Table of Contents. Disclosure

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1 1 Table of Contents Introduction to...2 HIPAA Guidelines & Release of Medical Information..3 Insurance Requirements.3 Managing Sports Related Injuries (Game Coverage). 4 Pre-participation Physicals..5 Treating Sports Related Injuries: Using the R.I.C.E. Principle.5 Adverse Weather Conditions - Lightning Guidelines..6 When to clear the field Flash-to-Bang Ratio Safe Shelters Lightning Safety Basic 1st Aid for Lightning Strike Victims Heat-Related Illness..8 Sign & Symptoms Heat Stroke Heat Exhaustion Basic 1st Aid for Heat Illnesses Cooling Procedures Hydration...9 Effects of Dehydration Acclimation Hydration Guidelines Heat Guidelines 11 Heat Index Chart Heat Policy Activity Restrictions Concussions Skin Wounds and Infection..14 Outreach Policies.15 Coverage of Unscheduled/Unanticipated Events Back-up Staffing Priority Coverage Driving Directions & Maps 16 Vanderbilt Medical Center Vanderbilt Children s Hospital Vanderbilt Orthopedic Locations Disclosure This is not a source of medical advice. The information is designed to support, not replace, the relationship which exists between you and your existing physician or health care provider. Please contact your physician or healthcare provider for specific medical advice and/or treatment recommendations.

2 2 Outreach Program is proud to be the provider of outreach athletic training services at your high school and is committed to providing excellent service to its outreach partners. Our goal is to provide one-on-one sports medicine coverage by assigning a certified athletic trainer to each area high school. is currently providing outreach athletic training services to 27 high schools in the Middle Tennessee area. The education and experience of the team offers the community the highest level of service available. We are committed to providing our athletes, coaches and parents with the highest quality of care. Included in this booklet you will find highlights of our recommendations regarding information on heat and hydration, sports specific injuries, as well as, general information regarding our referral procedures. hopes our services and this information will lead to an outstanding continuity of care should your athlete be injured during the course of the school year. What is an Athletic Trainer? Athletic trainers are experts in the prevention, recognition, evaluation, immediate care, and rehabilitation of athletic injuries. They are certified by the National Athletic Trainers Association Board of Certification and licensed by the State of Tennessee. It is this unique knowledge and professional skill set which makes certified athletic trainers the ideal individuals for providing all of your sports medicine needs. Our certified athletic trainers will be present for practices and home games. In addition, they will accompany varsity football and, occasionally, varsity basketball teams to away events; assuming there are no conflicts with home events. It is this unmatched consistency and quality of care that allows coaches, athletes and parents to easily recognize, identify and communicate to their outreach sports medicine provider. Physicians The team shares a common commitment to professional and personal excellence. All physicians on staff are fellowship trained in Sports Medicine. Our goal is to provide our patients with the highest standard of care possible. You will receive an individualized treatment and rehabilitation program designed to return each athlete to his/her previous level of activity as quickly and safely as possible. The Vanderbilt Orthopaedic Institute and Vanderbilt Bone & Joint clinics are dedicated to excellence in patient care, research, education, and sports medicine. Our Sports Medicine Team At, our certified athletic trainers work in close conjunction with our physicians, to assist and expedite the referral process should your athlete require a sports medicine physician evaluation. Open communication between our athletic trainers and sports medicine physicians ensures the safe and efficient progression of your child s rehabilitation and return to full sports participation. physicians also aid in performing pre-participation physicals every spring. With the collaborative effort of our sports medicine physicians, certified athletic trainers, and other medical professionals, we are able to offer a convenient opportunity for your athlete to complete the annual requirements to be able to participate safely in whatever sport they choose.

