Committee on Safety in School Sports (CSSS) Report on School Sports Safety

16 Dec 2010

CONTENT PAGE Main Paper 1. 2. 3. 4. Chapter Introduction and background to School Sports Findings from the Committee on Safety in School Sports Recommendations to enhance Safety in School Sports Implementation and conclusion Page 2 5 10 16

Annexes Annex A Annex B Annex C Annex D Annex E Members of the CSSS List of Sports CCAs and Competitions Current Safety Framework for PE and Co-Curricular Activities in Schools Best Practices on Youth Sports Safety from Other Countries Roles of Stakeholders in Promoting School Sports Safety

INTRODUCTION AND BACKGROUND ON SCHOOL SPORTS

INTRODUCTION 1. In schools, sports and physical activities are an important component of holistic education, as they develop our students physically, and also provide opportunities for them to develop discipline, life skills and sporting skills. In May 2010, the Ministry of Education (MOE) set up the Committee on Safety in School Sports (CSSS) to review safety practices and issues in the conduct of school sports, and make recommendations for sustained improvement of safety in school sports. The composition of CSSS is at Annex A. In the course of its review, the Committee surveyed current guidelines and practices governing school sports, studied data on injury rates related to sporting and physical activities in schools, considered best practices in other countries, and tapped on views from the sporting community.

2.

BACKGROUND ON SCHOOL SPORTS 3. Sports and physical education (PE) are integral building blocks in a holistic education system. Through sports, we can build confidence, resilience, teamwork and other soft skills that are important for students to excel both in school and later in life. Students with sporting talents can also be identified and further groomed to realise their potential. It is useful to highlight MOEs guiding principles of PE and sports development to set the context for the review of sports safety. Specifically, our guiding principles are: a. Participation in PE & sports confers a range of benefits, such as psychomotor skills, health and fitness, and these benefits contribute to the holistic development of the students. Provision for mass participation is our priority. At the same time, we also aim to provide a range of opportunities catering to students of different sporting abilities to achieve excellence.

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VISION AND PURPOSE OF PE IN SCHOOLS 5. The vision of PE in Singapore is "Every Child is Physically Educated", with the aim to develop students motor skills and games skills, and equip them with the skills, knowledge and attitudes to pursue and enjoy a physically active and healthy lifestyle. The specific objectives of PE in schools are: a. b. To develop and maintain physical health and fitness through regular participation in physical activities. To practise safety habits during physical activities. 2

c. d. 6.

To demonstrate positive self-esteem through body awareness and control. To demonstrate the spirit of teamwork, sportsmanship and fair play.

PE is compulsory at all levels. At the primary level, students are taught fundamental psychomotor skills and games concepts, and are given the opportunities for structured play, interaction and co-operation. At secondary level, students extend their psychomotor and games skills, develop more games concepts, acquire a holistic perspective of health and fitness, and foster teamwork, sportsmanship and discipline through sports. At Junior College (JC) level, students refine their sports and games skills and concepts, develop health-enhancing fitness management skills, and are given opportunities for leadership in sports.

VISION AND PURPOSE OF CCA IN SCHOOLS 7. CCAs are an integral part of the curriculum as they provide students with authentic platforms to live and practice the values and soft skills taught in the classroom. CCAs foster social integration and help students develop a sense of belonging, camaraderie and loyalty. Active participation in CCAs allows students to develop healthy recreational interests, and improve their physical and mental well-being. Students with enriching CCA experiences will emerge from schools moulded in character and equipped with competencies, ready for the challenges in their adult life. The purposes of CCA are as follows: a. b. c. d. Develop sound values, resilience and character. Equip pupils with knowledge and skills to manage their mental and physical health. Develop bonds of friendship and ability to work effectively in a team. Develop pupils tacit knowledge to be comfortable operating in a variety of cultures and situations and awareness of a balanced lifestyle by exposing them to a variety of experiences, including those related to sports.

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Students are introduced to CCAs at Primary 3 and participation is voluntary. At the secondary level, they must participate in at least one core CCA. There is a wide range of CCAs in our schools. Students may choose from four main groups comprising Sports, Uniformed Groups, Performing Arts, and Clubs & Societies. There are currently a total of 63 Sports CCAs offered by our schools, ranging from Air Rifle, Cross Country, to Sailing and Tennis (see Annex B for the full list of Sports CCAs). Schools have the flexibility to determine which CCAs to offer based on their students interests and needs, and availability of facilities, teachers-in-charge of CCAs, and qualified coaches. 3

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Over the years, with the growing emphasis on sports in Singapore and the provision of holistic education to our students, MOE has increased the diversity of sports CCAs and competitions. For example, in recent years, the range of CCAs and competitions has been expanded to include Wushu (2005), Floorball (2007) and Taekwondo (2010).

S CHOOL S PORTS C OMPETITIONS 12. Sports competitions help generate students interest in sports and spur the pursuit of excellence in the respective sports. MOE set up the Singapore Primary Schools Sports Council (SPSSC) and Singapore Schools Sports Council (SSSC) in 1959 to oversee and organise inter-school competitions. Today, national inter-school competitions are organised by the SPSSC for 21 sports in primary schools and the SSSC for 27 sports in secondary schools, JCs and the Centralised Institute (CI). (See Annex B for the list of sports CCAs with competitions)1. Schools compete in a number of co-curricular events at the zonal and national level each year. These include sports events such as the National Track and Field Championships. Outstanding athletes are then selected into the Singapore Schools Sports Teams2 to take part in regional and international competitions.

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Two sports Floorball and Taekwondo are organized by the respective National Sporting Associations. 2 Previously known as the Combined Schools Teams.

FINDINGS FROM THE COMMITTEE ON SAFETY IN SCHOOL SPORTS KEY AREAS OF STUDY 1. To understand the current sporting environment in schools and identify potential areas for improvement, the Committee conducted a series of studies in the following areas: a. Best practices in youth sports safety in other countries. Best practices for youth sports safety in the United States, United Kingdom and Australia, which have established policies and initiatives on sports safety, and where sports play an important part in everyday life, were studied. Benchmarking against international rules and best practices. The Committee benchmarked the local competition rules and practices issued by the SSSC and SPSSC for 6 key sports against international rules and best practices. These sports were: Basketball, Hockey, Judo, Rugby, Soccer and Taekwondo. Focus Group Discussions (FGDs) with sporting community. FGDs were conducted with members of the sporting community to surface potential areas for improvement. Assessment of the current safety framework. This covered issues ranging from leadership, safety education and training to safety practices in schools. Governance of school sports competitions. The Committee studied the governance of the Singapore Primary Schools Sports Council (SPSSC) and Singapore Schools Sports Council (SSSC) to assess if and how safety in school sports competitions could be further improved upon. Injury rates in school sports. The Committee studied the injury rates in schools to determine if they were reasonable and could practicably be further reduced and if there were any specific sports or injuries that required more attention.

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K EY F INDINGS 2. The Committees findings are elaborated in the following paragraphs.

Best Practices in Other Countries 3. In scanning best practices for safety in youth sports, the Committee focused on the United States, United Kingdom and Australia, where sports play an important part in the life of their citizens, and regular research and studies on sports safety are conducted. These countries also have established initiatives and policies on sports safety. Websites consulted included those of international multi-sports organizations (e.g. International Olympic Committee or IOC), national or states sports councils (e.g. Australian Sports Commission), and non-profit athletic associations (e.g. National Collegiate 5

Athletic Association or NCAA of USA). Peer-reviewed journal articles were also referred to. (See Annex C for details of the study.) 4. The Committee notes the following good practices: a. Educating and involving not only those who are directly participating in youth sports events (i.e., youth athletes, coaches and sports providers), but also relevant parties such as parents, sports officials and safety personnel. Strong partnerships between key stakeholders to develop safety standards and good safety practices for sports providers, coaches and other relevant parties. For sporting and physical activities with higher inherent risk of injuries, significant preventive measures include: modifying rules to be ageappropriate and minimize injury; matching competitors by strength and skill as well as by age, and ensuring proper use and maintenance of protective equipment. Regulation and training of coaches to ensure that coaches are qualified and competent to train youths to play properly and in a safe way. Tracking the type, incidence and severity of injuries in selected sports, especially those with high injury rates (e.g. Basketball, Martial Arts and Rugby). Based on this data and from existing findings on the aetiology of injuries in youth sports (i.e. where, when, and what injuries occur), safety measures and rules of the sport can be reviewed and further refined.

