Chest protectors and ND200: the commotio cordis standard, and who requires it.

What commotio cordis is, and how often the medical literature records it, is on commotio cordis. This page is about the standard and the rules.

The standard: ND200

ND200's full title is "Standard Test Method and Performance Specification Used in Evaluating the Performance Characteristics of Protectors for Commotio Cordis". ND201 is the laboratory guide for certifying new chest protectors to it.

How it was adopted

• NOCSAE introduced a proposed chest protector standard at its January 2016 meeting, open for comment until January 2017, covering baseball and lacrosse because catchers and goalkeepers are typically the most exposed (NOCSAE, 15 June 2016).
• NOCSAE's Standards Committee voted to finalise it on 27 January 2017 in Phoenix. NOCSAE announced it on 30 January 2017 as the world's first such standard for baseball and lacrosse, taking effect in January 2018, and said it is intended to significantly reduce the likelihood of commotio cordis.
• NOCSAE says the research behind it was funded by the Louis J. Acompora Memorial Foundation and carried out with USA Lacrosse. USA Lacrosse Magazine (19 March 2019) credits the research and testing to work led by Dr Mark Link, a cardiac electrophysiologist.

Editions and dates

• NOCSAE's ND200 page lists ND200-22m25 as current and ND200-22m22 as the previous edition. It shows "Approved January 2022" and "Effective January 2023" against the ND200-22 designation, but the layout leaves unclear which edition those dates belong to.
• The ND200-22m25 document is marked "Modified December 2025", carries a 2017 NOCSAE copyright line, and lists changes dated February 2017, June 2017, February 2018, July 2019, January 2021, January 2022, June 2022 and December 2025. NOCSAE's February 2026 Standards Committee agenda describes the 2025 change as replacing references to ND001 with its text and reformatting; the research found no separate effective date for it.
• ND200-21: at its 23 July 2021 meeting NOCSAE set an effective date for this revision, after which products certified to ND200-19 could still be sold but no longer made. The date differs between sources: the National Sporting Goods Association's report gives 31 January 2023, and NOCSAE's ND200 document page gives 1 February 2023.

What it tests, named only

• Protectors are tested as offered for sale, with their hardware and fitting instructions, on the NOCSAE Thoracic Surrogate, which NOCSAE believes will improve protector performance and so reduce the risk of commotio cordis.
• The maker designates a baseball or a lacrosse ball as the projectile, and impacts are made at 30 mph and 50 mph at the centre of the cardiac silhouette and at random locations.
• Pass or fail in the current text: peak force at the cardiac load cell may not exceed 90 lbf (400 N) at 30 mph or 180 lbf (800 N) at 50 mph.
• ND200 says it does not claim to address all safety problems associated with its use.

Its history, as the document lists it

A June 2017 revision cut the equipment level from 3 to 2 and raised the pass/fail values (90 to 112 lbf and 180 to 225 lbf) for the upper and lower load cells then in use. July 2019 required the logo on the primary protective component and changed "chest protector" to "protector". January 2021 removed the upper and lower load cells and their criteria and changed how random impacts are placed. January 2022 added labelling for removable primary protective components. December 2025 was editorial.

Labels

Each protector must show the maker, model, size, month and year of manufacture, a notice that more information is available, and the sport-specific seal on the outside of the primary protective component. Where that component sits inside an assembly, such as a shirt-like garment, the supporting part must say the product is not compliant unless assembled as the maker instructs. A warning must say no protector can prevent all cardiac or other injury.

NOCSAE's statement on versions, and a disagreement

An undated NOCSAE statement says revisions over several years changed testing protocols but not the protective ability of certified equipment or the performance demands and pass/fail levels; that a revision does not void a certification to an earlier version; and that products certified to any ND200 version remain actively certified by SEI. It adds that ND200 is pass/fail with no ranking, that NOCSAE regards claims that one certified product protects more than another as unsupported by independent research, and that it will act against licensees making false or misleading claims. It notes that USA Lacrosse, NCAA and NFHS rules require ND200 equipment without naming a version, and says they should not name one.

The document's own history, however, lists the June 2017 revision that raised the pass/fail values for the upper and lower load cells, later removed in January 2021. The statement may refer only to the versions in force since certification began in 2018, but it does not say so; the two are left side by side here.

Who requires it, and from when

United States

• USA Lacrosse, autumn 2018: approved rules requiring goalkeepers to wear ND200 chest protectors, written into the 2019 US Lacrosse rule books and the 2019 NFHS/US Lacrosse girls' high school book, with enforcement delayed to 2021 to give makers time (USA Lacrosse Magazine, 19 March 2019).
• Goalkeepers, from 1 January 2021: all goalkeepers at youth (USA Lacrosse rules), high school (NFHS) and college (NCAA) level, men's and women's (USA Lacrosse Magazine, 31 March 2021).
• Boys' and men's field players, from 2022: USA Lacrosse boys' youth, NFHS boys' and NCAA men's lacrosse (USA Lacrosse Magazine, 31 March 2021; USA Lacrosse, 9 November 2021). USA Lacrosse says compliant chest protectors and shoulder pads must carry the NOCSAE lacrosse logo and the SEI mark on product and packaging.
• NFHS 2026 boys' points of emphasis (19 February 2026): shoulder pads and goalkeeper chest protectors must meet NOCSAE standards and be worn as the maker intended; goalkeepers also wear a throat protector.
• Girls' and women's field players: none of the US sources found requires ND200 chest protection for them. That is an absence in the sources, not a confirmed rule; the current girls' and women's books were not read.

NOCSAE and USA Lacrosse say USA Lacrosse was the first governing body to mandate the standard and that the NCAA and NFHS also require it. The NCAA's own effective dates were not read in an NCAA document.

World Lacrosse

• Men's field, Rule 17.1 (2025-2027, v1.0; a v1.1 dated January 2026 was not read): a chest protector is required only for the goalkeeper, and no standard is named.
• The May 2026 decision: on 12 May 2026 World Lacrosse adopted standards requiring goalkeeper chest protection meeting NOCSAE standards in men's and women's field and sixes, and shoulder pads meeting NOCSAE commotio cordis standards in men's field, men's sixes and men's and women's box, at its owned and sanctioned events. The phase-in runs from the 2027 Sixes championships, the 2028 Box championships, and the 2029 Women's and Men's U20 championships (or an earlier continental qualifier for the 2030 women's or 2031 men's championship) for field. World Lacrosse says members are strongly encouraged to adopt the standards for domestic play.
• Sixes, Rules 2.4.1M and 2.4.3 (2026-2028, v2.0): from the 2027 Sixes World Championships, men's shoulder pads must carry commotio cordis certification, and goalkeepers must wear goalkeeper-specific chest protection meeting NOCSAE or comparable standards.
• Box, Rule 2.5.1 (2026-2028, v2.0): from the 2028 Box Lacrosse World Championships, all players must wear lacrosse shoulder pads with NOCSAE or comparable certification and commotio cordis certification.

World Lacrosse's FAQ explains why women's field and sixes field players are not required to wear commotio cordis protection. It cites data for 1982 to 2023 of four incidents and one death among female athletes in all sports, none attributed to lacrosse, against 60 incidents and 33 deaths among males. The page does not name the data's source, and it was not checked for this site.

Lacrosse Canada

Lacrosse Canada's Technical Bulletin 21-3 (2021) says that on adopting World Lacrosse's men's field rule book it added policy 12.9.1.2, requiring all men's field players to wear shoulder pads and a protective cup, because World Lacrosse did not require them.

Certification problems

In November 2019 NOCSAE relayed an SEI alert on chest protectors released before SEI certification was complete. The detail is on recalls and decertification.