3 3 HIPPA Guidelines and Release of Medical Information Vanderbilt University Hospital respects each patient s right to privacy. Every Vanderbilt Sports Medicine athletic trainer has reviewed and understands the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which is a law outlining patients privacy rights. High School coaches and administrative staff are considered part of the care team and will be updated on assessment findings and participation recommendations following an injury to your athlete. In the event an athlete is seen by a physician, we must have written documentation from the physician releasing the athlete to return to activity. Coaches should avoid discussing any information regarding an athlete s condition, injury, or health status with other coaches, teachers, media, parents or student-athletes. Insurance Requirements The Tennessee Secondary School Athletic Association (TSSAA) requires written evidence be provided to ensure every student-athlete is covered by a primary insurance policy. This primary insurance policy may come from a personal or employer s insurance. Parents must provide current insurance information on the emergency contact card provided by each coach. This ensures the athlete will be able to receive emergency medical attention in the event of a parent s absence. Having this information also ensures the athlete will be eligible to compete. Please review each emergency card for insurance information, including all insurance policy numbers, parent social security numbers (if required), as well as primary physician contact information. This will help expedite the referral process for physician consultations or emergency care access. In the event an athlete is injured, our athletic trainer s have the ability to schedule a Vanderbilt Orthopedic physician consultation within hours. However, certain insurance policies require an athlete see his/her primary care physician prior to seeing a specialist. It is important to confirm with the athlete, parent, or athletic trainer that written consent from a physician has been obtained prior to allowing an athlete to return to participation. This is to protect you from liability as a coach, and prevent further harm to the athlete.

4 4 Managing Sports Related Injuries A certified athletic trainer will be on site for most home events and practices at your high school. Should one of your athletes sustain an injury, the athletic trainer will provide the initial medical response. In many cases these injuries are minor and can be treated on site or in the school s athletic training room. If further medical treatment is warranted, the athletic trainer will make the appropriate recommendations for the plan of care related to the athlete s injury. In the event of an emergency, each school has an emergency plan (EAP) in place, which will be activated by the Athletic Trainer (ATC). In the event of an injury, the schools athletic trainer will contact the parent of the injured child as quickly as possible. It is for these reasons that a current and accurate emergency contact card is filled out on each child, each year. Away Games A certified athletic trainer will travel with varsity football, and in some cases boys and girls varsity basketball team s to assist with their sports medicine needs. If an athlete should sustain an injury while traveling to a game where his/her athletic trainer is not present, most opposing teams in the Middle Tennessee area will have an athletic trainer on-site. The athlete should inform their coach he/she has been injured and the coach will ask the opposing team s athletic trainer to evaluate the injury. If the injury needs further medical attention all coaches have their school s athletic trainer s contact information and can call at any time with questions to expedite treatment and referral to a sports medicine or emergency physician. Referral Process Should an athlete sustain an injury requiring a physician consult, your school s athletic trainers are generally able to secure an appointment with a team physician within hours. Encouraging your athletes to be seen at Vanderbilt University Hospital will expedite their care and ensure open lines of communication between the physician and athletic trainer allowing the greatest continuity of care possible. Each athlete will be required to fill out an Athlete Registration Form prior to scheduling an appointment. Your schools athletic trainer will schedule the appointment at a time convenient for both the athlete and his/her parent or guardian.

5 5 PRE-PARTICIPATION PHYSICAL EXAMS TSSAA Requirements Prior to participation in TSSAA sanctioned athletics several forms must be completed. All student athletes must have a current physical on file in the athletic office and a copy held by the coach or athletic trainer. In accordance with TSSAA handbook, physicals must be signed by a doctor of medicine, osteopathic physician, physician assistant, or certified nurse practitioner. Physicals for high school athletic participation must be performed after April 15 th to be valid for the following school year. A physical must be obtained before participating in any practices, scrimmages or games. Pre-participation Physicals offers one day mass pre-participation physicals each year at the Vanderbilt Orthopedic Institute during the month of May. Each participating school will be assigned a specific time to attend the physicals on that day to expedite the entire process. We encourage all parents and legal guardians to attend physicals with their son/daughter. Regardless, a parent or guardian is required to complete and sign the physical form prior to the physical exam. Our physicians will not sign the form without the parent/guardian signature on it! The athletic trainer assigned to your child s school will coordinate the physicals. These pre-participation physicals should not take the place of your annual exam with your primary care physician. TREATING SPORTS RELATED INJURIES Typically, muscle strains and ligament sprains are not considered emergencies. Your school s athletic trainer will assess the severity of the injury and treat the injury accordingly. Generally, these injuries are treated utilizing the RICE principle. Rest: Avoid any unnecessary activity. If your athlete is unable to stand or a fracture is suspected obtain crutches or another assistive device such as a sling. Ice: Apply an ice bag or a cold pack to the affected area for approximately minutes and reapply every hour. If using a frozen chemical pack use a barrier between the skin and the cold pack (i.e. a damp cloth). Heat should be avoided for the first 72 hours of the healing process. Compression: Lightly wrap the injured area with a compression bandage starting with the area furthest away from the body and working your way up. The compression wrap should be left on at all times during the first 72 hours with the exception of icing and bathing. It should be loosened if uncomfortable or you get swelling in your fingers and toes. Elevation: The injured body part should be raised above the level of the heart to allow swelling to drain from the affected area. Simply propping a foot up onto a chair is not sufficient to achieve this function. For the leg, the athlete should lie down and prop their foot (not the knee) with a pillow. This method is most effective when accompanied by ice and compression. *Encourage your child to notify their athletic trainer and/or coach of injury and be sure to seek appropriate medical care.

