Contents

Student Protection
Protection Against Child Abuse and Improper Conduct
Sports Injury Prevention Measures and Strategies
Injury Countermeasures
Infectious Diseases Control Guidelines
Sun Protection
Inappropriate Activities
Additional Protection Measures

Best practice, sound practice and experience in the field indicates that the following countermeasures do have a role in preventing injuries:

Education

Education of students and teachers in sport safety is an essential component of any injury prevention program. Changes in knowledge and attitudes generally precede changes in behaviour, so education is a vital step in any program focussing on injury prevention.

Schools can contribute to education in injury prevention through the Personal Development, Health and Physical Education (PDHPE) key learning area and specific sport programs. Sports and physical education teachers are in a position to inform, teach and instruct students in a wide range of sport and physical activities, including how to prevent injury and adhere to the correct codes of conduct.

Education of teachers in sports safety can be implemented through school training and development activities. Increasingly, courses are being developed and implemented to equip teachers who are appointed as coaches, officials and administrators with the knowledge and skills required to conduct a sport or activity. Programs, for example, are available from the Australian Coaching Council, Sports Medicine Australia, St. John Ambulance or Red Cross, state and national sporting organisations and associations.

Injury management and rehabilitation

Despite application of the best preventive methods, there is always the possibility of injury when participating in sport and physical activity. Any safety framework should therefore include components dealing specifically with injury management. Injury management includes: first aid, transport, treatment, rehabilitation and education to protect against further damage.

A set of procedures and advice regarding accident prevention and injury treatment should outline:

• the immediate treatment (or referral) of injury
• contact persons or centres for injury treatment
• the responsibilities and the role of the teacher in first aid
• the treatment of major vs minor injuries
• basic and prudent first aid procedures
• notification of accidents
• accident reports and records of accidents
• location and availability of medical kits for all sports locales.

Students should only participate in vigorous sporting activities if medically fit. Students must not be allowed to play or continue to play if they are injured. If a teacher has reason to believe that a student is injured, the student must be removed from the sporting activity.

Teachers and coaches are to encourage students not to return to playing after injury until it is clear that the injury has healed. If there is any doubt, the student is not to play until medically cleared.

Personal Protective Equipment

The role of protective equipment in sports is to prevent the risk of injury from accidental or routine impacts. Protective equipment ranges from helmets, eyewear and mouthguards to shin padding, gloves and genital protectors. The sports using protective equipment range broadly from cricket, and all codes of football, to squash and cycling.

Protective equipment used to prevent and control injury is increasing. In many sports such as cricket and baseball, the use of protective equipment is part of the culture and well accepted. In others, it is up to the individual to be aware of the potential injury risks and benefits of protective equipment and use is therefore voluntary.

An important part of any sports safety framework is to educate players, parents, coaches, trainers and officials in the appropriate use of protective equipment. This should include the selection, maintenance, proper fit and adjustment of this equipment.

There already exists a culture of mouthguard-wearing by young people in contact and non-contact sports in both club and school settings. The NSW Youth Sports Injury Report 1997 published by the Northern Sydney Area Health Service indicates the following percentage of participants wearing mouthguards: Rugby Union - 82%, Hockey - 64%, Rugby League - 58% and Australian Football - 56%.

With the increased popularity of contact sports and encouragement to participate at an early age, the role of mouthguards in relation to prevention of sporting injuries to dental and other oral tissues has become more important.

Dental injuries are the most common type of facial injury sustained during participation in contact sports. The majority are preventable if a professionally fitted mouthguard is worn. Dental injuries often cause considerable pain and distress and frequently present a difficult and costly treatment problem.

National and State sporting organisations strongly recommend the wearing of properly fitted mouthguards for competition and training. The NSW Department of Health, Sports Medicine Australia, the Australian Dental Association (NSW Branch) and Dental Health Foundation Australia recommend the wearing of custom-made mouthguards.

In order for parents and caregivers to choose an appropriate guard, the relative merits of the types available are outlined in APPENDIX B of this document.

Sport coordinators are encouraged to make this information available to parents, caregivers and students.

Note:

Where the wearing of protective gear is specified in the Guidelines for Specific Activities section of this document, it must be worn.

Playing Equipment

The playing equipment itself (eg. balls, bats etc.) is an important factor to be considered in injury prevention. If a participant cannot wear protective equipment to prevent an injury, then modifying the playing equipment will assist in providing a safer playing environment. For example, the use of softer balls in baseball and softball has been widely promoted in reducing the risk of injury to the hands and other areas of the body.

All equipment that is used should be suited to the size and ability of the student, regularly checked for safety and maintained according to manufacturers instructions, padded as appropriate, stable and properly erected and constructed.

