Helping children play it safe.

We're all familiar with those proud parents and retired coaches who cheer in the bleachers at little-league games. They are reliving youthful experiences and getting a thrill out of the game once again. In the past, cuts and bruises were part of the game, and injuries were an accepted risk. But youth sports are different these days in at least one area: most parents now opt for their children to wear protective gear, and the use of safety equipment is literally changing the face of sports.

Playing It Safe

Today, providing for safety is a mainstream goal in most aspects of American life. Once considered "uncool," bike helmets are mandated in many jurisdictions. Roller skating--now in-line skating--also has experienced a dramatic turnaround within a generation. Elbow and knee scrapes used to be as ubiquitous as bubble gum. Now, helmets and pads are standard for the current-day version of skating. Safety features in cars, once objected to, have gradually become the norm and are now considered a positive selling feature by many automobile manufacturers.

Safety has become a complex issue for athletic directors and recreational managers. In today's society, these professionals must be constantly on guard against potential legal action. Insurance rates reflect high-figure law suits. But protecting players from injury can be expensive, too; typically, it costs $200-300 to outfit a beginning hockey player and as much as $1,000 or more for high-school players. Risk management involves the obligation to protect players. Organizations may be held liable if commonly available devices like hockey masks are not used.

Sports Safety Lineup

In one sport after another, players have adopted gear to protect themselves from the most severe accidents. Take football, which traditionally has had a track record of serious injuries despite helmets and padding. Over the past few years, protective headgear evolved from a single nose bar to a complete mask, including a solid visor for eye protection. In hockey, one of the most injury-prone sports, players now dress like little gladiators. In soccer, some leagues don't permit players on the field without shin guards.

Surprisingly, some field sports have been overlooked, even though statistics clearly show players' vulnerability. Baseball, one of the most popular sports in the United States, has been slow to respond to the safety trend. Yet more than 160,000 injuries are reported in emergency rooms each year from this sport, and thousands more incidents never become recorded statistics. Perhaps it is because of the "tradition" of baseball that there has been resistance to safety changes within this sport. The Consumer Product Safety Commission (CPSC) has been aware that this sport contributes to youth injuries. In 1996, the CPSC identified these risks and evaluated several safety products available for baseball. One specific safety product evaluated was a batting helmet with face guards. It's been almost two years since the CPSC issued its report on baseball injuries, and very few leagues have made positive safety changes.

The Dixie organizations (Dixie Youth, Dixie Boys, and Dixie Softball) have taken the lead to bring more safety into the sport. In 1995, Dixie mandated batting helmets with face guards to be worn by all batters. This virtually eliminated facial injuries to batters in their league. Dixie has made a good start in improving safety in baseball by protecting batters, but the fielders, or defensive players, really need the facial protection even more. Statistics show that fielders are subject to more than four times the facial injuries than batters (Figure 1).

Sports-medicine professionals certainly recognize the need for improving facial protection in field sports and have formed advocacy groups to bring awareness to the problem. Prevent Blindness America, a national advocacy group, distributes literature specifically focused on preventing eye injuries in sports. A new manufacturer in Frederick, Maryland, has also recognized the need for safety equipment for fielders and has just released the GameFace Sports Safety Mask, which promises to alleviate much of the risk for fielders. Steve Chafitz, GameFace president, said, "Just as Dixie reduced facial injuries to batters, we are going to start seeing a major reduction in facial injuries to fielders."

Safety Equipment and the Risk Manager

The introduction of these new safety devices creates a unique situation for risk managers. Somewhere between a product's release and its widespread use, there is a gray area, according to Stephen Hull, who directs sports and recreation programs for the Maryland National Capital Parks and Planning Commission. The availability of safety products "is a double-edged sword for risk management," he said. "Assume, five years ago, a child playing the field was hit in the eye. There was no liability because no product was available. Once all risk managers know a product is available and in the public domain, they have liability." Meanwhile, he says, "some risk managers resent that they will be required to use any device; but there's no going back."

John Sadler's firm in Columbia, South Carolina, handles insurance for Dixie Baseball, Inc. He advises caution in adopting a new device. "What initially looks like a great idea may turn out to be not so great; you don't just jump on the bandwagon," he said. Sadler recommends that new products be tested in the field for a number of years. He estimates that if a fielder's mask turns out to be a "workable solution" (accepted and effective over time), "it holds a very large potential to prevent up to 25 percent of all injuries in youth baseball."

Under the U.S. legal system, the definition of liability is "reasonable and ordinary care." Three conditions must be satisfied in order for an organization to be at risk for liability if a player wasn't wearing the protective gear. The product must have been demonstrated to significantly reduce potential injuries; it must be generally available; and it must be widely known.

Hull believes the proper course for a risk manager is to first concentrate on proper skills training. Chafitz also agrees with this philosophy and added that many times safety equipment, such as his fielder's mask, aids coaches with teaching these skills. "It's hard to ask a player, especially a young player who lacks strong hand-eye coordination, to keep their eye on the ball when they instinctively turn their heads away from oncoming balls to protect themselves," he said.

