INTERCOLLEGIATE ATHLETICS CONCUSSION MANAGEMENT PLAN

Transcription

1 INTERCOLLEGIATE ATHLETICS CONCUSSION MANAGEMENT PLAN I. PURPOSE In an effort to better serve the healthcare needs of its student athletes, as well as to adhere to best practices recommended by the National Collegiate Athletic Association (NCAA), Fayetteville State University (FSU) has developed this comprehensive concussion management plan. The intent of this plan is to minimize the risk of permanent damage following a concussive injury to an FSU student athlete. The procedure and implementation of this plan should be well-known and practiced by FSU student athletes, coaches, certified athletic trainers, team physicians and all other athletic staff. II. DEFINITIONS A. C oncussion A concussion is a complex pathophysiological process affecting the brain that is induced by traumatic biomechanical forces. Several common features incorporate clinical, pathologic and biomechanical constructs of a concussive head injury. The following is a list of those common features: 1. A concussion may be caused by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head. 2. A concussion typically results in the rapid onset of short-lived impairment or neurologic function that resolves spontaneously. 3. A concussion may result in neuropathologic changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. 4. A concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follow a sequential course; however it is important to note that in a small percentage of cases, post-concussive symptoms may be prolonged. 5. No abnormality on standard structural neuroimaging is seen when a person experiences a concussion. B. Student Athlete A student athlete is a member of any one or more of FSU s officially recognized athletic teams. This definition is not applicable to students who are engage in playing intramural sports.

2 III. Symptoms of a Concussion Symptoms of a concussion may occur immediately or may initially occur in the minutes, hours or days following a blow to the head, face, neck, or impulsive force to the body. Symptoms include but are not limited to the following: headache, dizziness, nausea/vomiting, disorientation, emotional changes, slurred/incoherent speech, vacant stare, loss of consciousness, confusion, post-traumatic amnesia, amnesia about events occurring before the injury, delayed verbal and motor responses, inability to focus, excessive drowsiness, visual disturbances (sensitivity to light) involuntary eye movement, blurry vision, double vision), disequilibrium or lack of stability and balance, feeling in a fog or zoned out, fear of or hyper-sensitivity to noises, loss of intellectual capacity, poor recent memory, personality changes, poor attention, fatigue, irritability, sleep disturbances, depressed mood, and/or anxiety IV. RESPONSIBILITIES A. Student Athletes Should a student-athlete experience any symptoms identified with a concussion, that studentathlete is required to immediately inform the FSU athletic training staff. Should the athletic training staff not be available, the student-athlete should immediately contact the student athlete s coach or call 911. If a student athlete becomes aware of these symptoms some time after practice or following a game and the athletic training staff is not available, the student athlete should make every effort to contact the coach or the athletic training staff as soon as possible. If contact cannot be made, the student athlete should call ext if on campus or 911 if offcampus. No student athlete who may have sustained a concussion should attempt to operate a motor vehicle. All student athletes must sign a statement of understanding accepting responsibility for reporting injuries and illnesses to the FSU athletic trainer, including signs and symptoms of concussions. (Appendix C) B. C oaches, Athletic T raining Staff, T eam Physicians and Athletic Staff A coach or athletic staff, who witnesses or receives a report that a student may be experiencing concussion symptoms, must contact an athletic training staff as soon as possible -- even if the symptoms do not occur at the time of the initial blow causing the injury. 2

