. Closed fracture of orbital floor (blow out) Diagnosis Code 802.6 2. ICD-9 Code - Modifiers for Child Abuse. See below. Data mining is an important injury statistic resource. Less important, but an incentive, is that the modifier codes allow for additional 3rd party reimbursement to treating physicians and facilities. Many Physicians do not realize that the following modifer Codes for Child Abuse should be added to the above injury and similar injuries, because Physicians have not been properly educated concerning their Duty-to and Legal Relationship-with Children. Most don't fully understand their Duty to Report Child Abuse in general and Child Athlete Abuse specifically. Doctors are mandated to Report ALL the types of Child Abuse. Physicians don't realize that they can face charges of failure to Report and malpracitce litigation for the failure should another incident arise because they failed to Report the Perpetrator in the first instance and the bad behaviors were allowed to continue. The Child Abuse modifer codes are there for application. Physicians should not cheery pick the incidents they want to Report. CAAS is Called a “A NEW DISEASE” because many in the entire athletic community, including leadership officials, witnesses, the media and Responsible Systems are acting irresponsibly and are in Child Abuse Intervention and Reporting Responsibility Crisis, acording to the Surgeon General of the United States. Responsible systems and officials have failed their duty to Children and have covered-up Sexual, Physical and Psychological Abuse. They have attempted to spin All athletic injuries and deaths as unfortunate byproducts of playing the game. The Penn State Tragedy is a prime example. The Sandusky Tragedy has enlightened the public about evil behaviors of some Problematic Coaches and leadership officials who have attempted to cover-up. Former Penn State head football “Coach Joe Paterno seriously faulted” in the Coach Jerry Sandusky Tragedy that found Sandusky guilty on 48 counts of Child Sexual abuse. The self investigation of Penn State notes that University President Graham Spanier, Senior Vice President Gary Schultz and Athletic Director Tim Curley altered their decision to report the sexual abuse crimes after a meeting with the head Coach Paterno who died in January 2012, two months after the story broke. [8.] Physicians who Fail to Report, according to one Public Health Official are like the fox watching the hen house. They don't want to jepordize their referral network from schools, trainers and Coaches for Athlete Injuries. Modifier Child Abuse ICD-9 Codes that should be added to the aforementioned Orbital Floor Fracture ICD-9 Codes: • ICD-9 Code for Child Physical Abuse (CPA) 1. T74.12 Child Physical Abuse Confirmed 2. YO7 The Child Abuse Perpetrator is Known and is the Coach CAAS IS ILLEGALIZED Child Athlete Abuse Syndrome has been “illegalized”. Battered Child Syndrome (BCS) was first reported in 1962. It evolved into United States Federal Child Protection Laws. [4.] Child Abuse Prevention and Treatment and Reauthorization Act 2010, Public Law 111-320 which was first enacted into Federal Law in 1972 and has been amended several times, most recently 2010. Many Offenders and Predaters have been tried and crimminally convicted for Child Abuse of Athletes. “The lack of definitional uniformity between states and cultures increases the potential for disputes concerning the "correct" definition of child abuse and neglect...."[44.] This publication offers the definition of Child Athlete Abuse Syndrome. “Modern child abuse and neglect statutes have three primary purposes: 1. "to define child abuse, neglect and to identify children at risk," the purpose of CAAS Forensic Definition for SRE Athletes. 2. "to recognize a specific agency to receive and investigate reported incidents of abuse and neglect," the purpose of CAAS Forensic Definition for SRE Athletes. I recommend doctors and all Health Care Personnel Report CAAS to the County Attorney. Once reported to the County Attorney, the Doctors Duty to Report is accomplished. 3. "to offer appropriate services and programs for abused and neglected children and their families. 169 [44.] Authorities can offer services and programs solutions. SRE are not Cultures and Nations unto their own. Child Abuse is Abuse in any culture, including SRE. “Currently, there is no formally recognized "cultural defense" (for Child Abuse) in the American system of criminal justice. 96 This absence, however, has not prevented defense attorneys from introducing cultural information about their clients under the context of preexisting defenses. 