Put Me in Coach!! Rich Dandridge, St. Louis Children s Hospital Pre-Hospital Outreach Coordinator B.A., EMT-P

Transcription

1 Put Me in Coach!! Rich Dandridge, B.A., EMT-P St. Louis Children s Hospital Pre-Hospital Outreach Coordinator

2 Objectives: 1. Understand the signs and symptoms of concussions 2. Demonstrate the sideline assessment of a concussion 3. Management of a concussion 4. Return to Play(RTP) protocols 5. The Role of the Athletic Trainer It s not us vs them!!

3 Statistics Injury is still #1 mortality/morbidity 20/day More than all other childhood illnesses combine Head injury Most under-recognized public health problem in US $17 billion annually

4 Leading Causes of mtbi Falls (35.2%) 2 nd leading cause kids 0-14 (25%) Motor vehicle traffic (17.3%) Struck by/against events (16.5%) Assaults (10%) 2.9% of kids 0-14 Other/unknown (21% ) second leading cause of TBI among children aged 0 to 14 years, with 25%.

5 How big is the problem? 3.8 million sport related annually Est 144K peds/adolescent seek EU care -ever increasing PCP office (up 300%) Contributing factor in 30.5% all injury related death in US Annually 75% of TBIs are concussion 1 concussion every 16 seconds

6 Definition Complex pathophysiological process affecting the brain, induced by biomechanical forces 1st Int l Symposium on Concussion in Sport (Vienna, 2001) Organized by FIFA, IIHF, IOC

7 Definition: 5 Major Features 1. May be due to direct blow to face, head, neck, or elsewhere on body with impulsive force to head 2. Rapid onset of short-lived impairment of neurologic function that resolves spontaneously 3. Acute symptoms usually due to functional disturbance rather than structural injury 4. Results in graded set of clinical syndromes that may or may not involve loss of consciousness (LOS) 5. Typically associated with normal neuroimaging studies

8 Concussion Epidemiology Marrar M, et al; AJSM, 2012

9 Common Signs and Symptoms +/- LOC Headache Dizziness Nausea/vomi8ng Unaware of period, opposi8on, score Confusion Amnesia Unaware of 8me, place, date Vacant stare/glassy eyed Slurred speech Feeling dinged, slow, foggy Visual changes Sensi8vity to light/sound Unusual/inappropriate emo8ons (cry, laugh) Inappropriate playing behavior (running in wrong direc8on) Seizure

10 Common Symptoms Meehan WP 3rd, d Hemecourt P, Comstock RD. High school concussions in the academic year: mechanisms, symptoms, and management. Am J Sports Med. 2010;38(12): ; and Castile L, Collins CL, McIIvain NM, et al. The epidemiology of new versus recurrent sports concussion among high school athletes Br J Sports Med. 2012;46(8):

11 Acute Life threats Sub-acute rest Follow-up Weekly Symptoms check-list modifications Chronic/long-term needs Management options

12 Zurich 2012 Guidelines No grading of injury Treat every concussion seriously 4th International Conference on Concussion in Sport FIFA IOC

13 Zurich Concussion Guidelines Any athlete who show ANY symptoms or signs of a concussion: athlete should not return-to-play in the current game or practice Athlete should be monitored for deterioration for 24 hours return-to-play must follow a medically supervised stepwise process athlete must be symptom-free at rest AND after exertion When in doubt sit em out

14 Medical Protocol Any athlete who suffers a concussion should undergo medical evaluation within 24 hours Anyone with loss of consciousness should be evaluated that day If confused or not fully conscious, transport by EMS with immobilization Follow athlete until asymptomatic First medical clearance is to begin return- to-play progression If no return of symptoms with exertion, then final clearance for game play

15 Legislation States with Enacted and 2012 Introduced Legislation Targeting Youth Sports-Related Concussions Source: National Conference of State Legislatures, 2012.

16 Missouri: 2011 HB 300 Provides for the establishment of the interscholastic youth sports brain injury prevention act; which requires rules to educate coaches, student athletes, and their parents or guardians on the nature and risk of concussion and brain injury. Also requires an athlete to be removed from the field/ practice for a minimum period if suspected of sustaining a brain injury.

17 MO: Interscholastic Youth Sports Brain Injury Prevention Act Remove from play immediately if child appears to have sustained a concussion No play or practice for 24 hours post injury Must be evaluated by a concussion trained licensed health care provider and provided written clearance to return to play or practice

18 Illinois 2011 Ill. Laws, P.A. 204 (2011 HB 200) Requires each school board to adopt a policy regarding student athlete concussions and head injuries to be included with any participation agreement. Also requires school districts to use educational materials to educate specified people regarding concussions and authorizes park districts to make available to residents and users of park district facilities educational materials that describe the nature and risk of concussion and head injuries.

