Loss of consciousness (LOC) Poor recall for events prior to injury or after injury

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Willa Copeland
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1 NAIA Championship Concussion Policy Concussions can be serious and potentially life threatening injuries in sports. Research indicates that if concussion symptoms are appropriately managed, an individual is very unlikely to have a prolonged recovery or long term issues. In an effort to manage these relatively common injuries, a concussion management protocol/policy has been developed by the NAIA championships committee for athletes participating in NAIA championship events. Recognition of Head Injuries A concussion is a brain injury that is caused by a bump, blow, or jolt to the head, or by a blow to another body part with the force transmitting to the head. They can range from a mild traumatic brain injury (mtbi), which can disrupt the brain briefly (hours or days), whereas the severe traumatic brain injury (TBI) can result in more permanent disruption. A concussion may present itself differently for each student-athlete and occurrence. Coaches and fellow teammates can be helpful in identifying those who may potentially have a concussion, because a concussed athlete may not be aware of a concussion or potentially try to hide the injury to stay in the game, on the field or court and even stay in swimming/diving events. Signs and symptoms of concussion may show up right after an injury or can take hours or days to fully appear. Symptoms may include one or more of the following (reported by the athlete) Headaches Brief loss of consciousness (LOC) Fatigue/Vomiting/Nausea Poor recall for events prior to injury or after injury Pressure in head Difficulty with memory Sensitive to light or sound Feeling sluggish More emotional Difficulty concentrating/confusion/feeling foggy Change in sleep patterns Neck pain Balance problems or dizziness Irritability Repeating the same question/comment Balance problems or dizziness Blurred, double or fuzzy vision Report they don t feel right. * Not all symptoms have to be present for a concussion. Each concussion will present itself differently for each individual. ** A student does not have to be withheld from competition when a headache is the only symptom reported. A student shall be withheld from competition in accordance with RTP protocol when (a) the student reports a headache, (b) there is a mechanism of injury and (c) one other symptom is present. Signs observed by teammates, parents, coaches Appears dazed/stunned/exhibits confusion Balance problems or moves clumsily Vacant facial expression Personality change Unsure of game, score, or opponent Memory changes Responds slowly to questions Slurred speech Loss of consciousness (LOC) Seizures or convulsions Can t recall events prior to hit Can t recall events after hit Last Modified: 12/8/2017

Same Day Return-to-Play (RTP) A student-athlete playing in an NAIA championship event who exhibits any signs or symptoms of concussion or potential brain injury shall be withheld from the competition

2 Same Day Return-to-Play (RTP) A student-athlete playing in an NAIA championship event who exhibits any signs or symptoms of concussion or potential brain injury shall be withheld from the competition or practice and will not return to any activity for the remainder of that day. The athlete will be evaluated by the athletic training staff immediately following the injury episode. A determination of the student-athlete s medical status will be made by the on-site championship venue physician. If an institution is traveling with an athletic trainer, the team s athletic trainer will evaluate the injury episode per the institution s concussion management policy and request a determination of the student-athlete s medical status by the on-site championship venue physician. The student-athlete will be reassessed 24 hours after the injury event by the host athletic trainer, athletic training staff, or team s athletic trainer to determine his or her medical status. This post-event assessment will be documented by the host athletic trainer, athletic training staff or team s athletic trainer. The host athletic trainer, athletic training staff or the team s AT will implement recommendations made by the on-site championship venue physician for the athlete diagnosed with a concussion. On-the-Field/Court Immediate Referral Upon initial evaluation, activation of the appropriate Emergency Action Plan (EAP) and immediate transport/referral to an appropriate hospital is warranted with any of the following findings: Extended loss of consciousness (LOC) High index of suspicion of spinal or head injury Seizure activity Deterioration of vital signs Off the- Field/Court Immediate Referral Should the student-athlete present any of the findings in the athletic training room (ATR)/athletic training areas/bench or sideline, activation of the appropriate Emergency Action Plan (EAP) and immediate transport/referral to an appropriate hospital is warranted. Deterioration of neurological signs such as motor, sensory and cranial nerve deficits subsequent to initial on-field/court assessment. Extended loss of consciousness Persistent vomiting Post-concussion symptoms that worsen Non-Immediate Referral All student-athletes who have been diagnosed with a concussion will be evaluated by the on-site championship venue physician prior to return to unrestricted activity. Student-athletes may be referred to specialists if necessary and host athletic trainer or on-site championship venue physician may arrange this. Follow-Up Care In the event of a concussion, follow-up care and proper education is critical. The studentathlete will be released under the care of the team s athletic trainer, coach, and/or parents/guardians. 2

