Evaluating Athletic and Heat Injuries in Preseason NCAA Football Following Policy Change Using the NCAA Injury Surveillance System Jill Corlette, National Collegiate Athletic Association Robert Oppliger, American College of Sports Medicine Randall Dick, National Collegiate Athletic Association

Objectives NCAA Injury Surveillance System overview Recognize the unique risk of heat injuries in preseason football practice Preseason football practice policy changes

ISS Background NCAA created ISS in 1982 as an injury data collection tool for collegiate athletics NCAA Competitive Safeguards and Medical Aspects of Sports NCAA sport rules committees Data collection by certified athletic trainers

ISS Definitions Injuries: a recordable injury is one that 1) occurred as a result of participation in an organized intercollegiate practice or contest; and 2) required medical attention by a certified athletic trainer or physician; and 3) resulted in restricted participation for one or more calendar days beyond the day of injury

ISS Definitions Athlete exposures (A-E): defined as 1 student-athlete participating in 1 practice or contest in which he or she is exposed to the possibility of athletic injury Injury Rate: the number of injuries in a particular category divided by the number of athletic-exposures (A-E) in that category.

Preseason Football Injuries Data Committees concerned about data regarding preseason heat injuries in NCAA: 95% of time loss HI occurred in preseason 85% of time loss HI occurred wearing full pads or helmets and shoulder pads

NCAA Preseason Football Policy Change 87% of time loss HI occurred on days with multiple practices 49% of ALL practice injuries over the entire season (and all 45% of injuries with time loss of 7 days or more) occurred during the 8-10 preseason multiple practice days 2003 NCAA modified the preseason fall football practice because of concerns about high rates of preseason injuries.

NCAA Preseason Football Policy Change 2003 – No limit on number of practices 2004 – 5 day acclimatization period (3 hrs max.) 2003 – No equipment limitations (DI and DII) 2004 - Days 1-2 : Helmets only Days 3-4 : Helmets and Shoulder pads Day 5 : Full pads

NCAA Preseason Football Policy Change 2003 – No required recovery time 2004 – 3 hours recovery between practices 2003 – No limit on practice length 2004 – Single or split practices, total 3 hours Additional 1 allowed walkthrough for first 5 days of acclimatization without any equipment at all

Preseason Football Injuries Data Heat injury classification: (NATA*) Heat cramps Heat exhaustion Heat syncope Exertional heat stroke Exertional hyponatremia *Casa DJ, Armstrong LE, Hillman SK, Montain SJ, Reiff RV, Rich BE, Roberts WO, and Stone JA. National Athletic Trainers' Association Position Statement: Fluid Replacement for Athletes. J Athl Train. 2000 Apr–Jun; 35(2): 212–224.

Football Sample Represent 10% of NCAA schools sponsoring football 2006 2007 Totals Number of schools in ISS 56 60 116 Number of schools with heat injuries 25 31 Preseason A-E 145,822 148,629 294,451 In season A-E 293,921 310,958 604,879 Represent 10% of NCAA schools sponsoring football For both years, the average number of Preseason practice days were 24 (± 7) days.

Preseason Football Injuries Data 2006 N (Avg Rate with SD) 2007 Heat Injuries Days 1 -5 38 (1.46 ± 4.35) 42 (1.59 ± 4.22) Days 6 + 56 (0.48 ± 1.03) 52 (0.37 ± 0.88) In Season 13 (0.04 ± 0.15) 12 (0.04 ± 0.11) All Injuries Days 1-5 438 (13.97 ± 10.68) 409 (16.84 ± 12.51) Days 6+ 1106 (9.58 ± 6.57) 974 (14.32 ± 8.69) 2269 (7.85 ± 5.10) 2059 (12.00 ± 7.57)

Preseason Heat Injuries by Equipment 2006 N (%) 2007 Helmets Only 24 (25.53) 14 (14.89) Helmets and Shoulder Pads 19 (20.21) 23 (24.47) Full Pads 37 (39.36) 34 (36.17) No Pads 0 (0.00) 6 (6.38) Unknown 17 (18.09) Totals 94

Preseason Heat Injuries by Practice Type 2006 Heat Cramps N (%) Heat Exhaustion Hypo- natremia Syncope Totals Regular 47 (50.00) 40 (42.55) 4 (4.26) 91 Walk-through Scrimmage 2 (2.13) 1 (1.06) 3 2007 32 (34.04) 57 (60.64) 2 Other 1

Comparison Before Policy Change (16 years) After Policy Change Preseason HI rate 0.44 per 1000 A-E 0.43 Preseason all injuries rate 7.24 11.95

Limitations Voluntary data collection Small number of schools reporting data Variability in data entry System change from paper-based system to web-based system beginning in 2005

Conclusion ISS data collection important for NCAA informed decision-making Heat Injuries are a continued concern in preseason football NCAA policy on acclimatization days will continue to be assessed in coming years