MEDICAL CLEARANCE AND RETURN TO PLAY

Transcription

1 MEDICAL CLEARANCE AND RETURN TO PLAY WIAA CONFERENCE AUGUST 1, 2014 YAKIMA, WA Presented by Raymond A. Roberts, ARM, SCLA, CPSI

2 AGENDA What are Negligence and Liability? Return to Play Liability Exposures for Coaches Duties Owed to Student Athletes Coverage Compromising Actions and Omissions 2

3 LIABILITY EXPOSURES Negligent Acts Unintentional errors in performing duties Example: Failure to recognized a concussion Criminal Acts Example: Providing enhancement or pain medications Intentional Acts May be criminal Not be covered by insurance Example: Intentional disregard for player safety 3

4 INJURY RELATED DUTIES Proper supervision & instruction Includes: Injury prevention, recognition and prompt care Control of Aggression Volunteer and Assistant training Record Retention Warn of inherent risks of the individual sport Develop and follow an Emergency Action Plan Return to active play and practice plan 4

5 SUSPICION OF CONCUSSION OR OTHER SERIOUS INJURY Officials may sideline a player for suspected concussion Officials must notify the AD and WIAA Do not get swayed by athlete or parent opinions If concussion is suspected, athlete must be removed RCW 28A (Lystedt requirements) Concussion forms and information are available at WIAA.org 5

6 DUTY TO PROVIDE PROMPT MEDICAL CARE When in doubt, call 911! Current training in First Aid/CPR/AEDs Adequate and accessible First Aid supplies Do not have another student transport the injured athlete Report injuries to parents and to the A.D. or 6 administrator immediately

7 POST-INJURY LIABILITY EXPOSURES Post-injury actions/omissions may create liability where not existed Failure to develop, implement and practice your EAP Failure to obtain prompt medical care Allowing RTP on same day as suspected injury 7

8 AVOIDING POST-INJURY EXPOSURES Is there a school district-wide Return to Play procedure? Are coaches, assistants and volunteers trained in concussion recognition? If an injury is suspected, athlete must be removed from play and practice 8 Do not rely on athlete or parent opinions

9 RETURN TO PLAY LIABILITY EXPOSURES Applies to all WIAA activities Negligent Return to Play No written medical report on file Overriding of Coach s decision to not allow RTP Failure to follow school district protocols 9

10 RETURN TO PLAY(RTP) Must be a school district-wide policy Be aware that a few doctors are clearing athletes by phone having never seen them post-injury or post suspected injury Administrators should not override the coach s decision to keep athlete sidelined 10

11 RETURN TO PLAY No return to play until written clearance is supplied by a licensed health care provider trained in the evaluation and management of concussion (emphasis added) ( RCW 28A (Lystedt requirements) Coaches can require a second opinion if in doubt Concussion forms and information are available at WIAA.org 11

12 ALLOWED LICENSED HEALTH CARE PROFESSIONALS All must be trained in the evaluation and management of concussion WIAA approved practitioners: Medical Doctors (MD) Doctor of Osteopathy (DO) Advanced Registered Nurse Practitioner (ARNP) Physicians Assistants (PA) Certified Athletic Trainers No other health care professionals are allowed to clear for return to play 12

13 HEALTH CARE PROFESSIONALS (CONTINUED) WIAA may make a case-by-case exception for health professionals with special training WIAA is developing a checklist for schools to have clearing health professionals complete Ultimate decision on return to play is yours 13

14 RTP DOCUMENTATION Report from medical professional should include: Date examined Location of examination Diagnosis, prognosis, treatment rendered Clearly expressed release to return to play and practice* *Be aware that some medical professionals have issue release after only a telephone consult. 14

15 RTP CONSIDERATIONS No RTP within 24 hours of suspected concussion Classroom teachers must be notified Complete physical and cognitive tests Symptom free for 24 hours prior to starting 5 Steps 15

16 RTP PROGRESSION Baseline: Symptom free after 24 hours of complete physical and cognitive rest Step 1: Light aerobic exercise Limit to 5-10 minutes Biking, walking No weight lifting, jumping or hard running Step 2: Moderate exercise Limited body and head movement Reduced from regular pre-accident routine Moderate jogging, stationary bike and weight lifting 16 CDC-A Heads Up on Managing Return to Play

17 RTP PROGRESSION (CONTINUED) Step 3: Non-contact exercise Increased intensity but no contact Close to usual exercise routine time Running, high-intensity stationary biking, regular weight training and non-contact drills Step 4: Practice goal of reintegration into full contact activity Step 5: Play and return to competition 17 But only if.

18 CAN ONLY PROGRESS IF Symptoms and cognitive function are monitored during each step Not experiencing symptoms at current level If symptoms return the activity must stop Cannot re-start the Step where symptoms occur until symptom-free for 24 hours 18

19 RELATED COMPLICATING FACTORS History of: Multiple concussions or internal injuries Migraines Mood disorders or anxiety Learning disabilities, including ADHD Medications such as antidepressants 19

20 RELATED COMPLICATING FACTORS (CONTINUED) Symptoms worsen over time Symptoms last more than days Age-younger players should be treated more conservatively 20

21 INJURY RECORD RETENTION Think defensively-a minor can file a claim or suit up to age 21 Keep all records relating to a significant injury Health/Physical exams Signed consent-to-play and Inherent Risk forms Injury forms and Return-to-play/Doctor s clearance 21

22 RESOURCES British Journal of Sports Medicine Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport Center for Disease Control WIAA 22

23 SUMMARY Post-injury omissions can create liability If in doubt, keep the player out Document your actions Think and act defensively it s your career and reputation! 23

24 THANK YOU

25 CONTACT INFORMATION Ray Roberts Washington Schools Risk Management Pool P.O. Box Tukwila, WA (206)