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My interview was with  current high school Athletic Director at Midland Greenwood, Rusty Purser.  We discussed the fact that sports safety, especially facility safety, is a vital part of what Administrators do and are responsible for.  When it comes to safety and risk management in sports we must always ensure that we provide a safe infrastructure for participants first and foremost.  He discussed that after this step, that proper training and continuing education for all coaches must be implemented.

Best Practices:
* Be aware of any and all facilities and facility rules.
* Have a good understanding knowledge of your surroundings and any dangers that could possibly occur.
* Prepare staff and students on any and all procedures and rules.

We are responsible for all and must provide safety and shall not " deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws." ( U.S. Const. amend. XIV, § 2 ).

U.S. Const. amend. XIV, § 2

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"The sports organization should create the formal position of risk management officer to be responsible for implementing, monitoring, and taking corrective action on all issues related to the risk management program. " (Sadler & Company, Inc.. 2019).

Sadler & Company, Inc.. sports insurance. (n.d.). Retrieved September 28, 2022, from https://www.sadlersports.com/implementing-risk-management-program-sports-organizations/

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For Administrators Only Video Link

By John M. Sadler

Introduction

This training content is directed towards directors, officers, and other administrators of sports organizations who are interested in implementing an effective risk management program with the least amount of effort and expense.

Many of our insurance clients tell us that they'd like to implement a formal risk management program but don't know where to start and need guidance. Others have purchased a book or attended seminars on sports risk management and are intimidated by the task of customizing their own written program with all of the forms and time-consuming documentation.

It's been my experience that most risk management programs are too long, complicated, and never implemented to any great degree. For this reason, I believe its the best approach for most sports organizations to spend the greatest amount of time on the bare essentials, which if fully implemented will have the most impact on injury and liability reduction.

The risk management section of our website is a place where you can find all the sample forms, risk management programs, important articles, and other instructional videos on sports insurance and risk management that I refer to in this training.

The term staff refers to either your employee or volunteer workers, including coaches, managers, umpires, referees, concession workers, field maintenance workers, etc. A dministrators refers to your directors, officers, or other personnel who plan, manage, and supervise overall operations.

This content was designed for both adult and youth sports organizations. If all of your participants are adult, just ignore the sections that cover abuse/molestation risk management issues for youth.

Simplified Sports Risk Management Theory

I've spent hundreds of hours studying the formal, textbook risk management process, which stresses a focus on injury prevention first and insurance last. However, for sports organizations, particularly those that are volunteer-run, I deviate from the textbook in order to be realistic about what can actually be implemented in the real world.

The first, most important, and easiest step in the process is to buy the best, most comprehensive insurance that's available. But a risk management program to reduce liability and injuries is also needed because even if your insurance does cover the claim and protect everyone's assets, its a terrible feeling when someone is unnecessarily injured under your watch. If you have a serious injury and face litigation, you, the program, and your reputations can suffer a black eye in the community and in the local media. Anyone who has gone through depositions and litigation will tell you that it's a terrible experience. If you are in litigation, having a risk management program shows the judge and jury that you care. A final factor is that you want to prevent injuries to protect your loss record under your insurance policies to help prevent non-renewal or rate increases.

The second step is to contractually transfer the risk of loss to another party whenever feasible, such as through waiver/release forms.

The third step is to avoid or mitigate high-risk activities that are not essential to your operations and that could result in in serious injuries. Common examples of activities that most sports organizations should avoid are transportation of players and overnight sleepovers.

The fourth and final step is to prevent or reduce the frequency or severity of injuries before they occur. A traditional sports risk management program can be effective by concentrating on your facilities, equipment, instruction, supervision, sport injury care, and use of autos. And more attention should be paid to severity risks that could possibly result in serious injury or death.

What Type of Risk Management Program Is Best For You? Basic or Broader?

Your choice as to the plan that's right for your sports organization will be based on a number of factors.

The size of your sports organization in terms of number of participants. Generally, the larger the number of participants, the greater the need for the broader program.

Sports programs that own their own premises or facilities have a greater need for the broader program.

The nature of the particular sport. Higher risk sports such as gymnastics, diving, football, or cheer will require more staff training or equipment controls offered in the broader program.

Available staff resources in terms of selecting a risk management officer and time commitment of staff.

The risk management section of our website includes both a basic version and a broader version that you can easily adapt and customize to meet your needs.

Risk Management Programs: A Double-edged Sword

Risk management and safety programs can be a double-edged sword. On one hand, the national standard of care as indicated in textbooks and described by expert witnesses will state that sports organizations should have a formal, written program. If you don't, the plaintiff's attorney will argue your organization was negligent for falling below the national standard.

On the other hand, if you have a written risk management program, but failure to follow one of your own required safety rules results in an injury and lawsuit, the plaintiff's attorney can argue negligence - and will likely prevail.

Since the plaintiff's attorney is out to get you either way, it's best to have a written risk management plan but to take some precautions in its design. First, never call it a safety program. Safety programs are meant to protect participants and spectators and it looks especially bad if you don't follow one of your own written safety rules and if doing so could have prevented the injury. Instead, call it a risk management program, as risk management programs are meant to merely reduce the liability risk of a sports organization. If you don't follow your own risk management program to the exact letter despite your best intentions, you can argue that it was not meant to protect the safety of the participants and spectators, but instead was meant to protect the sports organization against lawsuits.

Important Elements of A Sports Risk Management Program

Appoint a Risk Management Officer (RMO)

The sports organization should create the formal position of risk management officer to be responsible for implementing, monitoring, and taking corrective action on all issues related to the risk management program. Like any officer, the RMO should answer to the board but should be empowered to make all day-to-day decisions on issues related to hazards, including the modification or halting of practice and/or play if necessary.

It's best if the RMO is solely dedicated to risk management and has no other duties. However, in smaller sports organizations, this many not be possible and the RMO position may be combined with another officer position.
The coaches, managers, and other staff members should be an extension of the RMO by way of their presence at every practice and game, and should be in close contact with the RMO should any problems arise ,such as physical hazards or unsafe acts.
The RMO must self train on all applicable videos, programs, reports, and articles found on the risk management section on our website. It's also recommended that additional training be received from other resources.

Insurance Policies

The sports organization should carry comprehensive insurance policies that meet or exceed certain minimum standards. Almost all sports organizations should carry Accident, General Liability, Directors & Officers Liability, Crime, and Equipment policies. Larger organizations with more complex operations, paid employees and owned vehicles and buildings may also need Workers' Compensation, Auto, and Property insurance. Our article, "7 Critical Mistakes To Avoid When Buying Sports Insuranc e," provides an excellent explanation of why you need each policy type.

Having the proper policies in place isn't enough. You also need to make sure that the coverages really give you the protection that you need. Many popular Accident and General Liability policies that are sold by both local insurance agents and so-called sports insurance experts contain some unacceptable policy exclusions that can leave you wide open in the event of a lawsuit. The best way to protect against this is to download our checklist, hand it checklist over to your existing insurance agent, and ask him/her to complete and it. This shifts all of the work to your insurance agent.

You need to be aware that our checklists outlines minimum standards only. If your governing or sanctioning body has higher requirements or if you can find insurance that exceeds these minimum standards, you should buy it. Don't skimp on the quality of your insurance and don't blindly rely on your insurance agent to protect you. Always go the extra mile to use the checklist tools.

Contractual Transfer of Liability

The sports organization should contractually transfer the financial responsibility of paying for losses:

Waiver/Release

The first place to start is with your participant registration forms. It's critical that all of your participants sign a waiver and release of liability form to protect your sports organization and its people against lawsuits whenever there's an injury to a participant. A waiver/release form is not a magic cure all that takes the place of liability insurance, but it's definitely worth the paper it's written on as explained in detail here.

Not all waiver/release forms will gain an advantage for you as most have defects in how they were drafted. The language must avoid 10 common pitfalls that courts use to invalidate them. We have downloadable sample minor and adult forms that were designed by law firms that specialize in defending clients against sports related lawsuits. Every phrase and every word in these forms exist for a reason that's to your advantage. I recommend that you scrap your existing forms and use these with the approval of your legal counsel. Or better yet, hire a waiver/release specialist to draft a custom agreement for your specific activity and state (scroll to bottom of article for sources).

Emergency Information & Medical Consent

In addition, you should always require your participants to sign an emergency information and medical consent form in the event they're injured and require emergency medical treatment. A copy of this form should be kept on file for immediate retrieval in either a hard copy or electronic format by both the sports organization and the coach.

An image release form will protect against potential lawsuits where the photograph image or video recording of a participant is used in the marketing materials for the sports organization. There have been some cases where participants have sued for invasion of privacy or undue publicity.