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Benchmarking against International Rules and Best Practices 5. The Committee undertook a benchmarking exercise of the local competition rules issued by the SSSC and SPSSC for six sports involving higher levels of contact or collision and cardiovascular and muscular intensity against international rules and best practices. These sports were: Basketball, Hockey, Judo, Rugby, Soccer and Taekwondo. The Committee found that in general, the local rules follow the recommendations by international organisations with respect to modifications for youth participants. These include modifications to the playing area, playing duration, and playing regulations. Some examples are: a. For Judo, certain moves are banned and the duration of bouts is shortened. Students are also required to attain a certain level of proficiency (as sanctioned by the Singapore Judo Federation) before they are allowed to take part in competitions. For Taekwondo, head kicks are disallowed. For Soccer, the rules stipulate modified playfield dimensions.

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However, the benchmarking exercise highlighted instances when some specific technical aspects could be improved. For example, the SSSC and SPSSC rules and regulations largely focus on guidelines on personal 6

protective equipment, and provide fewer guidelines on facilities and general equipment. In contrast, the rules of the international federations cover detailed specifications of facilities and general equipment in addition to personal protective gear. Feedback from Sporting Community 8. The Committee consulted members of the sporting community, comprising a mix of athletes, coaches and sports officials from across a range of sports3, through Focus Group Discussion (FGD) sessions, to gather feedback on current safety practices and to obtain suggestions for further improvements. Overall, the FGD participants were generally of the view that safety standards and measures relating to sporting and physical activities in schools were sufficient and appropriate, and were sometimes even stricter than those applicable to the general public. The FGD participants also identified some areas where safety measures could be improved, for example, better-fitting body floatation devices for water sports. The FGD participants further noted that some students might push themselves beyond their limits in training and competitions to meet expectations, which could result in higher risk of injuries. It was also felt that teachers-in-charge of CCAs could be given better training and support, so as to help them better oversee the conduct of their CCAs and work in partnership with coaches to ensure the safety of students. The FGD participants also suggested that awareness of sports safety among parents, students and teachers could be improved.

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Current Safety Framework 10. The Committee studied MOEs current safety framework in detail, which covers the following key aspects: a. Leadership. Within MOE HQ, the MOE School Safety Committee was set up in 2006 to provide leadership on school safety and develop safety policies and initiatives. Every school also has its own School Safety Committee, with the Vice Principal as the Chief Safety Officer. The Committees at the school level are responsible for addressing school safety concerns; the development of safety practices; planning and implementing safety training; and incident management. Safety Practices. MOE provides schools with guidelines on school safety, including safety measures during PE lessons and CCAs and the use and maintenance of sports equipment. Safety Education and Training. The MOE School Safety Unit (SSU) conducts seminars for schools Chief Safety Officers to share best practices. Training is also carried out through briefings to school personnel, e.g. Chief Safety Officers and Heads of Department (HODs) for PE and CCA, on areas such as the MOE Risk Assessment

b.

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The FGD participants came from the following sports: Contact Sports (Basketball, Hockey, Rugby and Soccer); Martial Arts (Judo, Taekwondo and Wushu); Water-based Sports (Canoeing, Diving, Sailing, Swimming, and Water-polo); and High Intensity Sports (Cross Country and Triathlon).

Management System (RAMS). The External Safety Validation of schools safety practices, carried out by teams comprising HQ officers and key school personnel, further serves as a platform to learn about good practices. All qualified PE teachers are also trained in first aid. 11. The Committee is of the view that the current safety framework is largely sound, and the guidelines also address a wide range of aspects for schools to take note of when conducting sporting and physical-related activities. To further improve on the current safety framework, the Committee also notes: a. There is scope to further emphasise safety awareness amongst stakeholders (school leaders, teachers-in-charge of CCAs, PE teachers, coaches, sports officials, parents and students), as well as to enhance safety training and education, in particular, for teachers-incharge of CCAs and coaches. There is some variation in implementation of the guidelines by schools. The levels of proficiency in technical and pedagogical skills amongst some of our school coaches can be further enhanced.

b. c.

Governance of School Sports Competitions 12. The Committees assessment is that the overall governance structure for school sports competitions is sound, with the appropriate checks and balances already in place to ensure that governance and safety issues are well looked after. The following summarises the Committees assessment of the key aspects of the governance structure: a. Proper oversight from MOE. The Chairmen of the SSSC and SPSSC are appointed by MOE, and MOE CCA Branch (CCAB) officers are present at the various Council levels. All members of the SSSC and SPSSC are Principals in our school system, and are ultimately accountable to MOE. Annual review of competition framework and regulations. Each year, the framework and regulations for school sports competitions are reviewed by each Convenor4 based on technical advice from CCAB, and the recommendations are tabled to the SSSC and SPSSC. Professional expertise. All the Convenors and schools receive support from CCAB and National Sports Associations (NSAs). The NSAs main contributions come in the form of technical expertise (in particular, tailoring adult-level sport regulations to suit the needs of our students) and the provision of qualified referees and officials. Together, MOE and NSAs work hand-in-hand to provide technical and professional support for the organisation and conduct of school sports competitions. Affiliation to larger sporting bodies. The SSSC and SPSSC are affiliated to the NSAs, which, as the national bodies, are in turn affiliated to credible international bodies in the sporting field. This

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In the SSSC and SPSSC framework, each sport is assigned a Principal who serves as the Convenor and is responsible for overseeing the organisation and conduct of inter-school competitions for the particular sport.

allows the SSSC and SPSSC to tap into the larger network of sporting and safety best practices. 13. Moving forward, the Committee recommends that MOE continue to ensure that there are adequate resources (in terms of school facilities, teachers and MOE personnel) as we continue to expand school sports and competitions in our education system. Injury Rates 14. Aggregated data on sports injuries provide an important perspective in analysing and reviewing sports safety practices, by providing information on aspects such as the nature, incidence rates and severity of injuries. The Committee conducted a survey to determine injury rates in schools arising from sporting and physical activities. 85 schools (representing approximately 25% of the total number of 355 mainstream schools) participated in providing data on injuries relating to sporting and physical activities, for 2008 and 2009. The 85 schools were randomly selected to provide a good representation across different educational levels (primary, secondary, JC/CI), clusters, and zones. Overall, the survey data showed that: a. The annual rate of serious injuries sustained during participation in sporting and physical activities was 1.6 per 1,000 students per annum. Serious injuries referred to injuries where significant medical treatment was required, such as fractures, dislocations, and lacerations which required stitching. 90% of the serious injuries sustained were fractures or dislocations. Of the serious injuries, 44% were sustained during participation in contact sports5, 30% during general exercise, and 15% in individual sports.

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A rough comparison with publicly available data from other countries suggests that our injury rates are relatively low. For example, US data indicates injury rates of between 2.4 to 10 injuries per 1,000 students (no age provided), while Australian data indicates 12.3 significant injuries6 per 1000 children aged between 0 to 14 years. However, the Committee noted that there are difficulties in directly benchmarking the Singapore data against those of other countries, due to differences in surveyed groups and lack of detailed data definitions (e.g. participating population, definition of injuries). A compilation of the injury rates in other countries is included in Annex D. In addition, as part of its study, the Committee also took into consideration the findings of the Committees of Inquiry (COIs) that were set up to look into two serious sports incidents in Rugby and Judo, which had taken place in Mar and

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Of injuries sustained during contact sports, 75% were contributed by soccer, basketball and rugby. In the study, a serious injury was defined as a reported injury that required treatment, interfered with performance of the activities of daily living, and/or had adverse effects on participation or performance in subsequent activity.

Apr 2010 respectively. The findings from the COI for the Judo incident revealed that there were ample safety measures put in place for the Judo match and the rules and regulations for the Judo competition were also more stringent as compared to most international youth championships. There was no evidence of any illegal moves made by the players. In the case of the Rugby incident, the COI concluded that the organisation and safety provisions for the match were consistent with matches played at the National InterSchool Rugby Championships 2010 Police Cup Under-17. The COI also noted that the referee had carried out his duties in accordance with the applicable protocols, and was in control of the match. S UMMARY 19. F INDINGS

OF

The Committee has studied international best practices and sporting rules, consulted members from the sporting community, and reviewed MOEs internal safety frameworks and injury rates over the course of its study. The Committees assessment is that MOEs safety framework is largely sound, and is generally in line with international best practices. For example, as highlighted in the benchmarking exercise, the local rules had followed the recommendations by international organisations with respect to modifications for youth participants. There is also proper leadership and designation of roles and accountability in the safety framework for schools and governance for sports competitions. Overall, the sports injury rates in schools are relatively low, and indicate that our safety framework is generally working well. In the pursuit of excellence, the Committee nevertheless sought to identify additional measures to further level up safety across our schools. The Committees detailed recommendations on these areas are outlined in the following chapter. .....

