The Korey Stringer Institute recently released results of a study that was designed “to provide an assessment of the implementation of health and safety policies pertaining to the 9 leading causes of sudden death and catastrophic injury in sport within secondary school athletics. (source)” The resulting ranking list has been titled, Health and Safety Policy Ranking for High School Athletics. There has been a wide range of responses to the resulting rankings – some states are celebrating high marks, while others are disputing their results. There is a definite buzz around the results over the last week or so and I thought it might be interesting to take a closer look. 

The Study:

The study findings will be published by the Orthopedic Journal of Sports Medicine. The resulting rankings are based on best practice policies that are described in the Inter-Association Task Force Document Preventing Sudden Death in Secondary School Athletics, a publicly available document.

The study methodology included:

• The development of a 5-part, equally weight rubric designed utilizing current evidence-based practice policy concepts for sudden cardiac arrest, head injuries, exertional heat stroke, appropriate medical coverage and emergency preparedness;
• Extensive review of publicly available state high school association policies, enacted legislation and Department of Education policies for all 50 states and the District of Columbia – excluding policies that were recommended or encouraged since it could be left up to the individual schools to implement;
• Credit was given for each, specific criterion that was met and then an overall weighted score was calculated; based on this calculated score states were ranked from 1 – 51;
• After each individual state score was determined the executive director for the respective state high school athletic association was contacted and given 30 days to comment on potential discrepancies (15 - 20 states responded);

The rubric can be found starting on page 15 of the study.  Each of the 5 sections is weighted to be worth 20 points for a maximum score of 100.  For detailed ranking information for your state visit, the KSI website.

Public Response:

Since the announcement of the study results on August 8, 2017 several states and organizations have responded regarding the results. A collection of those responses can be found linked below.

For those states disputing the results the most common concerns regarding the results include:

• The study results do not paint the full picture of sport safety policies in any given state;
• Executive Directors dispute being contacted to comment on the results or to provide complete information;
• States are requesting a seat at the table as part of the research process

The National Federation of High Schools (NFHS) issued a public response on behalf of all its member organizations, saying in part:

“For a number of years, the NFHS and its member state associations have worked cooperatively with organizations such as the National Athletic Trainers’ Association (NATA) and the Korey Stringer Institute (KSI) to provide as much information as possible for the nation’s 19,000-plus high schools regarding heat illness awareness and prevention, as well as other safety issues related to the heart and head injuries."

"Unfortunately, the Korey Stringer Institute has proclaimed itself as judge and jury of heat-illness prevention and other safety issues by ranking the 51 NFHS-member state high school associations – these very associations that have been promoting risk-minimization precautions in their schools’ athletic programs for many more years than the seven-year existence of the KSI. (source)”

Douglas J. Casa, PhD, ATC, FACSM, FNATA, had this to say about the results and plans for future research when responding to the Colorado State High School Athletic Association:

“…the goal of the rankings is to get information to parents across America, because almost no parent in America realizes what the health and safety standards are right now in the state in which their kid participates in a high school sport. We do all of this for the parents. Obviously, some people are going to be upset, like administrators and others, but we do it to service the parents to try and make sure they don’t lose one of their children. …the rankings are in “real time” and will be updated as state associations make adjustments to their best practice guidelines. We’re hoping that administrators will be sitting in a meeting and literally want to go from twentieth to fifth on the list, just because some of the changes they can make online in terms of their available resources. (source)”

Additionally, according to Hartford Courant, "We believe you can get to 85 points out of 100 for less than $5,000 a year," Casa said. "We're trying to institute policy and do whatever we can before [young athletes] die, to not have to wait for your particular state to have an emergency or tragedy to implement policy, to maybe learn from a tragedy that happens across a state line. (source)”

Published State-specific Responses:

For those states that published an article on the study that I was able to locate based on an internet search - please click the state to learn more.  Some states simply published the standard Associated Press release while others included input from the state associations.  Some input supported the results, while others disputed them.

1. Alabama
2. California
3. Colorado
4. Connecticut
5. Hawaii
6. Kentucky
7. Maine
8. Massachusetts
9. Minnesota
10. New Hampshire
11. New Jersey
12. Nevada
13. North Carolina
14. North Dakota
15. Ohio
16. Oregon
17. Pennsylvania
18. Rhode Island
19. South Carolina
20. South Dakota
21. Utah
22. Vermont
23. Washington
24. West Virginia

In conclusion, the KSI study is trying to provide simple information to help parents make decisions on how safe their schools are when it comes to preventing, planning for and responding to emergency situations that can potentially be fatal.  While the results may be disputed by some, at the very least it seems to have started a larger conversation about sport safety policies across the United States.  I have compiled information here so that you can make your own decision about the results and how you wish to move forward.  For those who need some resources on policy development The Board of Certification, Inc. recently made information available that you may find helpful.  At the end of the day, we all have the same goal - keeping young athletes safe.