KOREY STRINGER INSTITUTE 2020 ANNUAL REPORT 10 YEAR ANNIVERSARY PERTINACITY MOVING FORWARD FASTER: a Reflection on 10 Years of the Korey Stringer Institute

KOREY STRINGER INSTITUTE 2020 ANNUAL REPORT 10 YEAR ANNIVERSARY PERTINACITY MOVING FORWARD FASTER: A Reflection on 10 Years of the Korey Stringer Institute

Hello to our partners, collaborators, supporters, friends, and global network — What an awesome opportunity our first decade has been. Every day I pinch myself because it is an honor to do such meaningful work with such amazing people. The staff at KSI, now over 80 people strong, bubbles with THE MISSION OF THE KOREY STRINGER INSTITUTE inspiration, creativity, and passion. You just have to climb on board the wave of collective forward IS TO PROVIDE RESEARCH, EDUCATION, ADVOCACY, momentum and you are immediately the sense that KSI exhibits pertinacity catapulted to a destination closer to — persistent determination — when AND CONSULTATION TO MAXIMIZE PERFORMANCE, your goal. I had not known anything looking to overcome challenges like it prior, and I am wise enough to that have long faced those who do know it will likely never occur again. intense physical exercise as athletes, OPTIMIZE SAFETY, AND PREVENT SUDDEN DEATH But given my memorable past, having warfighters, or laborers. staff and volunteers who put in suffered life-threatening exertional the tough, thankless, and critical heat stroke at 16 years old, I can tell KSI has been unbelievably fortunate work overseeing research projects FOR THE ATHLETE, WARFIGHTER, AND LABORER. you that I will cherish every single to leverage connections in these and public health initiatives; to the second of this joyous experience. industries, along with active corporate partners who believed in collaborations in the academic and us; to the end user who showed faith I had a recent emotional experience medical space, to create a unique in what we could do to help them. All with one of my children where her not-for-profit. We not only work of it has helped us get where we are safety was briefly in grave danger, to mobilize public health policy right now. and another one of my children and changes to serve these constituents, I had to rise to the occasion to assist but being at UConn, KSI also gets My thanks to the entire KSI family my child in distress. We overcame in to do something most nonprofits for working together to honor the that wildly emotional moment, and don’t: we create new knowledge. legacy of Korey. I believe everything it was like a jolt of electricity being We implement our expertise in we have done and will do in the sent through my system. I had always the field to increase the safety and future, collectively, is a tribute to our cherished my second chance at life, performance of those in the military, namesake, and I hope with all my but was I doing every possible thing sport, and the workforce. We respect heart that our efforts will help the to make sure those who work for me this privilege and try to live up to memory of this great human being know that I appreciate them? Am I a high standard of leadership by endure. I can assure you, pertinacity inspiring them? Helping them? When remaining humble, intellectually will remain our guiding torch as we all the chips are down, am I coming curious, and engaged. push toward the next big thing. through in the clutch for them? I cannot begin to list all of those who And, yes, we will continue to stir the It is my everlasting hope that those helped us in the journey over the past pot so that we can move forward faster. who work for and with KSI not only 10 years, from the founders at UConn, experience kindness, knowledge, the NFL, and Gatorade who joined empathy, and problem solving, but Kelci and Jimmy and I to build out the Douglas J. Casa University of Connecticut most of all, I hope they’re left with bold dream of KSI; to the countless CEO, Korey Stringer Institute

01 KSI CELEBRATES INFORMATION KEY 10 YEARS HISTORICAL RESEARCH ADVOCACY MEDIA OUTREACH EDUCATION CONSULTATIONS TESTING LIVING OUR MISSION New Jersey and Texas are first states to pass heat acclimatization laws KSI begins formal collaboration with the We’re proud of a decade of accomplishments. with the help of KSI National Center for Catastrophic Sport Here are some of the highlights of the Injury Research 50 states pass laws on concussion PBS airs “Frontline: Football High” JANUARY 7TH with the help of KSI past 10 years. Timex Triathlete Training Camp KSI moves into new facility at multi-sport team research study Gampel Pavilion

Pre-season research with the KSI organizes the Inter-Association Task New York Giants Force for Preventing Sudden Death in APRIL 23 Secondary School Athletics meeting NFL and Gatorade join UConn to announce the creation of the ESPN airs “Outside the Lines: KSI’s TED-Ed video, “What happens when you Korey Stringer Institute Heat Stroke” get heat stroke?” premieres (Nearly 1.5 million Kona World Ironman Championship views today) JANUARY “Good Morning America” interview elite triathlete research study The NFL, Kelci Stringer with Dr. Douglas Casa to discuss Research partnership begins with the (Korey’s wife), and Jimmy exertional heat stroke USA Cycling webinar “Exertional National Football League Gould (Korey’s agent) reach Heat Illnesses” out to Dr. Douglas Casa National Athletic Trainers’ KSI assists Portugal National Soccer Team as AUGUST 1 Association (NATA) Webinar, NFL Combine Health and Safety they prepare for the heat of the FIFA World Cup Korey tragically dies from SEPTEMBER Exertional Heat Illnesses Summit presentation KSI assists athletes at Ironman Lake Placid in Rio de Janeiro, Brazil the consequences of Key planning meeting to exertional heat stroke suffered create KSI occurs on KSI assists NASA with heat Pentagon and U.S. Army release new “Preventing Sudden Death in Sport and Falmouth Road Race research Work to improve heat safety policies with in pre-season practice UConn’s campus policies for training programs heat guidelines assisted by KSI Physical Activity (1st ed.)” is published studies begin major U.S. Army and U.S. Air Force bases begins

2001 2009 2010 2011 2012 2013 2014

HBO airs “Real Sports with Bryant Gumbel: Sudden Death”

Over $1.5 million in funding secured Inaugural Collaborative Solutions for Safety in for Team Up for Sports Safety KSI hosts experts in the field to clarify Sport meeting held at NFL headquarters, APRIL 23 HBO airs “Real Sports with (TUFSS) initiative, impacting high hydration recommendations for athletes, hosted by KSI, the NFL, NATA, and the Ameri- 10th Anniversary of KSI Bryant Gumbel: Overheated” school sports safety policy across the coaches, and parents at the Practical can Medical Society for Sports Medicine U.S. through 2021 Hydration Solutions for Sports summit KSI and the TUFSS initiative help Louisiana pass ATLAS Project is initiated Wet Bulb Globe Thermometer (WBGT) law NPR Morning Edition airs “Off Your National Football League Foundation Mental Game? You Could Be Mildly SEPTEMBER funds Validation of Brain Function BrainScope research study starts with the KSI helps Florida pass the “Zach Martin Act,” a law requiring Dehydrated” MISSION Heat Lab Grand Opening Assessment Algorithm for mTBI from Department of Defense AEDs, AED training, cold water tubs, and WBGT in Gampel Pavilion Injury to Rehabilitation in College NPR Weekend Edition airs Athletes through 2019 First-of-its-kind online course for athletic “Return to Sports and Exercise during the COVID-19 “Researching Heatstroke in Athletes” KSI announces state Health and Safety trainers to meet evidence-based practice CEU Pandemic: Guidance for High School and Collegiate Athletic KSI, NFL team up to create video Policy Rankings for High School Athletics Boston Marathon Medical Meeting requirements developed Programs” position paper published designed to educate football CamelBak Products Hydration App at NFL Headquarters press conference presentation community about heatstroke Health Outcomes and CamelBak U.S. Tennis Association Meeting presentation KSI launches innovATe Team Sport Cooling studies Internal Body Temperature and Phys- on heat illnesses KSI hosts first HEATT Innovation iological measures validated during Douglas Casa works with the International Olympic Technology Summit NATA Research and Education Exercise and Rest study Marine Corps Marathon Medical Conference Committee in preparation for the Olympic Games Tokyo 2020 Foundation Grant secured to presentations (through 2018) Douglas Casa works with the disseminate comprehensive safety “From Science to the Field” presentation . New Jersey signs two bills into law requiring high schools IAAF Track and Field World toolkit to improve best-practice at U.S. Soccer, Major League Soccer, KSI convenes first Youth Sport Safety to follow best practices guidelines for WBGT environmental Championships Organizing policy adoption at the secondary National Women’s Soccer League Head White House Roundtable on Climate Governing Bodies (YSSGB) meeting, hosted monitoring and implementing emergency action plans Committee in Qatar school level through 2020 Injury and Concussion in Soccer summit and Sports by the NFL at NFL Headquarters in NYC

2020 2019 2018 2017 2016 2015

03 2020 BY THE NUMBERS

PUBLICATIONS MEDIA APPEARANCES STATE LEGISLATIVE 2020 FUNDING (KSI SPEAKERS) PUBLIC TESTIMONIES $1,820,148 TOTAL BOOK57 CHAPTERS/ 20INTERVIEWS/ 6 MANUSCRIPTS (published/in press) PODCASTS

STATES MAKING POLICY $1,489,706 CHANGES IN 2020 RESEARCH

ACTIVE GRANTS CY 2020 WEBINARS/8 CONFERENCES 17 $179,319 NON-RESEARCH

RESEARCH9 NUMBER OF POLICY CHANGES IN 2020 OTHER1 $132,484 CORPORATE FUNDING/DONATIONS NON-RESEARCH3 PERSONNEL 76

TOTAL FUNDING BY YEAR RESEARCH TRIALS 22 PAID STAFF

2011-2012 $324,238 83 2013-2014 $384,700 341 VOLUNTEERS 2015-2016 $3,122,721

2015 2017-2018 $2,416,802 13 STAFF, 30 VOLUNTEERS 2010 2019-2020 $2,518,445 3 STAFF, 7 VOLUNTEERS 0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000