The AUSSIE SPORT program developed by the Australian Sports Commission has been successful in providing an extensive range of modified sports using safe modified equipment, modified rules and increasing the participation opportunities for many students.

Stretching including warm-up and warm-down

A warm-up (prior to stretching) prepares the body both physiologically and psychologically for
the activity and is seen as an essential and successful preventative activity.

The warm-up:

• raises the temperature in muscles and increases circulation around joints
• increases oxygen delivery to the muscles so that they are available for more vigorous activity
• encourages faster and stronger muscle contraction.

The goal of a warm-up is to gently raise the heart rate, and most importantly to raise the body temperature to a light perspiration level. Movement of the major muscle groups is the key to warming-up.

The warm-down involves exercises that decrease the heart rate and temperature slowly and rhythmically, are of low intensity, lengthen muscles and move through a full range of motion, such as marching, knee lifts, shoulder rolls, arm extensions. The warm-down should include stretching of the major muscle groups.

There are many exercises which are best avoided because they compromise body parts. In addition to lack of control of movement, poor posture and body alignment and often too many repetitions of the same action, some of the old fashioned exercises which are potentially dangerous include those which place:

Excessive loads on the spine (avoid these movements):

• neck circling and rolling
• extreme neck extension (backwards) or flexion (forwards)
• bending forward to touch the toes and any similar actions
• bending forward without support and twisting
• bending backwards to an extreme position
• straight leg sit-ups
• straight leg raise activities
• sit-ups with held ankles or feet (this over-strengthens muscles which are attached to the lower back)
• the plough position (feet over head to touch floor).

Excessive loads on the knees (avoid these movements):

• full knee bends
• knee rotation
• duck walking
• hurdles stretch.

Excessive loads on the elbows and shoulders (avoid these movements):

• locking or snapping the elbows
• hanging through the shoulders in the all 4’s position
• holding arms above the head for more than 20 seconds
• impact push-ups.

Training and Conditioning

Appropriately structured training and conditioning programs are significant factors in injury prevention. In developing specific training and conditioning programs for students, coaches and instructors will need to consider:

• maturity and age of the participants
• physiological requirements of the activity
• physiological capabilities of the individual participants
• level of competition and nature of the activity
• the participants' playing positions.

Where schools, for example, participate in representative rugby league or rugby union, they are required to have in place a structured training program. The training must be specific to the players' positions and physiques.

Physical conditioning can occur through well organised and active skill drills, practices and games. Fitness and strength development promoted through enjoyable learning activities, will establish a good base for specific conditioning in the future.

A supervised strength and weight training program can be introduced at the adolescent stage of development. Strength or weight training before this age may cause damage to the immature growth regions of the bones causing long term abnormalities. A strength and weight training program may include body weight exercises, free weights, weight machines and circuit training.

Coaches

The team coach can play a critical role in the prevention of sporting injuries. Coaches should undertake regular updates in injury prevention, injury recognition, first aid and basic life support principles.

Level 1 coaching accreditation is supported and encouraged by all sports with courses being coordinated by the National Sporting Organisations and accredited through the Australian Coaching Council or the state sporting bodies themselves.

Schools are encouraged to incorporate Level 0 and Level 1 coaching accreditation for teachers in the school's training and development plans.

Coaches, particularly of representative sport teams, should be aware of the specific strength and physical requirements of the activity, for example, the most desirable and suitable body build for a front row forward in rugby league or rugby union. Students must be selected on the basis of ability and suitability for the position they are to play.

Officials

Rules and the way they are implemented by game officials are a key approach to injury prevention in sport. The application of appropriate sanctions for infringements of the rules which may lead to injury is an effective injury prevention strategy.

Administrators of inter-school competitions are encouraged to use accredited umpires and referees. Zone sport coordinators are encouraged to arrange coaching and officiating accreditation courses for teachers officiating at inter-school competitions.

Rule Modification for Juniors

Those involved in the development of injury prevention strategies should understand the difference between child and adult athletes in skill, strength and coordination skills.

Children mature and develop at different rates and may not have the background knowledge of what is an appropriate activity. It is for this reason that modifying rules of adult sport is recommended for sporting activities for young students.

AUSSIE SPORT programs highlight the importance of modifications to equipment, rules, the principles of fair play and consequently contribute to a reduction in injury. Many sports have developed modified versions of the adult game.

These include Netta Netball (Netball), Roo Ball (Soccer) and Kanga Cricket (Cricket). The modifications include decreases in the size of the playing field, smaller and often softer playing equipment, rule changes and an increased use of body protection required.

