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Do You Play on a Field of Dreams or an Accident Waiting to Happen?

By Philip Hurley, M.D., and Bart Peterson, MSS, ATC on April 14, 2020 hst Print

“Common sense is a flower that doesn’t grow in everyone’s garden.” –Anonymous

Safety. Every athletic organization wants its players to be well conditioned and wear protective equipment in order to minimize the risk of injury. Unfortunately, many facilities throughout the country have sideline hazards that can cause injuries. Although one solution could be to replace facilities, this is usually not feasible, so schools should review hazards that exist and discuss ways to minimize them.

Many times, a field will be used for multiple sports such as football, soccer, lacrosse, and track and field events. In some cases, the area that would be considered the sideline for the first three sports would also be used for long jump, triple jump and pole vault.

As a result of these events, there may be depressions in the ground. If an athlete is running out of bounds and suddenly encounters a depression in an otherwise level surface, he or she stands a chance of falling and sustaining an injury.

These injuries could range from a simple ankle sprain to a knee ligament injury or worse. The solution is obvious and simple: any depression on the sideline should be filled in with sand or dirt and covered with natural or artificial turf.

Another common problem is that of drains. Obviously, they are necessary to handle runoff water from rain. Nevertheless, they can be a source of injuries.

For instance, in the 2019 football season a football player sustained an otherwise avoidable grade 2 ankle sprain. He was walking off the field to the locker room at halftime when he stepped into the 4-inch-deep hole with the drain at the bottom. Admittedly, he was not paying attention to where he was walking because he was talking to a teammate. As a result of this injury, he missed the rest of that game and the following two games.

The solution here is to make sure that the entire field, including all portions of the sideline, is level and consistent across all surfaces. The use of temporary covers could help mitigate risk if permanent solutions are not available. Of equal importance would be to ensure that sprinkler systems do not rise above the playing surface.

Currently, there is no minimum for the width of the sideline. NFHS guidelines specify that the “Restricted Area” of the Team Box in football (the area between the 25-yard lines) must be 2 yards or more in width. Many fields currently being used have fairly narrow sidelines because of the presence of a track or proximity of the stands, many of which are permanent structures that simply cannot be moved.

In one instance, a team physician was injured because of a narrow sideline. During the game a player had sustained a broken ankle and was being treated on the sidelines. He was as far off of the field as possible with his back against a chain-linked fence. The team physician had his back to the field as he was in the process of stabilizing the ankle. While doing this, a subsequent play resulted in two players being forced out of bounds as part of a tackle. One of the two players struck the back of the team physician causing minor rib injuries. This particular sideline safety issue often will not have an easy solution other than for those on the sideline to take as many precautions as possible to be aware of a play being forced out of bounds and being able to get out of harm’s way.

At many schools, practice fields are at a premium. Schools will lay out a partial field in order to have a space for a team to practice when there is not enough room to provide a regulation field of play. It is not uncommon to have these partial fields “squeezed” into an area between other fields or structures. It is important that there is sufficient area beyond the outline of the field clear of structures in the event that athletes cross the boundary in the heat of competition.

Another concern would be holding a lacrosse or soccer practice on the main football field surrounded by a track and holding track practice at the same time. An errant ball or player could easily come in contact with a runner causing an unfortunate event.

In some areas of the country, geese use athletic fields as stopping grounds during their migration seasons. Their droppings contain disease causing germs such as e-coli and salmonella, as well as others. If an athlete has an open wound that becomes contaminated with these droppings, a severe infection may ensue. All wounds should be properly cleansed, covered with a sterile dressing and monitored closely for signs of infection. Athletes should be advised to report all wounds in order to have them properly dressed prior to practice or competition on fields that may have been frequented by migrating fowl. Do NOT suture such a wound as that significantly increases the risk of infection.

In 2019 the National Athletic Trainers Association (NATA) published the Appropriate Medical Care Standards for Organizations Sponsoring Athletic Activity for the Secondary School–Aged Athlete (AMCS) The AMCS document features 12 standards which schools or other organizations that sponsor athletic activities for secondary school-aged participants can do to ensure they are following best practices for their participants and students. Standard 2 of this document states:

“Practice and Competition Equipment Used by Athletes and Athletic Health Care Facilities Is Safe and Clean. Those engaged in organized athletic activities deserve the opportunity to play in a safe and hazard-free environment…”

It is the expectation when parents drop their children off for practices and games that the facilities they use are safe and clean. In an effort to assist these organizations and schools, the AMCS document outlines questions to ask organizations that sponsor activities.

  • Does the organization have written policies, procedures and protocols in place to ensure that practice, competition and athletic health care facilities as well as equipment used by athletes are cleaned and disinfected on a regularly scheduled basis (e.g., daily, weekly or monthly) to prevent the spread of infectious diseases?
  • Does the organization have an exposure-control plan to minimize occupational exposure to blood or other bodily fluids?
  • Does the organization post guidelines and instructions for handwashing and hand sanitization?
  • Does the organization ensure that locker and dressing rooms are cleaned and sanitized on a regularly scheduled basis?
  • Does the organization ensure that all athletic surfaces and equipment used by athletes are cleaned and sanitized on a regular basis (e.g., daily, weekly and monthly)?
  • Does the organization ensure that playing fields and courts are inspected for hazards before each use and on a regular basis?
  • Does the organization supply a safe and clean area for the Qualified Medical Provider to provide immediate treatment and care of athletes with injuries or illnesses?
  • Does the organization ensure that hydration equipment is cleaned and sanitized on a regular basis?

These questions do not ensure that every event and student will participate injury/illness free; however, they do ensure that parents can be assured that the organizations they entrust their children to are making every effort to protect their child’s health and safety. While providing exciting and better facilities is always a good thing, care must be made to prioritize the health and safety of the participant simultaneously. Additional questions surrounding facilities and safety could focus on emergency access for EMS, provision of AEDs, provision of equipment and supplies to treat heat illness and the list goes on.

The NATA has created a tool whereby schools can create a selfstudy of the AMCS standards. The tool is accessible to schools at http://pass.nata.org/ (PASS stands for ‘Program Assessment for Safety in Sport’). The AMCS standards have been adopted by many non-school based entities such as some State Special Olympics organizations, club sport organizations and is also currently being studied for use by some NGBs.

With some common-sense changes and a watchful eye, schools can protect the health and safety of their student athletes. Providing systematic safety and cleanliness checks can further this effort and go a long way toward preventing injury and illness.


Appropriate Medical Care Standards for Organizations Sponsoring Athletic Activity for the Secondary School–Aged Athlete: A Summary Statement. https://natajournals.org/doi/pdf/10.4085/1062-6050-544-18 J Athl Train. 2019 Jul;54(7):741- 748. doi: 10.4085/1062-6050-544-18. Epub 2019 May 28.