04 05 NEW HAMPSHIRE November 2019

WASHINGTON MARYLAND September 2019 October 2019

MASSACHUSETTS August 2020 CONNECTICUT January 2019, 2020 UTAH NEW JERSEY March 2018 March 2019 DELAWARE October 2019 ATLAS PROJECT CELEBRATES 5TH ANNIVERSARY COLORADO WASHINGTON, D.C. October 2018 April 2021 WEST VIRGINIA February 2020 AMIDST THE COVID-19 PANDEMIC SOUTH CAROLINA February 2021 In 2015, Robert Huggins, Ph.D., KSI can make more informed decisions Recently, athletic trainers from the GEORGIA president of research and athlete regarding the policies that they enact Lafayette Parish school system in January 2019 performance and safety; Larry Cooper, to improve the health and safety of Louisiana used ATLAS-provided data FLORIDA chair of the National Athletic Trainers their athletes. to advocate for appropriate medical LOUISIANA February 2017, Association (NATA) Secondary services and improved sport safety. ARKANSAS January 2020 January 2018, School Athletic Trainers’ Committee; For the innovATe Project, ATLAS can March 2021 June 2019 March 2019 and Ronnie Harper, athletic trainer at overlay availability of AT services with “The administration is moving forward OKLAHOMA Dutchtown High School in Louisiana, socioeconomic status of a state on a with further discussions regarding the January 2019 TEXAS huddled over a bar napkin, sketching map to help researchers determine health care their parish provides to February 2021 out the details for a project. This which areas would benefit most from their student athletes,” Huggins says. project would become the go-to innovATe support. Anticipated state visits for 2021 Colorado – June 2021 Kansas – June 2021 New York – June 2021 Pennsylvania – October 2021 (firm dates are listed) Missouri – June 2021 New Hampshire West Virginia – October 2021 Virginia – October 2021 source for information on providing “ATLAS, KSI, and the NATA are proud athletic training services at secondary Ph.D. students Erica Filep and Ayami to help ensure athletes can play the schools, the KSI and NATA ATLAS Yoshihara and 10 ATLAS independent sports they love in a safe manner,” Project: Athletic Training Locations study students each year work says Huggins. “Student-athletes The TUFSS project accomplishes its In August 2020, KSI released an and Services, which celebrated its 5th tirelessly alongside Huggins, the ATLAS deserve preparedness, they deserve TUFSS CONTINUES goals by identifying and bringing updated High School Sports Safety anniversary this past summer. Project director, to import surveys, to be safe, and they deserve to go together the key individuals Policy Review to reflect the notable update maps, and produce data every home at the end of the day to their TO PROPEL POLICY responsible for improving health progress states made between Since launching, ATLAS has mapped week, enabling states to make real- loved ones. As long as there are and safety policies for high school August 2019 and August 2020 in and surveyed secondary schools time decisions about the status of the schools with athletics programs NATIONWIDE athletes within a particular state. adopting important new policies. nationwide, producing annual reports, profession. Furthermore, states can without proper — or sometimes any — These state-specific meetings States adopting policy changes that publications in peer-reviewed request data from the ATLAS team to medical care, ATLAS will continue its After publishing research in 2017 that facilitate the collaboration of key went into effect during that time journals, and abstract presentations help advance the services provided mission to visually report schools that found many states fell short when it stakeholders with the objective include Alabama, Arkansas, Colorado, at national conferences; collaborated within a specific area. lack these critical services. We can do came to mandating best health and to formalize actionable items for Delaware, District of Columbia, on numerous joint research better for our athletes.” safety best practices for athletes, adoption or improvement of health Florida, Hawaii, Illinois, Iowa, projects; and fulfilled hundreds of KSI launched Team Up for Sports and safety policies as it pertains to Louisiana, Missouri, New Jersey, requests from state athletic training Safety (TUFSS) in 2018 to propel the secondary school athletic health care. New Mexico, New York, Oklahoma, association leaders, individual athletic adoption of policies proven to reduce Tennessee, Texas, and Vermont. training advocates, and legislators. the incidence of catastrophic sport While state visits were halted due to TUFSS is funded through the NFL ATLAS also provides key data for injuries for secondary school athletes. COVID, planning and communication Foundation and the National Athletic KSI’s Team Up For Sports Safety has continued. TUFSS has rescheduled Trainers’ Association, along with (TUFFS) and innovATe projects. “Many state policies do not include and is actively planning more than a countless private donors. even the most widely accepted dozen state meetings and has hosted For TUFFS, ATLAS provides standards,” KSI CEO Douglas Casa four virtual meetings that couldn’t TUFSS continues to work to reach all stakeholders with school-specific said at the time, in a press release occur in person, with plans to follow 50 states and the District of Columbia information on access to athletic about the research. “Simple, cost- up in person when possible. in order to accomplish our goal of training (AT) services and critical effective strategies can prevent enhancing the health and safety of emergency medical equipment, as nearly all deaths, but currently no In the three-year period since all secondary school athletes. well as risk management processes state meets 100% of the minimum KSI published their initial report for emergency action planning. With best-practice standards.” examining health and safety policies Read more and learn about our these data in mind, state leadership for high school athletes, 38 states current status at: ksi.uconn.edu/ and high school athletics associations have adopted legislative or state high outreach/team-up-for-sports-safety school athletic association changes The latest ATLAS map indicates the locations of secondary schools that make high school athletes safer that have full-time athletic training in their respective states. services with green dots and secondary schools that have part-time athletic training services with teal dots. 06 07 NATIONAL CENTER University of Colorado FOR CATASTROPHIC High School RIO Dawn Comstock, Ph.D. Emerson Hospital SPORT INJURY American Medical 1 Boston University Society for Robert Cantu, MD RESEARCH (NCCSIR) Sports Medicine 2 6 (AMSSM) NCCSIR was founded at the University of North Carolina Chapel Hill in 1982 National Operating under the leadership of Frederick O. Committee on Standards Mueller and is currently directed by for Athletic Equipment Dave Klossner, Ph.D., ATC Dr. Kristen Kucera. In 2013 NCCSIR RESEARCH DIVISIONS (NOCSAE) University of Maryland created three research branches: the 5 Traumatic, Cardiac, and Exertional CARDIAC INJURY 3 Injury divisions, the last of which KSI University of Washington leads. The mission of NCCSIR is to Division Director conduct surveillance of catastrophic Jonathan Drezner, MD injuries and illnesses related to National Federation of participation in organized sports in State High School EXERTIONAL INJURY the United States at the collegiate, Associations (NFHS) Korey Stringer Institute high school, and youth levels of 4 University of Connecticut RESEARCH PARTNERS play. The goal of the Center is to improve the prevention, evaluation, Division Director management, and rehabilitation of Douglas Casa, Ph.D., ATC catastrophic sports-related injuries. TRAUMATIC INJURY The center also brings together many Matthew Gfeller Sport-Related prominent research and funding FUNDING PARTNERS TBI Research Center-UNC at Chapel Hill partners to accomplish its goals. Division Directors Research now focuses on generating Kevin Guskiewicz, Ph.D., ATC reliable data that can be used to Johna Register-Milhalk, Ph.D., ATC make sports safer for athletes, Thomas Dompier, Ph.D., ATC increase the amount of information National Athletic NCCSIR STAFF Lebanon Valley College that is available about catastrophic Trainers’ Association (NATA) Director: Kristen Kucera, Ph.D., MSPH, ATC, LAT sports injuries, and to increase Medical Director: Robert Cantu, MA, MD, FACS, FACSM 4 general awareness of catastrophic 3 Research Coordinator: Randi DeLong, MPH injuries in all sports. Graduate Research Assistant: Erin Shore, MPH Research Assistant: Garrett Moseley NCCSIR has become the leader for housing the critical epidemiological evidence for catastrophic injury in American Football sport, which has helped to drive policy Coaches Association (AFCA) change to enhance the health and 2 Injury Prevention Research Center safety of athletes across all levels of UNC-Chapel Hill play. Recently, in 2019, KSI published Steve Marshall, Ph.D. an epidemiological paper on sudden Zachary Kerr, Ph.D. death in youth athletes, which was National Collegiate 5 the first comprehensive article to Athletic Association address this topic. Most notably, it (NCAA) Datalys Center 1 Christine Collins, Ph.D. concluded that the majority of youth athlete deaths occurred in males, 6 were due to cardiac causes, and occurred while playing basketball. sportinjuryreport.org

