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Rule Change to Enhance Heart Protection for Athletes


The US Lacrosse Board of Directors has approved equipment-related rule changes designed to enhance heart protection for youth players, specifically to reduce the risk of the rare yet potentially catastrophic injury of commotio cordis.

The rule changes will be included in the 2019 US Lacrosse Boys’ and Girls’ Field Lacrosse Rulebooks, with a delayed implementation requirement to allow for product development by equipment manufacturers.  

Beginning in January 2021, US Lacrosse boys’ and girls’ youth field lacrosse rules will require that all goalie chest protectors must meet the NOCSAE performance standard ND200 in order to be deemed legal for play. In addition, beginning in 2022, all field players in boys’ lacrosse must wear protection for commotio cordis that also meets the same NOCSAE performance standard. US Lacrosse will be updating the 2019 box/indoor lacrosse rules later this fall.

All goalie and field player equipment meeting the NOCSAE performance standard must contain an SEI (Safety Equipment Institute) certification mark. Consumers can verify the certification status of equipment by accessing the SEI website at and clicking on NOCSAE: Chest Protectors (Lacrosse) (ND200-17a). 

The NFHS (National Federation of State High School Associations) is also adopting similar language for goalies for the rules that govern high school boys’ and girls’ lacrosse. The NFHS has not yet mandated the protection requirement for boys’ field players.

The NOCSAE ND200 performance standard was formally approved in 2017, and became active with an effective date of January 2018. The chest protection standard was developed based on substantial research and testing conducted by Dr. Mark Link, a board-certified cardiac electrophysiologist and worldwide authority on commotio cordis. Link’s research provided critical data to support an equipment intervention in reducing the likelihood of commotio cordis.

“I applaud US Lacrosse on this decision because mandating the use of chest protection that meets the performance standard will make lacrosse safer,” Link said. “This is simply another step in US Lacrosse’s established history of being focused on player safety.”

US Lacrosse has been committed to expanding and elevating safety initiatives in lacrosse since its inception in 1998, and has funded over $1 million in health-related research to improve the well-being of lacrosse participants at all levels of play. Primary in that endeavor has been the organization’s commitment to the study, understanding and prevention of commotio cordis, a type of sudden cardiac arrest caused by a blunt, but often relatively mild, blow to the area of the chest directly over the heart occurring during a precise moment of heart's cycle. 

US Lacrosse continues to advocate for the presence of an AED at every lacrosse practice and game, and partners with One Beat to provide discounted AED devices to the lacrosse community.

“US Lacrosse is grateful for NOCSAE’s leadership in voting to approve a chest protection standard to address commotio cordis. US Lacrosse has been an eager partner in this process for many years and has provided substantial research funding that has supported the development of this performance standard,” said Ann Carpenetti, vice president of lacrosse operations at US Lacrosse. “Our organization continues its commitment to working with rule making bodies in lacrosse to incorporate the use of NOCSAE-certified chest protectors in the sport.”

The specific language that was approved for inclusion in the 2019 NFHS/USL Girls’ High School Rulebook, 2019 US Lacrosse Boys’ Youth Rulebook, and 2019 US Lacrosse Girls’ Youth Rulebook is as follows:

Beginning in 2021, only a goalkeeper chest protector designed for lacrosse that incorporates the NOCSAE ND200 standard will be legal for play and shall contain an SEI certification mark.

Also, this additional language has been approved for the 2019 US Lacrosse Boys’ Rulebook only:

Beginning in 2022, field players must wear protectors for commotio cordis that meet the NOCSAE ND200 standard and contain an SEI certification mark.

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