6 6 ADVERSE WEATHER CONDITIONS - LIGHTNING WHEN DO WE CLEAR THE FIELD??? Postpone or suspend activity if a thunderstorm appears imminent before or during a practice or game (regardless of whether lightning is seen or if thunder is heard) until the hazard has passed. *Signs of imminent thunderstorm activity include: Darkening clouds, High winds Thunder or lightning activity Recommended Guidelines Have a means of monitoring local weather forecasts and warnings. Designate a safe shelter for each venue. Use the flash-to-bang count to determine when to go to safety. By the time the flash-to-bang count approaches 30 seconds all individuals should be inside a safe structure. Once activities have been suspended, wait at least 30 minutes following the last sound of thunder or lightning flash prior to resuming an activity or returning outdoors. If you can hear thunder, you are close enough to the storm to be struck by lightning! FLASH-TO-BANG RATIO To use the flash-to-bang method, begin counting when sighting a lightning flash. Counting is stopped when the associated bang (thunder) is heard. Divide this count by five to determine the distance to the lightning flash (in miles). For example, a flash-to-bang count of thirty seconds equates to a distance of six miles. Lightning has struck from as far away as 10 miles from the storm center! athletic trainers will use the Flash-to-Bang method to make a recommendation to the administrative and coaching staff whether to suspend or return to activity concerning threatening weather.

7 7 LIGHTNING SAFETY Avoid being the highest point, in contact with, or in proximity to the highest point in an open field. Also avoid being on the open water. Do not take shelter under or near trees, flagpoles, or light poles. 1. There should be no contact with metal objects (bleachers, fences, golf clubs, bats). 2. Avoid single or tall trees, tall objects and standing in a group. 3. If there is no other shelter you may seek refuge in a hardtop vehicle. 4. The existence of blue skies and/or absence of rain are not protection from lightning. (Lightning can strike 10 miles from the rain shaft.) 5. DO NOT LIE FLAT ON THE GROUND. 6. Avoid using a land line telephone. 7. Avoid standing water and open fields. 8. If in a forest, seek shelter in a low area under a thick grove of small trees. 9. If you feel your skin tingling immediately crouch and grab your legs and tuck your head. 10. Persons who have been struck by lightning do not carry an electrical charge. 11. All individuals have the right to leave an athletic site in order to seek a safe structure if the person feels in danger of impending lightning activity, without fear of repercussions or penalty. Lightning Safe Position: crouched on the ground, weight on the balls of the feet, feet together, head lowered, and ears covered. Assume the lightning safe position for individuals who feel their hair stand on end, skin tingle, or hear crackling noises. (See Figure 2.) Figure 2: Lightning Safe Position SAFE SHELTER A safe location is any substantial, frequently used building. The building should have four solid walls (not a dug out), electrical and telephone wiring, as well as plumbing, all of which aid grounding a structure. The secondary choice for a safer location from the lightning hazard is a fully enclosed vehicle with a metal roof and completely closed windows. It is important to not touch any part of the metal framework of the vehicle while inside it during ongoing thunderstorms. It is not safe to shower, bathe or talk on landline phones (cell phones are allowed) while inside a safe shelter during thunderstorms. Basic First Aid for Lightning Strike Victim Survey the scene for safety Activate local EMS Lightning victims do not carry a charge and are safe to touch If necessary, move the victim with care to a safer location Evaluate airway, breathing and circulation, and begin CPR if necessary Evaluate and treat for hypothermia, shock, fractures and/or burns.