08 09

innovATe: THE VALUE OF TAKING ACTION IN 2020 WITH ATHLETIC TRAINERS OUR CORPORATE PARTNERS

Last summer the Korey Stringer “We know, through our research at “Sadly, there are many student Institute launched its latest project, KSI, the value athletic trainers bring to athletes across our country who innovATe, whose mission is to communities, especially as it relates don’t have access to this care, often increase access to medical care to promoting safety, injury prevention, because of financial constraints. The provided by an athletic trainer and emergency response,” says innovATe project allows us to provide for secondary school athletes in Christianne Eason, a UConn alumna help and offer tangible resources to underserved communities across the who is KSI’s President of Sport Safety these communities,” says Eason. United States. and director of innovATe. “Athletic FOUNDING PARTNER trainers in the high school setting • Team Up for Sports Safety (TUFSS) This $3 million collaborative project, are invaluable to the health and “ATHLETIC TRAINERS IN • Marketed KSI’s “Preventing and Treating FOUNDING PARTNER administered by KSI and funded by well-being of student athletes. High Exertional Heat Stroke” video to the Education Fund established as school athletes are vulnerable to long- THE HIGH SCHOOL SETTING athletes at all levels • Helped to fund renovation of KSI’s original heat lab part of the settlement of the NFL term consequences of sport-related ARE INVALUABLE TO THE • UConn research equipment grant Concussion Litigation, will provide injuries due to their musculoskeletal HEALTH AND WELL-BEING awarded to KSI in 2020 funding, advocacy, education, and cognitive development. These mentorship, and strategic support to athletes need access to care just as OF STUDENT ATHLETES.” 10-14 school districts over the next much, if not more than, college and five years. professional athletes.” In addition to establishing athletic Though KSI research and policy training programs, innovATe aims to advocacy efforts effect change secure strategic partners to sustain throughout the country, if there is these new programs. KSI staff will not an athletic trainer present in also work with the NFL Alumni schools, there is no one to implement Association to identify retired NFL FOUNDING PARTNER • National Heat Safety Coalition • The MISSION Heat Lab at the • Athletic Training Locations the research and safety policies to players who will provide education and Services (ATLAS) • COVID-19 Return to Sports and Korey Stringer Institute • Team Up for Sports Safety (TUFSS) improve safety. The innovATe project and help build community support in Exercise document endorsing agency • Increasing access to Athletic • NATA Live Expert Chat will help fill that gap. each funded area. Training Services in Secondary Schools (innovATe) “The innovATe project is an The goal is for the first cohort of opportunity for us at KSI to take athletic trainers to begin supporting what we have learned from all of our these communities in summer 2021. ongoing projects to help protect the health and safety of student athletes Visit ksi.uconn.edu/outreach/ at these schools,” says Douglas Casa, innovate to learn more. KSI CEO and UConn professor of • Circuit Vest Study kinesiology. • Hydration Monitoring system algorithm collaboration • Heat Stress Tracker Donation Program KSI’s ATLAS project has shown • innovATe Equipment Provider that many high schools across the country lack access to the medical care provided by an athletic trainer. • New corporate sponsor for 2020 As of June 2020, 34% of all public • innovATe Equipment Provider • AED donation to Hartford Public and private schools had no access to Schools Athletic Trainer athletic training services.

• New Corporate Partner for 2021 •Partnering with KSI to bring awareness and resolution to lethal heat stress-related incidents through innovative products such as the Immersion Cooling Equipment 10 (ICE) System KSI AND THE MILITARY

KSI continues to be heavily involved in advancing military medicine and protecting soldiers from the dangers of heat, specifically by testing and validating technologies to help protect warfighters in FIRST PERSON: extreme environments. In 2018, the Major Cody Butler, active-duty Air Force Physical Therapist Biotechnology High Performance Computing Software Applications Institute (BHSAI), a Department of Three years ago, I was selected by the Air Defense research unit within the U.S. Force Institute of Technology as one of the Army Medical Research and Materiel first-ever Air Force PTs to complete a Ph.D. Command (now the U.S. Army in Exercise Science. The purpose was to gain Medical Research and Development advanced training in exercise science, human Command), partnered with the Henry performance, and injury prevention to later M. Jackson foundation and KSI to apply at an Air Force base. validate biotechnological solutions through wearable technologies to I’ve been very fortunate to be at UConn and protect soldiers training and fighting to work with the Korey Stringer Institute in extreme environmental conditions. (KSI). When I first arrived, I wasn’t sure The grant associated with this project what to expect, as I had been a practicing is still active and has funded five clinician for nearly a decade and hadn’t projects housed at KSI, involving been in a lab or classroom in years. But my more than 100 research subjects and experiences with KSI were remarkable from spanning more than four years of the start. I gained invaluable experience with data collection. a diverse set of lab and field studies related to heat, hydration, performance, and injury Additionally, KSI is involved in two prevention. other Department of Defense- funded grants that began in 2020: I’ve had the opportunity to share findings one sponsored by BrainScope to at multiple conferences, including the 5th validate a concussion assessment International Congress on Soldiers’ Physical Performance in Quebec City, Canada, in tool, the other sponsored by Amp February 2020, where military delegates Human to evaluate the effects of a from across the globe discussed exercise topical sodium bicarbonate lotion on science topics specific to warfighters. While hydration and fluid balance. DOD GRANT there, I presented the findings from a recent In April of 2021 KSI received the exciting news that we were study our lab completed regarding the Furthermore, in 2019, General Electric recommended for funding from the Department of Defense effects of heat and hydration on cognitive (GE) partnered with KSI using an Air to conduct a three-year, $2 million study titled: “Enhancing and physical performance. Force grant to validate a wearable Lethality by Targeting Cognitive and Physiological Mechanisms sweat patch that helps military of Female Warfighter Resiliency to Consecutive Days of My experiences at KSI will be a tremendous personnel estimate sweat rate in Intense Exercise in the Heat.” The study will begin in the anchor and guide for me as I embark on the hot environments. The Air Force summer of 2021 and continue through summer 2024. KSI has next chapter of my military career, using also recently awarded a grant to KSI been unbelievably fortunate to conduct 14 different federally these skills to conduct research, create partner company Kelvi to evaluate funded (DOD, NIOSH) projects in the past five years, some of injury prevention programs, and oversee the hand- and back-wrap cooling devices which continue today. We will provide an extensive update of general health and wellness of our nation’s during exercise in the heat. this new project in our 2021 annual report. warfighters.

12 13 and training programs for the NATIONAL millions of vulnerable laborers who have to perform intense HEAT SAFETY exercise in the heat as part of their jobs, such as those working COALITION in farming, construction, the oil or gas industries, and firefighting KSI is excited to announce the and train rail, landscaping, and creation of a new entity within road work laborers. The NHSC will KSI that will focus on protecting create a Heat Safety Certification the health and safety of industrial program for worksites, companies, laborers working in the heat. The and organizations to become National Heat Safety Coalition certified in best practice heat (NHSC) will gather leading safety safety policies and procedures to experts and researchers who will protect their workers. work together to provide research, advocacy, consultation, and The NHSC has hit the ground education with the common goal of running, working on several keeping laborers safe. important initiatives aimed at protecting workers from The NHSC was created through occupational heat stress. a collaboration between KSI and two personal protective equipment manufacturers, MISSION and Magid, and will be housed at KSI. The organization will work to overhaul heat safety guidelines and provide organizations and occupational safety stakeholders with recommendations and solutions to protect workers from heat injury. The NHSC will initiate public health surveillance protocols

The National Heat Safety Coalition will develop policies and procedures to keep workers safe in extreme heat, including firefighters who may fight blazes as hot as 500 degrees fahrenheit. 14 15 The MISSION Heat Lab at the UConn Storrs campus allows for precise control of ambient temperature and relative humidity.

our research capabilities by allowing inception, graduate students THE MISSION HEAT for precise control of ambient who have worked at KSI in the heat temperature (below freezing to 110°F), lab and have been integral to our LAB AT UCONN’S relative humidity (20-90%), and productivity now work in various post- varying solar radiation conditions. doctoral and faculty appointments, KOREY STRINGER positions within the private sector, and With high-speed treadmills, advanced in professional sports organizations INSTITUTE cycle ergometers, metabolic carts for across the globe. human gas exchange, and a bathroom The year 2020 marks 10 years and cooling area for subjects, we can since KSI opened its doors. In that mimic environments experienced in time, KSI’s exercise physiology WE CAN MIMIC ENVIRON- the field by athletes, warfighters, and research division has become world- laborers in a safe manner. In 2020, MENTS EXPERIENCED IN renowned, with an agenda focused our team was able to successfully on thermoregulation, exertional heat THE FIELD BY ATHLETES, complete four projects requiring stroke, and elite athlete testing. WARFIGHTERS, AND LABOR- the new heat lab that are currently

awaiting or being prepared for ERS IN A SAFE MANNER. In 2018, the KSI research program publication in peer-reviewed journals. was dramatically enhanced with the

addition of the MISSION Heat Lab Some recent notable endeavors As the MISSION Heat Lab is the at UConn’s Korey Stringer Institute. include collaborating with the cornerstone of our physiological The heat lab came to be due to the Biotechnology High Performance studies, we are indebted to philanthropic efforts of some of KSI’s Computing Software Applications everyone involved who supports us most cherished partners, including Institute (BHSAI) and Department to facilitate the lab’s productivity MISSION, the National Football of Defense, culminating in novel and continued success. League, the University of Connecticut, advances in wearable technology, and the Professional Football Athletic thermoregulation, and hydration Trainers Society, as well as other research. important supporters of KSI. The 450-square-foot environmental BHSAI has been a fantastic group chamber has significantly enhanced KSI staff members conduct to work with and our relationship athlete performance testing is slated to continue into 2021 in the MISSION Heat Lab with novel projects currently in at UConn’s Korey Stringer Institute. development. Notably, since its

