Purpose: The purpose of the concussion protocol administered by CC Sports Medicine is to provide a plan to effectively and safely manage and prevent concussions suffered by CC athletes. This protocol aims to appropriately educate athletes and athletics personnel as to the signs, symptoms, treatment options, and prevention strategies associated with sport-related concussion. The goals of the sports medicine staff are to identify concussions accurately, administer proper treatment, appropriately refer, and responsibly return athletes to play using a team approach based on clinical expertise and scientific evidence, under the direction of the CC team physician staff. Pre-Season Education Student-athletes, Coaches, and Athletic Administrators at CC, are issued annual concussion education information fact sheets, as designed by the NCAA. Staff ATCs and Team Physicians are presented with annual educational materials that reflect current evidenced-based practices in clinical concussion management. Each of these parties signs a form of acknowledgement of having read and understood the concussion education materials. Pre-Participation Assessment Each student-athlete at CC is required to provide brain injury and/or concussion history via Physical Exam and/or our Health History Questionnaire (HHQ) on an annual basis. This HHQ also serves to gather any and all other injury history that is unrelated to concussions. All student-athletes are tested in a baseline format to gather information in regards to: 1) Symptom Scale, 2) Cognitive Assessment, and 3) Balance Evaluation. These three components are accomplished by administering the SCAT 3 tool, which includes the SAC (Standard Assessment of Concussion) battery, and the BESS (Balance Error Scoring System). All student-athletes at Colorado College who are at higher risk of head injury, or those who participate in contact sports, are mandated to complete the ImPACT baseline test. This group-based Revised 8-7-17 1 of 12
test is usually administered in a reservable computer lab on campus, in a group, with their respective teams. The ImPACT baseline test is repeated every two years to accommodate the developing brain. Brain injury/concussion history, SCAT 3 data, and Impact data are documented into the athlete s medical record. Colorado College Team Physician Staff determines the final clearance of each student-athlete in the pre-season, based on their examination along with the above baseline testing platform. Concussion Recognition & Diagnosis Any student-athlete at Colorado College with signs/symptoms/ behaviors consistent with a concussion: 1) Are removed from their practice, competition, or training. 2) Are evaluated by a Staff ATC and/or CC Team Physician. 3) Removed from practice/play if a concussion is confirmed. 4) Are not permitted to return to play on that day, if concussion is confirmed. Initial Suspected Concussion Evaluation: - PCSS (post concussion symptom scale), and Immediate History - Physical Exam and Neuro Exam - Cognitive Assessment and Balance Exam (SCAT 3) - Clinical assessment for potential cervical spine trauma, skull fracture and intracranial hemorrhage. Coverage of Athletic Contests/Practices: Colorado College sports medicine staff members are present and available for on-site concussion examinations during competitions for the following contact/collision sports: Lacrosse (men's and women's), Basketball (men's and women's), Soccer (men's and women's), Men's Ice Hockey, and Pole Vault events (Track and Field). Revised 8-7-17 2 of 12
Colorado College sports medicine staff members are either on-site or "available" for communication, per NCAA definition, during the following sports' practices: Lacrosse (men's and women's), Basketball (men's and women's), Soccer (men's and women's), Pole Vault (Track and Field), and Men's Ice Hockey. Post Activation of CC Emergency Action Plan, including transportation to Concussion Penrose Emergency Department, for any of the following: Glasgow Coma Scale < 13 Prolonged Loss of Consciousness, > 1 min Focal Neurological Deficit identified from neuro exam Repetitive Vomiting Persistently diminished/worsening mental status or other neurological signs/symptoms Potential Spinal Injury CC ATC/Team Physician will provide home instructions to both the injured student-athlete as well as another responsible adult, as included in the SCAT 3, and also will follow up with serial evaluation, beginning the first day post-concussion, then continuing on a serial basis, until student-athlete demonstrates an asymptomatic state for an extended period of time. CC staff ATCs will refer all concussions to a team physician for evaluation, treatment options, further referral, and for return to play consultations. Time frames for the injured athlete to see the physician will vary per the specific physicians' treatment policies. Student-athletes will be referred to the appropriate specialty if they demonstrate a prolonged recovery time (> 4 weeks), suffer from an identifiable symptom subset of concussion such as post concussion syndrome, persistent sleep dysfunction, complicated migraine disorder, on-going mood disorders, anxiety, or depression. Revised 8-7-17 3 of 12