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RECOMMENDATIONS TO ENHANCE SAFETY IN SCHOOL SPORTS 1. Based on the key findings described in the preceding paragraphs, the Committee has made its recommendations for continuous improvement, which are broadly categorised into three key areas: a. b. c. Safety Education and Training. Preventive Measures. Monitoring, Intervention and Follow-up Measures.
AND

I) S AFETY E DUCATION

T RAINING

Continuously Improving Safety Culture, Education and Training in Schools 2. All stakeholders schools, teachers, coaches, sports officials, parents and students have a role to play in safety. Given its importance, safety must be maintained as a priority and as a part of all stakeholders mindsets. The Committee recommends that MOE promote greater awareness amongst the various stakeholder groups of their responsibilities in ensuring safe practices, and augment the safety training and education of school leaders and teachers. Some ways this can be done include: a. Providing teachers-in-charge of CCAs with more training and support to enable them to play a stronger role in ensuring school sports safety and enabling students to better realise the rich learning outcomes from involvement in CCAs. The Committee recommends strengthening CCA teacher deployment and handover guidelines (between CCA teachers) for schools. For example, schools should as far as possible take into account teachers backgrounds, interests and qualifications when deploying them to CCAs. For in-service teachers who are already deployed by their schools to oversee certain CCAs, the Committee recommends that their training be enhanced through regular briefings on safety rules and the use of safety checklists specific to these CCAs. As teachers-in-charge are often the first responder to incidents involving students, the Committee also recommends that teachers-incharge of sports CCAs maintain current first-aid certifications. b. Enhancing the recruitment and training of new PE teachers, as well as the deployment of qualified PE teachers. As qualified PE teachers would have the necessary background and interests to conduct PE and sports CCAs for students and would also have undergone training in first aid, the Committee recommends that MOE ensure that there are sufficient numbers of qualified PE teachers deployed in schools even as MOE increases PE curriculum time in Primary and Secondary levels. The Committee notes that the recent establishment of the Physical Education and Sports Teacher Academy (PESTA) will further support the in-service training and professional development of qualified PE teachers to strengthen the delivery of PE and sports CCAs in schools. 11

c.

Better engagement with parents. Parents play important collaborative and supportive roles in helping to promote and encourage school sports safety. In this regard, the Committee recommends that schools can better engage parents through ways such as school briefings, and providing accessible information on safety practices. Parents may also be able to provide help and support to schools, teachers or coaches in increasing sports safety awareness and in the implementation of safety practices. Heighten schools and students awareness of safety issues. The Committee recommends that MOE heighten schools awareness of safety issues, by continuing to reinforce safety messages at a senior level and to key personnel in schools. Currently, prior to the start of any physical activities, students are asked to alert their teachers and coaches if they feel unwell or have recently recovered from illness. Some students may, however, not understand the potential implications of taking part in physical activities when unwell, and choose not to highlight their conditions for various reasons. Given these observations, the Committee recommends reinforcing the awareness of safety among students, through parents, PE teachers and teachers-in-charge of CCAs.

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Instilling a healthy sporting culture that encourages fair play and playing within the rules amongst all stakeholders (schools, teachers, coaches, parents, students, sporting associations), in cognisance that an overly competitive mindset can be detrimental to sports safety.

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Annex E summarises the roles that the Committee recommends various stakeholders can play to enhance sports safety in schools.

II) P REVENTIVE M EASURES Boosting Safety Standards 4. The Committees findings revealed that MOEs safety framework is largely sound, and schools generally adopt MOEs safety guidelines in the conduct of sporting activities. There are also benefits to be gained from minimising variations in implementation across the school system, while increasing the pervasiveness of safety guidelines. As such, the Committee recommends that MOE should expand on its existing guidelines to cover areas, where applicable, such as equipment and protective gear, facilities and environment, first aid, medical support and pre-participation screening and consent, and ensure that there is more even and pervasive implementation of these guidelines across all schools. Implementation-wise, MOE would need to continue to carry out the necessary checks for adherence to the safety framework, through a centralised unit in MOE HQ, with cognisance that the unit will need to be staffed adequately to perform this role. This unit could also take on the role of promoting a safety culture, training, and the sharing of best practices across schools.

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Enhanced Safety Standards for Specific Sports 6. Beyond the general safety guidelines applicable to all sports, additional safety measures would probably be beneficial for specific sports. In general, the risks of injury would depend mainly on three key factors: a. b. c. Risk of contact or collision; Cardiovascular and muscular intensity of the activity; and Specific environment, facility or equipment factors.

7. The Committee recommends taking a risk management approach to adopt additional safety measures for different sports. Table 1 reflects the nature of some sporting activities involving moderate and above levels of contact/ collision and/or intensity, as well as those involving specific environment/ facility/ equipment factors. Table 1: Examples of Sporting Activities Involving Moderate and Above Levels of Contact/Collision; Intensity; Environment / Facility / Equipment Contact or Collision Basketball Hockey Judo Rugby Soccer Taekwondo 7. Intensity Cross Country Triathlon Environment / Facility / Equipment Archery Sailing Shooting

In formulating additional safety measures and classification guidelines for existing and new sports CCAs, MOE should consult practices established by international sporting federations, best practices in other countries, the Singapore National Sports Associations (NSAs), as well as local experience and injury data. Based on the Committees findings in benchmarking the local competition rules issued by SSSC and SPSSC for the six sports highlighted in Chapter 2 (namely, Basketball, Hockey, Judo, Rugby, Soccer and Taekwondo), the Committee recommends that: a. The level of detail in documentation be increased for the SSSC and SPSSC rules and regulations. The current rules and regulations do not spell out every game-specific rule, although they specify that the rules from the governing bodies of each sport are to be used in conjunction with them. The Committee recommends that, as far as possible, the documentation of the SSSC and SPSSC rules and regulations be selfcontained one-stop reference documents for coaches and teachers-incharge of CCAs, eliminating or minimizing cross-references to other documents. The consequence of violations be more particularly spelt out in the SSSC and SPSSC rules and regulations. The consequences of violating sporting rules and regulations are generally taken from the 13

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penalty norms of the respective International Federations. These penalty norms could be further refined, especially for the purposes of adapting them for school sports competitions. c. d. MOE carry out further benchmarking exercises for other sports CCAs. MOE institute a more robust approval process for new CCAs and student activities. Currently, schools do their best to accommodate a wide range of student interests. A more robust and systemic approval process for offering new CCAs and student activities would be a useful upstream measure to instil greater awareness among schools of the need to take into account issues such as the requirement for adequate expertise / training of their teachers, resources, and ability to sustain the CCAs.

Uplifting the Capacity of School Coaches 9. Sports coaches hired by schools play an integral part in the school sporting landscape. As they spend a substantial amount of time with students during actual training and gameplay, they can help minimise the chances of injury by instilling a strong sense of safety consciousness in students, enforcing safety regulations, and taking timely corrective measures when they spot early warning signs of injury. By providing proper training and guidance to our students, coaches help our students build important soft skills, values and enhance their mental and physical well-being, through participation in sports. Given the important role that coaches play in school sports, the Committee recommends that MOE work closely with coaches to enhance coaches level of safety awareness and ownership of safety issues during the conduct of sports training and competitions. The Committee recommends the following: a. Emphasise the importance of safety during sports trainings and competitions. MOE should make explicit in contracts with school coaches that they are responsible for the safety and welfare of the pupils under their charge during training and competitions, and that safety is paramount. Together with the teachers-in-charge of CCAs, coaches should make the necessary risk assessments and put in place appropriate safety measures prior to the conduct of sports activities. Encourage coaches to upgrade through technical skills qualifications, for instance, the National Coaching Accreditation Programme (NCAP) qualifications administered by the Singapore Sports Council and NSAs, which would allow them to conduct sports activities with greater confidence and proficiency. MOE will conduct courses for coaches on safety. MOE will also conduct courses to familiarise coaches on the desired outcomes of sporting activities in schools, such as the inculcation of sporting values. Enhance sharing of information on school coaches across schools, such as by creating a central register of CCA coaches and instructors in MOE. This will allow schools to more effectively identify suitable coaches for their needs.

