Abstract
Context: Lightning-related injuries are among the top ten causes of sport-related death at all levels of sport, including the nearly 8 million athletes participating in secondary school sports. Objective: The purpose of this study was to investigate the adoption of lightning policies and the influencing factors for the development of a comprehensive policy in United States secondary schools. Design: Cross-Sectional. Setting: Secondary School. Patients or Other Participants: Athletic trainers (ATs). Main Outcome Measure(s): An online questionnaire was developed using the NATA Position Statement: Lightning Safety for Athletics and Recreation using a health behavior model, the Precaution Adoption Process Model (PAPM), along with facilitators and barriers to identify current adoption of lightning-related policies and factors influencing adoption of lightning policies. PAPM stage (unaware for need, unaware if have, unengaged, undecided, decided not to act, decided to act, acting, maintaining) responses are presented as frequencies. Chi-square tests of associations and prevalence ratios were calculated to compare respondents in higher and lower vulnerability states, defined based on data regarding lightning-related deaths. Results: The response rate for this questionnaire was 13.43% (n=365), with additional questionnaires completed via social media (n=56). A majority of ATs reported “maintaining” (69%, n=287) and “acting” (6.5%, n=27) a comprehensive lightning policy. Approximately 1 in 4 athletic trainers (25.1%, n=106) reported using flash-to-bang as an evacuation criterion. ATs practicing in higher-vulnerability states were more likely to adopt a lightning policy than those in lower-vulnerability states (57.4% v 42.6%, PR=1.16 (1.03, 1.30); p=0.009). The most commonly reported facilitator and barrier were a requirement from a state high school athletics association and financial limitations, respectively. Conclusions: A majority of ATs reported adopting (e.g., “maintaining” and “acting”) the best practices for lightning safety. However, many AT's also reported continued use of outdated methods (e.g., flash-to-bang).