Facility Lease Or Permit Agreements

Whenever you lease your facilities to a third party or you lease facilities from a third party, you should have a written lease agreement that specifies the terms of the lease. T hat agreement should have a hold harmless/indemnification provision that is fair to both parties. Our article, "Before You Sign the Sports Facility Lease Agreement," explains how hold harmless/indemnification provisions offer protection and provides sample hold harmless and indemnification provisions for your consideration. In addition, the lease agreement should require the party that is the tenant to carry General Liability insurance with a limit of at least $1,000,000 and should name the landlord as an additional insured.

Hosting Tournaments or Outside Teams

Whenever you invite an outside team to play against a team from your sports organization or you host a tournament, you need to make sure you're protected. You should have a written agreement that has a hold harmless/indemnification provision in your favor and require the visiting teams to carry General Liability insurance with a limit of at least $1,000,000 naming your sports organization as additional insured.

Service and Product Vendors

Many sports organizations subcontract out parts of their operations to vendors or service providers, such as umpire associations, concession vendors, janitorial, security, and field maintenance. Written agreements should be in place that specify the terms of service and the responsibility for injury to workers and third parties. The agreement should have a hold harmless/indemnification provision that is favorable to your sports organization and an insurance requirements provision that protects your organization. "Collect Certificate of Insurance from Your Vendors" is an excellent summary of the insurance coverages that should be carried by your vendor or service provider.

Abuse/Molestation Risk Management

The sports organization should implement an abuse/molestation risk management program. This critical topic is so important that we have devoted separate content that explains how to set up a program from A to Z. I strongly recommend that you view our Safe Sport Child Abuse and Other Misconduct Risk Management Plan on setting up and implementing such a program.

Avoid or Mitigate High Risk Activities

Sports organizations should avoid certain high risk activities that are not mission critical and that create a potential for severity lawsuits.

Transporting participants: This risk has a high severity potential as auto injuries tend to be serious and it's likely that multiple passengers will be injured. It's best to leave the transportation to the parents, but if your sports organization must be involved with the transportation of participants, the risk can be mitigated by running motor vehicle record checks on drivers and by proper vehicle selection.

15 -passenger vans: Rented or borrowed 15-passenger vans for transporting participants is a bad idea for the reasons already mentioned plus 15-passenger vans are particularly dangerous due to their high propensity for tipping over, as documented by warnings from the National Highway Traffic Safety Administration. The fact that many state statutes prohibit their use for the transportation of students and that churches are phasing them out should tell you something about this risk. Also, 12-passenger vans and SUVs don't fare much better than 15-passenger vans. If participants must be transported, it should be done in vehicles such as a school bus, 7-passenger minivans, or private passenger cars. More detail on the topic is provided in our article, "12- and 15-Passenger Vans."

Overnight sleepovers: Overnight sleepovers present an opportunity for sexual predators to make advances on youth participants. If sleepovers can't be avoided due to tournament travel, steps should be taken to run background checks on all staff and require all youth to be supervised by two adults who are in each other's presence at all times. See Safe Sport Child Abuse and Other Misconduct Risk Management Plan for more information on overnight travel.

Serving alcoholic beverages: This can result in problems for obvious reasons. If alcohol at an event must be served, the liability risk should be transferred by subcontracting this function to a bar tending company that can provide a certificate of insurance evidencing Liquor Liability coverage in the amount of at least $1,000,000.

Certain fundraisers: These are considered by the insurance industry to be high risk such as dunk tanks and inflatables.

Swimming parties: The biggest source of deaths and serious injuries to my clients over the past 20 years has been swimming parties both at the homes of staff members and at motels without lifeguards. We've had serious problems with these even when multiple adult staff members were supervising the pool. If you must have a swim party, only do it at a location that provides a trained and certified lifeguard.

Conduct Mandatory Staff Meeting to Review Basic Risk Management Policies and Procedures

The sports organization should conduct a mandatory staff meeting prior to the start of each season to review common sense risk management policies and procedures. None of these are rocket science, but they do cover the majority of what can go wrong in a very general way. A more detailed review of suggested policies and procedures is part of our sample risk management plan.

Abuse/Molestation protection (ex: use of buddy system, no improper touching)

Child pick-up/take-home policy

Transportation of participants

Prohibition of alcohol, illegal drugs, tobacco

Facility/equipment inspection

Identifying and responding to hazards and unsafe acts

Medical emergencies

Complaint reporting

Awareness Training for Administrators and Staff

Awareness training is an overview of the physical hazards and unsafe acts and conditions that most frequently lead to injuries and resulting lawsuits. It also includes guidance on the standards of care that the law requires of administrators and staff when performing their job functions. In addition, administrators and staff are expected to respond to hazards or unsafe acts and conditions by taking immediate corrective action, if feasible, and by notifying the RMO.

Facilities and Equipment

Awareness training keys in on the important risk management standards required by the courts for all aspects of a sports program.

For both your facilities and equipment, our awareness training program keys in on the points outlined above. Most of this is just common sense for those with prior experience but many of your new coaches will be exposed to these concepts for the first time.

Facilities

layout and design

adequate and appropriate for use

controlled access

routine inspection, maintenance, and repair

choosing proper equipment

modification

maintenance and repair

fitting

inspection, reconditioning, replacement

Supervision and Instruction

Lack of supervision is the leading category of sports related lawsuits. This training helps your staff visualize what can go wrong and will help them to recognize and react to risky situations.

Supervision

overseeing activities

recognizing hazards, implementing protection

monitoring for compliance

duty to stop rowdiness

location of supervisor

competency of supervisor

ratios of supervisors to participants

selection of size, age, and skill of participants

Instruction

sports specific techniques and skills

game rules

safety rules

Sports Injury Care and Autos

Below are critical areas where failure to follow accepted standards of care can result in major liability.

Sports Injury Care

prevention of injuries

recognition and treatment

first aid and CPR

emergency medical plan

return to play

discourage the use of group and individual staff provided transportation

motor vehicle registrations and disqualification criteria

15-passenger vans

Other Awareness Training

The above topics should be a required part of your awareness training. Not every article will apply to all sports organizations. Based on my personal experience, I would say that the 30/30 lighting safety rule is the most overlooked risk management rule in all of sports and most administrators and staff need training on this.

Customization of Your Risk Management Program

No two facilities or sports are exactly the same. Therefore, the development of a risk management program will require some additional customization on your part. We provide both a basic program and a broader program template that you can easily customize to suit your needs.

Conclusion

Our website provides all of the tools that you need to get started and to complete the project including sample sports risk management programs, awareness training content, articles, and forms.Hopefully you'll agree that implementing the appropriate risk management program for your sports organization is not so complicated after all.

REV. 04/2019

©Copyright 2009 - 2019 Sadler & Company, Inc.

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Implementing a Risk Management Program for Sports Organizations

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For Administrators Only Video Link By John M. Sadler This training content is directed towards directors, officers, and other administrators of sports organizations who are interested in implementing an effective risk management program with the least amount of effort and expense.

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Chen, Y., Buggy, C. & Kelly, S. Winning at all costs: a review of risk-taking behaviour and sporting injury from an occupational safety and health perspective. Sports Med - Open 5, 15 (2019). https://doi.org/10.1186/s40798-019-0189-9

This article speaks about the facts of how athletes are willing to risk all in order to win. Athletics is a big business and is very popular amongst young people. But risking personal and occupational safety in order to be successful is a fine line that all athletes must cross or not. It is the responsibility of the supervisors or coaches to help athletes understand these consequences and make the appropriate decisions.

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Review Article

Open Access

Published:

Sports Medicine - Open 5, Article number: 15 (2019) Cite this article

16k Accesses

15 Citations

13 Altmetric

Metrics

Abstract

Professional athletes involved in high-performance sport are at a high injury risk, which may lead to long-term health consequences. Professional athletes often expose themselves to risky behaviours, resulting in a higher acceptance level of occupational risk compared to other occupations. To date, many studies have focused on elite athletes' specific injury prevention techniques. The objective of this narrative review is to (1) summarise elite athletes' attitudes towards important occupational safety and health (OSH) practices, including injury reporting, medicine usage and personal protective equipment (PPE) usage, and (2) explore factors that may influence elite athletes' injury awareness. If injury awareness were given a similar weighting in elite sports as in any other highly physical occupation, the potential benefits to elite athletes and their long-term health could be highly significant. This review identifies that most elite athletes are not aware that sporting injuries are occupational injuries requiring behaviours determined by OSH rules. All the 39 studies identified met the moderate methodological quality criteria according to the Mixed Methods Appraisal Tool (MMAT). The factors impeding athletes' injury awareness from achieving occupational health standards are discussed from three safety management perspectives: organisational, societal and individual. This review contributes to a better understanding of how to build a positive safety culture, one that could reduce elite athletes' injury rate and improve their long-term wellbeing. Further research is required to develop a quantitative measurement instrument to evaluate occupational health awareness in the sport context. Based on the papers reviewed, the study population was categorised as elite, professional, high-performance amateur and student-athletes.