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11. With these recommendations, MOEs aim is for school personnel, such as our teachers-in-charge of CCAs, and our coaches to work together more confidently and effectively to ensure that our students will be able to safely benefit from participation in school sports. III) M ONITORING , I NTERVENTION
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F OLLOW - UP M EASURES

Enhanced Framework of Tiered Insurance Coverage 12. The Committee recognises that despite best efforts in enhancing safety measures, it is not possible to prevent accidents or injuries. Currently, schools purchase insurance for their students, with coverage including medical expenses and hospital allowance benefits. The specific amount varies from school to school, depending on the plan chosen. We have noted that some insurance plans purchased are personal accident plans, for which claimable medical expenses could be a few thousand dollars. There may also be a weekly hospital (ward) allowance included in the plan, up to a cap. These are comprehensive insurance plans under which all student incidents during participation in activities in schools, including PE and sports CCAs, are covered. While the basic level of insurance coverage is generally adequate for the daily activities of the majority of students, this may not be the case in the event of very serious accidents involving intensive medical treatment and/or prolonged hospitalisation. In such instances, the costs of medical treatment would pose a significant burden to the families involved. As the probability of very serious accidents leading to prolonged hospitalisation and medical treatment is very low, insurance is an effective means of pooling risks to cushion the financial impact of medical treatment. The Committee thus recommends a tiered framework of school insurance, comprising a basic comprehensive insurance coverage for all students, with enhanced payouts to cover the risks of accidents or injuries. MOE could examine if centralised purchase of insurance plans for students will allow for significant economies of scale to be reaped.

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Improved Injury Data Collection System 15. To facilitate regular review and improvements in safety, it is important to have a robust and comprehensive system to collect data on injuries and when and how they occurred. The Committee recommends that MOE require schools to carry out incident reporting, and establish a repository of specific types of injury data. The repository could include data on the nature/type/severity of injury and type of activity that led to the injury. In developing this repository, a balance would have to be struck between comprehensiveness and level of detail of data, versus convenient data reporting / entry and timeliness of reporting by schools.

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The Committee further recommends that MOE put in place a structured process to periodically analyse the data, with a view to determining the effectiveness of existing sports safety measures, proposing refinements suggested by the data analysis, and track the follow-up actions taken.
WITH

C ONSULTATION 18.

S CHOOLS

ON

R ECOMMENDATIONS

The Committee consulted school principals, Heads of Department, and teachers-in-charge of CCAs for their views on the recommendations through FGD sessions. The participants were supportive of the key recommendations of the Committee, especially the recommendations to uplift the capacity of school sports coaches, and for better training and support to be given to teachers-in-charge of CCAs. In particular, teachers expressed strong support for the recommendations to strengthen CCA teacher deployment and handover guidelines for schools; provide teachers-in-charge of CCAs with more training on safety through means such as safety briefings and safety frameworks; and require teachers-in-charge of sports CCAs to maintain current first-aid certifications. .....

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CONCLUSION 1. The Committee recommends that MOE set up an implementation committee, comprising professionals with the expertise in the various areas, to work out and coordinate the details and implementation of the various recommendations. The Committee also recommends that the implementation committee aim to put in place the majority of the recommendations by end 2011. These include the expanded safety guidelines, providing teachers-in-charge of specific sports CCAs with better safety training and support, for example through the development of safety frameworks for each of these sports CCAs. Some recommendations such as the additional safety-related training courses for school coaches may however require more time to be developed and rolled out. In conclusion, the Committee notes that PE and sports play an important role in our schools, by contributing towards developing students psychomotor skills, health and fitness, as well as a lifelong orientation towards managing ones health and well-being. They also enhance the development of 21st century competencies in our students, by providing opportunities for them to develop life skills such as teamwork, resilience, and discipline. While MOEs current safety framework and practices are already sound and are generally in line with international best practice, the objective of this report is nevertheless to seek out areas for improvement. The implementation of these recommendations would require additional effort, resources and commitment on the part of MOE, schools and other stakeholders, including the National Sports Associations, parents and students. The Committees view is that these additional measures will help to further ensure that students can enjoy and excel in PE and sports activities, training and competitions in a safe environment. .....

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Annex A MEMBERS OF THE COMMITTEE ON SAFETY IN SCHOOL SPORTS (CSSS) Chairman Dr Mimi Choong May Ling Deputy Secretary (Services), MOE Members BG Ishak Bin Ismail Commander, 6th Division Mrs Shirley Lo nee Shirley Hoo Sok Kuan Chairman of South View Primary Parents Association Oon Jin Teik Chief Executive Officer, Singapore Sports Council Dr Quek Jin Jong Principal Officer, Office of Director, National Institute of Education Richard Seow Chairman, Singapore Sports Council Dr Ben Tan Head & Senior Consultant, Changi Sports Medicine Centre Wong Siew Hoong Director, Schools, MOE Ms Sum Chee Wah Director, Education Programmes, MOE Chua Kwan Ping Director, Finance and Development, MOE (up to 11 Oct 2010) Ms Evelyn Khoo Director, Finance and Development, MOE (from 12 Oct 2010) Ms Melanie Martens Principal, St. Anthonys Canossian Secondary School and Member of Secondary Schools Sports Council

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Annex B LIST OF SPORTS CCAS AND COMPETITIONS Sports CCAs offered by schools 1. 2. 3. 4. Adventure Club Aikido Archery Artistic Gymnastics 5. Athletics 6. Badminton 7. Basketball 8. Boccia 9. Boules 10. Canoeing 11. Cricket 12. Cross Country 13. Diving 14. Dragon Boat 15. Equestrian 16. Fencing 17. Floorball 18. Frisbee 19. Golf 20. Hockey 21. House 22. Ice Skating 23. In-line Skating 24. Judo 25. Karate 26. Lawn Bowls 27. Modular Sports 28. Mountain Trekking 29. Netball 30. Petanque 31. Rhythmic Gymnastics 32. Rowing 33. Rock Climbing 34. Rope Skipping 35. Rugby 36. Sailing 37. Sea Sports 38. Sepak Takraw 39. Shooting 40. Shorinji Kempo (Japanese Shao Lin) 41. Silat 42. Snooker 43. Soccer 44. Softball 45. Squash 46. Swimming 47. Synchronized Swimming 48. Table Tennis 49. Taekwondo 50. Tchoukball 51. Ten-pin Bowling 52. Tennis 53. Touch Football 54. Touch Rugby 55. Track & Field 56. Trampoline 57. Triathlon 58. Volleyball 59. Water Polo 60. Weightlifting 61. Windsurfing 62. Wrestling 63. Wushu

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Sports CCAs with inter-school competitions Competitions for Secondary Schools and above (Organised by SSSC) 1 Badminton 2 Basketball 3 Canoeing 4 Cricket 5 Cross Country 6 Golf 7 Gynmastics 8 Hockey 9 Judo 10 Netball 11 Rugby 12 Sailing 13 Sepak Takraw 14 Shooting 15 Soccer 16 Softball 17 Squash 18 Swimming 19 Table Tennis 20 Tennis 21 Tenpin Bowling 22 Track & Field 23 Volleyball 24 Waterpolo 25 Wushu 26 Floorball 27 Taekwondo Competitions for Primary Schools (Organised by SPSSC) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Badminton Basketball Floorball Golf Gymnastics Hockey Netball Rope Skipping Rugby Sailing Sepak Takraw Soccer Softball Swimming Table Tennis Taekwondo Tennis Tenpin Bowling Track and Field Volleyball Wushu

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Annex C BEST PRACTICES FOR SAFETY IN YOUTH SPORTS IN OTHER COUNTRIES BACKGROUND AND METHODOLOGY 1. In carrying out the scan of best practices for safety in youth sports, the Committee focused on the U.S, United Kingdom and Australia, where sports play an important part in the life of their citizens, and regular research and studies on sports safety are conducted. These countries also have established initiatives and policies on sports safety. Websites consulted included those of international multi-sports organizations (e.g., International Olympic Committee or IOC), national or states sports councils (e.g., Australian Sports Commission), and non-profit athletic associations (e.g., National Collegiate Athletic Association or NCAA of USA). Peerreviewed journal articles were also identified7. W HAT
ARE THE

F ACTORS

THAT CAN

A FFECT S AFETY

IN

Y OUTH S PORTS ?

