CHAPTER 6 • CATASTROPHIC SPORTS INJURIES 29safety of aluminum or enhanced bats. Nonwood bats
are typically lighter than woods bats and can be
swung faster with greater ball velocity off the bat.- Commotio cordis is arrhythmia or sudden death from
low-impact blunt trauma to the chest in subjects with
no preexisting cardiac disease (Maron et al, 1995;
Janda et al, 1998). The proposed mechanism is impact
just prior to the peak of the T wave on an EKG which
induces ventricular fibrillation. The pediatric popula-
tion may be more susceptible because of a thinner layer
of soft tissue to the chest wall, increased compliance of
the immature rib cage, and slower protective reflexes.
PREVENTION
- Protecting pitchers from a batted ball may be accom-
plished by requiring pitchers to wear helmets at all
times, using protective screens during batting prac-
tice, and regulating the bat and ball (Boden et al,
unpublished).
•In 2003, the NCAA and NFHS placed new regulations
on bats. All bats must be certified as having a ball exit
speed that cannot exceed 97 miles per hour as meas-
ured by the Baum hitting machine. In addition, certi-
fied bats may not weigh more than 3 oz less than the
length of the bat (i.e., a 34-in. long bat cannot weigh
less than 31 oz) (www.nfhs.org). - Decreasing the ball’s hardness and weight may signif-
icantly reduce injury severity. The coefficient of resti-
tution or the measure of rebound that a ball has off a
hard surface cannot exceed 0.555 at the high school
and college levels. - Preventive strategies for commotio cordis include
teaching youth baseball players to turn their chest
away from a batted ball. The use of chest protectors is
controversial. Automatic external defibrillators hold
promise for preventing fatalities but require further
research (Maron et al, 1995; Janda et al, 1998).
ICE HOCKEY
EPIDEMIOLOGY
- Although the number of catastrophic injuries in ice
hockey is low compared with other sports, the inci-
dence per 100,000 participants is high (Mueller and
Cantu, 2000). - The majority of catastrophic injuries occur to the cer-
vical spine.
MECHANISMS
- Most injuries occur when an athlete is struck from
behind by an opponent and contacts another object,
especially the boards, with the crown of the head
(Reid and Saboe, 1989; Tator et al, 1991).- Head and facial injuries are common from collisions
or being hit by the puck or stick. - Catastrophic accidents from collisions with goalposts
were common before the advent of displaceable goal-
posts.
- Head and facial injuries are common from collisions
PREVENTION- Enforcing current rules against pushing or checking
from behind. - Encouraging the use of helmets and face masks.
•Padding the boards and developing a potential space
between the boards and the plexiglass extension may
reduce the frequency and severity of head and neck
injuries. - Ensuring that the goals can slide out of position to
protect athletes from colliding against an immovable
object. - Discouraging aggression and fighting in hockey.
SWIMMINGMECHANISMS- Most catastrophic swimming injuries are related to
the racing dive into the shallow end of pools (Mueller
and Cantu, 2000). - Hyperventilating just prior to swimming can rid the
body of carbon dioxide. This fools the brain into
thinking it doesn’t need to breathe, even when its
oxygen stores are dangerously low, which may lead to
loss of consciousness and drowning.
PREVENTION- At the high school level, swimmers must start the race
in the water if the water depth at the starting end is
less than 3.5 ft. If the water depth is 3.5 ft to less than
4 ft at the starting end, the swimmer may start from
the deck or in the water. If the water depth at the start-
ing end is 4 ft or more the swimmer may start from a
platform up to 30 in. above the water surface
(www.nfhs.org). - The NCAA is in the process of requiring water depth
at the starting end to be a minimum of 5 ft when start-
ing platforms are in use (www.ncaa.org). - The NFHS mandates that swimmers break the surface
of water to breathe at or before 15 m to prevent shal-
low water blackout.
GYMNASTICS- There is a paucity of information on catastrophic
gymnastics injuries.