Persistent ocular and vestibular cases will be referred out to external physical therapy for athletes that experience these symptom subsets greater then 2-3 weeks. The CC Sports Medicine team will administer the ImPACT test to the student-athlete within 5 days of the injury, when possible. Serial ImPACT testing will occur to track the neuro-cognitive progress of the injured student. Return To Play Final return to play post-concussion will be determined by a CC team physician or their designee. Student-athletes must successfully progress through a step-wise return to play format supervised by a CC ATC. Progressive steps in the physical process are as follows: Light Aerobic Exercise w/o Resistance Training Sport Specific Exercise and Activity w/o Head Impact Non-Contact Practice(s) with Resistance Training Unrestricted Training Return to Competition Other criteria for qualifying for a return to play may be: Returning to within normal/baseline limits in all testing modules of the ImPACT test and/or other neuro-psychological test batteries. Return To Learn CC Sports Medicine is proactive in assisting the student-athlete with necessary academic accommodations and special arrangements following a concussion, through partnerships with a faculty liaison and the college s Department of Assisted Services. Student-Athletes will remain at home/dorm if they cannot tolerate light cognitive activity, and will gradually return to classroom/ studying as tolerated. Colorado College s Department of Assisted Services is in full compliance with ADAAA standards, with assisted learning services being coordinated through Jan Edwards and Sarah Rotonno (learning specialists). Our academic team is Revised 8-7-17 4 of 12
prepared to modify students academic schedules/accommodations for two weeks or as necessary. A team physician, along with members of our academic team, will re-examine the student-athlete if symptoms that affect academic potential persist beyond two weeks. No classroom activity should be permitted on the same day of a concussion. Each post-concussion academic plan will most likely need to be individualized per student-athlete, based on presenting symptom trajectories and their relationship to the particular academic task. Our academic team consists of: Pedro de Araujo Mike Edmonds Rochelle Mason Jan Edwards Sarah Rotonno Bill Dove Tom Monagan Faculty Academic Representative Athletic Dept Point Person for Assisting Student Athletes Faculty Liason Dean of Students Senior Associate Dean of Students Director of Assistive Resources ADAAA Compliance Officer Assistance Director of Assistive Resources College Counselor/Psychologist Director of Sport Medicine Annually, a concussion educational/informative memorandum is distributed to all faculty members of Colorado College. This letter is generated out of the office of Pedro de Araujo, Faculty Athletics Representative. (Letter attached) In the event of a concussion, the student-athletes's professor and the applicable members of the above team are notified by the designated team ATC, within 24 hours of the injury. Each team member is prepared to offer their expertise/specialization in terms of assisting the student-athlete. (Email attached) CC Team Physicians participate may in this process, upon referral from the CC ATC, in the context of increasing symptoms from academic activity. Revised 8-7-17 5 of 12
* It must be noted that Colorado College functions on a unique "Block Plan", requiring students to take one class at a time, for three and a half weeks. Class schedules are a daily 9-12pm lecture, with an associated 1-3pm lab for many courses. Missing only a couple of days of class, often requires the drop of a block (class). All involved parties in our academic concussion management plan understand the nature of this block plan, and its potential effects on graduation rates, completing major requirements, and remaining NCAA eligible. Reducing Head Trauma CC Athletics is committed to adhering to the, 1) Inter-Association Consensus: Independent Medical Care Guidelines, 2) to Reduction of Gratuitous Contact During Practice, 3) "Safety First" Approach to Sport, 4) Taking the Head out of Contact, and to the 5) Education of Student Athletes Regarding Safe Play and Proper Technique. Revised 8-7-17 6 of 12
COLORADO COLLEGE CONCUSSION /HEAD INJURY FLOW CHART Head Injury/Suspected Concussion = On-field and/or Sideline Clinical Evaluation. 1. Suspected Severe Head Trauma/C-Spine injury = Activate Emergency Action Plan/Spinal Protocol. 2. Symptomatic Athlete/Dx of Concussion = Remove From Play, not to return until medically cleared. *Athlete may not return to play per the NCAA on the same day as injury episode. 3. Asymptomatic Athlete + Normal Physical/Neuro/SCAT 3 Exams = Return to Play (RTP) at discretion of CC Sports Med Staff. Athlete Suspected of/diagnosed with Concussion w/o concern for Emergency as Follows: 1. Monitor for increasing symptoms: significantly increasing headache, repeated vomiting, increasing GCS. 2. If athletes condition is stable: give home instructions (SCAT 3), emphasis on absolute rest/ sleep. 3. Schedule next day appointment for follow-up. 4. Email Blast to the student-athlete's professor and the academic concussion management team. 5. Continue an emphasis on rest until a reduction in symptoms, or over the period of about 2 days. 6. Re-evaluate athlete and obtain symptom score as necessary on situational basis, usually daily. 7. Administer Impact Post-Injury Exam 2-5 days post-concussion, and then as needed per clinician. Revised 8-7-17 7 of 12
Physical RTP Progression *Adopted from InternationalConcussion Expert Panel Consensus Statement 1. Light Aerobic Activity without Resistance Training 2. Sport Specific Activity without Head Impact 3. Non Contact Practice/Introduce Resistance Training 4. Full Practice/Unrestricted Training 5. Return to Full Competition Before a complete return to contact play... Student-Athletes must prove to be asymptomatic in all phases of the above physical RTP progression, Be cleared by a CC Team Physician, or their designate, and, Score within normal limits on the Post-Injury Impact Test. Key Points: Returning to learning will vary per student-athlete, likely based on symptoms experienced. On-going communication with coaches and professors is essential. Absolute rest should allow for easy listening music, breaks for socialization/ going for a walk, and occasional phone/technology use per allowance of symptoms. Identified symptom clusters/subsets should be specifically addressed and managed. Recommendations for further treatment and return to play considerations will be discussed with the ocular/vestibular physical therapist, if applicable. Neurology/Specialty Referral: Per team physician or ATC discretion. Revised 8-7-17 8 of 12
