NSCA’s Coaching Podcast, Special Edition: Heat Injury - Korey Stringer Institute

Courteney Benjamin and Yasuki Sekiguchi, from the Korey Stringer Institute, talk to the NSCA Head Strength and Conditioning Coach, Scott Caulfield, about preventing sudden death in the heat and how coaches can plan ahead, create, and respond with an emergency action plan.

Find the Korey Stringer Institute on Twitter: @K_S_Institute | Find Scott on Instagram: @coachcaulfield

“But I think you know, as we all know, sometimes in the high school setting or in other settings, the athletic trainers just can't physically can't be everywhere. So at least having coaches that are site that at least have the basic lifesaving skills is crucial.” 12:24

“…if someone collapses on the field, where is our closest AED? Where is the cold tub? And who's putting it on? Who's calling EMS? Do we have a way for EMS to get here?” 17:18

“Like, that should be thought about weeks before going into what is our-- what do we want our plan to look like? And then let's stick to it, you know? I think-- I know coaches don't always don't always like to do that, but I think at least having the conversation, it at least like plant a seed, you know? Like, it plants that little seed in their mind that they might be start thinking that way.” 20:36

“…the CSCCA and NSCA joint consensus guidelines for a transition period, safe return to training following an activity. That's a really awesome one. Another one that recently came out from NCAA is the inner association recommendations preventing catastrophic injury and death and collegiate athletes. And then I think the other one that still just a really, really good resource is the 2012 NATA and NSCA joint task force recommendations for preventing sudden death in collegiate conditioning sessions…” 21:28

“You mentioned before we started rolling too, the NCAA inter-association recommendations has a great checklist in it. So really super simple yes, no you know, so you can really evaluate what you're doing and how you're-- you know, if your program meets these.” 22:12

“…people are always welcome to reach out to me or Yasuki or really anyone at KSI…” 22:31

[00:00:00.80] Welcome to the NSCA Coaching Podcast. This is a special bonus episode with staff from the Korey Stringer Institute sharing tips for keeping athletes safe during this transition period as we go from summer into fall sports seasons.

[00:00:13.44] At least walking through, OK, if someone collapses on the field, where is our closest AED? Where is the cold tub? Where like, who's putting it on? Who's calling EMS? Do we have a way for the EMS to get here? Like, all those thing--

[00:00:27.06] This is the NSCA's Coaching Podcast where we talk to strength and conditioning coaches about what you really need to know, but probably didn't learn in school. There's strength and conditioning, and then there's everything else.

[00:00:37.35] Welcome to the NSCA Coaching podcast. I am Scott Caulfield. Today, joining me in Washington, DC, at the 2019 National Conference, from the Korey Stringer Institute, Courteney Benjamin Director of Communications, and Yasuki Sekiguchi, Director of Athlete Performance and Safety. Guys, thanks for being on the show.

[00:00:56.91] Thanks for having us.

[00:00:58.06] Yeah, we're excited for you guys to be here. If people haven't heard about the Korey Stringer Institute, if they've been under a rock, what can you guys tell them about it?

[00:01:07.88] Yeah. So I can start with this. Korey Stringer Institute started-- Korey Stringer was an NFL football player, played for the Minnesota Vikings. And he passed away unfortunately from an exertional heat stroke. And basically, that kind of sparked his wife and Dr. Casa is now the CEO of KSI to start this Institute that basically focuses on research and advocacy and education for preventing sudden death in sport and optimizing performance. So we're housed at UConn.

[00:01:40.58] Cool. And so what, as director of communications, your role is kind of spreading the message and the mission, obviously. What else is in your wheelhouse?

[00:01:49.59] Yep. So both Yasuki and I, we kind of have a couple of different divisions at KSI. Yasuki and I are both more on the performance side. Obviously, coming from shrinking auditioning background, we work with a lot of athletic trainers, a lot of KSI's athletic trainers. There's a couple of strength and conditioning coaches.