Key points

The key factors influencing an elite athlete's occupational safety and health (OSH) awareness have been neither evaluated nor adequately identified in research studies to date.

Occupational risk communication should be improved by establishing a proactive injury prevention culture and identifying clear-cut responsibilities for key stakeholders within sport organisations.

Future research could develop an instrument focused specifically on the unique sport setting, which would elicit the factors hindering the improvement of elite athletes' OSH awareness.

Background

In an article about concussion in professional rugby union, ex-Scotland representative player Rory Lamont comments that "a flagrant disregard for your own welfare almost seems a prerequisite for achieving success at the highest level" [ 1]. The pressure of sports competitiveness inspires elite athletes to "win at all costs" [ 2] and may lead them to neglect injuries and continue playing with pain [ 3, 4, 5, 6], resulting in a higher occupational risk acceptance [ 5]. Sporting injuries limit an athlete's preparation and subsequent performances, which can have both short-term [ 6] and long-term health impacts [ 7]. According to statistics reported in the UK, the overall injury risk in professional soccer is 1000 times higher compared to other high-risk occupations such as construction and mining [ 8, 9]. One potential reason for this is that non-sporting workplaces have adopted OSH management practices to reduce the risk to as low as reasonably practicable (ALARP) [ 10]. OSH management practices have been embedded into organisational management in international and national health and safety legislation [ 11, 12, 13] but not completely adopted in elite sport organisations [ 14]. The incorporation in elite sport of OSH practices to reduce risky behaviours could minimise the health impacts of inevitable sporting injuries in the long-term [ 15]. If injury awareness were given a similar weighting in elite sport as in any other highly physical occupation, the potential benefits to elite athletes and their long-term health and wellbeing could be highly significant.

Literature search and evaluation methodology

This paper adopts a narrative review method to transmit knowledge and information across the two disciplines [ 22]. The databases searched were PubMed, Scopus and Web of Science. The Boolean operators AND, OR and NOT were used to narrow or broaden the literature search. The combination of key terms searched are ("elite athletes" OR "professional players" OR "professional athletes" OR "elite players" OR "professional sports" OR "elite sports") AND ("occupational safety" OR "occupational health" OR "occupational risk" OR "occupational health and safety") AND (awareness OR perception). Because, considered occupational health terms in sports may not have been commonly used, articles identified by manual journal search were also included for a more comprehensive coverage. Since each database provides different facilities for paper screening, papers were generally screened by limiting publication date (2008-2018), article type (original research), English written, publication status (fully publicised) and text availability (full-paper available) in the searched databases. Explicitly, 47 books, 3 book series, 3 conference proceedings, 27 review papers, 1 conference paper, 1 short survey and 7 articles written in a language other than English (i.e. French, Spanish, German, Portuguese, Croatian, and Polish) were excluded. After limiting the publication date from 2008 to 2018, 163 documents were identified. Following a manual search, 36 papers were identified. One hundred ninety-six articles were identified after removing duplication. The first author reviewed and assessed all the 196 articles retrieved against criteria agreed by the other two authors to determine their inclusion in the final sample. On a case-by-case basis, we excluded a further 157 articles which met the key word criteria but following a review of the title and abstract, were not relevant to this study. In the first instance, we excluded 79 articles which focused on a non-sport setting (e.g. military). Furthermore, studies on dancing were not included in this review. In the second instance, we excluded 20 articles in which the health awareness of sport supporting staff is examined rather than that of athletes (e.g. coaches' burnout, physiotherapists' burnout or Paralympic leaders' stress). Subsequently, 44 studies not focused on health awareness were also excluded (e.g. studies focused on the association between training load and sleep quality, studies focused on associations between common mental disorder symptoms and potential stressors or studies focused on associations between athlete burnout, insomnia, and polysomnographic indices among athletes). The abstract of the studies were reviewed if the information the study title provided was insufficient for screening. For example, studies such as Mental and psychosocial health among current and former professional footballers were excluded after reviewing the abstract, in which the association between the prevalence of mental health complaints and the psychosocial problems was examined rather than how players are aware of their mental health. In addition, 13 studies that did not meet the study type were excluded. We also excluded another one paper, the full text of which could not be located. Finally, 39 studies meeting the inclusion criteria were included. Figure 1 flowchart diagram indicates the overall search process. Table 1 presents the study information of the final included 39 papers after the inclusion and exclusion criteria screening process conducted. The study population of athletes was categorised as professional, elite, high-performance amateur, student athletes and mixed population as presented in Table 1.

Flowchart diagram of search process

Inclusion criteria

The following are the inclusion criteria:

1. 1.
Qualitative or quantitative original research published in academic journals written in English

2. 2.
A study population who were currently or previously involved in elite sports ("rule-governed, structured, competitive gross movement characterised by physical strategy, prowess and chance" [ 63])

3. 3.
Studies that investigate awareness of sporting injuries or risk-taking behaviours

Exclusion criteria

The following are the exclusion criteria:

1. 1.
Studies on dancing

2. 2.
Studies that focus purely on injury prevention skills or techniques and do not measure awareness (i.e. physiology, epidemiology, sports technique, pathology)

3. 3.
Articles reporting second-hand data only (i.e. review papers, editorials, letters, books, book chapters, conference papers, theses and other unpublished works)

4. 4.
Studies that did not focus on player health (i.e. studies focused on coaches' health were excluded)

5. 5.
Studies where the full paper was unable to be retrieved

The quality and strength of the selected studies were graded according to the criteria of the Mixed Methods Appraisal Tool (MMAT) by the first author in consultation with the two co-authors. The MMAT can be used to evaluate qualitative, quantitative and mixed-methods studies, especially health-related studies [ 62]. The papers reviewed were categorised by study type: case-control study, cohort study, cluster-randomised controlled trial, grounded theory study and cross-sectional study. The data extracted from each identified study included study year, participants, sample size, research methods, awareness type (i.e. specific sporting injuries or risk-taking behaviours) measured and significant associations. The scores calculated using the MMAT are presented in Table 1 varying from * (one criterion met, rating of 25%) to **** (all criteria met, rating of 100%). Overall, the methodological quality of the 39 identified studies ranged from 50% to 100%. Among those, 12 studies were of moderate quality (rating of 50%) and 22 studies were of high quality (rating of 75%) and 5 studies were of excellent quality (rating of 100%).

Results

After reviewing the papers included, the three most frequent themes were injury reporting, medicine usage and PPE usage. The results of the remaining studies on other health and safety issues have also been included in the table, though not discussed within the three themes.

Sporting injury- concussion reporting awareness

Sporting injuries can be classified as occupational injuries because elite athletes are contracted or remunerated employees in sport organisations. Under the legislation in most developed countries [ 12, 13], employees are responsible for notifying their employer of occupational injuries. Accordingly, elite athletes should report their sporting injuries to the management staff as soon as possible. However, some elite athletes fail to report sporting injuries and consequently miss the time window for medical treatment [ 34]. From the papers reviewed, there are mainly four injury-reporting failures. First, elite athletes do not realise that they are actually injured [ 43]. Second, elite athletes do not think that their injuries are serious enough to report. Third, elite athletes do not disclose sporting injuries because of pressure from coaches, teammates, fans and parents [ 64]. Finally, elite athletes report the injury as regulated but the injury disclosure is then underestimated by the management staff [ 65].

Based on the ALARP standard [ 10], occupational injury reporting as a basic OSH management practice has not been adequately adopted within elite sport. In terms of the first two injury-reporting failures mentioned above, it is important for elite athletes to perceive injury symptoms and injury consequences. Of the 39 articles reviewed, seven studies examined injury symptom awareness and six studies examined injury consequence awareness: most of these studies focusing on brain injuries, especially concussion, are presented in Tables 2 and 3, respectively. This may because brain injuries are more difficult to detect when compared to limb injuries, which can hinder sport performance in a more obvious manner. Taking this into account, the findings in this section can only be discussed based on concussion. Most of the studies reviewed on concussion awareness have an overall high methodological quality.

After a concussion, 52% of rugby players make their own decision to continue playing, while only 22% return after medical clearance [ 72]. The Pitch Side Concussion Assessment (PSCA) tool has been widely used [ 73], but after suffering a concussion elite players may deliberately cheat to pass the test in order to return to the field according to news reported [ 74] and previous review paper discussed [ 75]. Similarly, in non-contact sports like equestrian sports, concussion can equally lead to serious long-term effects [ 76, 77, 78, 79] but many professional equestrian riders are not aware of the consequences. Almost half of the equestrian riders in Kuhl's [ 40] study that received a self-reported concussion were likely to return to training or competing without seeking medical clearance. After experiencing concussion symptoms, more than 30% of riders thought that they could get back on a horse on the same day [ 40].