Annual concussion letter sent out to the faculty and staff of the college: Dear CC Faculty and Staff: This annual email serves as a reminder that head injuries and concussions are a reality in the lives of our physically active student population. Although this email is generated from the perspective of athletics, we should also be reminded that our students at large, engage in many and various activities that hold risk for concussions. Each year, several CC students suffer from concussions, caused by impacts, that lead to the brain itself being damaged. The damage can significantly affect the brain all the way down to the subcelluar level, and can vary in severity from very mild to potentially completely debilitating (Shaw, 2002, Prog Neurobiol, 67, 281-344). Some symptoms of concussions are confusion, nausea or vomiting, headache, dizziness, fatigue, memory/concentration problems, and sleep disturbances. These symptoms may not always be immediately apparent, and can actually worsen over time. Recovery from concussions can be very idiosyncratic. Depending on the severity of the concussion and the medical history of the individual, a person can recover spontaneously in a matter of days, or over very prolonged period. Individuals with repeated concussion are at particular risk. A large concern is the potential for poor and/or uncharacteristic academic performance after suffering a concussion. If a CC athlete receives a concussion, sports medicine staff will notify that student s professor to provide information so that the professor remains informed of the student s condition. We will also be in contact following the concussion to notify the professor whether the student will likely be missing any class days, and to assist in strategies allowing the student to make up his/her work. Please visit the following link for further information, as presented by the NCAA, regarding "return to learn" following concussions. Scroll down on the page to reach Return to Academics and Step Wise Progression: http://www.ncaa.org/health-and-safety/concussion-guidelines We greatly appreciate your efforts ahead of time in establishing a flexible environment for our students and student-athletes who may be debilitated by this condition. Sincerely, Pedro de Araujo NCAA Faculty Athletics Representative Chair Economics and Business Revised 8-7-17 9 of 12
Mike Edmonds Vice President for Student Life Dean of Students Jan Edwards Director of Accessibility Resources ADA/504 Coordinator TBD Director of Sports Medicine Revised 8-7-17 10 of 12
Email correspondence sent to the applicable professor post-concussion: Dear Professor ( ), One of your students, ( ), was injured, suffering a concussion. (He/She) will remain in the care of CC sports medicine staff, as well as CC team physicians. If appropriate, (he/she) will be referred to a neurologist and/or other head injury specialists. Neuropsychology studies show significant cognitive impairments following concussion, which may be associated with headaches, vision disturbances, memory loss, and/or many other symptoms. A large concern is poor and uncharacteristic academic performance secondary to the concussion ( )'s treatment currently involves reducing stimuli that exacerbates this condition. In some circumstances, these are bright light(s), noise, reading, computer use, text-messaging, and academic activity. ( ) may be missing some time in your class, but is advised to be proactive in communicating with you and seeking appropriate makeup work. ( ) will engage in full academics once the concussive symptoms begin to resolve. Time frames for adequate cognitive recovery from concussions can vary, however a few days is fairly standard for simple concussions, but complex cases may take longer. Students should be monitored closely for diminishing academic performance by both faculty and staff members. Unfortunately, in some circumstances, dropping classes/block(s) may be necessary while attempting to fully recover from concussion. CC staff athletic trainers or team physicians will refer student-athletes with associated academic deficits, prolonged symptoms, or post-concussion syndrome to local medical providers for appropriate specialized care and rehabilitation considerations. Students who appear to demonstrate anxiety or depression postconcussion can be referred to the counseling center. Thank you for your consideration in this matter and for your attention to the safety of our CC students. Coordinated assistance and resources are available through the Counseling Center (Dr. Bill Dove - x6389), Sports Medicine (Athletic Training Staff - x6490), and Accessibility Resources (Jan Edwards - x8294, or Sara Rotunno - x8287), if your student is having cognitive impairment that may result in academic consequences. Sincerely, ( ), ATC Revised 8-7-17 11 of 12
Compliance Statement: The Colorado College Concussion Protocol, specific to the department of intercollegiate athletics, will be the official document that represents the identification and management strategies of athletic-related concussion, pertaining to intercollegiate student-athletes, at this institution. Colorado College reserves the right to make team physician suggested and/or evidence-based adaptations and adjustments to this protocol, as it deems necessary, to ensure and foster a safe environment for, and in efforts to provide optimum medical service to, it's student-athletes. The Colorado College agrees to comply with guidelines as set forth by the NCAA in relation to sport-related concussion management. Jason Bushie, ATC, Acting Athletics Health Care Administrator Date Revised 8-7-17 12 of 12