[00:02:07.74] And then we also have some exercise physiology researchers there as well. So we have a policy division that really focuses on enhancing high school safety policies at the high school level. And then we also have our heat lab that we do a lot of thermophysiology and hydration research.

[00:02:28.17] Cool, very cool. And Yasuki, what's kind of your primary role there?

[00:02:32.73] So we, as Courteney mentioned, we are working mainly with athlete, not just in the lab setting, but also we're working with a lot of athlete in the field setting, monitoring athlete on the improved performance. So we can just incorporate with field data on the like, level data that's our uniqueness over the KSI other performance divisions.

[00:02:53.18] Cool. And being at UConn, you're using the UConn athletes. Is that who you guys are--

[00:02:59.22] We are working-- we are working with UConn athlete, but not just the UConn athlete, like, all that professional athlete are coming around the world to testing or monitoring for the [INAUDIBLE].

[00:03:09.87] Oh, wow. Super cool. And for those of you listening, Yasuki is from Japan, right? And he's actually a former NSCA intern, spent some time with us. We want to talk a little bit about when you did your internship and--

[00:03:24.98] Yeah. So I originally from Japan. I did my undergrad in Japan. And after that, I came to the US on the-- I did my master at the University of Arkansas. And during my first year in the summer, I came to the Colorado Springs for the interns.

[00:03:39.45] I spend quite a bit a lot of time there for the intern. And I work with Scott and the other coaches and the athlete. And I had a great time on the [INAUDIBLE] the basics [INAUDIBLE] strength conditioning. That was a great time for me.

[00:03:53.04] Very cool, very cool. Yeah. It's always great to see you guys again. Yeah, yeah.

[00:03:57.35] And you guys are both finishing your PhDs, right? Maybe just hit on that a little bit and what your kind of final projects are for that real quick.

[00:04:06.11] Yeah. So we both are going into our last year. So the goal is to graduate in May this next year. So yeah. We're both actually doing our dissertation project sort of on the same-- different questions, obviously-- but it's the same big-- we have 36 pretty elite runners that we're bringing in to our heat lab and doing a heat acclimation study.

[00:04:30.03] So we're looking at natural heat acclimation. So having them go and run on their own over the summer. And then bringing them back into the lab in the fall to see if we can maintain heat acclimation.

[00:04:42.44] Nice. Well, good luck with that. I know you guys are seeing the light at the end of the tunnel. Yeah. Do you have any like, foresight that you can share on what you think you're going to find out here?

[00:04:55.89] Yeah, I think we can. So a lot of research previously just showing how to induce a heat acclimation piece. But when if like, if they don't explode to the heat, they do as all the heat acclimation adaptations. So we try to maintain those adaptations for a longer period with time, because a lot of athlete have to move to the [INAUDIBLE] for the competitions, but they have to train in the cold. So that's very important to maintain the heat acclimation adaptation.

[00:05:24.04] Also, their are a lot of performance enhancement in the cold after the heat adaptation. So we try to improve not just safety, as well as the performing in the heat and the cold. So our primary goal is to maintain heat adaption for a longer period of time.

[00:05:40.92] Cool.

[00:05:41.28] And the whole way we got to this was working with the women's cross-country team. I heard you ask earlier about that we work with UConn athletes. We're working with the UConn women's cross-country team there. And that's kind of what sparked us into this project. We are working with them the past couple of years.

[00:05:55.95] We were bringing them into the lab a couple of times a week or one time a week to try to help them out with their competitions that were down. And with our conference, they have like, USF, Houston, all these places, and they're training up in Connecticut.

[00:06:09.14] Yeah, yeah, OK. Cool. Great. And again, one of the big things we wanted to kind of kick off because NSCA and KSI have been kind of trying to collaborate and see where we can do more stuff. And you know, the CSCCA and NSCA just came out with this joint consensus guidelines for transition periods.