Concussion consequences could be minimised if both elite athletes and their supporting staff had better concussion-reporting awareness. This requires encouraging a culture of concussion disclosure in the organisation and adequate knowledge of concussion symptoms. As to the third injury-reporting failure, many studies found that the pressure from individuals or groups around elite athletes such as coaches, teammates, fans and parents could directly or indirectly impede injury-reporting behaviour [ 64]. These influences on injury reporting will be further discussed in the " Societal factors" section. In addition, while many elite athletes do successfully report their injuries, management staff such as clinicians may allow athletes to continue playing after a head impact based on their subjective interpretation of the concussion symptoms due to a lack of quantitative information [ 65, 80]. A lack of objective tools to diagnose concussion is no doubt an issue in this case. Nevertheless, if elite athletes and their supporting staff had a better OSH awareness to prioritise health and safety rather than sports performance, a more conservative and safer decision could be made.

Awareness of the health risks of inappropriate medicine usage

All of the four studies reviewed on medicine usage awareness have high or excellent methodological quality. The main reason for the World Anti-Doping Agency (WADA) ban on the use of certain medicines is because of an actual or potential health risk to the athlete [ 81]. Many elite athletes take non-doping-classified medicines for enhancing athletic performance or treating injuries. From an OSH perspective, a control measure can increase the occupational risk if it is not appropriately managed. In this case, there will be a potential source of harm or adverse health effect on elite athletes if the medicine is taken improperly. Injured athletes who fail to report an injury may take medicine to mask pain so they can continue training and competing [ 82]. By examining urine sample of athletes in the Olympic Games in Sydney 2000, a study pointed to a dangerous overuse of nonsteroidal anti-inflammatory agents [ 83]. Blood sample measurements from athletes ( n = 330) in the 2004 New Zealand Ironman triathlon identified the prevalence of non-steroidal anti-inflammatory drugs (NSAID) was 30% [ 84]. Another study [ 85] has identified a high rate of non-prescribed use of NSAID consumption among triathletes from 23 different countries, but it was not specified how the questionnaires were distributed and collected. Among younger athletes, a study [ 86] reported nearly one of seven high school football players used NSAIDs daily, according to data from self-administered questionnaires. However, the incidence might be under-reported considering coaches distributed the questionnaires which may lead to bias. These studies indicate elite athletes frequently take incorrect doses for extended periods and are not aware of the potentially deleterious adverse effects. Elite athletes have also been shown to use NSAIDs the day before competing for pain prevention [ 85, 86], such as for delayed-onset muscle soreness [ 87] as a "prophylactic pain treatment" [ 88]. Medicine usage for pain prevention can be found in various sports such as American football [ 86], soccer [ 88], marathon running [ 89] and triathlon [ 84].

Injured athletes can reduce rehabilitation time by using NSAIDs, but if they return to intensive training too soon they may be at risk of overuse injuries and inappropriate biomechanical stress [ 90, 91]. Some types of sports involving extensive and strenuous use of limbs and muscle groups may cause chronic tendinopathies and inflammation, in which conditions professional athletes may take NSAIDs with medical instruction [ 92]. Though permitted by WADA, elite athletes should not take non-doping classified medicines without medical supervision [ 93] because of the risk of the side effects [ 94, 95, 96]. Many athletes are still unaware that inappropriate medicine use can adversely affect their wellbeing in the long-term.

Personal protective equipment (PPE) usage awareness

In combat sports, various types of protective gear have proved effective. Through repeatability tests by a spring driven linear impactor (Punch machine), one study [ 103] identified the important role of Association Internationale de Boxe Amateur (AIBA) headguards in reducing the risk of concussion and superficial injury in boxing competition and training. By reviewing 24 articles of level I or II evidence for prognostic studies, one systematic review paper [ 104] found that the implementation of full facial protection can reduce the risk of overall head and facial injuries in ice hockey compared with partial facial protection. This study also found that partial facial protection still offers more risk reduction than no facial protection.

In junior ice hockey, a 3-year prospective cohort observational analysis of elite players from 10 teams in 10 cities across 5 states played in the same league governed by the same rules and referees demonstrated how both full and partial facial protection can significantly reduce eye and face injuries without increasing neck injuries and concussions. Furthermore, the eye injury risk was 4.7 times greater for players with no protection compared with those wearing partial protection [ 105].

A retrospective analysis of data collected from 1833 American footballers between 2005 and 2010 from 8 collegiate teams found that a helmet is the primary item of equipment used to protect a player from head-related injury and may reduce the risk of sustaining a concussion [ 106]. Similar results have been observed by another three-year prospective cohort study with 2141 high school American football players [ 107]. It has been reported that the implementation of National Operating Committee on Standards for Athletic Equipment (NOCSAE) helmet standards in American football have resulted in an 88% decrease in serious head injury: this resulted in an average of only 0.51/100,000 players during the 2002-2006 seasons compared to that an estimated average 4.25/100,000 players in the 1964-68 era [ 108]. However, the effect of helmet use on brain injury risk in some sports is still contentious according to a systematic review conducted by Benson [ 109].

In a general working environment, positive safety culture includes the enforcement of appropriate PPE usage [ 110]. In comparison, the usage of PPE in sports is frequently optional or poorly implemented. Given the opportunity for nonresponse bias of a self-administered questionnaire by mail, Hawn [ 111] found that mouthguard use among NCAA ice hockey players in competition is not consistently enforced as it should be according to the sport's regulations. Recently, World Rugby has adopted the regulation requiring players of all levels to wear adequate equipment such as mouthguards during training and competition [ 112]. This practice was strongly recommended by the Irish Rugby Football Union (IRFU) from the 2015/16 season but there is limited data on the effect of this regulation's implementation to date.

Most of the reviewed studies on PPE usage (shown in Table 4) reported on athletes' awareness of PPE, as opposed to its effectiveness. Mouthguards may help to reduce the probability of oral trauma, brain injuries, cerebral haemorrhage and possibly even death [ 113]. Orofacial injuries often result in life-long sequelae requiring expensive follow-up treatment which could be significantly reduced or avoided by the use of a mouthguard [ 113, 114, 115, 116, 117]. However, a high level of ignorance regarding mouthguard use is reported by analysing survey data collected from 1478 soccer and 1192 rugby players at high schools in Japan [ 118]. In a relatively recent study [ 42] in China, using an attitude survey after an epidemiological survey, 59% of basketball athletes investigated regarded basketball as a medium-to-high-risk sport, but few of them thought it necessary to wear a mouthguard. Considering the samples ( n = 236) were all recruited from Chinese Basketball Association (CBA) based in Beijing, players in less developed cities could potentially report a lower awareness on mouthguard use. The reasons for not using a mouthguard included ignorance, non-availability, non-affordability, discomfort [ 29, 30] and their hindrance to verbal communication [ 42]. Participants in Berry's study [ 30] tended to modify mouthguards to make them more comfortable ignoring the potential impact on their effectiveness. Similar to other control measures [ 97], the usage of PPE may create or contribute to occupational hazards for athletes, such as heat stress, physical injury and psychological pressure. From an OSH perspective, these issues must be acknowledged and confronted by athletes during PPE usage training [ 42].

Discussion

The factors hindering elite athletes' occupational health awareness are interrelated. To demonstrate these factors in a clear way, this review categorised them into three different types: organisational safety management factors, societal factors and individual factors.

Organisational Safety management factors

An organisation's OSH system will not be effective without a positive safety culture [ 119]. Safety culture consists of shared values, attitudes, perceptions, and beliefs that drive decisions and behaviours regarding safety [ 120], and can be manifested by human workplace behaviours in the organisation as a part of organisational culture [ 121, 122]. When a positive safety management culture that is fostered by all in an organisation, positive behavioural change that is measurable ensues, this would also potentially be equally true in any sporting organisation that places an emphasis on safety.