16 17 COVID-19 RETURN TO We are proud that this document ACTIVITY WHITE PAPER was endorsed by numerous organizations including the American College of Sports Medicine, the KSI is pleased to have published Collegiate Strength and Conditioning KSI studied the effects a collaborative paper detailing Coaches Association, the National of different types of not only how athletes could safely face masks on Athletic Trainers’ Association, and return to sports and exercise but thermal regulation. the National Federation of State High also how health care providers School Associations. could help their athletes during the PHOTO COVID-19 pandemic. Early in the pandemic we realized that many athletes were being sidelined from their typical training activities. FACE MASK STUDY The combination of decreased activity and potential health risks Since the COVID-19 pandemic associated with COVID-19 presents began, the use of face masks has important health and safety risks been widely recommended by specific to athletes as the return to international and national authorities sport plans emerge. to limit the transmission of airborne infectious agents. Present studies While it is clear that transition have reported protective face periods between inactive and masks may cause discomfort due active training have a higher risk for to increased breathing resistance major sport injury, social distancing and thermal perception; however, measures required during the the evidence related to the thermal pandemic could place athletes at burden of face masks is limited. After the abrupt shutdown of all KSI staff prepare the higher risk for significant injuries research activities in March, the forearm immersion tub and illnesses. Additionally, it is To increase knowledge of the team at KSI was anxious to resume during a research trial in the heat lab. important for organizations to effect of the face mask on KSI AND COVID-19 research as quickly as possible consider how to safely return to thermoregulation, KSI conducted a when the University announced activity during a pandemic and study in which participants wore four Like the rest of the world, KSI was a phased reopening of research avoid increased instances of injury, different face masks — a surgical significantly impacted by health and activities would commence. In late and logging arrival/leaving time illness, and sudden death in sport. mask, an N95, a MISSION adjustable temperature and humidity inside safety regulations required due to May, we began creating the KSI for contact tracing purposes, Therefore, the purpose of this gaiter, and a MISSION adjustable and outside of the masks. Our the COVID-19 pandemic over the COVID-19 Safety Plan as the first adhering to guidelines regarding paper was to create an overarching sport mask — in heat during light- teamwork enabled us to complete past year. Although the unexpected step in gaining University approval PPE requirements in both office consensus statement across high to moderate-intensity exercise, 72 subject visits safely and shutdown of campus and extended to resume our research. The safety settings and in the lab, and setting school and collegiate athletics such as walking and jogging while successfully in three weeks, under absence from research activities plan was developed based on CDC up all physical spaces at KSI to allow to address return to physical monitoring rectal temperature, skin continued COVID-related safety initially paused research, we are guidelines and UConn’s Office of the for maintaining social distancing activity considerations during or temperature, and several perceptual protocols. We hope this study proud of the work we accomplished Vice President for Research (OVPR) guidelines. These protocols have immediately following variables. Additionally, we measured will benefit the essential workers once we were able to resume guidelines, and was approved by been in place since KSI was approved physical distancing. and athletic population who are collecting data in our labs at the the OVPR before we resumed any to resume research in June and will participating in activities related to beginning of July. Our staff worked research activities. The purpose of continue to be until OVPR instructs their profession or sport with face tirelessly to write and implement the safety plan was to facilitate an us to discontinue these practices. masks during this pandemic. safety plans to get our labs up orderly ramp-up of lab operations, Thanks to our incredible teamwork, and running again after shutdown minimize any exposures to COVID-19 we were able to successfully to maintain a high level of safety between our staff and subjects, and complete four research projects in after our return to campus, and we maintain safe lab and office spaces fall 2020: the VIPER, MAMBA, ICE, are honored to have been able to for the return to research activities. and Face Mask studies. contribute to the body of COVID- related research. Some of the protocols we developed as a part of this safety plan included: A subject in the Face Mask pre-screening questionnaires via study exercises in the heat while KSI staff monitor Qualtrics survey for any staff or changes in physiological subjects prior to arriving on campus, and perceptual variables. recording temperatures

18 19 2020 STUDIES IMPROVING NATURAL SPORT OUTCOMES AND LANDING EFFICIENCY (INSOLE) STUDY

To combat the risk of lower body injuries, the use of protective IMPACT OF IMMERSION HYDRATION equipment has become common in sport. Typical shoe insoles are COOLING EQUIPMENT ON INTERVENTION IN unable to generate mechanical power and react to the individual’s EXERCISE PERFORMANCE ADOLESCENTS needs, reducing the interaction between the device and user. But insoles that can absorb power have the ability to dramatically IN THE HEAT Maintaining a desirable level of improve movement, thereby reducing risk for injury. The purpose of this study was to test the VKTRY Performance Insoles against Both physiological and perceptual hydration has been associated a control insole in 15 healthy, male participants. Joint angles and changes may occur while exercising with improvements in the overall running efficiency were assessed during a treadmill test performed in the heat, potentially leading to health and well-being of adults. to fatigue. Injury protection via lower body movement errors and reduced athletic performance. Various Adolescents have a more difficult ground reaction force as well as performance were assessed before cooling strategies have been explored time maintaining proper hydration and after the treadmill test. The study was conducted by KSI in to reduce internal body temperature, due to unique challenges with both association with the UConn S.O.A.R. Lab. enhance perceptual measures, and scheduling conflicts and beverage THE EFFECT OF AMP improve physical performance during preference. Furthermore, the harmful HUMAN PR LOTION ON exercise in the heat. In particular, effects of hypohydration on both physiological and mental health HYDRATION STUDY the practice of forearm cold-water immersion was recently evaluated for are not fully understood within the obtaining these positive responses adolescent population. In light of SWEAT ELECTRICAL EVALUATION AND PERCEPTIONS STUDY Various populations such as military by reducing skin temperature. these concerns, Kraft Foods Group SENSOR VALIDATION VALIDATION OF A personnel, athletes, and industrial However, there is a substantial gap Brands LLC of Glenview, Illinois has The purpose of the Perceptions laborers may practice harmful fluid DURING EXERCISE AND MULTIMODAL BRAIN in the literature regarding benefits of introduced an alternative beverage Study was to assess current ingestion behaviors potentially REST (SEVERE) AFRL FUNCTION BIOMARKER forearm cooling while participating in called Creative Roots to combat these knowledge and opinions of athletic increasing cognitive, physiological, athletic activity. First Line Technology potentially negative responses. This NEXTFLEX VALIDATION WITH NPC training and appropriate medical and heat stress. For example, military of Chantilly, Virginia, has created a study determined if the beverage care for student-athletes from pilots purposefully dehydrate convenient device, the Immersion improved measurements of hydration Maintaining an appropriate level of Mild traumatic brain injury (mTBI) key stakeholders who influence themselves due to difficulties with Cooling Equipment (ICE) System, for in adolescents. By providing an hydration has physiological, cognitive, is a global medical problem which the hiring of athletic trainers in urinating while flying an aircraft. use in forearm cold-water immersion alternative beverage that is both and performance benefits during has been identified as a major secondary schools. Data has already Currently, the consumption of sodium in both military and occupational tasty and satisfies the health-related exercise in the heat. Hydration, cause of death and disability. With been collected and analyzed from bicarbonate has been deemed settings. This study examined how desires of parents, adolescents may electrolyte concentration, and sweat a majority of concussion diagnoses athletic directors, superintendents, effective for improvements in fluid physiological, perceptual, and consume more fluids, which could rate can be assessed in a variety relying on subjective self-reporting principals, coaches, parents, and regulation; however, it may cause performance responses are affected improve hydration, leading to benefits of different ways. However, these of signs and symptoms, there is a legislators. With responses from abdominal discomfort. AMP Human by forearm cold-water immersion in both physiological and mental measures often require expensive need for an accessible device that more than 3,900 individuals, we Performance, based in Park City, during exercise in the heat. health, all of which are vital to the equipment and laboratory space, uses non-invasive techniques and were able to gather a baseline Utah, recently created a sodium development of adolescents. which limits their use in military objective measurements to rapidly assessment of knowledge that can bicarbonate solution called PR combat and training scenarios. The assess injuries with precision. be used to target educational efforts Lotion that can travel through the GE Sweat Sensor (General Electric The BrainScope Ahead® 300iP-O for support on the hiring of athletic skin after application. The research Research, Niskayuna, NY) is a non- (BrainScope Inc.®, Bethesda, MD) trainers in secondary schools. Data study evaluates the effects of this invasive, disposable sweat patch that has been developed to aid in the from the legislator, athletic director, sodium bicarbonate lotion on measures sweat rate and electrolyte assessment of concussions sustained. and principal stakeholder groups are physiological and psychological concentration. This patch was To be more effective, the device currently published in the Journal responses associated with fluid designed to measure hydration level procedures have been altered to of Athletic Training. The Perceptions balance in humans while sitting in a through sweat loss and electrolyte include a feature for the assessment Study is continuing into 2021 as we hot environment. If this product is composition while warfighters are of eye function, which will expand look to collect data from additional effective, then it may be available in combat or training. In order to upon the characterization of a brain stakeholder groups, including high to those who need it to improve assess this design, the study aimed injury. In order to demonstrate the school nurses. This study is partially hydration and regulate fluid balance. to validate this technology during effectiveness of the BrainScope funded by the National Athletic exercise and rest in the heat at Ahead® 300iP-O device, this study Trainers’ Association. varying levels of hydration in men is being conducted to evaluate and women. mTBI/concussion diagnoses while characterizing differences in severity and recovery within a population of males and females aged 13 to 50.