[00:06:29.62] And so I know there's some other documents too, the Inter- Association recommendations preventing catastrophic injury and death in collegiate athletes that the NATA put out. And I know you guys know way more about this stuff than I do. So maybe what we could look for is some of the big key points that takeaways you guys see from both of those documents and the real practical application side for the coaches, especially if they're listening. And we're going to hopefully have this out in August really before football starting and when some of these tragedies have happened, and really want people to be on the forefront. So what are the things they need to know?

[00:07:11.50] Yeah. So this document actually was put out by the NCAA.

[00:07:15.99] NCAA, OK.

[00:07:16.78] Yep. The inter-association recommendations. There is another document I actually presented at NSCA a couple of years ago or last year with the other document that you were talking about, there's another one that's really good for coaches to go back and look at that was a joint task force document that came out between the NATA and NSCA.

[00:07:36.63] That was the 2012 document.

[00:07:37.96] Exactly. So these three that we're going to be talking about today, those are kind of the big ones if people just want some like, good reads to make sure they're ready to go for a pre-season, those are the three that are really, really helpful. So yeah, basically, I think overall, it's all about planning ahead, generally. That's like, the idea that I've gotten from all three of these documents. I mean, we can dive in a lot deeper than that, obviously.

[00:08:05.16] But I know the first-- one of the first things that they talk about in that CSCCA and NSCA joint document is emergency action plans. That's one of the first things they dive into. And I think that just kind of sparks everything else. If you don't have that piece in play, and you don't have kind of the fore knowledge going into it, then nothing else is going to work out from there. So I don't know if you want to add anything else yet.

[00:08:29.36] That's the first step, yes.

[00:08:32.56] And I know that we have some examples of emergency action plans, policies, and procedures on the NSCA website. Does KSI have some example stuff like that if I don't have an emergency action plan, and I just realized that I need it, can I go to your guys site too to get some resources for that?

[00:08:51.35] You can. Yep. We have a lot-- we have a lot of resources like that on our website. And if we don't necessary-- I know for emergency action plans, we do. But even if there's other items, we'll at least have links that you can go to other people's resources as well to find things like that.

[00:09:06.54] And we have to sort of template on the like, at each institution has a different like, location and different situational. So based on their needs and opportunities, we can corroborate on the modifying [INAUDIBLE] based on the template.

[00:09:21.43] Nice. Yeah, yeah, that's cool. How about again, this table that was in the document you know, talking about some of the overview after transition periods? You guys want to just tee that up a little? Because I think there was some really good takeaways from that one.

[00:09:38.22] Yeah, absolutely. So I mean, we know you know, working under Dr. Casa for our PhD and at KSI, we both have gotten to take some really cool classes I think that have given us sort of a unique angle as strength and conditioning coaches, because like I said, we know we're most of the time with athletic trainers, which is obviously super important for them to really get a grasp on preventing sudden death, but sometimes strength and conditioning coaches, we get so focused on performance, performance, performance, that we don't always get that lens.

[00:10:06.90] And so I think that's been super, super cool for us to get that lens. And so we took a class one of our first years of our PhD that really dove in to individual cases of people who have had exertional heat stroke or suffered from cardiac death or sickling and things like that. In that class we learned so much about just the risk factors that go into why those things happen, what are the commonalities between the cases? And when you really start to dig into that and really like, break it down, you start to see like, wow, there are a lot of similarities that go on between these cases, and one of those being a lot of them happened during transition periods.

[00:10:48.32] And so that's why I think you know, this table really that's focused on transition periods for the different activities is so important for coaches to really understand, just that have the background of OK, wow, it really is transition periods. That's the big piece that we really got to focus on.

[00:11:08.54] Yeah, of course, like, people think like, in the preseason it's hot. So there are a lot of exhaustion heat stroke or exhaustion heat events happening in the first few days. And the exhaustion [INAUDIBLE] it's not just only for the hot. Like, after that winter break, they are coming back to the practice. But even though it's not hot, there are a lot of like, exhaustion [INAUDIBLE] that happens.