Safety culture in sport

As Yau [ 123] reported with regard to the declining accident trend in the construction sector in Hong Kong, safety culture is the key to building a safer workplace. From an OSH perspective, a culture's continual improvement cycle involves policy, organising, planning and implementation, evaluation and action for improvement [ 124]. Nevertheless, competitive sporting culture can conflict with the promotion of a positive safe working environment for elite athletes that includes OSH as a core aspect of risk management. Since mid-Victorian times, the ethics of muscular Christianity (e.g. teamwork, manliness, the moral and physical beauty of athleticism, discipline and self-sacrifice) underpinned rugby development within British and Irish public schools [ 125]. Sport cultures generally encourages athletes to keep competing regardless of pain [ 126, 127], to return quickly after injury [ 128] and to normalise injuries from a young age [ 129]. Sport-related identity, masculinity and risk-taking are components of the emerging portrait of a "toxic jock" [ 130], which may indicate an elevated risk of health-compromising behaviours [ 131]. Many elite athletes tend to be tough-minded and consequently they accept greater risk of injury than other people might. Though the culture may vary within different sports, the attitudes towards pain and injury are not confined to one sport or one cohort of athletes. In non-contact sports such as equestrian sports, riders are still encouraged to get back onto their horses immediately following a fall [ 40]. Furthermore, Paralympic athletes with spinal injuries intentionally induce autonomic dysreflexia for better performance, ignoring its risk [ 31].

Leadership plays a vital role in influencing the development of safety culture. In OSH management, senior managers in the human resources department are charged with "designing, fostering and nurturing" safety culture [ 132]. In a sport context, coaching staff can foster positive safety culture by encouraging injury-reporting habits through formal or informal means [ 25]. Likewise, leadership can destroy safety culture if it is not properly implemented [ 133]. For example, some studies found that coaches may exhibit a lack of injury identification knowledge [ 34] and compound the long-term impacts of injuries by neglecting injury prevention programmes [ 47].

Occupational risk communication

The communication between employer and employee is an important aspect of organisational safety management. Nevertheless, even if employers and management have adequate information, they cannot promote safety culture without effective communication.

First, employers are responsible for informing employees of occupational hazards that they may face in the workplace [ 12]. Like new employees, new elite athletes should be educated about the categories of playing conditions, hazardous sport-related factors, associated health effects and injury prevention techniques. A negative example in sports is that of the former American football players who sued the National Football League (NFL) for $1 billion for misrepresenting the long-term health impacts associated with on-field head injuries [ 134]. However, even if a sport organisation has an accurate understanding of the value of injury prevention techniques, the management team (such as coaching staff and medical staff) may fail to communicate this knowledge effectively to elite athletes [ 27]. Previous studies argued that there is no one-size-fits-all programme contributing to a better knowledge or understanding of injury consequences to elite athletes [ 38, 135]. Communication issues include not only access to safety knowledge but also the organisation's preparedness and willingness to implement safety programmes [ 136]. Thus, it is necessary to customise the intervention programmes for each specific sport [ 137, 138]. Unfortunately, the effectiveness of such intervention programmes may not have a lasting impact. For example, Cusimano [ 139] demonstrated that the brain injury knowledge of elite athletes can be immediately improved through video education; however, this method lost its effectiveness after just 2 months.

Third, occupational risk assessment is recognised as an integral part of successful OSH management [ 148]. The workplace is found to be much safer when the OSH-related practices are evaluated and feedback is given [ 149]. The purpose of carrying out a risk assessment is to determine whether the level of risk arising from workplace activities is acceptable, or whether more needs to be done to control or reduce risk. According to the Tolerability of Risk Framework [ 10], the UK Health and Safety Executive (HSE) expects that controls in place must, at a minimum, achieve the standards of relevant good practice precautions irrespective of specific risk estimates [ 150]. In most sports organisations, the acceptable level of occupational risk is higher than that in other industries. Thus, sports organisations may put greater emphasis on measures to control risk impacts rather than eliminating risks. This is an acceptable strategy for occupational risk management at the start of a risk assessment process as control measures evolve they should aim for risk elimination rather than control. However, a specific ALARP standard should be considered for risk level communication when occupational risk assessment is undertaken in sports organisations.

Societal factors

Societal factors, ranging from the surrounding social referents (e.g. teammates and family) to the mass media, can shape an individual's perception of health and safety over time. The most direct influences include the coach [ 29, 72], family and friends who are key referents in improving an athlete's injury awareness [ 151].

Elite athletes exist in an environment of complex networks with various health hazards, which may influence injury disclosure behaviour [ 39] or drug-taking behaviour [ 152]. For instance, according to the UK's online Drug Information Database (DID), 10% of UK professional athletes had contact with illicit drugs in both 2006 and 2007 [ 153]. The environment (inclusive of social interactions) may adversely affect elite athletes' perception of health and safety, particularly younger athletes [ 154]. The attitudes surrounding social referents can be reflected in, or impact on, the behaviour of the elite athlete as they observe behavioural change in others they can increase their own awareness and consequently adapt and change their own behaviour, in essence a form of peer learning [ 39]. Kotarba [ 155] found that the "Sportsnet" [ 156] enabled athletes to share information on how to camouflage injuries that may threaten their active playing status. In addition, factors in the athletes environment such as coach approachability may also affect OSH management practices such as injury reporting [ 157]. Teammates' or coaches' beliefs and experiences (including risk-taking behaviour) may also affect elite athletes' risk perception more than their own experiences [ 27]. For example, Kroshus [ 158] found that when collegiate athletes were pressured to continue playing after being concussed, they were more unlikely to reveal their symptoms. In Sye et al.'s study [ 72], 76% of rugby players believed that a teammate who had suffered from a brain injury would stay on during a game. Sye et al. [ 72] also reported that 151 elite athletes believed a concussed player on their team had continued playing due to pressure. Management and coaches may improve their own status (e.g. financial, commercial, status-related or career-related) by encouraging their athletes to make personal sacrifices "for the good of the team". Therefore, responsibilities between athletes and staff are needed to be transparent in order to minimise the interference from personal interests.

The family plays an important role around an elite athlete. For example, mothers may be more likely than fathers to regard brain injury as a "critical issue" and are better at distinguishing concussion symptoms than fathers [ 159]. This may be due to the differing levels of interest in health issues exhibited by men as opposed to women and the way they view sports injuries [ 160, 161]. It is important for stakeholders such as parents to be aware of the long-term risks of injuries. The education of players' family on injury consequences could be an effective approach, because family members may in turn encourage players' injury disclosure by urging them to seek medical service.

Sport-related policies have an indirect but inevitable impact on the elite athlete's OSH attitude. For instance, American college rugby has an injury rate three times higher than American football due to the lack of regulations stipulating the use of PPE [ 100]. After the National Football League implemented the "crown-of-the-helmet rule", weekly reported brain injury injuries among defensive players reduced by 32%. However, weekly reported lower extremity injuries among offensive players increased by 34% [ 162], suggesting a change in tackling tactics in response to the rule change. In Azodo et al.'s study [ 29], basketball players suggested that mouthguard-wearing rate would be improved during the game if mouthguard usage was made compulsory. Therefore, sport-related policies may need to be updated and translated from OSH legislation in general to the specific sports context.

From the social dimension, the mass media can reinforce the image of the sport person by providing visual cues to audiences thus contributing to its role of "televised sports manhood formula" [ 163]. Some audiences prefer seeing sport violence that emphasises masculine hegemony [ 164] and this can, in turn, shape elite athletes' behaviour. Even in female sport, a macho masculine-defined culture can be identified in the attitudes towards pain and injury [ 165]. The competitive culture driven by wider societal expectations of elite sport has become entrenched as one primary aspect of its own organisational culture. However, this situation can be augmented by adopting practices that engender a positive OSH culture, particularly in the processes relating to communication and consultation. Cusimano [ 139] deduced that long-term exposure to educational opportunities through coaches, parents and the media can make a bigger difference than short-term educational programmes. The active involvement of athletes' families in the OSH process is essential to enhance their long-term wellbeing [ 166, 167]. It is essential for researchers to focus more on specific groups of elite athletes and their social milieu [ 162] to improve athletes' OSH awareness multi-dimensionally.

Individual factors

This section reviews the manner in which individual differences in terms of physical factors, personal experience and self-expectation influence elite athletes' OSH awareness. Physical factors such as age, gender and ethnicity have been investigated regarding their influence on OSH awareness. These can be found in the "Associations" column in Table 1. Although physical factors are specific to the individual, a better understanding of them can contribute to effective interventions catering to different groups of elite athletes.

Injury experience

Attitudes are formed not only by social norms but also by personal experience [ 168, 169]. For example, elite athletes' injury experience can be assimilated into their cognition, which may change their OSH attitude. Elite athletes with an injury history display more fear of injury than those who have never been injured [ 170]. For example, a rugby player who has incurred a previous shoulder injury may not be confident to take on tackles despite being fully recovered [ 171]. However, the fear of injury can protect athletes from returning to competitive action before they are fully recovered, which reduces the possibility of re-injury. This could prompt an athlete to seek OSH guidance or take measures to avoid injury. Players could improve their OSH awareness based on their injury experience. For example, in Ma's study [ 42], only one of the basketball players was found using a mouthguard after a dental injury that dislocated his two incisors. Short [ 53] found that female soccer players with a history of injury reported greater risk perceptions than their uninjured peers. The reoccurrence of previous injuries can influence athletes' occupational risk assessment and improve their awareness.