8 8 HEAT RELATED ILLNESS What are the signs, symptoms and treatment for heat related illness? Heat cramps: Exercise associated muscle cramps that can be a result of dehydration. Treatment for heat-related cramps includes: stopping activity, gentle stretching, and immediate rehydration. Heat Syncope: Heat syncope is simply passing out when is it hot outside. The body temp is normal. This can be treated by removing the athlete from the heat, elevating your legs and liquids by mouth. Heat Exhaustion: Heat exhaustion is an emergency and results in the inability to continue physical activity due to elevated body temperature over 102F. Signs and symptoms include: muscle cramps, pale or red skin, headache and dizziness, hyperventilation, nausea and not acting right. Treatment includes: removing excess clothing; moving the athlete into the air conditioning; cooling with ice and/or fans; and rehydration with fluids. EMS should be contacted immediately. Heat Stroke: Heat stroke is an even more concerning situation. This occurs as a result of body temperature exceeding 104-degrees potentially causing organ system collapse. Signs and symptoms include: increase heart rate; decreased blood pressure; hyperventilation; Vomiting; collapse; coma; change in mental status; and possible death. The athlete should be rapidly cooled and EMS should be contacted immediately. How can heat related illnesses be prevented? Athletes should acclimatize themselves by increasing exposure to heat and increasing the intensity of their workouts over a day period. They must also assure they are following appropriate hydration and nutritional guidelines. In preparation for activity athletes should ensure they are rested and wear breathable and moisture-wicking clothing. Basic 1st Aid for Heat Illness- Cooling Procedures 1. Move the athlete to a shaded area or air condition room, if available. 2. Remove equipment and unnecessary and/or saturated clothing. 3. Lay athlete on his back with legs elevated. 4. Massage ice water soaked towels on athletes head, arms, and legs. 5. Ice packs to the neck, arm pits, and groin area. 6. Have athlete drink fluids if able. * Cold water immersion is the fastest way to cool an athlete suffering from exertional heat illness. If you have access to facilities with pools/tubs, immerse an athlete and then call EMS.

9 9 Hydration Why is it important to hydrate? Water should be readily available to the athletes at all times. It is recommended by the American Academy of Pediatrics Committee on Sports Medicine to take regular water breaks once the heat index reaches 82 degrees or higher. Water breaks should be taken every 30-minutes and last for approximately 5-10minutes. During water breaks athletes should be permitted to rest in shaded areas and remove protective equipment (i.e. helmets). Proper hydration is required for optimal athletic performance. Dehydration can affect an athlete in less than 1 hour of exercise and puts you at greater risk for heat illnesses like cramps, heat exhaustion and heat stroke. Proper nutrition should be taught and encouraged. Salt tablets, caffeine, pickle juice, protein and nutritional supplements are not recommended. Attention must be directed to replacing water to replenish body fluids and maintaining appropriate dietary habits. What are the warning signs of dehydration? Thirst Irritability Headache Weakness Dizziness Cramps Nausea Effects of Dehydration: For every 1-2% of body weight loss: Athletic performance is decreased. Physiologic function is compromised. Body temperature rises 0.15 C to 0.20 C. Heart rate increases 3-5 beats per minute. Gastric emptying slows at 4%. Muscle strength decreases at 5%. Thirst mechanism doesn t begin until 1-2% of body weight loss. What is the proper way to hydrate? Tips to Prevent Dehydration Drink 8-16 ounces of water one hour prior to exercise. Continue drinking water or sports drinks every minutes during exercise. Replace lost fluids after exercise by drinking ounces of water per pound of body weight lost.