19 IL: materials electronic or written advisability of removal from game or practice of youth athletes that: exhibit signs, symptoms, or behaviors consistent with a concussion loss of consciousness, headache, dizziness, confusion, or balance problems July 2011

20 The Plan TURN THE BRAIN OFF!!

21 The Plan Cognitive and Physical rest No school, no homework, no reading, no texting, no video games No symptom triggering physical activity TV, computer, music individualized Medications Tylenol/Motrin Over-exertion Rebound Graduated Return to Play

22 Concussion Protocols Who is responsible for the on-field response? Who will conduct the assessment? Who will communicate for advanced help, if needed? Who will observe the athlete on the sideline? Who will make the diagnosis and return-to-play decisions if a physician is not presence? Who will communicate the diagnosis to the parents and coaches?

23 Evaluating the Downed Athlete

24 The Downed Athlete For helmeted athlete with suspected C- spine injury Keep helmet and shoulder pads on Remove facemask before transport Cordless screwdriver better than trainer s angel or other removal devices Removal of helmet while leaving shoulder pads on causes excessive cervical spine movement and positioning

25 Sideline Evaluation n n n n n Standardized tools available n SCAT 3 n SAC Signs & symptoms Evaluation of cognition is an essential component n Standard orientation questions are unreliable Postural stability testing is a valid addition to assessment Serial testing recommended

26 BESS: Balance Error Scoring System Postural Stability Flat and 10cm foam 20 seconds each Count errors to score Eyes opening Movement Hands off hips Affected by environment Test after 15 minutes Footwear Surfaces Some rater reliability issues Some practice effect noted

27 Professional Education Athletic Trainer Foundational Courses Human physiology Human anatomy Exercise physiology Kinesiology/biomechanics Nutrition Therapeutic modalities Acute care of injury and illness Statistics and research design Strength training and reconditioning Professional Course Content Areas Risk management and injury/illness prevention Pathology of injury/illness Assessment of injury/illness General medical conditions and disabilities Therapeutic exercise; rehabilitative techniques Health care administration Weight management and body composition Psychosocial intervention and referral Medical ethics and legal issues Pharmacology Professional development and responsibilities

28 Athletic Trainer - CE FACTORS ASSOCIATED WITH CONCUSSION RECOVERY 8:00-9:15 am ICC, Room 243 Moderator: Rusty McKune, MS, ATC, Nebraska Medical Center 8:00 AM - 8:15 AM Post-Injury Item Endorsement and Correlation Between Symptom Severity and Days Post-Concussion for the Graded Symptom Scale in Concussed Adolescent Athletes, Lindsey Shepherd, MS, ATC, CSCS, A.T. Still University, 8:15 AM - 8:30 AM Treatment Characteristics and Return-To-Play Timelines Following Sport-Related Concussion: A Report from the Athletic Training Practice-Based Research Network Nicholas Kostishak, ATC, CSCS, A.T. Still University 8:30 AM - 8:45 AM Acute Cognitive and Physical Rest Do Not Improve Concussion Recovery Time, Thomas Buckley, EdD, ATC, Georgia Southern University 8:45 AM - 9:00 AM Symptoms Among Concussed Athletes Examined for Prolonged Recovery by a Neuropsychologist, Erin Snook, PhD, Datalys Center for Sports Injury Research and Prevention 9:00 AM - 9:15 AM Evaluating the Recovery Curve for Clinically-Assessed Reaction Time Following Concussion Injury, Gianluca Del Rossi, PhD, ATC, University of South Florida

29 Case Study 14 yo male playing freshman football is on the wall on kickoff return. Midfield head on collision with defending team. Players both go to the ground Attempts to ambulate but is staggering toward sidelines. Initial S/S: Photophobic, HA, Blurred vision, nausea, gait issue Sunglasses/Hat, Uniform off, off to ER

30 Case Study SCAT 2 used in ED(via iphone app) Concussed Brain Rest Re-evaled 10 days later Post-Impact test, BESS RTR Protocol initiated Game 21 days Post -Injury

31 Preventing Concussion Don t tolerate dangerous play Late and unprotected hits Blows to the head Participation in pre-screening surveys Helmet properly fitted and worn Age/wt restrictions ADVOCACY!!!!!! Who is doing the initial fitting????