Modified games have been tailored to enable students to participate effectively within their limitations and capacities.

Sports First Aid

Schools may seek to have members of the school community trained in sport first aid courses.

Sports first aiders/trainers receive instruction in the prevention of sports injury, assessment and
immediate management of sports injuries, cardio-pulmonary resuscitation (CPR), warm-up,
stretching and cool-down, taping and nutrition.

It is the primary role of the sports trainer to improve the safety of sport by assisting with injury
prevention measures such as taping, checking protective equipment, providing initial injury management on the field and referring injuries, as necessary, to a more qualified health professional.

Courses are conducted by Sports Medicine Australia NSW via the Safer Sport Program. These
courses are designed to increase the knowledge level of individuals as they acquire and apply
practical skills working with a sport or school. Available courses include a Sports Medicine
Awareness Course, Sports First Aid and Level 1 and 2 Sports Trainers Courses.

Well-equipped first aid kits must be readily available at all sport and physical activities conducted
on school grounds and at community venues and locations. Planning for excursions which involve
sport activities should also include provision for medical kits.

Sports first aid kits may be purchased from St John Ambulance Australia which has a range of
kits catering for various sport environments and specific activities (ph: (02) 9899 5366 for sales
and service).

Environment and Playing Conditions

Sport activities are carried out on a variety of playing surfaces in a range of surroundings and during different environmental conditions. All of these can be potential factors in causing injury.

The activity venue should be assessed before the activity commences to identify potential problems or dangers. This assessment should include checking that the playing surface is of a standard fit for safe play and is free of obstructions and loose objects.

Teachers should also assess the dangers associated with the conduct of the activity in inclement weather conditions including high heat and humidity, extreme cold or during electrical storms. In such instances, the activity should be restricted, or possibly cancelled to reduce the risk of injury.

Heat Stress

Environmental conditions, both hot and cold, can effect the student’s safe participation in sport and physical activity. Regular fluid replacement is important during any physical activity, particularly in hot and humid environments.

In all weather conditions, and whether the activity involves jogging, aerobics, playing games, walking or participating in an outdoor adventure program, the following simple guidelines will assist in preventing heat stress:

• The most basic way to prevent heat stress and dehydration is to schedule physical activity wherever possible to avoid peak radiation times, or relocate to a shaded area. The humidity is particularly important as the higher the humidity of the air, the less effective sweating is in cooling the body.
• As a guide only, young students eg. an average 10 year old, should drink 150-200mls of fluid 45 minutes before, and 75-100 mls every 20 minutes during sport or exercise. Senior students, eg. an average 15 year old, should drink 300-400 mls of fluid 45 minutes before an event and 150-200 mls every 20 minutes during the event or activity. Fluid replacement following exercise is equally important.
• Encourage the wearing of light-weight, loose and porous sports clothing made of absorbent material.
• Students often do not take off unnecessary layers of clothing when they exercise. They need to be reminded to take off some garments once they have warmed up.
• Do not allow students to exercise in hot weather if they are suffering from colds, sore throats or gastrointestinal disorders, especially those which might be causing diarrhoea, or if they are taking medication for them.
• Plain water is an effective fluid replacement.
• Schedule regular and compulsory fluid breaks during activity.
• Thirst is a poor indicator of fluid replacement. Encourage participants to drink before they feel thirsty.

Medical Conditions

There are a number of conditions which, when medically supervised, do not permanently preclude
a student's involvement in sporting activity (but may at any given time exclude participation).
These include:

• chronic infections
• cardiovascular abnormalities
• musculo-skeletal problems eg. arthritis
• medical conditions eg. diabetes, asthma, epilepsy.

Any student taking prescription medication should have a clearance from the treating doctor before participating in sport or physical activity.

Note:

Where a medical practitioner expressly stipulates to the principal of a school in writing that, for medical reasons a student should not play any sport, then the principal must draw the request to the attention of all teachers and ensure that the request is carried into effect. Refer to Memorandum to Principals Student Participation in Sport DG 94/012.

Asthma

Students who suffer from asthma should have an asthma management plan (established in conjunction with their doctor) and always have easy access to their inhaled medication. This is particularly important if the asthmatic student has a concurrent upper respiratory tract infection.

All students with asthma should be encouraged to exercise regularly for both its effect on cardiovascular fitness and general well-being. However, exercise can bring on an attack of asthma. This is particularly likely to occur after prolonged strenuous running (eg. cross country races).

Exercise-induced asthma may vary considerably from day to day and can be particularly troublesome when the student has a viral upper respiratory infection (cold or flu), is recovering from a recent flare-up of asthma, and during very cold weather. In most instances, the difficulty in breathing comes on soon after completion of the exercise when the student is cooling down, rather than during the exercise.