97 Clearly, cultural information will be admitted into courtrooms whenever a case involves a cultural conflict; it is practically impossible to exclude it entirely. 98 Therefore, the issue is not whether cultural evidence will be introduced, but whether such evidence can function to mitigate a defendant's charge and/or punishment.[44.] Adjudicating a Criminal Child Athlete Abuse case, based on the violations of High School Athletic Association Rules or other Sport Association, Federation, Organizations or League Rules violations, rather than violations of Child Protection Laws, would be a Phony Masquerade of Legal Interpretation and Forensic Medical Facts. “Modern child abuse and neglect statutes are commonly known as "reporting statutes" since they require certain individuals, based on their occupational contact with children, to report instances of abuse or neglect when they come into contact with it. See id. at 12, 18. A few examples of mandated reporters are physicians; hospital personnel engaged in the examination, care, or treatment of patients; public and private teachers; psychologists and psychiatrists; police officers; firefighters; social workers; and day care workers. See MAss. ANN. LAWS ch. 119, § 51A (Law. Co-op. 1995) [44.] Central to the theory of retribution is the idea that a person's punishment should fit the crime committed. Therefore, in determining the proper punishment (for Child Abuse) for a given individual, this reference discussion, has argued that an inquiry into a defendant's motivations for acting illegally is required, as is a moral judgment on these particular motives. In this way, a person who acts with "good" motives should be punished less severely than a person who commits exactly the same illegal act, but does so with "bad" motives. [44.] Child Athlete Abuse Syndrome, for the sake of winning Sports games, is an extremely “bad motive for Child Abuse". [44.] (Of course, no motive is good). In this instance, Sport Culture is the culture in question and Problematic Coaches are the potential Offenders. The Sport Culture strives to be a "nation unto its own" free from outside interferance and Child Protection Law. The Medical-Legal, Forensic definition of CAAS is extremely important moving forward with the rise in the popularity of SRE. Child Protective Services (CPS) and Juvenile and Family Courts appear to focus-on and limit their investigations and interventions on relational cases of Child Abuse i.e parents, live-ins, caregivers in the home etc. Family Rehabilitation rather than punishments are their goals. Currently, Family Courts and Adult Criminal Courts need reformation where CAAS is concerned. Presently, CAAS should be reported to the County Attorney. STATES HAVE JURISDICTION • “Parens Patriae” Doctrine Grants Power and Authority of the State to protect minor Children, age less than 18 • Therefore, States have jurisdiction and are the Supreme Guardians of Children and have the power to Intervene of behalf of Children and Enforce Child Protection and Supervision Laws and adjudicate their violations • Additionally, Children born in the USA are U.S. Citizens and, therefore, are also the subjects of Federal jurisdiction. STATES MUST COMPLY WITH CAPTA 2010 • State Child Abuse Performance Procedures and Actions should reflect CAPTA 2010, Public Law 111-320 and its amemdmemts because all states have received Federal Funds and Grants. States are obligated. • States are mandated to alter their powers, duties and management functions satisfying CAPTA 2010 compliance with the purposes for which the Federal Funds and Grants are made available to States by Federal Law • It is more than a Trickle-Down effect. Promulgated, Published Federal Law becomes a Deluge-Down to States. COACH OF CHILDREN IS A “TEMPORARY SUBSTITUTE CARETAKER” IN THE EYES OF PUBLIC LAW, BUT NOT THE EARS OF PUBLIC CITIZENS AND THE ATHLETIC COMMUNITY Everyone knows SRE accidents happen, while playing by the rules of the game, in safe SRE environments, with proper athlete protection, coaching supervision and conduct. Serious Injuries and Deaths that occur during blameless circumstances are Inherent and Natural to the game that athletes play. They are called Accidental and Not-Preventable. An aggressive clean football tackle that fractures an arm is an Accident and Not Preventable. Conversely, Preventable, Not Accidental Injuries and Deaths occur at a rate of approximately 50% and are the result of blameful circumstances that are not Inherent and