3 The concussion take home instructions will be explained and given to the concussed studentathlete as well as the coach or parents/guardians. The host athletic trainer should communicate what happened and care given to the student-athlete and the student-athlete s athletic trainer. (This may be electronically, verbally or written methods) The NAIA s responsibility ends at the conclusion of the tournament. Return to Play Guidelines Most NAIA championship venues have a limited time frame for practice and competition. A return to play guideline may not always be practical. It is important to note that a return to play timeline could last over a period of days, weeks, months and ultimately result in potential medical disqualification from participation in the championship venue. There are numerous yet similar return to play guidelines available. This policy cannot recommend one return to play guideline versus another. This will be left to the discretion of the on-site championship venue physician, host athletic trainer, athletic training staff, or the team s athletic trainer. A sample return to play guideline is provided here as an example: Rehabilitation Stage Functional Exercise Objective of Stage Criteria to Advance 1. No Activity Complete Physical & Cognitive Patience (rest) Recovery No symptoms at rest, neurocognitive and physical tests normal 2. Light Aerobic Exercise 3. Sport-specific exercise 4. Non-contact training 5. Full contact practice Walking, swimming or stationary bike <70% MHR Running drills, shooting drills, etc No Head impact activities Progression to more complex training drills, start resistive training Following medical clearance, normal training activities Increase Heart Rate Add movement Exercise, coordination, cognitive load Restore Confidence, assessment of functional skills 6. Return to Play Normal Game play Full 2 days of 1 day Any student-athlete diagnosed with a concussion may not return to full activity or competition until they are asymptomatic in limited, controlled, and full-contact activities and cleared by the on-site championship venue physician prior to returning to play. The on-site championship venue physician has the final say regarding whether a studentathlete may return to competition in a NAIA championship venue. In the event that the championship venue does not have an on-site physician, the athlete s college/university team s athletic trainer will determine athlete s return to competition in a NAIA championship venue. However; the host medical coordinator (athletic training staff) may assist in stabilizing and treating the athlete if requested until appropriate care is secured. This may consist of calling an on-call physician for the championship or referral to a medical facility. 3

4 Second Impact Syndrome Athletes with the signs and symptoms of a concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the student- athletes especially vulnerable to a greater injury. There is an increased risk for a period of time after a concussion occurs, particularly if the athlete suffers another concussion, before completely recovering from the first concussion. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It does not require a strong blow to the head to cause the effects of second impact syndrome. The student-athlete may receive a minor blow to the head, chest, or back that snaps the head (a minimal force causes irreversible damage). The second impact may often go undetected because it is not directly or under reported by the student-athlete. Rule will permit an unlimited amount of time to examine wrestlers June 15, :19pmGreg Johnson The NCAA Playing Rules Oversight Panel approved a rules change that allows medical personnel an unlimited and unimpeded amount of time for concussion evaluation of wrestlers, beginning in the season. Additionally, in cases of uncertainty, the medical staff will have the ability to remove participants from the wrestling area to perform a concussion evaluation. Panel members have asked that these medical evaluations be tracked in order to determine how often this rule is applied and the time it takes to perform an adequate evaluation. During the evaluation, the match will be suspended until a decision is rendered by the medical professional. The referee, the coaches of both participants and the noninjured wrestler are required to remain on the mat during the evaluation. A concussion evaluation timeout will not count as an injury timeout or recovery timeout. Coaching of the wrestler being evaluated is not permitted. In a separate rules change, injured wrestlers will not be permitted to be coached during all other nonbleeding injury timeouts. In the case of a severe or traumatic situation, medical personnel may request that the wrestler s coach assist in calming the injured wrestler. However, coaches are required to remove themselves from the situation during any assessment period related to the injury or concussion evaluation. 4

5 Concussion Home Instruction Sheet Athlete: Date: This athlete has sustained or is suspected to have sustained a head injury/concussion. Quite often signs of a head injury/concussion do not appear immediately after trauma. The purpose of this sheet is to alert you to the symptoms of significant head injuries/concussions that may occur several hours after the initial head injury. Please follow the instructions listed below: Keep careful watch over the athlete and observe overall physical and mental health. Contact the athlete s primary care physician or take the athlete to the nearest hospital emergency department IMMEDIATELY if any of the following symptoms persist or worsen: Increasingly severe headaches Repeated vomiting Dizziness, poor balance or unsteadiness Convulsion / Seizures Persistent ringing in the ears Slurred speech Neck pain Difficulty in waking the athlete Blurred vision Weakness or numbness in arms or legs Unusual or bizarre behavior Any discharge from the ears or nose Pupils that are dilated, unequal in size More emotional It is OK to Do Not Use an ice pack on head and neck as needed Do not exercise or lift weights Eat a light diet Do not take aspirin or ibuprofen unless directed by a physician Go to sleep Do not use sedating medication or alcohol Rest (no strenuous exercise or sports) Do not drive while you have symptoms Consult your physician about prescription meds Do not lie about or minimize your symptoms, be honest Special Instructions: Follow up with the Athletic Trainer / Physician the next day or as soon as possible to discuss signs/symptoms and receive directions for post-concussion care and treatment. Keep all medical paperwork about your concussion for your records and give instructions or medical clearance forms from your physician to the athletic trainer for guidelines for return to participation. Recommendations provided to: phone# Recommendations provided by: phone# Take Home Instructions This link from the CDC should be distributed to concussed student-athlete, coach, and/or parents/guardians. 5

Please feel free to contact me if you have any questions. HOME INSTRUCTIONS FOR CONCUSSION. Recommendations for monitoring symptoms at home:

Please feel free to contact me if you have any questions. HOME INSTRUCTIONS FOR CONCUSSION. Recommendations for monitoring symptoms at home: Recommendations for monitoring symptoms at home: What should I do when I m recovering? Physical and mental rest are very important to your recovery. Keep your heart rate low and do not do any physical