1. 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

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

3. 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

4. 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

5. 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.

6. 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

7. 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.

8. 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) Days 1-2 : Helmets only Days 3-4 : Helmets and Shoulder pads Day 5 : Full pads

9. 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

10. 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 Apr–Jun; 35(2): 212–224.

11. 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.

12. 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)

13. 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

14. 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

15. 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

16. 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

17. 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