Natural to the game that athletes play. These are called Preventable, Not Accidental Injuries and Deaths of SRE Children (<18) Athletes. This category of injuries and deaths are secondary to severe punishments, injury mismanagements, such as concussion, over-use exercise, physical assaults like the blow out fracture above cited, sexual abuse, human rights violations and participation during severe weather conditions i.e. dangerous heat index, poor air quality and electrical storms, to name a few. Recently I learned about push-up punishments to an adolescent swimmer that resulted in a Preventable, Not-Accidental torn shoulder labrum and dislocation necessitating surgery, an example of CAAS. [24.] Times have changed since many Coaches, the lawn chair grandparents and parents played the games. The Child Abuse Prevention and Treatment Reauthorization Act 2012, Public Law 111-320 was first enacted in 1972 after many Coaches, grown-ups and elders played the games. Voluntary Ignorance of Child Protection Laws (When Child Protection Laws are Crystal Clear to Coaches and Everyone) are: • Risk of injury to Children • No excuse for serious injuries and deaths • No defense in court serious injuries and deaths • Risk of litigation for Coaches The Following is a proposed additional Public Health Amendment to ‘42 USC 5101 note: ‘SEC. 3. GENERAL DEFINITIONS. Paragraph (2.) The New Language is Capitalized, in quotation marks. ‘42 USC 5101 note: ‘SEC. 3. GENERAL DEFINITIONS. Paragraph (2.) ‘‘In this Act—‘‘(1) the term ‘child’ means a person who has not attained the lesser of— ‘‘(A) the age of 18; or ‘‘(B) except in the case of sexual abuse, the age specified by the child protection law of the State in which the child resides; ‘‘(2) the term ‘child abuse and neglect’ means, at a minimum, any recent act or failure to act on the part of a parent or caretaker, “INCLUDING COACH SUBSTITUTE CARETAKERS OF SCHOOL AND NON-SCHOOL SPORTS, RECREATION AND EXERCISE”, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm; This amendment is an innovation by Athlete Safety 1st as suggested in 2005 by the U.S. Surgeon General to the general public The Jurisdiction, bringing criminal charges and criminal and civil litigations depend on interpretation of the laws in state or country of the incident. Once reported to the County Attorney, Child Protective Services and / or other authorities, the Reporters duty to Report is completed and the aurhorities will figure procedural details. CHILD ATHLETES ARE DEFINED BY THEIR AGE OF MINORITY, NOT THE SPORTS THEY PLAY Child Athletes and Youth Athletes, less than 18, are Children first and Athletes participating in SRE second. Child Athletes (<18) are defined and governed by their Age of Minority, not the activity in which they participate. “No Sport is a Kingdom unto its own,”…. “No one is above the Law.” said former Secretary of State and avid Sport Fan, Condeleezza Rice. [11.] Every Child is covered by the Umbrella of Child Protection Law on every inch of ground, and every venue, during every nanosecond of time. That Umbrella is passed from Caretaker to Caretaker as Children pass from one venue to another. Children are never without the Umbrella of Child Protection Law, until they reach the age of adulthood, 18 in most United States. Proper implementation of the Umbrella of Child Protection is the Responsibility of the Coach Supervisor who has the Duty for Child Protection and Safety while the Coach has care, custody and control of the Child Athlete, during any SRE activity in which Children Participate. There is no greater love in Sports than a Caretaking Coach, who places Athlete Safety and Athlete Accomplishment 1st before their own. This Caretaking Coach"s wisdom results in the following: • Team of dedicated, trusting, willing Athlete followers • Game Victories • Sportsmanship in all Sports • Positive outcomes Sports Children’s SRE Coaches are “Temporary Substitute Caretakers” (TSC) in the eyes of the U.S. Federal Public Law 111-320, Child Abuse Prevention Treatment and Reauthorization Act 2010 and in the eyes of the U.S. Surgeon General and most Department of Community Based Services (DCBS) and Child Protection Services (CPS) in the United States. Promulgation, publication, education, awareness and established universal public policy about both the medical-legal and forensic definitions of CAAS and the Coach’s TSC legal relationship with Child Athletes will be formidable deterrents to SRE Child Athlete injuries and deaths secondary to CAAS. • Children athletes SRE injuries and deaths will be prevented • Athlete safety 1st will be promoted • Citizens and doctors will report and child athletes will more likely self-report CAAS once Medical-Legal or Forensic Definition of CAAS is completely understood • and the Role of the Coach TSC becomes “crystal clear” public policy. [24.] • Coaches will cease and desist abnormal Coaching Behaviors “when they know they can't get away with it” • Coaches will not be blind-sided with criminal and civil litigations There is a disparity between the Will To Enforce The Law In Sports and The Laws That Have Been Enacted to Prevent Cruelty and Abuse of Children, that Lay Silent beneath the Lies and turned Blind Eyes, while Children suffer. Therefore, Child and Youth Athletes are a Health Disparity Population, which is Doctor-Legal Business, necessitating the Forensic Definition for Child Athlete Abuse Syndrome which has been defined References: 1. Surgeon General’s Workshop on Making Prevention of Child Maltreatment a National Priority: Implementing Innovations of a Public Approach, Surgeon General's Workshop Proceedings Lister Hill Auditorium National Institutes of Health Bethesda, Maryland, March 30–31, 2005] 2. [Online-Dictionary] 3. International Classification of Disease, 9th edition, 4. 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Citizenship Through Sports Alliance (CTSA) published the Report Card on Youth Sport in America 2005 11. State of The Nation, Candy Crowly, CNN News, Condoleezza Rice interview 12. Preventing Injuries in Sports. Recreation amd Exercise. CDC Injury Center, September 07, 2006. 13. Survey, Safe Kids Worldwide, sponsor Johnson & Johnson 14. McLeod v. Grant County School Dist. No. 128,255 P.2d 360,362 (Wash. 1953 15. [Sports Law Year-in-Review January 2010 High School Today, Sports Law Year-In-Review: 2009, By Lee E. Green, J.D., National Federation of High School Athletic Associations] 16. CDC Foundation, Partner With Us, Partnership with Johnson & Johnson to out source surveys and studies, http://www.cdcfoundation.org/what/partners#category-299 17. Personal email from C.A.R.E. Director, Kate Dean, and the KY Dept of Community Based Services (DCBS) 18. Malamud et al, Marquette Sports Law Journal, vol 2, Spring 1992, no. 2] 19. Marcia Sprague and Mark Hardin, University of Louisville Journal of Family Law, ARTICLE: COORDINATION OF JUVENILE AND CRIMINAL COURT CHILD ABUSE AND NEGLECT PROCEEDINGS * 1997, American Bar Association, Spring, 1996 / 1997, 35 U. of Louisville J. of Fam. L. 239 20. AAP, AMERICAN ACADEMY OF PEDIATRICS Vol. 107 No. 6 June 2001, pp. 1459-1462 : Organized Sports for Children and Preadolescents. POLICY STATEMENT, Committee on Sports Medicine and Fitness and Committee on School Health A statement of reaffirmation for this policy was published on September 1, 2007. This policy is a revision of the policy posted on September 1, 1989.] 21. National Association for Sport and Physical Education. National Standards for Athletic Coaches: Quality Coaches, Quality Sports. Dubuque, IA: Kendall/Hunt Publishing Co; 1995:1-124] 22. Albany Government Law Review, Amanda Sherman, Staff Writer BY ROBERT MAGEE, FEBRUARY 23, 2009, Football Death Leads to Reckless Homicide Charges: Kentucky Embarks on Unprecedented Case,] 23. Medical Records from the Coach Jason Stinson Trial 24. Journal of the Kentucky Medical Association, Sept. 2012, vol.110, p384 25. Annu Rev Public Health. 2006;27:167-94.,Health disparities and health equity: concepts and measurement., Braveman P. 26. Health Disparities in H.R. 3590 (Merged Senate Bill) “as defined in Section 485E (Sec. 931) Current Law Public Health Safety Act Sec. 1707(d)(3)) Policy 27. Johnson & Johnson and Safe Kids USA’s Coalition, http://www.jnj.com/connect/news/all/safe-kids-usa-and-johnson-and-johnson-aim-to-help-parents-and-coaches-protect-young-athletes-on-and-off-the-field, Founded in 1987 as the National SAFE KIDS Campaign by Children’s National Medical Center with support from Johnson & Johnson, Safe Kids Worldwide is a 501© (3) non-profit organization located in Washington, D.C. 28. American Academy of Orthopedic Surgeons, http://www6.aaos.org/news/Pemr/releases/release.cfm?releasenum=889 29. Stop Sports Injuries http://www.stopsportsinjuries.org/media/statistics.aspx 30. Child Athlete Abuse Syndrome, “A New Disease”, Athlete Abuse Prevention Summit, Omni Parker House, 2011 Boston MA 31 Bakhos L, Lockhart G, Myers R. Emergency Department Visits for Concussion in Young Child Athletes. Pediatrics. 2010;126(3):e550–6. 