3 Any athletic training staff who has been made aware of a student athlete s symptoms must ensure that the student is evaluated in accordance with this concussion management plan. Coaches, athletic trainers, athletic staff, and team physicians must sign a statement of understanding acknowledging that they have received education about concussions and that they understand the concussion management plan and their role within the plan. (Appendix D) V. BASELINE TESTING A. At a minimum, every FSU student athlete participating in football, cheerleading, men s basketball, women s basketball and softball will complete section 1 of the Sport Concussion Assessment Tool 2 (SCAT2) (Appendix A) or other symptom checklist deemed appropriate by the head athletic trainer. The baseline scores will be kept on-file in accordance with FSU s Records Retention Policy. B. FSU athletic training staff or the team physician may also conduct baseline cognitive and balance assessments (e.g. ImPACT, HeadMinder, BESS test, Neurocom, etc.) of individuals determined to be at risk, and may also conduct baseline cognitive and balance assessments of entire team rosters whenever time, staffing and equipment assets allow for the practicality and possibility of such testing. VI. CONCUSSION EVALUATION A. T eam Physician On-Site A team physician should evaluate and diagnose the student athlete onsite using standard emergency management principles with particular attention given to examining the possibility of a cervical spine injury. The authority of the team physician cannot be challenged. B. T eam Physician Not On-Site 1. An FSU certified athletic trainer must conduct an initial assessment to determine whether a concussion is likely. The components of the evaluation by the athletic trainer are as following: After first-aid issues are addressed, note the time of the injury, prior to beginning assessment of the concussive injury. Assess the concussive injury using the SCAT2, SAC, and Maddocks Score tools. Assess the physical symptoms of a concussion (e.g. Rhomberg testing, pupil reactivity, HGN, etc.). The student athlete should not be left alone in the hours following the injury. FSU athletic training staff or another medical professional shall monitor the student athlete for deterioration and document every five minutes whether and what type of deterioration is noticed. This monitoring is essential during the initial few hours following the injury. 2. If the assessment reveals that a concussion is present which requires further diagnostics or if symptoms persist, the certified athletic trainer must see to it that the student athlete is promptly and safely transported to the team physician to receive an evaluation and diagnosis. If the team physician is not available, the athletic training staff should see to it that the student athlete is promptly and safely transported to the emergency room. 3

4 C. Referrals If deemed necessary by the onsite healthcare provider, the student athlete may be transported to the nearest emergency room at Cape Fear Valley Medical Center located at 3425 Melrose Rd. Upon this occurrence, the student athlete s emergency contacts should be notified. Arrangements for transportation will be made so that the injured student athlete will not drive. D. E valuation W hen T her e A r e L ife T hreatening Signs or Symptoms If a student athlete displays any immediate life-threatening symptoms such as difficulty or lack of breathing, weak or no pulse, prolonged loss of consciousness, cervical injury, paralysis of extremities, or any other life-threatening sign or symptom, then the appropriate emergency action plan should be activated. VII. CONCUSSION MANAGEMENT A. C ontinuation of Play and Practice The student athlete showing signs of a concussion shall not be allowed to practice or play until he or she has been evaluated as described above. The student athlete should also not attempt to move until an athletic training staff, team physician or other medical professional has assessed whether a cervical injury has occurred. B. R eturn to Play (R T P) 1. RTP Decision: The student athlete diagnosed with a concussion shall remain out of any athletic activity until symptom free (including weight-lifting and any other team workouts). RTP decisions are to be made by the team physician. The team physician may designate the responsibilities for RTP assessments and testing to the certified FSU athletic trainer. The team physician s/certified athletic trainer s authority is unchallengeable. 2. Same Day RTP: Any student athlete diagnosed with a concussion shall not return to athletic activity for the remainder of that day. 3. Graduated RTP protocol: a. Day 1 Self-reported Asymptomatic (SRA) i. SCAT2 evaluation. ii. BESS testing or other applicable baseline comparisons. iii. Continue daily testing until evaluations show student athlete is truly asymptomatic. b. Day 1 Asymptomatic (ASY) i. SCAT2 evaluation. ii. Begin level 1 post-concussion exertional exercises and proceed through FSU Post-Concussion Exertional Testing Protocol. (See Appendix B) iii. The exertional protocol s goal is to only increase HR and monitor for postconcussive symptoms. If symptoms return, student athlete will rest for 24 hours (or until ASY) and reattempt the last level of the protocol completed prior to symptoms returning. 4