2. Several factors that affect safety in youth sports, for which safety procedures should be put in place, were identified (Australian Sports Commission, 2005; Reeser, Verhagen, Briner, et al., 2006; Sport and Recreation Victoria, 2008; Sports Medicine Australia, 2008; NCAA, 2009a). Please see Table 1: Table 1: Factors Affecting Safety in Youth Sports
Athlete Factors Pre-existing medical conditions Current health status Infectious Diseases Coach Factors Qualifications Competency Planning / management of activity sessions Sports Factors Nature of the sport Nature of the risks involved in the sport Adherence to the rules Environment Factors State of the facilities / equipment Weather conditions

3. Athlete Factors. These factors include the current health status of the participants (e.g., level of physical fitness), their known medical conditions (e.g., asthma, epilepsy, etc) and the presence of infectious diseases. Coaches and officials should be aware of these when making decisions about athletes during training and competitions. 4. Coach Factors. These factors include the qualifications of the coach in the specific sport, as well as his/her competency in effectively training athletes (e.g., teaching proper techniques in the game, conveying the right attitudes and values, etc). The coachs planning and management of activity sessions (e.g., ensuring proper warm-up and cool-down, managing the amount and intensity of the activities, sufficient preparation before competition, etc) also affect safety in youth sports. 5. Sports Factors. These factors include the nature of the sport and the nature of the risks involved in the sport. Participation in different sports presents different
7

Information about Asian-oriented sports (e.g., martial arts) was limited.

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levels of risk8 and different types of risks (e.g., different types of injuries to different parts of the body). In addition, steps taken to ensure adherence to the rules before, during and after the sport also affect safety in youth sports, particularly for those involving contact sport and competition. 6. Environment Factors. These factors include the state of the facilities and equipment used in the sport (i.e., these should meet standard requirements for safety in the sport), as well as weather conditions that can impact participants physical well-being (e.g., extreme heat or cold, lightning, rain, etc). W HAT P RACTICES S PORTS ?
CAN BE

I MPLEMENTED

TO

E NHANCE S AFETY

IN

Y OUTH

7. Based on the factors described above, best practices implemented in other countries to help promote and enhance safety in youth sports were identified, categorized into (i) Education and Public Awareness; (ii) Prevention and (iii) Intervention. (I) Education and Public Awareness

8. This includes programmes, campaigns and materials to educate the public and youths so as to raise their awareness of good safety practices in youth sports. In particular, those who are more directly involved in youth sports (e.g., athletes, coaches / teachers, sports providers, parents, etc) should be aware of their roles and responsibilities in promoting safety. 9. For example, under the National Safe Kids Campaign, the National Athletic Trainers Association (NATA) provides guidelines and checklists for parents and coaches on what to consider before a child participates in organized sports (physical examination; ascertaining coaches qualifications; reducing the risk of heat illnesses, dehydration or injury; emergency plans in the event of an injury, etc) (NATA, 2003; 2010). Likewise, the NCAA RESPECT Campaign was embarked on by the NCAA Committee on Sportsmanship and Ethical Conduct in U.S.A. to raise awareness and commitment to sportsmanship among members of the association. In line with this, the RESPECT campaign brochure was produced to provide information for campus leaders and advisory groups on communication and educational plans in order to promote sportsmanship in student athletes, student athletes family members, coaches, opponent teams and venue staff (NCAA, 2009b). (II) Prevention

10. Some of the sources reviewed estimated that 50% or more of sport injuries are preventable (USAs Centers for Disease Control or CDC, n.d.; Sports Medicine Australia, 2008). Some preventive measures to promote sports safety before, during and after games are listed below and summarized in Table 2 (Accident Compensation Corporation, 2002; Sports Medicine Australia, 2008):

For instance, football was found to cause 1,024,022 injuries, soccer led to 368,726 injuries, gymnastics resulted in 67,542 injuries among U.S. youths under the age of 18 (University of Michigan Health System, 2009).

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Table 2: Preventive Measures to Promote Sport Safety

Before game Screening for pre-existing medical conditions and for record-keeping Proper warm-up, cool-down procedures, learning right techniques in sport and avoiding overexertion Conducive environmental conditions and wellfunctioning equipment During game Abiding by rules (Note: this may include the need to review and modify rules to make the sport safer and more appropriate for younger athletes) Match competitors by size, gender, strength, skill or experience instead of age Use of protective equipment that meet safety standards After game Proper injury management procedures

Before the game Screening. Screening aims to identify athletes who have pre-existing medical conditions that pose as risk factors in sport participation; identify factors that may predispose athletes to an increased risk of injury; obtain baseline physical data; assess efficacy of a rehabilitation programme on previous injuries; and assess lifestyle factors that may affect injury risk or performance. Screening can be done through questionnaires or medical testing. Physical training and practice. Proper warming up and stretching procedures should be done to reduce the risk of injury during training and/or competition. In addition, physical conditioning is required to prepare the body for the demands of the game, and includes training in the areas of strength, flexibility, endurance, balance, speed, and power. Athletes should also be taught the right techniques as incorrect techniques increase risk of injuries. Coaches should also guard the athletes against overexertion. Environment. This involves assessing environmental conditions to determine suitability for the sport (e.g. not playing during a storm when there is a possibility of being struck by lightning). Playing fields and facilities should also be regularly checked to ensure they are safe to use (e.g., not littered with dangerous materials such as broken glass). A comprehensive checklist should be developed to note what needs to be done.

During the game Rules and Fair Play. Following the rules of the sport helps protect oneself and others from injury. Rules may also be changed or enforced to avoid a situation where injury often occurs (e.g., by making certain actions illegal9 or making the use of protective equipment compulsory). In sports involving children, rules may be modified depending on the needs and abilities of the young athletes (e.g., using smaller/lighter equipment, reducing size of playing area, reducing match time to adapt to different levels of physical ability).

For example, a research study found that modifying rules in a taekwondo competition such that contact to the head, face, neck, or groin was prohibited, with the exception of the headgear, led to a reduced injury rate (Burke, Barfoot, Bryant, et al., 2003)

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Matched Competitors. Competitions should be balanced (i.e., competitors should be ideally matched by size, gender, strength, skill, or experience instead of just by age group). Protective Equipment. This refers to the proper use and maintenance of equipment. Examples of protective equipment include: mouthguard, helmet, protective padding (e.g., shin guards), eyewear, and footwear. In addition, regulatory bodies should oversee and enforce standards for protective equipment. For instance, in U.S.A., sports equipment that meet a certain safety standard will be endorsed by the National Operating Committee on Standards for Athletic Equipment (NOCSAE) (NCAA, 2009a).

After the game Injury Management. An injured athlete should be assessed and managed by qualified personnel (e.g., a sports first-aider or sports trainer). Good injury management minimizes the consequences of the injury and pain / discomfort to the individual. An example of a first aid management approach is the RICED (apply Rest, Ice, Compression, Elevation, & Diagnosis). Intervention

(III)

11. In the event that injuries occur, it is important that the relevant parties are aware of the procedures to follow in order to minimize the damage done. The NCAA Sports Medicine Handbook (2009a) provides guidelines on emergency plans for practice sessions and competitive events. These include the presence of a qualified and dedicated person who is able to provide emergency care, access or planned access to a physician, access to working emergency equipment, planned access to a medical facility, access to a telecommunication device for communication and transportation, availability of emergency information about the student athlete, as well as certification of athletics personnel in cardiopulmonary resuscitation techniques (CPR), first aid, and prevention of disease transmission. Likewise, the Australian Sports Commission Junior Sport Guidelines (2005) also emphasizes on the need for emergency planning. Sport providers should be familiar with emergency procedures and possess current first aid qualifications. Medical advice should be sought when the health and recovery from illness/injury of a student athlete is uncertain; and when the student athlete is injured while training or during a competition. The Guidelines recommend the prohibition of the young persons to participate if medical advice is unavailable. 12. In addition, a sports injury surveillance system is required to collect information on the incidence, nature, and severity of injury in a sport, monitor longitudinal trends in injury, determine the risk and causal factors behind the injury, and assist in evaluating policy regarding injury prevention by planning preventive measures to reduce the incidence of injury. For example, the NCAA has a system which contains data on injury trends in U.S. intercollegiate athletics. Data on injury and exposure are collected on a yearly basis from a representative sample of NCAA member institutions. This data is then reviewed by NCAA Sport Rules Committee and the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports, to guide them in making appropriate recommendations for safety measures. One example is the NCAAs Competitive Safeguards Committees recommendation C-4

of having a championship sports-wide playing rule prohibiting student athletes who display signs of concussion from returning to play until they are cleared by a physician or designated health-care professional. Similarly, based on data on areas where injuries are most likely to occur, the rules of certain sports (e.g., volleyball, American football, taekwondo) have been modified to prevent / reduce injuries. L EARNING P OINTS S INGAPORE S CHOOLS

FOR

13. The above scan of best practices for safety in youth sports in other countries has highlighted the following learning points for Singapore schools, based on the three tier framework of Education and Public Awareness; Prevention; and Intervention: Education and Public Awareness (a) It is important to educate and involve not only those who are directly affected (i.e., youth athletes, coaches, sports providers), but also relevant parties such as parents, sports officials and safety personnel. Prevention (b) There should be strong partnerships among the key stakeholders (e.g., MOE, Singapore Sports Council (SSC) and the National Sports Associations (NSAs)), to develop safety standards and good practices for sports providers, coaches and other related parties. (c) For high-risk sports, important preventive measures that should always be in place include: ensuring that rules are appropriately modified to minimize injury and appropriate for youth sports; ensuring matched competitors (based on criteria such as strength and skill instead of purely by chronological age group); and ensuring proper use and maintenance of protective equipment. (d) A system to ensure the regulation and training of coaches should be established, to ensure that coaches are qualified and competent to ensure the youths are trained to play properly and in a safe way. Intervention (e) It is important to have an injury surveillance system, to track the incidence and severity of injuries in selected sports, especially those with high injury rates (e.g., rugby, football, martial arts, basketball). Based on such data and from existing findings on etiology of injuries in youth sports (i.e., how, where, when, what injuries occur), safety measures and rules of the sport could be reviewed and further refined.