[00:11:31.72] Yeah, yeah, right. Because they haven't been training or they possibly dehydrated or all of the above.

[00:11:37.22] Exactly, exactly.

[00:11:39.17] I know that obviously the immediate cooling you know, is a big one as far as like, if someone is you know, in the initial stages of heat stroke. And that's a pretty like low hanging fruit, right? Like, it does not prohibitive. It's pretty simple. Can you guys kind of give some like, tips or examples of what that's supposed to look like?

[00:11:59.93] Absolutely. Yeah, no problem. So yeah, basically, you know, we have a couple of infographics and a lot of education about this on our website. And we post stuff on our social media all the time about cool first, transport second. That's kind of the motto that we always tell everyone.

[00:12:16.03] You know, as strength and conditioning coaches, I don't want to try to pretend like, we're medical professionals or say that we don't need athletic trainers, because of course we do. But I think you know, as we all know, sometimes in the high school setting or in other settings, the athletic trainers just can't physically can't be everywhere. So at least having coaches that are site that at least have the basic lifesaving skills is crucial.

[00:12:42.20] Like, I mean, we all know how to do CPR, or we should, for the most part and put on an AED. Yeah, exactly, exactly. So I think exactly like what you just said. It's so simple.

[00:12:53.84] You know, our motto that we talk about all the time, cool first, transport second. Get them in an ice bath. So a cool tub. Super cheap. You can get them at Tractor Supply.

[00:13:04.85] Yeah. That's where we got ours. We have one. And again, you know, a lot of the time it just sits empty. But you know, at the time of year when it needs to be, we can fill it up, put ice in it, have it ready.

[00:13:14.81] Exactly, exactly.

[00:13:16.34] I think it's just having the tub all the time in the preseason for the first few days or just the entire pre-season. That's very important.

[00:13:23.69] Absolutely.

[00:13:24.58] No. I think it was like, you know, it's I don't know, $50 to $70. You know, it's very, very affordable in the big scheme of things.

[00:13:33.46] And I think it's important too, just because I know when I first got into this world, I was a little bit like, it can be a taboo topic a little bit when we were talking about how to treat an athlete. And so I do think it's important for people to really understand why those best practices and that gold standard is the way that it is.

[00:13:54.56] Going back to talking about the body temperature, we work with a lot with EMS as well, trying to get them on the same page. Because a lot of times you know, they're trained to-- as soon as they get to the field, transport the athlete to the hospital right away. And that's why we talk about cool first then transport, because even strength and conditioning coaches, you know, I know it's a very fuzzy world right now because you would never want to go to EMS and be like, oh! I know how to treat this.

[00:14:23.67] So you can't take them, because that's just opening yourself up. But at the same time, if you're talking about a life or death situation, like man, it's really, really tough. And I know for people who are aware of the gold standard way to treat it, it's a tough situation, because the reason you have to have body temperature, there's been a couple of cases that we talked about in that class that we were talking about earlier, where you know, if you just put them in an ice bath without knowing their temperature, if you take them out too soon, they could still have complications, they could still die.

[00:14:54.66] I mean, and that's what we're talking about. It's crazy when you're talking about life or death. But if you don't know when to pull them out of the tub with that body temperature, then you don't know.

[00:15:03.48] So that's our guide-- we don't have a time thing. It's a temperature thing.

[00:15:09.54] Exactly, because if you don't know where they're starting, like, let's say someone's starting at 109, they may take 25 or 30 minutes, sometimes longer, who knows, to get down below that critical threshold where they're not inducing anymore cell damage.

[00:15:23.76] What's that critical threshold number? Do we know--

[00:15:26.11] It's there are two numbers they are using in the research field. But CNS dysfunction plus 40.5.

[00:15:33.33] 104.

[00:15:34.15] OK, cool.

[00:15:35.19] Yeah. That's like, if you're above that, typically is what people are saying is--

[00:15:39.15] You got to get them in the tub.

