Catastrophic injury
A catastrophic injury is a severe injury to the spine, spinal cord, or brain.[1] It may also include skull or spinal fractures.[2] This is a subset of the definition for the legal term catastrophic injury, which is based on the definition used by the American Medical Association.
For description of catastrophic injuries that do not apply to the central nervous system, see Major trauma.
The National Center for Catastrophic Sport Injury Research in the United States classifies catastrophic injuries based on the three outcomes associated with them: fatality, those causing permanent severe functional disability, and those causing severe head or neck trauma with no permanent disability.[3][1] A fatal injury may be a direct result of trauma sustained during an activity or may occur indirectly. The indirect nonfatal catastrophic injury may occur as a result of systemic failure from exertion during an activity, such as from cardiovascular conditions, heat illness, exertional hyponatremia, or dehydration,[4] or a complication to a nonfatal injury.[1][2] Indirect fatalities are usually caused by cardiovascular conditions, such as hypertrophic cardiomyopathy and coronary artery disease.[4]
Fatal injury may reveal an unknown "underlying anatomical, or physiological abnormality".[5] Individuals with certain anatomical anomalies should not participate in some activities. For example, contact sports are contraindicated for individuals with an anomalous odontoid process, as any violent impact may result in a catastrophic injury.[6] This is because a malformed odontoid process may lead to instability between the atlas and axis (the C1 and C2 cervical vertebrae). Those with atlanto-occipital fusion should also avoid contact sports.[6]
One paradigm used in injury prevention is the Haddon Matrix[10] developed by William Haddon Jr. of the National Highway Safety Bureau in the late 1960s. The matrix was designed to categorize highway safety phenomena, and applied a public health model to traffic-related epidemiology.[78] It consists of ten strategies that are implemented based on temporality, that is pre-event strategies (primary prevention), event strategies (secondary prevention), and post-event strategies (tertiary prevention).[79] The purpose of injury prevention is to decrease the "burden of injury to the individual and to society",[80] which includes mortality, morbidity, disability, and economic cost.
The ten strategies are:[81]
In Catastrophic Head Injuries in High School and Collegiate Sports, Frederick Mueller states that the frequency of catastrophic injuries may be reduced by:[28]
Preparation for a catastrophic injury event includes a written emergency plan, which should incorporate an evacuation, transportation and communication plan, as well as notifying hospital emergency departments about game and practice schedules for teams and clubs.[28] Response to a catastrophic injury event should reduce its severity, such as via the administration of first aid.[80] In Catastrophic Injuries in Sports and Recreation: Causes and Prevention : A Canadian Study, Charles Tator states that effective injury prevention programs involve education, engineering, and rule enforcement. Education is intended to inform the participants of potential dangers of risky behaviour in the activity, and engineering "involved modifying the environment to create safer surroundings",[80] such as maintaining playing fields or improving the design of equipment.
Response[edit]
Sports organizations, leagues, and associations have integrated a catastrophic injury plan as part of their emergency action and emergency management plans,[82] and have also changed rules to prevent or reduce the incidence of catastrophic injuries. Such plans include a notification system, which may be used to contact the family of the injured athlete, athletic coordinators, officials, legal and risk management offices, and institutional insurance carriers.[82] It may also include the formation of a catastrophic injury team, which may include athletic directors, head athletic trainer, team physicians, legal counsel, and media relations.[82]
In 1985, the National Collegiate Athletic Association created an insurance plan for member institutions to provide benefits for student athletes who sustain a catastrophic injury, in response to an increase in workers' compensation claims filed by students.[83] This was designed to protect member institutions "against the sudden and substantial costs of injury benefits",[83] typically obtained by the student via worker's compensation claims and litigation. The injured student receives benefits immediately and does not incur litigation costs, but retains the right to litigation in cases of negligence by the institution.[84] In 2005, 25% of funds for insurance claim payouts were associated with cheerleading.[32]
The National Federation of High School Associations instituted a medical plan for high school athletic associations and their member schools and districts. This allows a catastrophically injured student athlete to receive "medical, rehabilitation, and work-loss benefits"[84] until death by waiving rights to litigation. The institution thereby need not invest the human and financial resources associated with litigation, in addition to a potential award to the plaintiff, and the student receives immediate and lifelong benefits.[84]
Athletic associations, organizations, and leagues update their rules based on research regarding catastrophic injuries. The amount of enforcement of the rules may explain variations in incidence of catastrophic injuries between jurisdictions.[42]
Litigation[edit]
In Canada, as of May 2012 the largest award to a plaintiff of a catastrophic brain injury was $18.4 million, and the largest award to a plaintiff of a catastrophic spinal cord injury was $12.33 million.[85]
In the US, as of 2021 the largest award to plaintiff was $20 million.[86]
In South Africa, the largest malpractice settlement for the Medical Protection Society as of 2011 was for R17 million, awarded to a patient who had catastrophic neurological damage as a result of a surgical procedure.[87]