32 Meehan WP, d'Hemecourt P, Collins C, Comstock RD. Assessment and Management of Sport-Related Concussions in United States High Schools. Am J Sports Med. 2011. dol:10.1177/0363546511423503. 33 Gissel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions Among United States High School and Collegiate Athletes. J Athl. Train. 2007;42(4):495–503. 34 Gilchrist J, Thomas KE, Xu L, McGuire LC, Coronado VG. Nonfatal sports and recreation related traumatic brain injuries among children and adolescents treated in emergency departments in the United States, 2001–2009. MMWR Morb Mortal Wkly Rep. 2011;60(39):1337–1342. 35 Centers for Disease Control and Prevention. Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities Among Persons Aged ≤19 Years—United States, 2001–2009. MMWR. 2011;60(39):1337–1342 36 Mueller FO, Colgate B. Annual Survey of Football Injury Research, 1931–2009. February 2010; University of North Carolina in Chapel Hill. 37 Centers for Disease Control and Prevention. Heat Illness Among High School Athletes—United States, 2005–2009. MMWR Morb Mortal Wkly Rep. 2010;59(32):1009–13. 38 Nelson NG, Collins CL, Comstock RD, McKenzie LB. Exertional Heat-Related Injuries Treated in Emergency Departments in the U.S., 1997–2006. Am J Prev Med. 2011;40(1):54–60. 39 American Heart Association. CPR Statistics. www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/CPR%20Statistics_UCM_307542_Article.jsp. 40 Wier L, Miller A, Steiner C. Sports Injuries in Children Requiring Hospital Emergency Care, 2006. HCUP Statistical Brief #75. June 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb75.pdf. 41 Centers for Disease Control and Prevention. 42 Boden B. Catastrophic Head Injury Three Times Greater in High School vs. Collegiate Football Players. Am J Sports Med. 2007;35(7):1075–1081 43 Kucera KL, Marshall SW, Kirkendall DT, Marchak PM, Garrett WE Jr. Injury history as a risk factor for incident injury in youth soccer. Br J Sports Med. 2005;39(7):462. 44 Volume 17 Issue 2 International Law and Human Rights Edition Article 4, 5-1-1997 The Cultural Defense and its Irrelevancy in Child Protection Law By Todd Taylor 45 Child Protection in Sport: Implications of an Athlete Centered Philosophy, Gretchen A. Kerr, Ashley E. Stirling, Quest, v60 n2 p307-323 May 2008 46 http://www.childstats.gov/americaschildren/tables/pop1.asp 47 Marianne Engle, Ph.D., sports psychologist and Clinical Assistant Professor at the NYU Child Study Center, interview, 2010 48 Statistics on youth sports safety - Youth Sports Safety Alliance www.youthsportssafetyalliance.org/docs/stats-december2011.pdf] Additional Reading 1 National Athletic Trainers’ Association. 4 Cantu RC. Second impact syndrome: immediate management. Phys Sportsmed. 1992;20(9):14–17. 5 Covassin T, Swanik C. Sex Differences and the Incidence of Concussions Among Collegiate Athletes. J Athl Train. 2003;38(3):238–244. 6 Yard E, Comstock R. Compliance with return to play guidelines following concussion in U.S. high school athletes, 2005–2008. Informa Healthcare. 2009;23(11):888–898. 8 Center for Injury Research and Policy. The Research Institute at Nationwide Children’s Hospital, Dr. Dawn Comstock, Columbus, OH. 9 Rachel J, Yard E, Comstock R. An Epidemiologic Comparison of High School Sports Injuries Sustained in Practice and Competition. J Athl Train. 2008;43(2):197–204. 10 National Athletic Trainers’ Association. 11 National Association of School Nurses, 2008 Survey. 13 American College of Sports Medicine. 15 SAFE KIDS USA. 16 Walker, SM, Casa, DJ, et al. Children participation in summer soccer camps are chronically dehydrated. Med Sci Sports Exerc. 2004;36 (5):S180–181. 17 Rupp NT. Diagnosis and Management of Exercise-Induced Asthma. Phys Sportsmed. 1996;24(1):77–80,83–87. 18 Asthma and Allergy Foundation of America. 22 Centers for Disease Control and Prevention. 25 Drezner JA. Preparing for sudden cardiac arrest—the essential role of automated external defibrillators in athletic medicine: a critical review. Br J Sports Med. 2009;43:702–707. 26 American Heart Association. Long-Term Treatment for Cardiac Arrest. www.heart.org/HEARTORG/Conditions/More/CardiacArrest/Long-Term-Treatment-for-Cardiac-Arrest_UCM_307916_Article.jsp. 27 Drezner JA, Chun JS, Karmon KG, Derminer L. Survival trends in the United States following exercise-related sudden cardiac arrest: 2000–2006. Heart Rhythm. 2008;5(6):794–799. 28 Minneapolis Heart Institute Foundation. 29 Pretzlaff RK. Death of an adolescent athlete with sickle cell trait caused by exertional heat stroke. Pediatr Crit Care Med. 2002;3(3):308–310. 30 Eichner RE. Sickle Cell Trait. J Sport Rehab. 2007;16:197–203.