Treatment:

If a student develops exercise-induced asthma, he/she should immediately cease the exercise,
rest and take a ‘reliever’ (bronchodilator) medication. Once all the symptoms have subsided,
he/she may be able to resume exercise. If the symptoms persist or worsen, then the attack
needs to be managed as described below (emergency treatment of an asthma attack).

Prevention:

• Exercise-induced asthma (EIA) can sometimes be prevented by a simple warm-up immediately before the planned activity. If this is not successful, two puffs of either a bronchodilator (reliever) or Intal (preventer) or both, should be administered immediately before the exercise.
• Obtaining better overall control of the student’s asthma with long-term preventive treatment (eg. Intal or inhaled corticosteroids) also reduces the likelihood of EIA. It is extremely unusual for any students with asthma not to be able to take part in normal school sporting activities, but some will need to use one or more of the above measures.
  If the student is obviously and repeatedly restricted, then the parents should be notified so that appropriate medical consultation can be arranged.

Emergency plan for treating an asthma attack:

The National Asthma Campaign advises the following emergency plan which was developed by the Thoracic Society of Australia and New Zealand.

What to do:

• Sit the student down, as breathing is easier sitting rather than lying down. Be calm and reassuring and do not leave the student alone.
• Without delay, administer two to four puffs of a bronchodilator or reliever (Ventolin, Respolin, Bricanyl, Respax or Asmol). Use a spacer if available. Shake the bronchodilator, insert it into the spacer and fire two to four puffs in rapid succession into the spacer chamber. Ask the student to breathe in and out through the mouthpiece (at the opposite end of the spacer) for four breaths.
• If a spacer is not available, shake the bronchodilator and place it in the student's mouth or slightly away from the open mouth. When the student begins to take a slow steady breath, fire one puff and repeat to a total of two to four puffs as required.
• If the student has not improved after four minutes, administer another four puffs.

Call an ambulance:

If there is still no improvement, call an ambulance. At any time during this process if the student has severe breathing problems, or is blue around the lips, call an ambulance. While waiting for the ambulance to arrive, four puffs can be repeated every four minutes.

Supplying bronchodilators:

If a student's own bronchodilator is not available, use one from the first aid kit or borrow one from another student or adult. The risk of infection is extremely small, and the bronchodilator may be lifesaving. It does not matter if another brand of
bronchodilator is used.

What if it is the first asthma attack?

If the student is not known to have asthma but has difficulty breathing or any other asthma symptoms, call an ambulance and administer the bronchodilator as described. Bronchodilators are safe even if the student does not have asthma.

Recording treatment:

Make a written note of any treatment given. Parents must be notified as soon as possible.

Atlanto-axial instability

A condition known as atlanto-axial instability exists in a small percentage of people with Down's Syndrome. The instability between the atlas and axis bones in the neck exposes people with this condition to much greater risk of spinal injury and even death in the event of injury to the neck. This condition is only revealed under x-ray examination.

While students with Down's Syndrome should participate in regular sport activity including running and jumping, some students should be dissuaded from involvement in more vigorous activity without first having a medical check, including x-ray examination.

As a precautionary measure, students with this condition should not be selected for participation in contact sports, somersaults, diving, trampoline activities or other activities including therapy programs, which potentially could injure the neck area. Reference: Memorandum to Principals Selection of Students with Down's Syndrome for Participation in Sporting Activities (88/128).

Diabetes

Every student with diabetes should be able to join in all school activities, including sport and physical education. All that is required is a little planning and a few simple precautions.

Precautions:

Always make sure that ‘hypo food’ for treating the student with low blood sugar level is available. These are simple sugars, such as a can of sweet drink, jelly beans or preferably Glucadin tablets, and complex carbohydrates, such as cracker biscuits or bread. If hypoglycaemia (low blood sugar levels) occurs, ask the student to sit quietly, give them simple and complex carbohydrates and, when fully recovered, let them rejoin the activity. Special care should be taken with water sports. Always make sure that a student with diabetes is observed. If hypoglycaemia occurs, the child may just sink. Because of the substantial risk of hypoglycaemia while underwater, scuba diving and snorkelling must not be permitted until medical clearance is received.

Water sports:

Special care should be taken with water sports. Always make sure that a student with diabetes is observed. If hypoglycaemia occurs, the child may just sink. Because of the substantial risk of hypoglycaemia while underwater, scuba diving and snorkelling must not be permitted until medical clearance is received.

Running:

For cross country and long distance events, a diabetic person should carry some simple and complex carbohydrates such as Glucadin tablets and a muesli bar or two.