[00:15:40.58] Got to get them in the tub. Yeah, and then typically pull them out at 102 is the normal, I think. I don't want-- don't quote me on that for the gold standard, but that's typically-- you want to make sure that they're at least low enough that they're not still having that dysfunction. And so that's why we love supporting our athletic trainers, because then when they're there, they can you know, take care of that stuff for us.

[00:16:06.96] I think, like, in addition to the stuff Courteney mentioned about the treatment, as a strength and conditioning coach, we have to very-- it's very important to recognize what the symptom looks like, because like, if it takes like, 20 minutes or 30 minutes as Courteney mentioned, to recognize heat exertion heat stroke it's already too late to treat, even like, [INAUDIBLE] treatment. The [INAUDIBLE] strength conditioning coach if we can just recognize symptom earlier, we can start treatment very quickly.

[00:16:38.11] Yeah, yeah. And again, more you know, more reason or you know, significance to why having a great relationship with the medical staff and the strength conditioning staff, you know, if they're separate-- and a lot of times they're not-- we're seeing them become more kind of unified. But huge to why you have to work so closely with athletic trainers.

[00:16:59.97] 100%, 100%. That's part of what the document I think talks some about that too, it's just the importance of establishing those good relationships between one another and communicating. And not only creating those emergency action plans and the things that we should have in place, but also practicing them. I mean, even if you don't go through the entire thing, at least walking through OK, if someone collapses on the field, where is our closest AED? Where is the cold tub?

[00:17:26.11] And who's putting it on? Who's calling EMS? Do we have a way for EMS to get here? Like, all those things, if you don't talk about them, sometimes you forget, just like anything else, you know?

[00:17:36.53] Yeah. And you know, on the flip side of that too, with like you said, if an emergency happens, knowing who does what? Who goes where? That all is contained in that emergency action plan. How about talking to you know, the sport coach about it, right?

[00:17:56.76] Because obviously, they're the one dictating the practice 99.9% of the time. Maybe they're doing conditioning that falls on the strength coach. But pretty much, I think we can say that this is-- a lot of this stuff happens in sport practice for sure. Any suggestions for how we bring this you know, literature to those coaches to try and get them you know, without just being like, you need to read this. Because that probably doesn't go over that well, depending on how [INAUDIBLE].

[00:18:28.41] That's a very good point. So like, [INAUDIBLE] just sharing the information with them, like first step is just knowing the like, order. Some coaches like, we're in this field.

[00:18:42.12] So we know these-- all the symptom, exhaustion, heat stroke, and [INAUDIBLE]. But if we are not in this field, it's so difficult to recognize. So like, of course, we have to like, share the information, what it looks like, symptom looks like, and like, why this happens. And then like, after that, we can start from there-- we can just like, make [INAUDIBLE] if that happens.

[00:19:06.53] I know one of the items that's in the NATA and NSCA document from 2012 that I love, that I think is such a practical but important way to sort of mitigate that miscommunication that happens between coaches and athletic trainers and strength and conditioning coaches is hopefully before the thing is, like, you know-- I'm sure all of us that are coaches or we played at some point, or we we've been involved in athletics for a while, so knowing that when you get-- when you get out there without having a plan, when you get out on the field without having a plan in place, that's a lot of times when these things happen, right?

[00:19:46.29] Because when you get out there and you're just like, oh, I think today we're going to do this. But if the athletes don't look you know it's absolutely dead enough, we're going to do a little bit more or we're going to do a little bit less or whatever.

[00:19:56.55] So I think going into-- get going into a meeting together before you ever get out on the field is one of the best things you can do, because that's when everyone's calm, the emotions of oh, we got to really push and we're in training mode-- because I mean, I get that way when I'm out on the field or when I played soccer. I mean, that was my-- that's what motivates you. When you're out on the field, you just want to push, push, push. But when you plan it ahead of time when you're just-- it's quiet, you have time to think. Your brain's fully working. Your emotions aren't all cranked up.