Athletes with greater playing experience in competitive leagues usually possessed enhanced injury knowledge [ 38]. Nevertheless, as playing experience increases, players are actually less likely to follow OSH management practices. For instance, McKay [ 27] found that the longer coaches and elite athletes are involved in soccer, the less likely they are to be willing to undertake the FIFA 11+ programme. McKay deduced that experienced elite athletes are so confident in their injury prevention techniques that they may undervalue the risk of injury during competitive games. This phenomenon exemplifies the fact that an athlete's experience can influence his or her injury risk estimation.

Self-expectation of sporting performance

Self-expectation here refers to an individual elite athlete's expectation of his or her sporting performance. Many elite athletes are willing to do whatever it takes to win, even sacrificing their health in order to leave a positive image while displaying toughness in order to earn peer group admiration and national recognition but also, importantly, financial rewards [ 6]. Athletes performing at a lower-level may be more eager to compete despite injury to gain respect and status by overconforming to the organisational and societal expectations placed upon elite sport [ 172, 173, 174]. Elite athletes may not report concussions because they do not want to stop playing or disappoint their teammates [ 43]. In team sports, a short period away from playing or training can have significant consequences for both the individual and the team [ 175]. The individual elite athlete may lose his or her position in the team, lose reputation due to missing training or lose earnings. Meanwhile, the team loses a potentially vital athlete that may impact team performance. As Rory Lamont, a retired rugby player who has cheated on concussion tests while playing the game, stated [ 1], "There is nothing more glorious than to show your teammates, coaches and fans that you are willing to put your body on the line for the cause". He then explains that rugby culture is viewed as a bravado and self-sacrifice type culture where showing pain is a sign of mental weakness and may contribute to players losing the respect of teammates and coaches. However, the player also indicates this culture may have serious influence when it comes to concussion.

In Kerr's et al. study [ 39], 67.6% professional athletes did not report injury because they did not want to be withheld from future game or practice. This study supports the view that self-expectation influences their injury-reporting behaviour, especially in countries where success at the university level of high-performance sport can facilitate an entry into a professional sporting career. This is validated by the fact that there is a practice among some professional rugby players to cheat on their return-to-play protocol after suffering brain injury by falsifying their cognitive tests for detecting brain injury [ 74, 75]. It is essential for the OSH philosophy to prevail by aiming at improving elite athletes' attitudes towards both current safety at work and long-term health which may, in turn, lead to the protection of their wellbeing.

There are some limitations associated with the current review. First, studies meeting inclusion criteria cover widely from awareness of disease, burnout, injury, medicine usage and PPE usage, but this review focuses on injury reporting, medicine usage and PPE usage, the most frequent three themes for discussion as aforementioned. Second, considering the quality and heterogeneity of the studies reviewed, it is impossible to clearly conclude how athletes are aware of their health and safety from a quantitative data synthesis.

Conclusion

In the studies reviewed, of seven studies on concussion symptom awareness, five studies reported on inadequate concussion symptom knowledge or awareness; of six studies examined injury consequence awareness, four papers reported inadequate concussion consequence awareness; and of seven studies on papers PPE, three studies reported inadequate mouthguard use. Since most of the included studies on sporting injury focused on concussion, the main discussion was based on concussion evidence, a topic which requires future research. Because OSH is a relative alien term in the sport literature the core purpose of this narrative review is to bridge the gap between the academic fields of OSH and sport.

The studies reviewed revealed that most elite athletes' injury awareness does not meet the basic requirements of OSH standards. Existing injury prevention programmes focus more on techniques rather than consistently raising awareness. From an OSH perspective, risk communication practices should be improved in the sport context by establishing a proactive injury prevention culture, identifying clear-cut responsibilities between athletes and staff. In addition, factors influencing elite athletes' OSH awareness have not been quantitatively measured since no such instrument has so far been devised. Arguably the development of an instrument or research toolkit linked to a conceptual framework is required to elicit the identification of the principal factors that could influence elite athletes from reaching appropriate levels of OSH awareness. Subsequently, OSH or welfare remedial programmes could be devised with the intention of improving awareness, enhancing involvement, increasing reporting and developing a safer sporting environment overall for the long-term wellbeing of athletes during and post-elite career.

Abbreviations

AIBA:

Association Internationale De Boxe Amateur

ALARP:

As low as reasonably practicable

BMI:

Body mass index

CBA:

Chinese Basketball Association

DID:

Drug Information Database

FIFA:

Fédération Internationale de Football Association

HSE:

Health and Safety Executive

IRFU:

Irish Rugby Football Union

MMAT:

Mixed Methods Appraisal Tool

NCAA:

National Collegiate Athletic Association

NFL:

National Football League

NOCSAE:

National Operating Committee on Standards for Athletic Equipment

NSAID:

Nonsteroidal anti-inflammatory drugs

OSH:

Occupational safety and health

PPE:

Personal protective equipment

PSCA:

Pitch side concussion assessment

WADA:

World Anti-Doping Agency

References

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Acknowledgements

The authors express gratitude to the UCD-CSC scholarship scheme supported by University College Dublin and the Chinese Scholarship Council.

Funding

This study was supported by a grant from Chinese Scholarship Council.

Availability of data and materials

All data supporting the findings of this study are available in this published article.

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Authors and Affiliations

1. Institute of Sport and Health, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland

Yanbing Chen & Seamus Kelly

2. Centre for Safety and Health at Work, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland

Conor Buggy

Contributions

All authors were involved in the design and concept of the study. YC drafted the manuscript and all authors provided critical input and final approval.

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Correspondence to Seamus Kelly.

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Chen, Y., Buggy, C. & Kelly, S. Winning at all costs: a review of risk-taking behaviour and sporting injury from an occupational safety and health perspective. Sports Med - Open 5, 15 (2019). https://doi.org/10.1186/s40798-019-0189-9
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Keywords

Occupational health

Athlete safety

Injury risk

Elite athletes

Safety management

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Winning at all costs: a review of risk-taking behaviour and sporting injury from an occupational safety and health perspective - Sports Medicine - Open

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Professional athletes involved in high-performance sport are at a high injury risk, which may lead to long-term health consequences. Professional athletes often expose themselves to risky behaviours, resulting in a higher acceptance level of occupational risk compared to other occupations. To date, many studies have focused on elite athletes' specific injury prevention techniques.

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LPS hosts risk management training for sporting events. Nebraska Public Media. (n.d.). Retrieved September 28, 2022, from https://nebraskapublicmedia.org/de/news/news-articles/lps-hosts-risk-management-training-for-sporting-events/

This article speaks more on the risk management aspect of this topic. It states that being prepared and having a plan in place and being pro-active is very vital when it comes to creating and maintaining a safe environment for sports.

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LPS Hosts Risk Management Training for Sporting Events

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Leadership from LPS, LPD Lincoln-Lancaster County Emergency Management and more received risk management training for school sporting events. LPS is one of the first districts in the country to receive this training.

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I will be speaking from the perspective of a high school administrator overseeing the athletic department.  It is important for all school administration and personnel to be aware of all areas of risk and possible negligence that could occur throughout the campus and district.  It is our jobs to have a proper risk management plan and make all employees aware it and be properly trained.

"The Christopher High School RMP plan will have procedures and policies set in place to identify these risks, have layers of protection to control the risks, and management to monitor and control these risks from occurring to reduce the chance of liability." (Christopher ISD Employee Handbook, 2019).

Christopher ISD. (2019, May) Employee Handbook, chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://chs.gilroyunified.org/uploaded/personal/4527/2019-2020_Christopher_High_School_Athletics_Risk_Management_Plan.pdf

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Federal Law: 14th Amendment

"No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property without due process of law, nor deny to any person within its jurisdiction the equal protection of the laws" (U.S. Const. Amend. XIV).

https://constitution.congress.gov/browse/amendment-14/#:~:text=No%20State%20shall%20make%20or,equal%20protection%20of%20the%20laws.

U.S. Const. amend. XIV, § 2.

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Federal Law: Torts Law

"A tort is an act or omission that gives rise to injury or harm to another and amounts to a civil wrong for which courts impose liability. In the context of torts, "injury" describes the invasion of any legal right, whereas "harm" describes a loss or detriment in fact that an individual suffers." (28 U.S.C., Chapter 171).

This law is to provide relief for parties injured due to others negligence.

Legal Information Institute. (n.d.). Tort. Legal Information Institute. Retrieved September 29, 2022, from https://www.law.cornell.edu/wex/tort

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DefinitionA tort is an act or omission that gives rise to injury or harm to another and amounts to a civil wrong for which courts impose liability.