21 CORPORATE PARTNERS National Football League - New York, NY Gatorade - Chicago, IL NATA - Dallas, TX MILITARY BASES Camelbak - Petaluma, CA Fort Benning - Fort Benning, GA Kestrel - Boothwyn, PA Fort Bragg - Fort Bragg, NC MISSION - New York, NY Lackland Air Force Base - San Antonio, TX Defibtech - Guilford, CT Worked with the U.S. Army and U.S. UConn - Storrs, CT Air Force to improve heat safety policy First Line Technology - Baltimore, MD

KSI’S GLOBAL IMPACTS

NORTH AMERICA ASIA

Washington, D.C. Kona, HI Doha, Qatar White House Roundtable on Climate & Sports Hawaii Ironman Triathlon World Championships IAAF World Athletics Championships, 2019 Marine Corps Marathon Medical Conference Data collection in collaboration with Timex FIFA World Cup 2022 presentations Aspetar, National Medical Supplier of IAAF The Pentagon Cancun, Mexico Dr. Douglas Casa spoke at the American Medical Society for Sports Medicine International Conference on Medicine and New York, NY Science in Athletics hosted by Aspetar. He Human Rights Watch Canada trained the medical staff to appropriately New York Giants Football Team Canadian Athletic Trainers’ Association recognize and treat exertional heat U.S. Soccer, Major League Soccer, National meeting, Vancouver EUROPE stroke. The medical staff was responsible for treating athletes at the IAAF World Women’s Soccer League - Head Injury and 5th International Congress on Soldiers’ Physical Athletics Championships 2019 and FIFA Concussion in Soccer Summit presentation Performance, Quebec City Evian, France World Cup 2022. 10th Annual Hydration for Health Conference Lake Placid, NY Dr. Gabrielle Giersch receives the “Pitch Tokyo, Japan Ironman Lake Placid Your Science Competition” Young Research International Olympics Committee (IOC) Award 2020 Tokyo Olympic games Boston, MA Dr. Douglas Casa, in collaboration with Boston Marathon Medical Meeting presentations Split, Croatia Dr. Yuri Hosokawa and Dr. Andrew International Conference on the Physiology and Grundstein, helps to prepare organizers Natick, MA Pharmacology of Temperature Regulation for extreme heat. U.S. Army Research Institute of Sports Safety Symposium Environmental Medicine Ukmergė, Lithuania Gedminas Grinus, a Camelbak pro sponsored Falmouth, MA athlete from Lithuania, is tested in the KSI Falmouth Road Race Medical Symposium MISSION Heat Lab Medical Tent Support Portugal Portugal National Football Team Dr. Douglas Casa and Dr. Robert Huggins assist the Portugal national soccer team in preparing for the heat of the 2014 FIFA World Cup in Rio de Janeiro, Brazil.

22 23 COMBATING HEAT STROKE IN ONE OF THE HOTTEST PLACES ON EARTH

The partnership began when Casa IAAF World Athletics Championships was invited as an international expert competition venues, including sports to advise on and help implement medicine doctors, physiotherapists, safety precautions for the 17th IAAF sports scientists, emergency doctors, World Athletics Championships in and paramedics, were in attendance. Doha, held from September 27 to October 6, 2019. In preparation for In addition, Casa delivered the MAKING AN the potential hot ambient conditions “Tuesday Morning Lecture” on the during the road race events, the IAAF preceding day, a plenary lecture INTERNATIONAL IMPACT (now known as World Athletics), attended on-site by more than the local organizing committee, and 100 practitioners and available FIRST PERSON: Aspetar took several precautionary on YouTube afterward. Casa also Yuri Hosokawa, Ph.D., ATC, Associate Professor, measures ahead of the events. attended and presented at the Waseda University, Tokyo, Japan The highlight of this partnership was International Conference on Safety and Performance Optimization Laboratory Casa’s visit to Aspetar in May 2019, Medicine and Science in Athletics where he delivered a workshop on the same week. Sébastien Racinais, Ph.D., exertional heat stroke management. I received an invitation to be part of at KSI. Being from Japan, it was a overstatement to say that I was the Head of Research at Aspetar The medical staff of the various the International Olympic Committee long-awaited opportunity because it only person who had treated EHS Adverse Weather Impact Expert has been my career goal to introduce patients following the premise of It’s only logical that KSI’s work Working Group for the Olympic and implement proper prehospital “cool first, transport second” before preventing exertional heat stroke Games Tokyo 2020 in October 2019. management of exertional heat stroke on-site training at test events began. extends to Qatar, a Middle Eastern Dr. Casa was already part of the (EHS) to the Japanese medical system. country that was already one expert group, and he and others The education and training for the of the hottest places on Earth nominated me for involvement with One of the primary tasks assigned to local medical team is an ongoing when temperatures started rising the initiative given my background the expert group was to establish a process, and the COVID-19 pandemic rapidly in recent decades. KSI medical response plan for collapsed has certainly impacted our initial plan. CEO Douglas Casa and Sébastien athletes with suspected EHS. The While many uncertainties about the Racinais, Ph.D., head of research for context of the Olympic Games Games remain, I can confidently say Aspetar Orthopaedic and Sports medical service is unique, to say the that they have given Japanese health Medicine Hospital in Doha, Qatar, least. The initial care at the field of care providers the opportunity to have developed a partnership, play is delivered by the local medical elevate their standard of care of EHS collaborating on educational articles team. This means that the host city prehospital management. on the management of heat stress, must ensure that team is able to the International Olympic Committee deliver care to the level expected The expert group has summarized Adverse Weather Impact Expert by the international standard. In the best practice for EHS prehospital Working Group for the 2020 Olympic Japan, there were several barriers care in a manuscript, which will be Games in Tokyo (being held this in implementing the common best available in the British Journal of summer after postponement due practice of EHS prehospital care, Sports Medicine. to COVID), and the “Exercise in the such as lack of on-site cooling and Heat” Guideline Development Group prehospital rectal temperature for the State of Qatar. assessment. It may not be an

24 25 LEADERSHIP STAFF BOARD OF ADVISORS LEADERSHIP STAFF BOARD OF ADVISORS 1 5 12 19 26 1 5 12 19 26 Douglas Casa Shawn Detoro Jeb Struder Ciara Manning Kelci Stringer Chief Executive Officer Chief Financial Officer Director of Research Assistant Director of Founder and Athlete Performance and Spokesperson Safety 2 6 13 Rebecca Stearns Erin Ballou Michael Szymanski 27 Chief Operating Officer Manager Director of Education 20 James Gould 2 6 13 20 27 Alex Alvarez Chair of Board Associate Director of Assistant Director of Advisors Occupational Safety of Military Safety 3 7 Robert Huggins Yasuki Sekiguchi President of Research Research Associate 28 and Athlete Performance 14 21 John Jardine and Safety Ayami Yoshihara Harry Georges Chief Medical Officer Co-Director of Sport Assistant Director 3 7 14 21 28 Safety of Research Chair of Medical and 8 Science Advisory Board Cody Butler 4 Director Christianne Eason of Military Safety President of 15 22 Sport Safety Gabrielle Brewer Timothy Gilgallon Associate Director of Assistant Director 9 Military Safety of Occupational Safety Erica Filep Vice President of the Co-Director of Sport 4 8 15 22 National Heat Safety Safety Coalition 23 Director of Tam-Anh Nguyen Communication Assistant Director of 16 Communication Sean Langan Associate Director 10 of Sport Safety Margaret Morrissey 24 Director of Occupational Megan Nye 9 16 23 Safety Assistant Director of Education President of the National 17 Heat Safety Coalition David Martin Associate Director Manager, MISSION Heat of Research 25 Lab at UConn’s Korey Melissa Weiand Stringer Institute Assistant Director of 18 Sport Safety 10 17 24 John Navarro 11 Associate Director Erin Dierickx of Athlete Performance Director of Athlete and Safety Performance and Safety