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REFERENCES Accident Compensation Corporation (ACC). (2002). ACC Sportsmart: Educational Resource. Retrieved, 30 April, 2010, from http://www.acc.co.nz/preventinginjuries/playing-sport/sportsmart-10-point-plan/index.htm. Australian Sports Commission. (2005). Making sport safe. Junior sports guidelines. Retrieved, 30 April, 2010, from http://www.ausport.gov.au/participating/schools_and_juniors/juniors/resources/ju nior_sport_framework. Burke, D., K., Barfoot, Bryant, S., Schneider, J., Kim, H., H., & Levin, G. (2010). Effects of safety measures in tae kwon do. British Journal of Sports Medicine , 37I, 401 . Centers for Disease Control (CDC). (n.d.) Protect the ones you love: Sports injuries. Retrieved 30 April, 2010, from http://cdc.gov/safechild/Fact_Sheets/SportsInjury-Fact-Sheet-English-a.pdf Dick, R., Agel, J. & Marshall, S. W. (2007). National Collegiate Athletic Association Injury Surveillance System Commentaries: Introduction and Methods. Journal of Athletic Training, 42 (2), 173182. International Olympic Committee (IOC). (2009). Olympic Movement Medical Code. Retrieved 30 April, 2010, from http://www.olympic.org/PageFiles/61597/Olympic_Movement_Medical_Code_en g.pdf. Junge, A., Engebretsen, L., Alonso, J. M., Renstrom, P., Mountjoy, M. L., Aubry, M. & Dvorak, J. (2008). Injury surveillance in multi-sport events The IOC approach. British Journal of Sports Medicine, 42, 413-421. McInulty, K. (2006). Creating a safe environment for children in sport. UK: CHILDREN 1st and Sportscotland. Retrieved 30 April, 2010, from http://www.childprotectioninsport.org.uk/. Micheli, L., Glassman, R., & Klein, M. (2000). The prevention of sports injuries in children. Clinics in Sports Medicine, 19(4), 821-834. National Athletic Trainers Association (NATA). (2003). Parents and coaches guide to dehydration and other heat illnesses in children. Retrieved May 3, 2010 from http://www.nata.org/consumer/docs/parentandcoachesguide.pdf National Athletic Trainers Association (NATA). (2010). Sports safety checklist to help prevent common athletic injuries. Retrieved May 3, 2010 from http://www.nata.org/youthsports/NATAcheklist9.pdf National Collegiate Athletic Association (NCAA). (2009a). 2009-10 NCCA Sports Medicine Handbook. Retrieved May 3, 2010 from

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http://www.ncaapublications.com/p-3937-2009-2010-sports-medicinehandbook.aspx National Collegiate Athletic Association (NCAA). (2009b). Respect. Its the name of the game. Retrieved May 3, 2010 from http://www.ncaa.org/wps/wcm/connect/45d9e68041ed57dd941694613c9c02ac/ RESPECT_Pamplet_New.pdf?MOD=AJPERES&CACHEID=45d9e68041ed57d d941694613c9c02ac National Youth Sports Safety Foundation (NYSSF). (2001). Emotional injuries fact sheet. Retrieved 30 April, 2010, from http://www.nyssf.org/emotionalabuse.pdf. Reeser, J., Verhagen, E., Briner, W., Askeland, T., & Bahr, R. (2006). Strategies for the prevention of volleyball related injuries. British Journal of Sports Medicine, 40, 594-600. Sport and Recreation Victoria. (2008). Keeping Junior Sport Safe. Australia: State Government of Victoria. Retrieved 30 April, 2010, from http://www.sport.vic.gov.au/web9/rwpgslib.nsf/GraphicFiles/Keeping+Junior+Spo rt+Safe/$file/Keeping+Junior+Sport+Safe+PDF.pdf. Sport England. (2007). Helping keep your child safe in sport: Child protection leaflet for parents. Retrieved 30 April, 2010, from http://www.culture.gov.uk/images/publications/safeinsport.pdf . Sports Medicine Australia. (2008). Safety guidelines for children in sport and recreation (2e). Retrieved 30 April, 2010, from http://www.sport.vic.gov.au/web9/rwpgslib.nsf/GraphicFiles/Safety+Guidelines+f or+Children+and+Young+People+in+Sport+and+Recreation/$file/SMA+ChildSaf +bkLRcompFinal.pdf. University of Michigan Health System. (2009). Youth sports safety: Your child. Retrieved 30 April, 2010, from http://www.med.umich.edu/yourchild/topics/sportsaf.htm. Van Tiggelen, D., Wickes, S., Stevens, V., Roosen, P., & Witvrouw, E. (2008). Effective prevention of sports injuries: a model integrating efficacy, efficiency, compliance and risk-taking behaviour. British Journal of Sports Medicine, 42, 648-652.

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Annex D Summary of Injury Rates in Various Studies

Country United States United States United States United States 15 to 24 years United States United States Canada Canada Holland Australia 15 to 39 years 5 to 9 years Australia 10 to 14 years 15 to 19 years 0 to 14 years Australia
SI

Age Group 7 to 13 years 13 to 18 years 0 to 19 years High school athletes 5 to 14 years

Injury Rate 16.4 (range 10 to 23) 1.94 333.25 260 (range 132 to 500) 1.38 (Range 0.02 to 5.29) 1.23 (Range 0.08 to 5.78) Game 13.79 Practice 3.98 2.51 Game 4.63 Practice 1.69 67.3 270.0 293.0 2.18 1.53 106 22.1 SI 12.3 26.1 SI 9.8 2.68 (2003) 2.81 (2004) 2.52 (2005) 5.59 (2003) 5.70 (2004) 5.72 (2005) 4.85 (2003) 5.01 (2004) 5.21 (2005) 5.43 4.70 5.17

Remarks Per 1000 athlete exposure (averaged over 5 sports) Per 1000 athlete exposure Per 1000 children and teenagers Per 1000 participants (averaged over 8 sports) Per 1000 population (Product-related injuries, averaged over 16 sports) Per 1000 population (Product-related injuries, averaged over 16 sports) Per 1000 athlete-exposure Per 1000 athlete-exposure Per 1000 hospitalisation cases Per 1000 hospitalisation cases Per 1000 hospitalisation cases (hospitalisation) Per 1000 population (hospitalisation) Per 1000 population Per 1000 participants Per 1000 participants Per 1000 participants (hospitalisation) Per 1000 population (hospitalisation) Per 1000 population (hospitalisation) Per 1000 population Per 1000 population Per 1000 population Per 1000 participants

College students High School athletes 5 to 9 years 10 to 14 years 15 to 19 years 0 to 14 years 15 to 24 years 8 to 17 years 5 to 14 years

15 to 24 years

Significant Injury

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SN 1.

Reference/ Country/ Sample Size/ Method Radelet, M. A., Lephart, S. M., Rubinstein, E. N. & Myers, J. B. (2002). Survey of the injury rate for children in community sports. Pediatrics, 110 (3), 1-11 United States of America 1,659 children aged 7 to 13 (participating in community organised baseball, softball, soccer and football) Observational cohort study, data collected through coaches using an injury survey tool

Definition of Injury An jury was defined as An injury that brought a coach into the field to check the condition of a player. An injury which a player was removed from participation. An injury which a player needed any type of first aid during an event.