10 10 Helpful Hints for Rehydrating: If you child weighs less than 90-lbs, he/she should consume 10 gulps of fluid (approx. 5oz) every 15-20minutes during activity. If you child weighs more than 90-lbs, he/she should consume 20 gulps of fluid (approx. 10oz) every 15-20minutes during activity. What to Drink: Cool beverages, such as water or sports drinks, at temperatures of degrees are optimal. If the activity lasts longer than 1 hour, a sports drink is recommended. Fluids containing small concentrations of salt are beneficial but do not completely replace the amount lost in sweat. If you choose a sports drink, it should contain no more than 8% of carbohydrates per serving. IF YOUR ATHLETE IS THIRSTY, THEY ARE ALREADY DEHYDRATED!! Acclimatization Acclimation is the physiological process of the human body adapting to the environment. (i.e. heat, cold, high altitude). Gradual heat acclimation is essential to prevent the onset of heat illnesses. Limit the first few practices to conditioning (only helmets for football). Gradually increase time and intensity of practice. Limit practice time to 3 hours maximum at one time. It takes at least 10 days for the body to become fully acclimated. Younger athletes may take a longer time to become acclimated.

11 11 HEAT INDEX RECOMMENDATIONS The following precautions are recommended when using the WBGT Index: (ACSM's Position Statement: Exertional Heat Illness during Training and Competition, 2007) Below 82% Gradual increase in activity for unfit individuals 82% - 86% - Limit intense exercise of unfit individuals 86% - 90% - Limit intense exercise for all individuals 90% plus Cancel exercise for all individuals Heat Index Calculations T E M P E R A T U R E (RELATIVE HUMIDITY) 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Web site that will calculate the heat index for you: Thirty (30) minutes prior to the start of activity, temperature and humidity readings should be taken at the practice/competition site. If a reading is determined whereby activity is to be decreased (above 95 degrees Heat Index), then re-readings would be required every 30 minutes to determine if further activity should be eliminated or preventative steps taken, of if an increased level of activity can resume. Using the following scale, activity must be altered and/or eliminated based on this Heat Index as determined.

12 12 HEAT POLICY HEAT INDEX Above 104 Provide ample amounts of water * * * 10 min Mandatory water breaks every 30 min * * * Ice-Down towels for cooling * * * Watch/Monitor athletes carefully for necessary action * * * Alter uniform by removing items if possible* * Allow for changes to dry t-shirts and shorts * Recommend moving practices before 10:00 am or after 5:00 pm * Reduce time of outside activity as well as indoor activity if air condition is unavailable * NO OUTDOOR ACTIVITIES * *Special considerations for contact sports and activities with additional equipment. Heat Index greater than 95-degrees: 1. Helmets and other possible equipment removed while not involved in contact. 2. Re-check temperature and humidity every 30 minutes to monitor for increased Heat Index. Heat Index greater than 100-degrees: 1. Helmets and other possible equipment removed if not involved in contact or necessary for safety. 2. If necessary for safety, suspend activity. 3. Re-check temperature and humidity every 30 minutes to monitor for increased Heat Index. Heat Index greater than 104-degrees: 1. ALL OUTDOOR ACTIVITIES should be moved indoors (air conditioned facility) or be completely suspended if no indoor facilities are available.

13 13 Concussions (Mild Traumatic Brain Injury) What is a concussion? A concussion, also known as a closed head injury or getting your bell rung, is an injury to the brain usually caused by a blow to the head. It can result in a loss of consciousness, or being knocked out, however this is not necessary in order to have had a concussion. In fact, most concussions do not involve loss of consciousness. What are the signs and symptoms of a concussion? Headache Pressure in head Neck pain Nausea or vomiting Dizziness Blurred Vision Balance problems Sensitivity to light and/or noise Feeling slowed down Feeling like in a fog Don t feel right Difficulty concentrating and/or remembering Fatigue or low energy Confusion Drowsiness Trouble falling asleep More emotional Irritability Sadness Nervous or anxious What things should I watch out for? Most people do well after a concussion. Teens often will feel tired and just want to sleep. However, you should monitor your child s behavior and seek treatment from the Emergency Department for the following concerning changes: Athlete is difficult to wake up or sleepy all the time Athlete is not fully awake or has severe confusion Athlete has a severe headache Athlete has numbness/ tingling or weakness in arms or legs Worsening symptoms Athlete has changes in vision What should I do after my child has sustained a head injury? 1. Remove the athlete from play. 2. Do not let athletes persuade you that they're "just fine" after having sustained a bump or blow to the head. 3. Ensure that the athlete is evaluated by a health care professional experienced in evaluating concussions. 4. Keep the athlete out of play until a health care professional clears for participate. 5. It is recommended athletes playing collision sports do a baseline ImPACT test prior to the start of the season. In the event an athlete sustains an injury during the following two years of their baseline test, the athlete will repeat the test and the post-injury scores will be compared to baseline scores. If an athlete has already sustained an injury without getting baseline tested, the ImPACT testing can still be given and the scores compared with normal age-matched athletes. Call the Vanderbilt Sports Concussion Center with any questions or visit the website: (615) 875-VSCC