11 18 25

27 MEDICAL AND SCIENCE ADVISORY BOARD

William M. Adams, Ph.D., ATC Lindsay J. Distefano, Ph.D., ATC Jay R. Hoffman, Ph.D., CSCS*D, FNSCA, Thom A. Mayer, MD, FACEP, FAAP Michael Ormsbee, Ph.D., FACSM, FISSN, Robert Sefcik LAT, ATC Assistant Professor, Department Department Head, Professor, Department FACSM Medical Director, NFL Players Association CSCS*D Executive Director, Jackson Sports of Kinesiology of Kinesiology, University of Department Chair, Education and Health Associate Professor, Department of Medicine Program Director, Athletic Training Program, Connecticut Sciences Nutrition, Food and Exercise Sciences Stephanie Singe, Ph.D., ATC, FNATA University of North Carolina Professor, Dual Appointment in Sport and Associate Director, Institute of Sports Associate Professor, Department of Michael Seth Smith MD, CAQ-SM, Greensboro Jonathan A. Drezner, MD Exercise Science and Burnett School Science and Medicine, Florida State Kinesiology, University of Connecticut Pharm.D. Associate Professor, Department of of Biomedical Science University Clinical Associate Professor, Division Family Medicine Lawrence Armstrong, Ph.D. of Sports Medicine, Department of Associate Director, Sports Medicine Brendon McDermott, Ph.D., ATC Professor Emeritus, Department of Yuri Hosokawa, Ph.D., ATC Orthopaedics and Rehabilitation, Fellowship Associate Professor, University of Julien D. Périard, FECSS, MA, Ph.D. Kinesiology, University of Connecticut Associate Professor, Waseda University University of Florida Team Physician, Seattle Seahawks & UW Arkansas Associate Professor, University of Huskies, University of Washington Canberra Research Institute for Sport Lindsay Baker, Ph.D. Ollie Jay, Ph.D., FACSM and Exercise Paul Sparling, MEd, AT, ATC Kevin Miller, Ph.D., ATC R&D Principal Scientist, Gatorade Sports Director- Thermal Ergonomics Laboratory Head Athletic Trainer, Cincinnati Bengals Christina M. Emrich, MS, LAT, ATC Professor, School of Rehabilitation and Science Institute Faculty of Health Sciences and Charles Athletic Trainer and Assistant Athletic Medical Sciences, Central Michigan Alicia Pike Lacy, Ph.D., ATC Perkins Centre, University of Sydney Director, Red Bank Regional High University Assistant Professor of Athletic Training, Erik Swartz, Ph.D., ATC, FNATA Mike Carroll, M.Ed., ATC, LAT School, Little Silver, NJ University of Maine Professor and Chair, Department of Head Athletic Trainer and Assistant John L. Jefferies, MD Physical Therapy and Kinesiology, Dan Newman, MS, LAT, ATC Athletic Director, Graham High School, Director of Cardiomyopathy and UMass Lowell Michael Ferrara, Ph.D., ATC Head Athletic Trainer, Union High School, Riana R. Pryor, Ph.D., ATC Graham, TX Advanced Heart Failure, The Heart Dean, College of Health and Human Tulsa, OK Assistant Professor, Exercise and Institute, Cincinnati Children’s Hospital Services, University of New Hampshire Nutrition Sciences James L. Thornton, ATC Medical Center Jason Cates, ATC, LAT Center for Research and Education Head Athletic Trainer, Clarion University Jeremy Ng, MD, CAQSM Head Athletic Trainer, Cabot Public in Special Environments, SUNY Athletics Matthew Ganio, Ph.D., FACSM Shawn F Kane MD, F.AAFP, FACSM Health Sciences Assistant Clinical Schools, Cabot, AR University at Buffalo Associate Professor Associate Professor, Department of Professor, David Geffen School of Director, Human Performance Laboratory, Family Medicine, University of North Medicine, UCLA Chris Troyanos, ATC Cindy J. Chang, MD University of Arkansas Carolina at Chapel Hill Department of Family Medicine, Division Margot Putukian, MD Medical Coordinator Boston Marathon Clinical Professor, Primary Care Chief Statistical Advisor, Korey Stringer of Sports Medicine, UCLA Health Director of Athletic Medicine, Head Team and Falmouth Road Race Sports Medicine, departments Institute Associate Lead Primary Care Team Physician, Princeton University Executive Director, International Institute Stavros A. Kavouras, Ph.D., FACSM, of Orthopaedics and Family and Physician, Los Angeles Dodgers for Race Medicine FECSS Community Medicine, University of Eric D.B. Goulet, Ph.D. Associate Professor, University of Sébastien Racinais, Ph.D. California, San Francisco Julie K. Nolan, Ph.D., ATC Associate Professor, Performance, Arkansas Head of Research at Aspetar Lesley Vandermark, Ph.D., ATC, PES Assistant Professor, Athletic Training Hydration and Thermoregulation Lead, European Network in Sports Clinical Assistant Professor, SUNY Buffalo Education Program, Sacred Heart Bud Cooper, Ed.D., ATC, CSCS Laboratory Sciences (ENSS) Glen Kenny, Ph.D. University Clinical Professor and Clinical Education Director, Ph.D. program, Université de Chair, IOC Adverse Weather Impact Professor, University of Ottawa Jennifer Vanos, Ph.D. Coordinator, Department of Sherbrooke Working Group, Olympic Games Assistant Professor, Climate, Atmospheric Francis O’Connor, MD, MPH Kinesiology, University of Georgia Tokyo 2020 Science and Physical Oceanography, Zachary Kerr, Ph.D., MPH Professor, Military and Emergency Medical and Scientific Commission Games Andrew Grundstein, Ph.D. Scripps Institution of Oceanography Assistant Professor, University of North Medicine, Uniformed Services Group, Olympic Games Tokyo 2020 Larry Cooper, MS, LAT, ATC Professor, University of Georgia Family Medicine, School of Medicine, Carolina University Athletic Trainer, Penn-Trafford High University of California San Diego Medical Director, Consortium on Health School, Harrison City, PA (Retired) Neha Raukar, MD, MS, FACEP Kevin M. Guskiewicz, Ph.D., ATC Kevin King, ATC, LAT and Military Performance Doctor of Emergency Medicine, Chancellor of the University of North Head Athletic Trainer, Carolina Panthers U.S. Army Liason to the Korey Stringer Mark Verstegen, MS, CSCS Mayo Clinic Ronald Courson, PT, ATC, EMT Carolina at Chapel Hill Institute Founder, EXOS Associate Professor Director of Sports Medicine, University of Co-Director, Matthew Gfeller Sport Lisa Larkin, MD, FACP, NCMP, IF Department of Emergency Medicine Georgia Athletic Association Related TBI Research Center Director of Division Midlife Women’s James Onate, Ph.D., ATC, FNATA Adjunct Professor Lisa Walker, ATC Director, Center for the Study of Retired Health and Primary Care Associate Professor, Athletic Training Department of Emergency Medicine Athletic Trainer, Springville High School Athletes David Csillan, MS, ATC, LAT Founder and CEO of MS Medical Division The Warren Alpert Medical School Athletic Trainer, Ewing High School, Director, OSU MOVES Research of Brown University Jonathan E. Wingo, Ph.D. Ewing, NJ Stanley A. Herring, MD Laboratory Elaine Choung-Hee Lee, Ph.D. Associate Professor and Chair, University Professor, Department of Rehabilitation Co-Director, OSU Movement Analysis & Associate Professor, University of Michael Ryan, MS, ATC, PT of Alabama Medicine, Neurological Surgery and Performance Lab (MAP) Ryan Curtis, Ph.D., ATC, CSCS Connecticut Head Athletic Trainer/Physical Therapist, Orthopaedics and Sports Medicine, The Ohio State University Athletic Performance Data Manager, Jacksonville Jaguars (Retired) University of Washington Susan Yeargin, PhD, ATC San Antonio Spurs Rebecca Lopez, Ph.D., ATC, CSCS Associate Professor, University of Associate Professor, University of Samantha Scarneo-Miller, PhD, ATC South Carolina Robert J. Davis, MD South Florida Assistant Professor and Program Director, Diplomat, American Board of Emergency Division of Athletic Training, School of Medicine Medicine, West Virginia University

