1 of 8
Laura Seitz, Deseret News
Football players put on their helmets during practice at East High School in Salt Lake City on Monday, Aug. 7, 2017.

SALT LAKE CITY — Utah's stringent approach to concussion protocol is protecting the well-being of high school athletes, according to a new national report.

But critical athlete safety precautions, such as accessible defibrillators and detailed emergency action plans, are not required in Utah, and that significantly hurts the state's standing in protecting those same competitors, according to the report from the University of Connecticut's Korey Stringer Institute.

The institute cited 735 high school athlete deaths as well as 626 catastrophic injuries between 1982 and 2015 as a reason the research was needed. In all, Utah earned 44 points out of a possible 100 after being graded on student safety criteria, finishing 30th among the 50 states plus Washington, D.C.

North Carolina had the best results in the country, finishing with 78.75 points, while Colorado was ranked last with 23 points.

The institute held a conference Tuesday promoting the study at the National Football League headquarters in New York City. The NFL is a sponsor of the institute but did not sponsor the study specifically.

Institute researchers have singled out traumatic head injury, sudden cardiac arrest, heat stroke and an episode called exertional sickling — which is a sudden decrease in blood flow affecting people born with a genetic condition called the sickle trait — as responsible for close to 90 percent of all sudden deaths in athletics.

Concussion safety

Utah scored full points for its traumatic head injury protocol because schools are required to not allow student athletes to return to activity on the same day of a suspected concussion. Utah also requires any subsequent clearance to play to come from a sufficiently licensed medical professional, and students may not resume participating in athletics before returning to school.

"I think we've led the country when it comes to concussion policy," said Rep. Paul Ray, R-Clearfield, who played high school football while living with a heart condition.

Ray sponsored the law passed in 2011 that's responsible for much of the concussion protocol for high school athletes, including requirements on how to obtain medical clearance to return to competition, and mandating that parents of minors participating in amateur sports sign that organization's head injury policy.

Rob Cuff, director of the Utah High School Activities Association, said he's appreciative of that law, adding that it "was good for kids and it was good for parents to be educated, and that was the only way it was going to happen."

It is helpful that member schools are required not only by UHSAA regulations but by law to treat concussions with caution, Cuff said.

"(It) is really binding," he said. "Schools need to make sure they're not only following our guidelines, but also state law."

Utah's overall score as it pertained to traumatic head injuries was pulled down 10 points because coaches are not required to participate in Heads Up concussion prevention training.

Cuff said that score is not reflective of the instruction Utah coaches undergo in the regular course of their jobs and independent of that program.

"You have to pay for that," he said, "and we feel like (concussion prevention) is an education piece that's already been covered by the coaches and their training."

It is the athletes and their parents who most often need the most persuasion to err on the side of caution following a concussion, said Ray, a former high school basketball coach.

"Really, the protocol was put into place for parents and students because they're the ones who want to push the envelope on that," he said.

Having a plan

UHSAA officials currently are focusing on shoring up schools' emergency preparedness plans, an area in which Utah lost points in the report's evaluation. Those efforts include ensuring that emergency transportation access for severely injured athletes from various venues is adequately thought out, Cuff said.

"It's very simple," he said. "It's just the protocol of what happens in the case of emergency. It just depends on the community or the area."

Emergency preparedness plans, as defined in the institute's analysis, may address where to keep the necessary emergency equipment, how to identify health providers that would respond to athletic venues and determining responsibilities for school personnel in a crisis.

Issues outlined in such a plan, Cuff said, also address other questions: Do medical personnel come to the games? Which sports so they attend?

"(Some) schools have them on call," he said, while others have a vehicle on hand.

"The bottom line is: What is their plan, and do they have a plan in place?" Cuff said.

Part of emergency preparedness means having athletic trainers on-site, said Ray, who sponsored a bill earlier this year to require high schools with athletics programs to have a full-time athletic trainer on staff.

Ray's athletic trainers bill was voted down in a legislative committee following opposition from groups worried about how feasible such a requirement would be for rural schools.

But Ray said high school sports programs are not worth the trouble if they can't afford to provide that type of care, which he called essential, for the safety of their athletes.

"They just have to step up to the plate," he said. "If they're going to have a sports program that has the potential to put youth safety in jeopardy, they need to step up to the plate or they need to not have athletics. … It's a matter of time before one of these schools get slapped with a multimillion-dollar lawsuit."

Valerie Herzog, president of the Utah Athletic Trainers Association, agreed that students are left too vulnerable without such a professional employed with the school full time. Because of their inherent risk, sports programs just aren't worth it without that safety guarantee, she said.

"If you're going to drive a car, and you say, 'I can't afford a seat belt,' then you shouldn't buy a car," Herzog said. "I wouldn't buy my kid a bike if I couldn't also afford to buy them a helmet."

Only roughly 1 in 10 Utah high schools employs an athletic trainer full time, while anywhere from approximately 30 percent to 40 percent do not employ any athletic trainer at all, she estimated.

Cuff said he likes the idea of requiring athletic trainers in schools, but he can sympathize with those who believe it's not doable.

"Well, certainly when you can get athletic trainers in your schools, you're going to have the advantage of people who are already in the know," he said. "Some of our rural districts just do not have access to an athletic trainer who's willing to come live in the community. … So that's really where the pushback (comes from)."

The Korey Stringer Institute report also recommended that athletic trainers be on- site at all contact practices.

Defibrillators access

Cardiac arrest preparedness issues also knocked Utah down a peg in the Korey Stringer Institute report.

"That's one thing that we're improving on, and we were aware of that score," Cuff said, "but I think we're doing a much better job (than before)."

The state scored zero points out of a possible 16 on the report's criteria that looked at policies mandating easy access to defibrillators at each athletic venue, training of athletics staff on how to properly use them and sufficient maintenance of the devices.

But even though the report reflects that there aren't policies formally requiring access to defibrillators, the state activities association has "made a big push" in recent years to get schools to buy them, Cuff said.

"What we do is tell them to apply for the grants" to be able to afford defibrillators, he said.

University of Connecticut spokesman Colin Poitras explained that "there was no credit given to recommended policies."

"The metrics are based on what states are requiring or mandating schools do," Poitras said in an email.

There are typically multiple defibrillators at sporting events between two schools, but "it's at practice that we're most concerned," Cuff said. Simply having one is no substitute for knowing where it is and having the proper training to remove and use it, he said.

"We found that with the defibrillator, they may have one in the school, but it may be locked up in the principal's office," Cuff said. "They need to be placed somewhere (accessible), similar to a fire extinguisher."

At next year's legislative session, Ray said his bill to mandate athletic trainers in schools will also include language requiring easy access to defibrillators throughout athletic facilities.

Herzog agreed that there needs to be defibrillators at schools, and coaches need to know where they are and how to use them.

Such preparedness genuinely saves lives, the Utah Athletic Trainers Association president said.

"A lot of these are preventable deaths, (and) if it's your kid, one's too many," she said. "This is real stuff. I mean, sports are dangerous. They push their bodies. ... They push them as far as they can go."

Utah also received mixed remarks for heat stroke prevention, earning credit for its regulations on high school sports practices and mandatory rest times, but missing out on points for requirements on heat-related workout modifications.

The state received high marks for UHSAA providing catastrophic health care coverage to all member school athletes in the case of severe injury.