14 14 Skin Wounds and Infections Skin wounds are very common in athletic events. If an athletes skin is broken in any way (abrasion, scratch, puncture), the area should be cleaned thoroughly with soap and water and covered during athletic practices and competitions. Band-Aids should be changed regularly and the area should be kept clean and dry. DO NOT leave bandages or tape on when showering unless directed by a physician or athletic trainer. DO NOT allow athlete to soak in whirlpools or swim with open wounds. This not only will put them at risk for infection, but also those around them. DISCOURAGE your athletes from sharing equipment such as helmets, shoulder pads, shin guards, jerseys, socks, or shoes. These are common ways for infection to spread quickly through your team. What are the signs and symptoms of a skin infection? If an athlete has any type of skin injury it should be monitored closely for signs of infection. Signs of infection include: Heat Redness Swelling Pain Loss of function If an infection is suspected, medical attention should be sought out immediately. Personal hygiene is the key to prevention of skin infections. What is Methicillin Resistant Staphylococcal Aureus (MRSA)? S. aureus is the leading cause of skin and soft tissue infections in the US and is present in approximately 75% of abscesses in the emergency department. MRSA lesions are often mistaken as spider bites and if left untreated can cause significant infection and death. If the lesion is very mild, topical antibiotics might be sufficient; however, if the lesion is more significant, incision and drainage and oral antibiotics will likely be needed. MRSA can be avoided by athletes by practicing good hygiene and limiting the sharing of personal equipment (pads, clothing, towels, razors, etc.), monitoring athletes closely for breakouts among athletes. The most important preventative step is regular showering, hand washing and washing of personal sporting equipment We recommend regularly cleaning and sanitization of locker rooms and athletic equipment to reduce the risk of spreading such serious infections.

15 15 Policies COVERAGE OF UNSCHEDULED/UNANTICIPATED HIGH SCHOOL OUTREACH EVENTS The contract between (VSM) and the individual high schools states the dates and times (of coverage) will be determined based on the TRAINER availability and SCHOOL schedules. There are times when events are not scheduled or not communicated to the Athletic Trainer in a timely manner (including tournaments). We request 24-hour notice of event changes for staffing adjustments. In the event a competition is unscheduled or unanticipated (i.e. rescheduled rain out), your athletic trainer will document (date, time, sport, coach involved) and communicate with the VSM Manager for follow-up. If possible the assigned athletic trainer will cover the event, or a manager or clinical coordinator will arrange for another athletic trainer to be present. If staffing cannot be arranged, coaches will be given emergency contact information and the Emergency Action Plan (EAP) should be followed. A manager will then follow-up with coaches and administrators to ensure communication is open and any other concerns or questions are answered. BACK-UP STAFFING PLAN In the event an athletic trainer must leave their high school or special event due to an emergency, he/she will contact the Manager so that staffing adjustments can quickly be completed. If there are no athletic trainers available to cover, coaches will be given emergency phone numbers and will be expected to follow the Emergency Action Plan, and school administration will be notified of the situation. PRIORITY OF COVERAGE Each athletic trainer will prioritize event coverage by sport based on the guidelines set forth by the National Athletic Trainers Association. This priority is based on type of sport, contact, and incidence rate of injury. Mitch Bellamy, Manager Mindy Chandler, Assistant Manager We encourage coaches to organize a parent meeting prior to the start of each sports season. A parent meeting ensures that parents are getting the important information regarding eligibility and safe participation prior to the start of practices & competitions.