5 c. Day 2 ASY i. Begin ATC-supervised sport specific non-contact drills. ii. The primary goal of this stage is to add movement to the exercises and monitor for post-concussive symptoms iii. This is not a return to practice. iv. If symptoms return, student athlete will rest for 24 hours (or until ASY) and reattempt Level 4 and 5 of Exertional Testing prior to Day 2 ASY drills. d. Day 3 ASY i. Student athlete may practice with the team under modified or limitedcontact rules. Specific instructions for these modifications should be provided to the coaches and the student athlete by the FSU athletic training staff. The student athlete is to be monitored during practice for a return o symptoms. ii. If symptoms return, the student athlete will rest for 24 hours and reattempt Day 2 ASY exercises. e. Day 4 ASY If the student athlete is still asymptomatic after Day 3 ASY, the athletic training staff may consult the team physician for RTP without restrictions. C. Role of Pharmacologic Therapy 1. Risks Drug therapy used to manage specific, prolonged symptoms (e.g. sleep disturbance, anxiety, etc.) as well as drug therapy to modify underlying pathophysiology of the condition with the aim of shortening the duration of concussion symptoms may mask a more severe injury or modify the symptoms of a concussion. 2. The decision to administer pharmacologic therapy to a post-concussive student athlete may only be made by the FSU team physician. This should be done in accordance with the FSU Over-the-Counter and Prescription Drug Policy. Post-concussive student athletes should not take any over-the-counter or prescription drugs unless recommended by the FSU team physician. Questions about current prescription drugs that the postconcussive student athlete is taking should be directed to the prescribing health care professional prior to continuing on the medication while symptomatic for the concussion. 5

6 APPENDIX A 6

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9 APPENDIX B 9

10 FAYETTEVILLE STATE UNIVERSITY SPORTS MEDICINE Post Concussion Exertional Testing Protocol Guidelines: All testing is to be done in a controlled setting and under the direct supervision of a certified athletic trainer Student-athlete should progress through each level continuously with minimal rest between levels unless postconcussive symptoms develop Testing should only be done if student-athlete has self reported to be asymptomatic and SCAT2 or applicable testing has returned to baseline levels Goal of testing is to monitor symptoms while increasing the heartrate. o If symptoms develop: STOP THE TESTING PROTOCOL Rest for 24 hours Resume testing at last asymptomatic level if SCAT2 or applicable testing has returned to baseline Exertional Testing Protocol- Level 1 (Sub-Maximal Cardiovascular Training) Non-impact cardiovascular implement of choice (e.g. bike, elliptical, ergometer, etc.) Duration 10min. 65% maximal heart rate Level 2 (Maximal Cardiovascular Training) Non-impact cardiovascular implement of choice Duration 15 min 85% maximal heart rate Level 3 (Sub-Maximal Anaerobic Training) Sit-ups, crunches and/or push-ups Duration 1 minute continuous exercise Level 4 (Maximal Effort Anaerobic Training) 300 yard shuttle run OR Treadmill interval run o 15 second sprint / 45 second jog o Duration 5 minutes Level 5 (Weight Training) Supervised weight-lifting under team s lifting program OR Similar supervised lifting program designed by certified athletic trainer 10

11 APPENDIX C Fayetteville State University Student-Athlete Concussion Statement I understand that it is my responsibility to report all injuries and illnesses to my athletic trainer and/or team physician. I have read and understand the NCAA Concussion Fact Sheet. After reading the NCAA Concussion fact sheet, I am aware of the following information: A concussion is a brain injury, which I am responsible for reporting to my team physician or athletic trainer. A concussion can affect my ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. If I suspect a teammate has a concussion, I am responsible for reporting the injury to my team physician or athletic trainer. I will not return to play in a game or practice if I have received a blow to the head or body that results in concussion-related symptoms. Following concussion the brain needs time to heal. You are much more likely to have a repeat concussion if you return to play before your symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage, and even death. Signature Date Printed Name 11

12 APPENDIX D Fayetteville State University Athletic Staff Concussion Statement I understand that it is my responsibility to report all suspected injuries and illnesses to the athletic trainer and/or team physician. I have read and understand the NCAA Concussion Fact Sheet. After reading the NCAA Concussion fact sheet, I am aware of the following information: A concussion is a brain injury, which I am responsible for reporting to the team physician or athletic trainer. A concussion can affect a student athlete s ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but some symptoms may be apparent in the student-athlete right away. Other symptoms can show up hours or days after the injury. If I suspect a student-athlete has a concussion, I am responsible for reporting the injury to a team physician or athletic trainer. I will not instruct a student-athlete to return to play in a game or practice if I believe or have been informed that they have received a blow to the head or body that results in concussion-related symptoms. Following a concussion the brain needs time to heal. A student-athlete is much more likely to have a repeat concussion if they return to play before their symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage, and even death. Signature Date Printed Name 12