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Barretto v. New York City Board of Ed. (229 A.D.2d 214,lv denied 90 N.Y.2d 805

In this case the student chose to engage in a non-related activity and was injured while not under the coach's supervision. Since the student knew the risks and was injured doing something that was not related to the sport, the courts dismissed the case.

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The New York City Board of Education appeals from a judgment awarding damages to plaintiff, an 18 1/2-year-old high school senior and member of the school's volleyball team, who, on April 12, 1988, injured his spine and suffered paralysis from the chest down when, in the coach's absence, during an equipment setup prior to the start of practice, he attempted a gymnastic dive over a half-raised volleyball net onto a mat, landing, not on his hands, as he intended, but on his head. The revised judgment awarded plaintiff approximately $15,000,000 in damages, past and future, after a verdict finding the Board 80% and plaintiff 20% responsible for causing the injury.

The trial evidence shows the following. Sometime after the March 1, 1988 start of the spring season, plaintiff, who had previously played volleyball in the Dominican Republic, where he was born, as well as in the regular gym class, joined the extracurricular, after-school varsity volleyball team at Richmond Hill High School. He did so after signing a consent form acknowledging his understanding that the Board would "not assume responsibility should an accident occur * * * during participation in any phase of the athletic program." According to plaintiff, although advised by the coach to be punctual and dressed properly, he was never given instructions as to proper gymnasium behavior. Plaintiff took part in his first practice session with the team on March 21, 1988.

On the day of the accident, at about 3:30 P.M., plaintiff and Pedro Russo, as well as five or six other members of the 10-man team, assembled outside the gym. The coach arrived sometime after 3:30 P.M. and unlocked the gym and locker room on the floor below. After the players had changed, the coach unlocked the gym closet containing the volleyball equipment, including two poles and a net, and, placing the team captains in charge, told the players to put up the net. The coach then left, either to change his clothes, as one of the players testified, or, as he testified, to find volleyballs. Before leaving, he warned the players "not to horse around with the volleyballs".

Some of the players, including plaintiff and Russo, then set up the net. After screwing the poles into the holes in the floor and attaching cables from the poles to the floor to secure the poles, they put the cables from the net through hoops on the poles, attached them to the cranking mechanism and began to crank up the net. When the net was one-half raised, they stopped cranking. At that point, the top of the net at its lowest point was three or four feet off the ground.

While the other team members were either sitting or playing with the volleyballs, Russo, who had gone to the back of the gym with a ball, ran, from a distance of 30 or 40 feet, toward the net, intending to jump over it. When he reached the net, however, he stopped, explaining, "Something told me not to jump, so I stopped right there." Plaintiff volunteered, "I can do it." He then brought over gym mats from the side of the gym and placed them under the net. Plaintiff conceded that he had never seen a mat under a volleyball net; nor had he ever observed anyone attempt to dive over one. Several team members warned plaintiff against jumping over the net. A teammate, Cruz, yelled at both plaintiff and Russo to stop "fooling around", but they "didn't mind him". Russo also tried to stop plaintiff, but as he explained later, "[I]t was too late, when I saw him, he already was [lying] on the other side of the net."

Plaintiff, from a distance of 30 to 35 feet, ran toward the net and jumped head first so that he "could land on [his] hands and roll on top of the mat." Instead, he caught his waist on the top of the net, and, unable to grab the net when he tried, landed on his head after the cable gave and his feet flipped upwards. Plaintiff had never attempted such a dive in any high school gym class; he had, however, performed such a maneuver when he was nine or ten years old and enrolled in a karate class in the Dominican Republic. When he performed the dive there, it was not over a volleyball net but usually over a barrel or over other students. In those instances, his karate teacher acted as a "spotter" to assure that "you wouldn't hit your head or something like that with the floor."

The school's assistant athletic director was the first adult to respond to the accident, followed, a few minutes later, by the coach. The police were called at 3:53 P.M.; an ambulance was dispatched at 4:02 P.M. Both plaintiff and Russo estimated the time of the coach's absence as about 20 minutes. The coach, a certified foreign language teacher, had coached during the previous school year. At the time he was hired to coach, the assistant athletic director gave him some printed materials and he met with the school's athletic director. He had, before 1988, supervised athletic activities involving younger students in two prior positions, serving for four years as athletic director at one school.

No specific license or other designation was required for supervisors of after-school athletic activities. Nor did the Board have specified rules and regulations for coaches or for the supervision of such activities. The proper supervision at athletic events and practice is, of course, included within the responsibilities of a public high school athletic coach, who is required to complete two coaching courses within three years of becoming a coach. Plaintiff's volleyball coach had completed the first aid course required of all high school coaches. He was compensated for a maximum of 32 hours per month of after-school volleyball coaching, including two-hour practice and four-hour game sessions.

The coach had warned the new team members, including plaintiff, not to play around in the gym and to observe safety rules. He told them "not [to] do anything else, just play volleyball, and that's all." It was his custom to have four members of the team, with the captains in charge, set up the equipment at every practice session. He had never instructed the players in any way with regard to jumping or diving over the net and had never observed a player attempt such a feat. He testified that he did not have disciplinary problems with the team and never saw them roughhousing. The only injury to a team member that he could recall was a pulled muscle during a spring 1987 game.

The school's assistant athletic director had given the new coaches, including the coach involved here, handouts, one of which, entitled "A 23-Point Defensive Game Plan for Lawsuit-Conscious Athletic Directors/Coaches", included a list of the varying situations that might cause accidents. In the assistant athletic director's view, the standard of supervision for coaches was the same as that of a teacher. In his words, a coach should be present "at the activity" and "never leave a class unattended." Plaintiff presented an expert in "physical education supervision", who testified that leaving high school athletes unsupervised in their activities for 5 to 15 minutes was unacceptable and unreasonable. The Board's motion to dismiss for failure to make out a prima facie case, made at the conclusion of plaintiff's case, was denied.

A unanimous verdict of liability was returned, the jury apportioning fault, as noted, against the Board and plaintiff. A second jury was empaneled and, after hearing testimony on damages, awarded plaintiff $18,834,000 which, after offsets for plaintiff's 20% fault and the receipt of disability payments, was reduced to $14,904,145. Since the Board did not owe plaintiff a duty to provide supervision during the prepractice setting up of equipment and, in any event, plaintiff assumed the known and obvious risks of his own voluntary actions, we reverse the judgment and dismiss the complaint.

"Schools are under a duty to adequately supervise the students in their charge and they will be held liable for foreseeable injuries proximately related to the absence of adequate supervision". ( Mirand v. City of New York, 84 N.Y.2d 44, 49.) In assuming physical custody and charge of the student the Board stands in the place of the parents or guardian. ( Supra.) The standard is not the same, however, in the case of school-sponsored extracurricular athletic activities. "In the context of wholly voluntary participation in intramural, interscholastic and other school-sponsored extracurricular athletic endeavors, we have required the exercise of the less demanding ordinary reasonable care standard" ( Benitez v. New York City Bd. of Educ., 73 N.Y.2d 650, 656), defined as "ordinary reasonable care to protect student athletes * * * from unassumed, concealed or unreasonably increased risks" ( supra, at 658). By implication, school boards are not required to protect student athletes from the risks inherent in the sport or the activity in which they are engaged. Nor does reasonable care impose upon a school board the obligation of assuring the safety of a student during after-school athletic activities against the consequences of his own independent and ill-advised acts unrelated to the sport in which he is engaged.

In this regard, plaintiff has failed to prove that he was faced with a risk that was unassumed, concealed or increased. The evidence shows that plaintiff himself created the peril and, aware of the danger, assumed the risks of his conduct. There was no evidence that the Board was on notice of the likelihood of any harm or that it could have foreseen that plaintiff would place himself in danger. Plaintiff himself testified that he had never attempted to dive over a net in any high school gym class and conceded that he never observed anyone else attempt to dive over a volleyball net.

Until this incident, there had never been any adverse consequences as a result of the coach's custom, before the start of practice, to leave the team members in the gym unattended with the understanding that they were to set up the volleyball net for the practice session. Leaving 17- and 18-year-old athletes unattended in such circumstances with the instruction to behave appropriately does not constitute an unassumed, concealed or unreasonably increased risk of harm from a sporting activity. While playing volleyball might itself involve an increased risk of injury through player contact, falls on the floor or even fighting, as the coach knew when he temporarily left the players unsupervised, there was no unreasonably increased risk during the period preceding the practice. Nor could plaintiff's action reasonably have been anticipated. "[I]f defendant's conduct was reasonable in light of what could have been anticipated, there is no breach of duty, no negligence and no liability." ( Gordon v City of New York, 70 N.Y.2d 839, 841.)

Thus, plaintiff is compelled to argue that the Board had the duty to supervise him and his teammates at all times during the extracurricular team practice session, including during the setting up of the net. Unfortunately for plaintiff, that is not the standard. As Benitez v. New York City Bd. of Educ. ( supra, 73 N.Y.2d, at 657-658) holds, a school board's duty of student supervision is not the same for voluntary after-school extracurricular athletic activities as it is for regularly scheduled school-day classes. The rationale behind the distinction is plain. A higher degree of vigilance is required whenever the student is required to attend or engage in a certain activity. On the other hand, when the activity is voluntary and extracurricular, and especially of an athletic nature, the normal risks of the activity are accepted and, therefore, a duty is imposed upon the Board only if the risks with respect thereto are unreasonably increased, concealed or are of an unassumed nature. It should be noted, however, that even in the case of regular school-day activities, constant supervision of high school students is not legally required ( see, Garcia v. City of New York, 222 A.D.2d 192, 196).

In the absence of prior incidents putting the Board on notice, the assemblage in a high school gym of a group of about seven or eight high school athletes, members of the volleyball team, who had been instructed to set up a volleyball net, would not trigger a duty of constant supervision. Neither the testimony of plaintiff's expert that young athletes should never be left alone nor the assistant athletic director's testimony of a similar vein established the applicable standard of care. ( See, Sherman v. Robinson, 80 N.Y.2d 483, 489, n 3; Pascarella v. City of New York, 146 A.D.2d 61, 70, lv denied 74 N.Y.2d 610.) Significantly, no Board regulation or formal policy statement specifically requiring a coach to remain with his team at all times was offered in evidence. As for the guidelines in the "23-Point Defensive Game Plan", they are clearly aspirational, not mandatory.

Nor did the presence of athletic equipment in the gym impose upon the Board a duty to supervise plaintiff and the other team members at all times. Neither a volleyball net nor a gym mat is inherently dangerous. In the absence of prior incidents involving improper use, the fact that these items could be used for a purpose other than their intended use did not render their availability foreseeably dangerous. ( Compare, Govel v. Board of Educ., 267 App. Div. 621, 624-625, affd 293 N.Y. 928 [verdict based on failure to supervise pupil with respect to gun repair reinstated].) The coach had not had prior disciplinary problems with the team. The insignificant, yet forbidden, "fooling around" that had occurred in his absence on earlier occasions did not pose a substantial risk of physical harm to the team members or portend that much more dangerous activity such as that which was engaged in here was likely to occur. ( See, Lawes v. Board of Educ., 16 N.Y.2d 302; compare, Alferoff v. Casagrande, 122 A.D.2d 183 [teacher aware of students' rowdy and disruptive behavior that regularly took place in his absence].) Thus, the record fails to show that the coach was on notice of such dangerous prior activity by the team members such that his constant supervision was required.

Moreover, as the trial evidence discloses, in attempting to dive over the volleyball net, plaintiff was fully aware of the risk he was undertaking and thus assumed that risk. He had seen Russo attempt a jump and decide against it. He had recognized the necessity of using a mat to soften the impact of his landing after the jump. As a youngster participating in karate classes, he had been warned of the potential for injury involved in such activity. His teammates, including Cruz, one of the team captains, told him that he should not attempt the jump. Moreover, he attempted the jump without the coach's consent and contrary to the latter's directions to set up the net and warning not to "horse" around. Furthermore, plaintiff had signed a form expressly waiving claims against the Board for injury incurred "during participation in any phase of the athletic program." Such broad language cannot be read in any way other than as including the prepractice activity of setting up the volleyball net.

The unauthorized nature of plaintiff's dive over the net bears significant similarity to the dive from a public pier in Heard v City of New York ( 82 N.Y.2d 66), held by the Court to be an assumed risk. After initially instructing the 17-year-old plaintiff not to dive, the lifeguard in Heard reluctantly permitted one more dive, which resulted in serious injury. The Court held that the City's duty to supervise recreational activities did not extend to "protecting patrons from `the dangers inherent in the sport so far as they are obvious and necessary'." ( Supra, at 71, quoting Curcio v. City of New York, 275 N.Y. 20, 23-24.) As in Heard, plaintiff, in attempting to dive over the volleyball net, knowing that he should not, accepted the obvious risks of that activity, and the Board did not owe him a duty with respect to the foreseeable injury that he might incur in attempting such a feat.

In light of our determination that plaintiff failed to prove the Board's negligence, we need not reach the other issues it raises.

Accordingly, the revised judgment of the Supreme Court, New York County (Lorraine Miller, J.), entered April 25, 1995, which, following a jury verdict finding plaintiff 20% and the Board 80% responsible for plaintiff's injuries, awarded him damages with a present value of $10,982,616, should be reversed, on the law, without costs or disbursements, and the complaint dismissed. The Clerk is directed to enter judgment in favor of defendant-appellant dismissing the complaint.

ELLERIN, MAZZARELLI and ANDRIAS, JJ., concur.

Revised judgment, Supreme Court, New York County, entered April 25, 1995, reversed, on the law, without costs or disbursements, and the complaint dismissed.

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The New York City Board of Education appeals from a judgment awarding damages to plaintiff, an 18 1/2-year-old high school senior and member of the school's volleyball team, who, on April 12, 1988, injured his spine and suffered paralysis from the chest down when, in the coach's absence, during an equipment setup prior to the start of practice, he attempted a gymnastic dive over a half-raised volleyball net onto a mat, landing, not on his hands, as he intended, but on his head.

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Federal Law: Americans with Disabilities Act
42 U.S.C. § 12101

This law protects the rights of and prohibits discrimination of all Americans with disabilities.

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New on ADA.gov

Explore the new content we've added to ADA.gov

This document discusses and explains the requirements of the ADA's integration mandate and the Supreme Court's decision in Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581 (1999), as applied to segregated employment settings and facility-based day programs. In addition, this document provides a link to the Department's Federal Register notice, which provides more information about this guidance.

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Disability rights are civil rights. From voting to parking, the ADA is a law that protects people with disabilities in many areas of public life.

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https://chs.gilroyunified.org/uploaded/personal/4527/2019-2020_Christopher_High_School_Athletics_Risk_Management_Plan.pdf

I am speaking from the perspective of an Athletic Director.  I would like to for everyone to take into perspective that all of our risk management plans in sporting activities will consist of proper training and documentation.

Christopher ISD Handbook, 2019.

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https://chs.gilroyunified.org/uploaded/personal/4527/2019-2020_Christopher_High_School_Athletics_Risk_Management_Plan.pdf

"This Risk Management Plan (RMP) is developed for Christopher High School Interscholastic Athletic Programs. The purpose of this plan is to establish an approach to monitoring, evaluating, and managing risks that may occur during athletic activities. A risk is an uncertain event or condition that, if it occurs, has a negative effect on the project’s objectives. The Christopher High School RMP plan will have procedures and policies set in place to identify these risks, have layers of protection to control the risks, and management to monitor and control these risks from occurring to reduce the chance of liability." (Christopher ISD Handbook, 2019).

These local policies ensure that all employees are aware and properly trained on any negligence alligations.

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https://www.icce.ws/_assets/files/projects/Codes_of_Conduct_2012_study.pdf

"Competence: Coaches only use methods and techniques that they are confident in teaching, where they possess the qualifications for. The coach avoids using methods that are a risk to health and safety of the athletes. A coach seeks continuous personal improvement. The coach keeps up with the latest developments in coaching and teaching. The coach only uses training methods that will benefit the athletes."

Codes of conduct for coaches for homepage.tmp - ICCE. (n.d.). Retrieved September 29, 2022, from https://www.icce.ws/_assets/files/projects/Codes_of_Conduct_2012_study.pdf

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Upon reviewing every court case and law that has been bestowed upon Athletic Directors and coaches, I feel that it is imperative that we continue to train and learn that we are responsible for the safety of children. It is our duty to ensure that the environment is suitable and adequate for success.

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After researching and speaking with individual over the subject of risk management in sports, I have come to the conclusion that any and everything that we can do to create a positive and safe environment for the athletes is our first priority.

The sport organization’s first responsibility is to provide a safe environment for participants. This means having policies and standards that promote safe programs in safe facilities, overseen by qualified personnel and trained volunteers.

The sport organization’s second responsibility is to make decisions fairly, especially decisions that affect members. This means having and following proper policies and procedures when making important decisions and handling disputes among members.

The sport organization’s third responsibility is to properly care for and protect its assets and resources, including money, equipment, facilities and intangible property such as data, corporate image and marketing rights

Risk management for sport organizations and sport facilities. Sport Law. (n.d.). Retrieved September 29, 2022, from https://sportlaw.ca/risk-management-for-sport-organizations-and-sport-facilities/