Types of Sports Baseball (boys) Football (boys) Soccer Softball (girls)

Summary of Findings Sports injury per 1000 athletes exposure Average 16.4

Type of Sports Soccer (girls): 23 Baseball (boys): 17 Soccer (boys): 17 Football (boys): 15 Softball (girls): 10 Types of injuries: Bruises (54%) Sprain or strain (15%) Laceration/abrasion (8%) Fracture (5%) Concussion (3%) Dislocation (1%) Neck Injury (1%) Others (13%) Circumstances: Injury rate for games significantly higher that injury rate for practice (except softball, higher but not significant)

2.

CHIRPP INJURY BRIEF Canadian Hospitals Injury Reporting and Prevention Program Injuries associated with ... TEAM SPORTS, 2000-2002 Canada 273, 293 records of ages 5 years and older Data collected from pediatric hospitals

No specifications

Baseball Basketball Broomball European handball Floor hockey Football Hockey Ice hockey Lacrosse Omikin Ringette Roller hockey Rugby Soccer Street hockey Ultimate Frisbee Volleyball Water polo Dodgeball Soccer-baseball Hockey

Sports injury per 1000 CHIRPP cases 5 to 9 yrs old 67.3 10 to 14 yrs old 270.0 15 to 19 yrs old 293.0 20 yrs and older 69.6 Injuries do not represent all injuries in Canada, but only those seen at the emergency departments of the 15 hospitals in the CHIRPP network. Under-representation of: older teenagers and adults native people people who live in rural areas fatal injuries

Type of sports (top 3 most frequent): Males (5-9) Females (5-9) Soccer Soccer Ice Hockey Basketball Basketball Baseball Males (10-14) Ice Hockey Basketball Soccer Males (15-19) Ice Hockey Basketball Football Females (10-14) Soccer Basketball Volleyball Females (15-19) Soccer Basketball Volleyball

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3.

Backx, F.J. G., Erich, B. M., Kemper, B. A. & Verbeek A.L. M. (1989) Sports injuries in

school-aged children : An epidemiologic study. AM J Sports Med 17: 234 Holland 7,468 pupils aged 8 to 17 Questionnaire covering a retrospective period of 6 weeks

A sports injury was defined as physical damage caused by a sports-related incident and reported as such by the respondent.

Badminton Ballet Basketball Club gymnastics Field hockey Handball Horse riding Korfball Martial arts Soccer Swimming Tennis Track and field Volleyball Others

Sports injury per 1000 participants: 8 to 17 yrs old 106 Type of injuries: Contusions (40%) Sprains (37%) Strains (7%) Fractures and dislocations (6%) Concussions (2%) Other injuries (8%)

Type of sports (top 5 most frequent): Badminton Field hockey Track and field Korfball Handball Cause of Injuries: Misstep, Twisting motion (31%) Falling/stumbling (24%) Kick (13%) Ball (11%) Opponent (10%) Tiredness (3%) Unknown (12%) Circumstances: Sports club training (29%) Sport club matches (33%) Physical education classes (21%) Non-organised sports (17%)

4.

Borowski L.A, Yard E.E., Fields S.K. and Comstock R.D. (2008) The Epidemiology of US High School Basketball Injuries, 20052007. Am J Sports Med (38) 2328-2335 United States of America 780,651 athlete exposures from 100 nationally representative US high schools (aged 13-18) Collected from 100 nationally representative high schools through High School Reporting Information Online system

An injury was defined as one that met the following 3 criteria: occurred as a result of participation in an organized high school basketball practice or competition. required medical attention by an AT or a physician. resulted in restriction of the student athletes participation for 1 or more days beyond the day of the injury.

Basketball

Sports injuries per 1000 athlete exposure Overall (13 to 18 yrs old) 1.94

Circumstances Practice (1.40) Competition (3.27)

5.

Conn J.M., Annest J.L., Bossarte R.M., and Gilchrist J. (2006) Non-fatal sports and recreational violent injuries among children and teenagers, United States, 20012003. Journal of Science and Medicine in Sport 9, 479489 United States of America Children and teenagers aged 0 to 19 yrs Data obtained from the National Electronic Injury Surveillance SystemAll Injury Program (NEISSAIP)a national sample of 66 U.S. EDs

A sports and recreational injury was defined as bodily harm caused by external force to a participant or spectator or by exposure to a substance associated with a sports and recreational activity.

Not specified

Sports injuries per 1000 children and teenagers Overall (0 to 19 yrs old) 33.33

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6.

Finch C., Cassell E. (2006) The public health impact of injury during sport and active recreation. Journal of Science and Medicine in Sport 9, 490497 Latrobe Valley, Australia 1,084 persons from 417 households (aged over 4 years) Random household telephone survey

A sport and active recreation injury was defined as any reported injury occurring during this participation, whether or not it required treatment or impacted on participation. A significant injury was defined as a reported injury that required treatment, interfered with performance of the activities of daily living and/or had adverse effects on participation or performance in subsequent activity An injury was defined as Any injury that causes cessation of participation in the current game or practice and prevents the player's return to that session. Any injury that causes cessation of a player's customary participation on the day following the day of onset. Any fracture that occurs, even though the athlete does not miss any regularly scheduled session. Any dental injury, including fillings, luxations, and fractures. Any mild brain injury that requires cessation of a player's participation for observation before returning, either in the current session or the next session. No consistent definition across agencies.

Australian football Basketball Cricket Netball Soccer Tennis Walking

Sports injury per 1000 participants: 5 to 14 yrs old 22.1 15 to 39 yrs old 26.1 Significant Injuries 5 to 14 yrs old 12.3 15 to 39 yrs old 9.8

Type of sports (top 5 most frequent): Cricket Soccer Baseball Netball Tennis

7.

Powell, J. W. & Barber-Foss, K. D. (1999). Injury Patterns in Selected High School Sports: A Review of the 1995-1997 Seasons. Journal of Athletic Training, 34(3), 277-284 United States of America High school athletes on varsity sports rosters Certified athletic trainers recorded data using a surveillance protocol

Baseball (Boys only) Basketball Field hockey (Girls only) Football (Boys only) Soccer Softball (Girls only) Volleyball (Girls only) Wrestling (Boys only)

Sports injury per 1000 participants: Average over the different sports 260 (range 132 to 500)

Type of sports (top 5 most frequent): Football Wrestling Soccer (Girls) Basketball (Girls) Basketball (Boys) Circumstances: Practice (55.5% [range 40.7% to 68.8%])) Game (44.4% [range 33.0% to 57.0%])

8.

Mitchell R. Boufous S. Finch CF. Sport/leisure injuries in New South Wales: Trends in sport/leisure injury hospitalizations (20032005) and the prevalence of non-hospitalised injuries (2005). Sydney: New South Wales Injury Risk Management Research Centre, July 2008. New South Wales, Australia Records of hospitalisation of NSW residents at NSW-based hospitals from NSW Admitted Patients Data Collection (APDC)

Code used with 260 different categories

Sports injury hospitalisations per 1000 population: 5 to 9 yrs old o 2.68 (2003) o 2.81 (2004) o 2.52 (2005) 10 to 14 yrs old o 5.59 (2003) o 5.70 (2004) o 5.72 (2005) 15 to 19 yrs old o 4.85 (2003) o 5.01 (2004) o 5.21 (2005)

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9.

National Electronic Injury Surveillance System (NEISS) 2009 United States of America 96 hospitals (national probability sample of hospitals) CPSC's National Electronic Injury Surveillance System (NEISS) collects current injury data associated with consumer products from U.S. hospital emergency departments across the country.

Injury cases collected from hospitals.

Included sports and non-sports product/ equipment: Baseball & softball Basketball Boxing Football Hockey In-line skating Lacrosse, rugby, misc. ball games Racquet sports Skateboards Skating (excl. in-line) Soccer Swimming, pools, equipment Track & field activities, equipment Trampolines Volleyball Water skiing, tubing, surfing

Estimated rate of product-related injuries per 1000 population 5-14 years old (average of selected groups) 1.38 (Range 0.02 to 5.29) 15-24 years old (average of selected groups) 1.23 (Range 0.08 to 5.78)

Type of Sports (5 to 14 yrs old) Football: 5.29 Basketball: 3.63 Baseball & softball: 2.69 Soccer: 2.16 Skateboards: 1.64 Type of Sports (15 to 29 yrs old) Basketball: 5.78 Football: 4.37 Baseball & softball: 1.98 Soccer: 1.91 Skateboards: 1.34

10.

Alberta Centre for Injury Control and Research Children and Youth Injuries in Alberta, Retrieved from: http://acicr.ca/Upload/documents-reports/injuryfactsdata-reports/injury-data-summaryreports/children-and-youth-injuries-in-albertadata-summaryreport/InjuriesChildYouth2009.pdf Alberta, Canada

Sports-related hospital admission

Sports and recreation related injury hospitalisation per 1000 population 0 to 14 yrs old 2.18 15 to 24 yrs old 1.53

11.