Hull further commented that new equipment should be tested in a controlled study. Pick some teams and compare injury rates with and without masks. "Obviously, the fielder's mask is going to prevent some injuries to kids," he said. Hull pointed out that a mask would cost only a fraction of what it takes to protect a hockey player.

How Standards Are Set

The American Society for Testing and Materials (ASTM) has established a protocol that takes three to four years to satisfy. First, a panel of volunteers (manufacturers, users, and general interest groups) gathers data; then a committee writes the standard. The best way for a manufacturer to demonstrate compliance with a standard is to submit a product to an independent testing laboratory. A company may apply for a product seal of approval from a certifying organization, such as the Hockey Equipment Certification Council.

Dr. Paul F. Vinger is clinical professor of ophthalmology at Tufts University School of Medicine and a member of the ASTM committee that wrote the ASTM standard for face guards for batters and runners in youth baseball.

Currently there are no ASTM standards for fielders' masks. Vinger, considered the guru of eye safety in sports, wants to broaden existing standards, extending them to include other sports and different aspects of the same sport. This could allow manufacturers to develop products that would meet standards for protection in multiple sports.

For example, ASTM added a standard specification for baseball fielder eye protection to the standard that was originally developed for racquet sports. "Let's say we find a face protector that could withstand impact of a ball at 100 mph. Then presumably it would cover other conditions and other sports, so manufacturers could meet standards more cost effectively," he said.

Dr. John B. Jeffers, an ophthalmologist at Wills Eye Hospital in Philadelphia, said he would like to see protective facial masks tested by independent labs to standards specified by ASTM. This would help set standards for the protection that is badly needed in youth baseball, he said.

Vinger and Jeffers have been involved with the Protective Eyewear Certification Council (PEEC), modeled on the Hockey Eyewear Certification Council (HEEC). Products that meet standards could be given a seal of approval, Jeffers said.

Vinger points to the example of hockey to show how the process of setting standards and gradual acceptance of products can pay off in reduced injuries. The Hockey Equipment Certification Council set the standards that have virtually eliminated eye and face injuries to protected players.

Vinger said he knows of no occurrence of blinding eye injuries from hockey since standards were mandated. He would like to see this same process extended to baseball through the use of certified protective devices, which could produce a very dramatic drop in eye and facial injuries to fielders.

According to Dr. Jeffers, some devices tested in the past may have failed to meet certain standards, but nevertheless protected players from the most serious injuries. "I would say that if it saves an eye, that's still safer," he said.

Skills vs. Safety?

Do protective devices take the fun out of sports? It doesn't have to be that way. John A. Bogert, DDS, executive director of the American Academy of Pediatric Dentistry, in comments submitted in 1996 regarding the use of face guards on batting helmets, stated, "Children who are currently using these devices experience no diminution of vision or restriction of airway. In fact, experience shows that children with a face guard on their batting helmet are more confident in the batter's box because they know they are safe from getting hit in the face." Dr. Vinger said in the report that face protectors do not appear to interfere with the player's performance, visual field, or enjoyment of the game.

Do players get lax if they know they are protected? That is not the case, said Dick Case, former CEO of USA Baseball and member of the U.S. Olympic Committee. With more than 40 years of coaching experience, Case said, "I know wearing a fielder's mask will buck tradition, but I feel strongly that it will provide the opportunity for more fun, safety and participation in amateur baseball." He believes players will be able to concentrate on sharpening their overall fielding skills using the mask.

Tom Petroff, former minor-league field coordinator for the Detroit Tigers and member of the American Baseball Coaches Association Hall of Fame, thinks a fielder's mask is long overdue. He once tried to protect an injured fielder with a cumbersome catcher's mask to help overcome fear of the ball. It was clumsy, but it worked. He thinks children actually will improve their skills by concentrating on the ball, not dodging it. Even with learning the best skills, a player is still at risk from a "bad hop" when playing on community fields that have ruts and stones.

Safety issues involve more than routine play. Dr. Kristen Schupp is a dentist in Hagerstown, Maryland, who has treated children injured during field sports. She likes the idea of wearing a protective device or mask for another reason. With the protection, her injured patients can return to the game sooner. Also, children with braces can play with less worry about injury and less risk to expensive dental appliances.

What's Next?

Safety issues will continue to drive manufacturers to provide safety equipment to protect our youth. The acceptance of these safety products will push risk managers to continually re-evaluate their programs and protocols. Whether or not a sport is included in recreational programs across the United States may be determined by the cost of purchasing the safety equipment needed to properly protect the athletes. As for baseball, it's up to parents and coaches to take the initiative to bring more safety equipment into the game. Some youth leagues have already taken steps to incorporate the new fielder's mask into the spring season.