28 29 Morrissey MC, Szymanski MR, Scarneo-Miller SE, Belval LN, Yeargin Stearns RL, Katch RK, Parker BA, Jardine 2020 PUBLICATIONS Hosokawa Y, Belval LN, Adams WM, Grundstein AJ, Casa DJ. New SW, Hosokawa Y, Kerr ZY, Casa DJ. JF, Casa DJ. Impact Of Statin Use On Vandermark LW, Chemically Casa DJ. Perspectives on Risk Factors for Exertional Heat Illness Preparedness Thermoregulatory Outcomes During Activated Cooling Vest’s Effect on Exertional Heat Stroke. Kinesiology Strategies: Environmental Monitoring Submaximal And Maximal Exercise: 2012 Cooling Rate Following Exercise- Cooper ER, Grundstein AJ, Miles JD, Review. 2020;1(aop):1-8. Policies in United States High Schools. May 28 4: 30 PM-4: 45 PM. Medicine Induced Hyperthermia: A Randomized BOOK CHAPTER et al. Heat Policy Revision for Georgia Medicina (Kaunas). Sep 23 2020;56(10) and Science in Sports and Exercise. Counter-Balanced Crossover Study. High School Football Practices Based Murata Y, Scarneo-Miller SE, McMahon doi:10.3390/medicina56100486 2020;52(7S):533. Adams, WM, Medicina (Kaunas). Oct 14 2020;56(10) on Data-Driven Research. Journal of LJ, Casa DJ. Adoption of Emergency Stearns, RL, Casa, DJ. doi:10.3390/medicina56100539 (2020). Exertional Heat Stroke. Athletic Training. Jul 1 2020;55(7):673- Action Plans in Secondary Schools: A Scarneo-Miller SE, DiStefano LJ, Singe Szymanski MR, Scarneo-Miller SE, 681. doi:10.4085/1062-6050-542-18 Study of School Nurses’ Knowledge and SM, Register-Mihalik JK, Stearns RL, Smith MS, Bruner ML, Casa DJ. Exertional Heat Illness. Hosokawa Y, Casa DJ, Racinais S. Behavior. Journal of School Health. Sep Casa DJ. Emergency action plans in Emergency Medical Service Directors’ Translating evidence-based practice to Curtis RM, Huggins RA, Benjamin CL, 2020;90(9):694-702. doi:10.1111/josh.1293 secondary schools: barriers, facilitators, Protocols for Exertional Heat Stroke. PUBLISHED clinical practice in Tokyo 2020: how to et al. Contextual Factors Influencing and social determinants affecting Medicina. 2020;56(10):494. diagnose and manage exertional heat Adams WM, Belval LN, Berg AP, External and Internal Training Loads Nedimyer AK, Chandran A, Hirschhorn implementation. Journal of Athletic stroke. BMJ Publishing Group Ltd and Hosokawa Y, Stearns RL, Casa DJ. in Collegiate Men’s Soccer. Journal of RM, et al. Exertional heat-stroke Training. 2020;55(1):80-87. Vanos JK, Thomas WM, Grundstein British Association of Sport and Exercise Exertional Heat Stroke of Max Strength and Conditioning Research. management practices and intentions AJ, Hosokawa Y, Liu Y, Casa DJ. A Medicine; 2020. Gilpin; A Preventable Death. Quest. Feb 2020;34(2):374-381. doi:10.1519/ among secondary school football Scarneo-Miller SE, Flanagan KW, multi-scalar climatological analysis in 2020;72(1):102-115. JSC.0000000000003361 athletic trainers. Journal of Athletic Belval LN, Register-Mihalik JK, Casa DJ, preparation for extreme heat at the , Ryan C, , Huggins R Benjamin CL Training. 2020;55(10):1081-1088. DiStefano LJ. Adoption of Lightning Tokyo 2020 Olympic and Paralympic et al. 104 Match congestion and Adams WM, Scarneo-Miller SE, Filep EM, Murata Y, Endres BD, Kim G, Best-Practices Policies in the Secondary Games. Temperature. 2020;7(2):191-214. training load influence injury risk in Stearns RL, Casa DJ. Nontraumatic Stearns RL, Casa DJ. Exertional Heat Parsons JT, Anderson SA, Casa DJ, School Setting. Journal of Athletic collegiate men’s and women’s soccer. Exertional Fatalities in Football Stroke, Modality Cooling Rate, and Sur- Hainline B. Preventing catastrophic Training. Nov 5 2020;doi:10.4085/175-20 British Journal of Sports Medicine. Players, Part 1: Letter to the Editor. vival Outcomes: A Systematic Review. injury and death in collegiate athletes: Wilde EA, Goodrich-Hunsaker NJ, Ware 2020;54(Suppl 1):A45. Orthopedic Journal of Sports Medicine. Medicina. 2020;56(11):589. interassociation recommendations Scarneo-Miller SE, Kerr ZY, Adams AL, et al. Diffusion Tensor Imaging Dec 2020;8(12):2325967120980395. endorsed by 13 medical and sports WM, Belval LN, Casa DJ. Influence of Indicators of White Matter Injury , , doi:10.1177/2325967120980395 Filep EM, Coleman KA, Yoshihara A. . Huggins RA Giersch GEW medicine organisations. British Journal State-Level Emergency Planning Policy Are Correlated with a Multimodal Belval LN, et al. The Validity and The Presence of Emergency Equipment of Sports Medicine. Feb 2020;54(4):208- Requirements on Secondary School Electroencephalography-Based Reliability of Global Positioning System Armstrong LE, Casa DJ, Belval LN. in Secondary Schools With Athletic 215. doi:10.1136/bjsports-2019-101090 Adoption. Journal of Athletic Training. Biomarker in Slow Recovering, Units for Measuring Distance and Human Intestinal Microbiota Heat Training Services by Employment 2020;55(10):1062-1069. Concussed Collegiate Athletes. Velocity During Linear and Team Sport Production Is An Unmeasured Quantity Provider. Journal of Athletic Training. Pike Lacy AM, Eason CM, Stearns Journal of Neurotrauma. Oct 1 Simulated Movements. Journal of In Thermal And Metabolic Studies: 3510 2020;55(6s):S-35. doi:10.4085/1062- RL, Casa DJ. Secondary School Scarneo-Miller SE, Saltzman B, Adams 2020;37(19):2093-2101. doi:10.1089/ Strength and Conditioning Research. Board# 331 May 29 2: 30 PM-4: 00 PM. 6050-55.6s.S-1 Administrators’ Perceptions WM, Casa DJ. Regional Requirements neu.2018.6365 Nov 2020;34(11):3070-3077. doi:10.1519/ Medicine & Science in Sports & Exercise. and Knowledge of the Athletic Influence Adoption of Exertional Heat jsc.000000000000378 2020;52(7S):974. Giersch GEW, Colburn AT, Morrissey MC, Training Profession, Part II: Specific Illness Preparedness Strategies in United Zhang Y, Casa DJ, Bishop PA. Emergency et al. Effects of sex and menstrual Considerations for Principals. Journal States High Schools. Medicina (Kaunas). Preparedness for Sudden Cardiac Death , McClaine KB, Belval LN, Giersch GEW, Adams WM, cycle on volume-regulatory responses Jardine JF, Stearns RL of Athletic Training. 2020 Sep 23 2020;56(10)doi:10.3390/ and Exertional Heat Stroke during Road Heroic, Lifesaving Measures et al. Age- and Sex-Based Differences to 24-h fluid restriction. American Casa DJ. medicina56100488 Races in China. Journal of Anthropology Are Unnecessary When Optimal Cooling in Exertional Heat Stroke Incidence in Journal of Physiology-Regulatory, Posada-Quintero HF, Reljin N, Moutran of Sport and Physical Education. Is Provided for Exertional Heat Stroke a 7-Mile Road Race. Journal of Athletic Integrative and Comparative Physiology. A, et al. Mild Dehydration Identification Sekiguchi Y, Benjamin CL, Butler CR, 2020;4(2):51-53. Victims. Journal of Emergency Medicine. Training. Dec 1 2020;55(12):1224-1229. 2020;319(5):R560-R565. Using Machine Learning to Assess et al. The Effect Of Hydration Status 2020;59(1):145-146. doi:10.4085/1062-6050-539-19 Autonomic Responses to Cognitive And Ice Water Dousing On Heart Giersch GEW, Morrissey MC, Katch RK, Stress. Nutrients. 2020;12(1):42. Rate Variability Prior To And During Kerr ZY, Yeargin SW, Hosokawa Y, IN-PRESS Benjamin CL, Curtis RM, Huggins RA, et al. Menstrual cycle and Intermittent Exercise In The Heat: 3505 Hirschhorn RM, Pierpoint LA, et al. Sleep Dysfunction and Mood thermoregulation during exercise in the Casa DJ. Pryor RR, Pryor JL, Vandermark LW, Board# 326 May 29 2: 30 PM-4: 00 PM. The Epidemiology and Management of Sekiguchi, Y., Benjamin, C.L., Manning in Collegiate Soccer Athletes. Sports heat: A systematic review and meta- et al. Acute Kidney Injury Biomarker Medicine and Science in Sports and Exertional Heat Illnesses in High School C.N., Struder, J.F., Armstrong, L.E., Health. 2020;12(3):234-240. analysis. Journal of Science and Medicine Responses to Short-Term Heat Exercise. 2020;52(7S):973. Sports During the 2012/2013–2016/2017 Lee, E.C., Huggins, R.A., Stearns, R.L., in Sport. 2020; Acclimation. International Journal of Academic Years. Journal of Sport Distefano, L.J., Casa, D.J. (2020) The Benjamin CL, Curtis RM, Huggins RA, Environmental Research and Public Sekiguchi Y, Filep EM, Benjamin CL, Rehabilitation. 2020;29(3):332-338. Effect of Heat Acclimatization, Heat et al. Sleep Dysfunction and Mood Giersch GEW, Charkoudian N, Stearns Health. Feb 19 2020;17(4)doi:10.3390/ Casa DJ, DiStefano LJ. Does Dehydration Acclimation and Intermittent Exercise in Collegiate Soccer Athletes. Sports RL, Casa DJ. Fluid Balance and Hydra- ijerph17041325 Affect the Adaptations of Plasma Miller KC, , Adams WM, et al. Health. May/Jun 2020;12(3):234-240. tion Considerations for Women: Review Casa DJ Volume, Heart Rate, Internal Body Heat Training on Time Trial Performance Roundtable on Preseason Heat Safety in doi:10.1177/1941738120916735 and Future Directions. Sports Med. Feb Scarneo SE, Adams WM, Yeargin SW, Temperature, and Sweat Rate During the in the Heat. Medicine and Science in Secondary School Athletics: Prehospital 2020;50(2):253-261. doi:10.1007/s40279- Konz MA, Potter JE, Casa DJ. The Induction Phase of Heat Acclimation? Sports and Exercise. In Press. Care of Patients With Exertional Heat Benjamin CL, Hosokawa Y, Curtis RM, et 019-01206-6 Prevalence of Secondary School Sport Journal of Sport Rehabilitation. Stroke. Journal of Athletic Training. 2020 al. Environmental Conditions, Preseason Safety Policies within State Athletic 2020;1(aop):1-4. Fitness Levels, and Game Workload: Giersch GEW, Colburn AT, Morrissey MC, Associations and Legislation. Internet Miller KC, , Adams WM, et al. Analysis of a Female NCAA DI National et al. Effects of sex and menstrual cycle Casa DJ Journal of Allied Health Sciences and Singe SM, Sheldon L, Rynkiewicz K, et Roundtable on Preseason Heat Safety in Championship Soccer Season. Journal on volume-regulatory responses to Practice. 2020;18(4):17. al. Mentorship Experiences of Doctoral Secondary School Athletics: Prehospital of Strength and Conditioning Research. 24-h fluid restriction. American Journal Students: Understanding Desired Care of Patients With Exertional Heat Apr 2020;34(4):988-994. doi:10.1519/ of Physiology- Regulatory, Integrative Scarneo SE, DiStefano LJ, Register- Attributes of Doctoral Student Mentors. Stroke. Journal of Athletic Training. Dec JSC.0000000000003535 and Comparative Physiology. Nov 1 Mihalik JK, et al. The Adoption Of Spinal Internet Journal of Allied Health 8 2020;doi:10.4085/1062-6050-0173.20 2020;319(5):R560-R565. doi:10.1152/ Cord Injury Policies In The Secondary Sciences and Practice. 2021;19(1):13. Casa DJ. Protecting youth athletes in the ajpregu.00173.2020 School Setting: 2494 May 29 10: 15 AM-10: Morrissey MC, Scarneo-Miller SE, heat: how a flawed governance system 30 AM. Medicine and Science in Sports Stearns RL, Hosokawa Y, Adams WM, creates unnecessary hurdles to achieve Grundstein AJ, Scarneo-Miller SE, Giersch GE, Jardine JF, Casa DJ. and Exercise. 2020;52(7S):676-677. et al. Incidence of recurrent exertional Assessing the Validity of Aural best practices. AMS; 2020. Adams WM, Casa DJ. From theory to heat stroke in a warm-weather road race. Thermometry for Measuring Internal practice: operationalizing a climate Medicina. 2020;56(12):720. Christenson AJ, Casa DJ. Analysis on vulnerability for sport organizations Temperature in Patients With Exertional the Effect of Ball Pressure on Head framework for heat hazards among Heat Stroke. Journal of Athletic Acceleration to Ensure Safety in Soccer. US High schools. Journal of Science Training. 2021 Proceedings. 2020; 49(1):3. https://doi. and Medicine in Sport. 2020; S1440- org/10.3390/proceedings2020049003 2440(20)30831-8. doi:10.1016/j. jsams.2020.11.009.