Hootman J. M., Dick R. and Agel J. Epidemiology of Collegiate Injuries for 15 Sports: Summary and Recommendations for Injury Prevention Initiatives. Journal of Athletic Training 2007;42(2):311319 United States of America Data from National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS)

An injury is defined as a condition meeting all of the following criteria: Occurred as a result of participation in an organized intercollegiate practice or contest. Injury required medical attention by a team certified athletic trainer or physician. Injury resulted in restriction of the student athletes participation or performance for one or more days beyond the day of injury.

Baseball (Men) Basketball Field Hockey (Women) Football (Men) Gymnastics Ice Hockey (Men) Lacrosse Soccer Softball (Women) Volleyball (Women) Wrestling (Men)

Sports injury per 1000 athleteexposures: Game 13.79 Practice 3.98

Cause of Injuries (Game): Player Contact (58.0%) No contact (17.7%) Other contact (20.0%) Unknown (4.3%) Cause of Injuries (Practice): Player Contact (41.6%) No contact (36.8%) Other contact (15.4%) Unknown (6.2%)

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12.

Flood L and Harrison JE (2006). Hospitalised sports injury, Australia 200203 Injury Research and Statistics Series Number 27. (AIHW cat no. INJCAT 79) Adelaide: AIHW Australia Data from the National Hospital Morbidity Database compiled by the Australian Institute of Health and Welfare (AIHW) for inpatient care in the financial year 20022003

An injury was defined as any sport related injury that was sufficiently serious to result in admission to hospital.

Code used with 260 different categories

Sports and recreation related injury hospitalisation per 1000 population 0 to 14 yrs old 5.43 15 to 24 yrs old 4.70 Sports and recreation related injury hospitalisation per 1000 participants 15 to 24 yrs old 5.17

Type of sports (top 5 most frequent): Football (Australian and Unspecified) Soccer Rugby (Union, League and Unspecified) Water Sports Cycling Type of injuries (in order of frequency most to least): Fracture Open wound (excluding eye) Dislocation Sprain/strain Intracranial Muscle/tendon Superficial (excluding eye) Internal organ Nerve & spinal cord Eye injury Cause of Injuries (in order of frequency most to least): Other fall Land transport Contact with another person Fall same level, contact by person Fall from slip, trip and stumble Contact with sports equipment Strikes/struck Other transport Foreign body Contact with animal or plant

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Julie A. Rechel, Ellen E Yard, and R. Dawn Comstock. An Epidemiologic Comparison of High School Sports Injuries Sustained in Practice and Competition. J Athl Train. 2008 MarApr; 43(2): 197204. United States of America High school athletes Collected from 100 nationally representative high schools through High School Reporting Information Online system

An injury was defined as a condition meeting all of the following criteria: Occurred as a result of participation in an organized high school practice or competition. Required medical attention by an AT or physician. Resulted in restriction of the student-athlete's participation for 1 day or more beyond the day of injury.

Baseball (Boys) Basketball Football (Boys) Soccer Softball (Girls) Volleyball (Girls) Wrestling (Boys)

Sports injury per 1000 AthleteExposure Overall 2.51 o Practice 1.69 o Competition 4.63

Type of sports (top 5 most frequent): Football (Boys) 4.36 Wrestling (Boys) 2.50 Soccer (Boys) 2.43 Soccer (Girls) 2.36 Basketball (Girls) 2.01 Types of injuries: Sprain or strain (52.1%) Contusions (12.3%) Fracture (9.8%) Concussion (9.1%)

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Annex E ROLES OF STAKEHOLDERS IN PROMOTING SCHOOL SPORTS SAFETY Stakeholder Role in promoting school sports safety
Stakeholders within the MOE / School system MOE HQ The MOE School Safety Committee (MOE SSC), supported by the School Safety Unit (SSU), oversees the development, review, implementation and compliance of school sports safety (as part of the larger school safety framework) at the MOE level. The MOE SSC regularly and effectively communicates safety information to schools. MOE HQ maintains and reviews regularly an overall risk classification and baseline safety framework which is mandatory for schools to adhere to. [MOE HQ oversees the risk-tiered insurance framework which schools take guidance from and procure appropriate insurance for students accordingly, based on the risk levels in their sports. MOE HQ oversees the incident management system by schools, and tracks injury data with a clearly specified and standardised set of data fields. MOE HQ performs regular analysis of the injury data, proposes refinements to sports safety measures arising from the data analysis, and tracks the follow-up actions taken. The School Safety Committee (SSC), headed by the VP (or a suitable representative) of each school, oversees the development and review of sports safety issues at the school level. The MOE SSC regularly and effectively communicates safety information to stakeholders at the school level. School leaders implement MOE HQs sports safety guidelines, and ensures accurate and timely reporting of sports incident data and school coach issues to MOE HQ. School leaders ensure that students involved in the respective sports are covered by the appropriate level of insurance.

School leadership

PE / CCA Teachers

Safety education and training Most importantly, PE / CCA teachers are responsible for the achievement of the student learning outcomes during school sports Ensure that they possess basic knowledge about sports safety and possess current first-aid certification. Conduct generic safety briefings for students and include safety briefing specific to the CCA they are in charge of. Preventive measures 10 Pre-screen student data for medical conditions. Exempt unwell students (those with MCs, letters from parents, teachers observations) from physical activities. Conduct checks before each CCA to ensure that the equipment and facilities (fitness stations, courts, fields, availability of water, first aid kit) are safe for use. Conduct robust risk assessment through the Risk Assessment and Management System (RAMS) prior to activities, if necessary. During conduct of activities

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Through data sources such as the Annual Precautionary List, Individual Pupils Precautionary Forms and use the Pupil Medical Record Forms

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Ensure that coaches conduct trainings safely and report unsafe practices or behaviour of coaches to School SSC. During competitions, ensure that there are safety measures in place. For example, ambulances can be on standby for sports such as Rugby, Judo and Taekwondo (facilities and equipment are organisers and NSAs responsibility). Ensure that students follow safety rules and guidelines. Be on the lookout for students in need or who needs to discontinue participation. Responding to safety incidents First responder to safety incidents. Perform first aid if necessary. Make decision on whether to send student to hospital. Report incident to school SSC and inform parents as necessary. Students Understand and obey safety rules and procedures. Highlight to teacher or coach when there is an incident or when there are unsafe practices. Understand when to cease participation in activity when feeling unwell. Internalise school sports ethics and values, such as integrity, fairness, respect, good sportsmanship, team spirit, and safety and reinforce them in teammates and schoolmates. Stakeholders outside MOE / School system Coaches Safety education and training Ensure that they meet the minimum requirements in the technical skills, pedagogical skills, continuing training areas in the school sports coaches framework. Communicate and ensure that students are aware of safety rules and regulations. Establish and promote safety habits for student athletes (e.g. conducting warm-up before training or events). Preventive measures Conduct regular checks to ensure that the equipment and facilities (fitness stations, courts, fields, availability of water, first aid kit) are safe and well-maintained. Exempt unwell students from physical activities. During conduct of activities Create an environment that encourages fair play and playing within the rules. Ensure that activities are appropriate for the physical and skill levels of different students, and be aware of students medical conditions. Be on the lookout for students in need or who needs to discontinue participation. Responding to safety incidents First responder to safety incidents. Perform first aid if necessary. Attend to student and seek medical help if needed. Report incident to MOE teacher-in-charge. Take note of relevant details and assist in investigations if necessary. Developing safety guidelines and standards for their respective sports. Ensuring that coaches are properly trained and possess the necessary qualifications, such as through working with SSC on NCAP. Providing national awareness of safety in respective sport. Preventive measures Officials have to ensure that the safety aspects of the event (e.g. weather, facilities, equipment) are acceptable before allowing the event

NSAs and Officials

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to take place. During conduct of activities During the event, ensure that rules are enforced. Officials to identify students in need and assist in seeking medical help when necessary. Responding to safety incidents Assist in investigations. Initiate review of safety SOPs and guidelines if necessary. Parents Play collaborative and supportive roles in helping to promote and encourage school sports safety. o Parents awareness and participation in sports safety would encourage and support a sports safety culture in school and help children to learn the importance of sport safety measures and practices. o Inculcate ethics and values in sports, such as integrity, fairness, respect, good sportsmanship, team spirit, safety amongst others to students. o Parents could be engaged to support the school in suitable roles in helping to ensure sports safety awareness and practices are in place.

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