16 16 DRIVING DIRECTIONS TO VANDERBILT ORTHOPAEDIC INSTITUTE From The North: I-65 South to I-40 East. Take the Broadway/Demonbreun Street exit and turn right onto Broadway. Broadway will become West End Avenue. Turn left on 21 st Avenue and follow the curve around, staying in the right lane. Turn right on Medical Center Drive. The East Parking Garage will be on the left around the curve. Take the elevators to the 3 rd floor of the Medical Center East building, and follow the signs to Vanderbilt Orthopaedic Institute. From The South: I-65 South to I-40 West. Take the 21 st Avenue/ Hillsboro Rd exit, and turn right on 21 st Avenue. Continue on 21 st Avenue and turn left on Medical Center Drive. The East Parking Garage will be on the left around the curve. Take the elevators to the 3 rd floor of the Medical Center East building, and follow the signs to Vanderbilt Orthopaedic Institute. From The East: I-24 to I-440 West. Take the 21 st Avenue/ Hillsboro Rd. exit, and turn left on 21 st Avenue. Continue on 21 st Avenue and turn left on Medical Center Drive. The East Parking Garage will be on the left around the curve. Take the elevators to the 3 rd floor of the Medical Center East building, and follow the signs to Vanderbilt Orthopaedic Institute. From The West: I-40 East to I-440 East. Take the 21 st Avenue/ Hillsboro Rd. exit, and turn left on 21 st Avenue. Continue on 21 st Avenue and turn left on Medical Center Drive. The East Parking Garage will be on the left around the curve. Take the elevators to the 3 rd floor of the Medical Center East building, and follow the signs to Vanderbilt Orthopaedic Institute. Parking: The East Parking Garage is the most convenient parking facility for the Vanderbilt Orthopaedic Institute patients and families. There is no charge for patient and visitor parking when parking tickets are validated. No fees for parking on Saturday

17 17 Driving Directions to Monroe Carell Jr. Children s Hospital at Vanderbilt FROM THE NORTH Take I-65 South. Take the Wedgewood Avenue exit, exit number 81. Turn right onto Wedgewood Avenue. Cross the 21st Avenue intersection. Wedgewood Avenue becomes Blakemore Avenue. Turn right onto 23 rd Avenue. You will be facing Vanderbilt Children s Hospital and the South parking garage. Turn right at the stop sign onto Children s Way. The entrance/patient drop-off of Children s Emergency room is on the left. FROM THE SOUTH Take I-65 North. Take the Wedgewood Avenue exit, exit number 81. Turn left onto Wedgewood Avenue. Cross the 21st Avenue intersection. Wedgewood Avenue becomes Blakemore Avenue. Turn right onto 23 rd Avenue. You will be facing Vanderbilt Children s Hospital and the South parking garage. The entrance/patient drop-off of Children s Emergency room is on the left. FROM THE EAST Take I-24 to I-40 West. Take I-65 South to the Wedgewood Avenue exit, exit number 81. Turn right onto Wedgewood Avenue. Cross the 21st Avenue intersection. Wedgewood Avenue becomes Blakemore Avenue. Turn right onto 23rd Avenue. You will be facing Vanderbilt Children s Hospital and the South parking garage. The entrance/patient drop-off of Children s Emergency room is on the left. FROM THE WEST Take 40 East. Take the 440 East Exit, exit number 206. Take the 21 st Avenue/Hillsboro Pike, US 431 Exit, exit number 3. Take the 21st Avenue, US 431N Ramp. Continue on 21st Avenue for approximately 1 mile. Turn left onto Blakemore Avenue. Turn right onto 23rd Avenue. You will be facing Vanderbilt Children s Hospital and the South parking garage. The entrance/patient drop-off of Children s Emergency room is on the left. PARKING South Garage is the most convenient parking facility for Vanderbilt Children s Hospital patients and families. There is no charge for patient and visitor parking when parking tickets are validated at the second floor information desk. Complimentary valet parking is available at the first floor main entrance. For longer-term parking options, check with the Parking Facilities Office by calling SOUTH GARAGE

18 18 Vanderbilt Orthopaedic Institute st Avenue Medical Center East, South Tower, Suite 3200 Nashville, Tennessee Phone: (615) Vanderbilt Cool Springs 324 Cool Springs Boulevard Franklin, Tennessee Phone: Vanderbilt Bone & Joint 206 Bedford Way Franklin, Tennessee Phone: