When it comes to protecting high school athletes from potentially life-threatening risks, Maine ranks 26th overall and second among New England states, according to a state-by-state survey conducted by the Korey Stringer Institute.

KSI announced its results Tuesday at NFL headquarters. The league partially sponsors the sports safety research and advocacy institute located at the University of Connecticut, and named for the Minnesota Vikings lineman who died from exertional heat stroke in 2001.

The study judged how well states implement key safety guidelines to prevent and manage sudden-death and catastrophic injuries, at practices and games.

Only guidelines mandated by state high school athletic associations were considered worthy of a positive score.

Maine ranked 26th among the 50 states plus the District of Columbia with a graded score of 47.1 percent of safety guidelines met.

The Maine Principals’ Association did not have an immediate comment on the KSI report. Executive director Dick Durost referred comment to assistant director Mike Burnham, the staff member serving on the MPA’s Sports Medicine Advisory Committee. Burnham wasn’t available.

North Carolina topped the rankings, meeting 79 percent of guidelines, followed by Kentucky (71 percent), Massachusetts (67), New Jersey (67) and South Dakota (61).

Colorado (23) and California (26) had the lowest rankings.

Among the six New England states, Maine ranked ahead of Rhode Island (27th), Vermont (34th), Connecticut (38th) and New Hampshire (44th).

“The goal of KSI in releasing these rankings (is) to prevent needless deaths in high school sports,” Dr. Douglas Casa, the study’s lead author, told the Associated Press.

Cardiac arrest, traumatic head injuries, heat stroke and exertionally sickling occurring in athletes with sickle cell trait account for 90 percent of sudden deaths in the high school age group.

Over 7.8 million students participate in high school sports annually. Between 1982 and 2015 there have been 735 fatalities in high school sports.

In 2016, seven high school football players died from direct (on-field impact) or indirect (heat stroke, cardiac arrest) causes.

The KSI study claims sports fatalities and other catastrophic injuries are reduced when best-practice guidelines are followed.

The KSI portrayal of Maine is “accurate,” said John Ryan, the South Portland High athletic trainer and vice president of the Maine Athletic Trainers Association.

“I think the overarching issue is one of mandating,” Ryan said. “Any time something is mandated educationally and there is no money behind that mandate, school systems are hesitant to proceed forward.”

Scoring was based on a grading system that had five major categories, each worth 20 points: exertional heat stroke, traumatic head injuries, sudden cardiac arrest, appropriate health care coverage and emergency preparedness.

Maine graded poorly in exertional heat stroke (2.5 points out of 20) and traumatic head injuries (4 of 20).

Part of the exertional heat stroke grade is based on preseason practice rules to promote heat acclimatization. The MPA has preseason practice guidelines but none met the KSI standards, in part because Maine allows two-a-day practices.

“I am of the opinion and I think many of my colleagues would also agree, that we need to be moving away from double sessions,” Ryan said.

Ten of the traumatic head injury “points” are tied to states requiring football coaches to take Heads Up Football training, an NFL-funded youth program.

Heads Up Football, and the NFL, drew criticism in 2016 when the New York Times reported Heads Up Football’s claims of significantly reducing injuries and concussions were not supported by research.

Four states – New Mexico, Oregon, Washington and Vermont – require Heads Up Football certification.

Maine scored well in the KSI study for being prepared for sudden cardiac arrest (16 of 20) and having appropriate coverage by licensed health care providers at athletic contests (15 of 20 points).

Maine received 9.6 of 20 points under the emergency preparedness category, most of the points coming from the MPA’s requirement that all coaches be trained in CPR/first aid, and annually complete video courses related to heat illness and sudden cardiac arrest.

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