30 31 2020 MEDIA APPEARANCES

INTERVIEWS AND PODCASTS 1. Gatorade Performance Partner Chat at vNATA 2020 LinkedIn Live 2. Gatorade Informational Video – “Beat the Heat” with Dr. Douglas Casa 3. “The In with Dr. Tim” Podcast 4. “The Healthy Young Athlete” Podcast 5. “Three Cycle Strength” Podcast 6. “Madam Athlete” Podcast 7. WILI Radio 8. “Doug Casa Discusses Decade Leading Stringer Institute,” Athletic Business 9. “UConn’s KSI Launches innovATe Program to Aid High School Athletes,” UConn Today 10. “NFL Partner Korey Stringer Institute Drives Progress in High School Sport Safety,” NFL.com 11. “Korey Stringer Institute: Progress Made in High School Sports Safety Policies,” UConn Today 12. “Recommended Is Not Enough: Korey Stringer Institute Releases State Policy Scores,” Local 12 Cincinnati 13. “Where’s the Water? Schools Not Allowed to Supply Hydration Stations,” Local 12 Cincinnati 14. “The All-American Who Became the Protector of Thousands of Athletes,” Fox 28 Columbus 15. “Florida Enacts Heat Stroke Protections for Student Athletes,” NBC 6 Miami (Laurie Giardano, KSI Ambassador) 16. “Focusing on Solutions by Teaming Up for Sport Safety in High Schools,” Local 12 Cincinnati 17. “38 States Have Made Policy Changes Under KSI Rubric but Not Ohio,” Local 12 Cincinnati 18. “Ohio Scores 43.93 out of 100 on Korey Stringer Institute Evaluation,” Local 12 Cincinnati 19. “Hot Zones: Dr. Doug Casa and Return to Play,” AFCA Insider 20. “Secondary School AT? Then You Should Be Familiar With and Completed the Atlas Project Survey,” The Sports Medicine Broadcast

WEBINARS AND CONFERENCES 1. Earth Networks Webinar 2. vNATA 2020 3. WV TUFSS Visit 4. LA TUFSS Visit 5. MA Virtual TUFSS Meeting 6. CT TUFSS Meeting 7. “Preparing Athletes & Athletic Trainers to Return to Sports after the COVID-19 Pandemic: Physical and Psychosocial Considerations” Webinar by A.T. Still University 8. Virtual Environmental Ergonomics: Heat Preparation for Toyko 2021 and Major Events 9. 2020 National NSCA Coaches Conference

OTHER 1. Arizona State University EHI Infographic Collaboration

32 KSI ACTIVE GRANTS SUBMISSIONS CY 20 ACTIVE GRANTS CY 2021

SUBMITTED APPLICATIONS CY20 - RESEARCH GRANTS - RESEARCH

SPONSOR TITLE PROJECT PERIOD TOTAL AWARD SPONSOR TITLE PROJECT PERIOD TOTAL AWARD First Line First Line Technology ICE Study 7/1/20—6/31/21 $49,982 DOD/Henry M. Jackson Validation of Internal Body Temperature and 9/15/17—7/31/21 $561,385 Foundation Physiological Measures During Exercise and Rest Amp Human AMPlify Human Hydration Study 8/23/20—5/22/21 $90,234 Department of Defense Enhancing Lethality of Female Warfighters by Increasing 10/1/20—9/30/23 $1,633,566 National Collegiate Athletic National Center for Catastrophic Sport Injury 8/1/17—7/31/21 $150,000 Resiliency to Repetitive Days of Intense Exercise in the Heat Association/University of Research (NCCSIR) DOD/Henry M. Jackson Foundation Continuation — Validation of Internal Body Temperature 11/1—20—01/31/21 $22,838 North Carolina at Chapel Hill and Physiological Measures During Exercise and Rest NFL Concussion Settlement – InnovATe 6/1/20—12/31/24 $3,000,000 NIOSH/Harvard Education & 1/1/21—6/30/21 $13,894 Safety and Performance Monitoring During Education Fund Research Center Occupational Work 1/6/21—1/5/24 $173,648 NATA 4/1/20—3/31/24 Magid Glove & Safety Company The National Heat Safety Coalition TUFSS $600,000 1/6/21—1/5/24 $173,648 First Line First Line Technology ICE Study 7/1/20—6/31/21 $49,982 MPUSA, LLC The National Heat Safety Coalition 1/6/21—1/5/22 $49,964 Amp Human AMPlify Human Hydration Study 8/23/20—5/22/21 $90,234 Camelbak The Effect of Running Vest Garment Material and Design During the Exercise in the Heat NFL Foundation TUFSS 12/1/19—11/30/21 $799,960 2/1/21—7/31/21 $147,889 DOD/Henry M. Jackson Foundation Continuation — Validation of Internal Body Temperature NIOSH/Harvard Education & Safety and Performance Monitoring During 1/1/21—6/30/21 $13,894 and Physiological Measures During Exercise and Rest Research Center Occupational Work 6/1/20—12/31/24 $3,000,000 NFL Concussion Settlement – InnovATe Education Fund Magid Glove & Safety Company The National Heat Safety Coalition 1/6/21—1/5/24 $173,648 MPUSA, LLC $173,648 UNC— Chapel Hill NCCSIR—NCAA Continuation 7/1/20—7/31/21 $44,068 The National Heat Safety Coalition 1/6/21—1/5/24 Camelbak The Effect of Running Vest Garment Material and 1/6/21—1/5/22 $49,964 NATA Athletic Training Locations and Services 4/1/20—3/31/23 $300,000 Design During the Exercise in the Heat and Consumer Awareness Projects NATA Athletic Training Locations and Services and 4/1/20—3/31/23 $300,000 Consumer Awareness Projects ACTIVE GRANTS CY20 - RESEARCH DOD/U.S. Air Force/Kelvi SHE Cool (Semiconductor Heat Extraction Cooling) 4/1/21-3/31/22 $156,735 DOD/Henry M. Jackson Foundation Validation of Internal Body Temperature and 9/15/17—7/31/21 $561,385 Physiological Measures During Exercise and Rest DOD/U.S. Army/Army Medical Enhancing Lethality of Female Warfighters by 10/1/20-9/30/23 $1,658,261 Research Acquisition Activity Increasing Resiliency to Repetitive Days of Intense National Collegiate Athletic National Center for Catastrophic Sport Injury 8/1/17—7/31/21 $150,000 Exercise in the Heat Association/University of North Research (NCCSIR) Carolina at Chapel Hill

NATA TUFSS 4/1/20—3/31/24 $600,000

First Line First Line Technology ICE Study 7/1/20—6/31/21 $49,982

NFL Concussion Settlement – InnovATe 6/1/20—12/31/24 $3,000,000 Education Fund Amp Human AMPlify Human Hydration Study 8/23/20—5/22/21 $90,234 Kraft Heinz Company Hydration Intervention in Adolescents 12/1/19—12/31/20 $274,999 NFL Foundation TUFSS 12/1/19—11/30/21 $799,960 DOE/BrainScope Co., Inc. Evaluation and Validation of a Multimodal Brain 9/1/19—2/28/21 $164,903 Function Biomarker with NPC

34 35 The annual Korey Stringer Institute Gala allows us to gather to celebrate the year’s achievements and to honor our annual KSI Lifesaving Award winners. Each year, KSI leadership and staff gather with our corporate partners, supporters, and friends to celebrate the important work being done at KSI and throughout the country to maximize performance, optimize This year’s Gala is pending COVID-related guidelines. safety, and prevent sudden death.

36 37 A SPECIAL THANK YOU TO OUR CORPORATE PARTNERS. WITHOUT YOU, NONE OF THIS WOULD BE POSSIBLE.

NFL GATORADE UCONN CAMELBAK MISSION NATIONAL ATHLETIC TRAINERS’ ASSOCIATION KESTREL DEFIBTECH FIRST LINE TECHNOLOGY

Published 05/21