[00:20:29.84] That's when I think the best communication can happen. So it can't just be five minutes before practice. Hey, it's pretty hot today. I think we should take it easy.

[00:20:38.27] Like, that should be thought about weeks before going into what is our-- what do we want our plan to look like? And then let's stick to it, you know? I think-- I know coaches don't always don't always like to do that, but I think at least having the conversation, it at least like plant a seed, you know? Like, it plants that little seed in their mind that they might be start thinking that way.

[00:20:59.27] That helps not just only for the safety, but also the performance.

[00:21:02.87] Right. Right, right. No, that's such a great point. Cool. Well, this has been awesome.

[00:21:07.31] If people-- you know, OK, we spark their interest now. They know a little bit. They heard-- can you guys just reiterate you know the key documents that you want to point out to people, and also you know, what else might be available at KSI for them as resources?

[00:21:26.57] Yeah. So yeah, the big one obviously, is the CSCCA and NSCA joint consensus guidelines for a transition period, safe return to training following an activity. That's a really awesome one. Another one that recently came out from NCAA is the inner association recommendations preventing catastrophic injury and death and collegiate athletes. And then I think the other one that still just a really, really good resource is the 2012 NATA and NSCA joint task force recommendations for preventing sudden death in collegiate conditioning sessions, I think is what it's called.

[00:22:05.49] And I think there's one in on the same basic title for secondary schools--

[00:22:10.81] Yes.

[00:22:11.00] --as well. It was super close to that.

[00:22:12.59] There are. There are two of them.

[00:22:14.93] You mentioned before we started rolling too, the NCAA inter-association recommendations has a great checklist in it. So really super simple yes, no you know, so you can really evaluate what you're doing and how you're-- you know, if your program meets these.

[00:22:32.09] Exactly, exactly. And then yeah, people are always welcome to reach out to me or Yasuki or really anyone at KSI, even if they just want to have a conversation about hey, we're getting ready to go play in for our pre-season. You know, can you guys take a look at our stuff. Like, we're happy to look at that and also use our friends, our athletic training friends as resources to make sure that we're telling everyone you know, the best practices too.

[00:22:57.47] Use your network, totally.

[00:22:58.91] Absolutely.

[00:22:59.48] Well, thanks, guys. I really appreciate you being on again. Big shout out to Doug Casa, your boss and you know, the head of the Korey Stringer Institute. We'll definitely have to get him on at some point.

[00:23:10.16] And I know he has a book-- a new book. Do you know the title of top your head? It was something preventing heat illness or injury. I don't-- I have the book sitting on my desk.

[00:23:21.62] Doug, I'm sorry, if you're listening to this. If you Google Doug Casa and heat illness, you'll find it anyway. And I'm sure it's on the KSI website too.

[00:23:30.25] Yeah, and all resources are on there.

[00:23:32.33] Yeah, it's amazing. But again, we'll put your guys contact info in the show notes, so that people can reach out to you after this is over if they have more questions. But I really appreciate you guys spending the time. And enjoy the rest of the time at the conference.

[00:23:45.90] Thank you.

[00:23:46.19] Thank you very much. It was a very fun talk.

[00:23:48.38] And as you know, we at the NSCA love research, and especially applying that research. If you're not a member yet, join us and get access to the best strength and conditioning journals available. Just go to NSCA.com/membership.

[00:23:59.87] And a big thanks to our sponsor, Sorinex Exercise Equipment. We appreciate their support. And to all of you listening, we appreciate your support. Again, if you like the podcast, make sure that you subscribe wherever you download your podcasts from.

[00:24:14.08] Write us a review, and keep listening in. Look forward to talking with you all soon. Thanks.

[00:24:20.03] This was the NSCA's Coaching Podcast. The National Strength and Conditioning Association was founded in 1978 by strength and conditioning coaches to share information, resources, and help advance the profession. Serving coaches for over 40 years, the NSCA is the trusted source for strength and conditioning professionals. Be sure to join us next time.

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