Policy, Prevention, Report and Assessment of High School Sports Concussions

1. Policy, Prevention, Report and Assessment of High School Sports Concussions By: Daniel Murray, Steven Connors, Derek Habershaw and Michael Chang

2. Concussion Policy Michael Chang

3. Safety Regulations • Between 2009 and 2011, 33 states passed laws to prevent concussions in youth sports • 15 more states, including Wisconsin, passed concussion laws this year due to 2 former NFL players who committed suicide after suffering severe head injuries

4. Rochester NY • - Students who are believed to have suffered a concussion are removed from activity immediately and can only return when they are symptom free for 24 hours with written authorization from a doctor. • -The new law boosts education and requires more stringent regulations for dealing with concussions.

5. Wisconsin Act 172, signed into law on April 2, contains three main components. • 1.Parents of students 18 years old or younger must sign a concussion information form before their kids can participate on a sports team; • 2.any athlete suspected of a concussion must be immediately removed from play; • 3.and those who get removed can't return to competition until they are cleared to play by a physician.

6. Policy on uninsured kids • some School districts and other organizations provide insurance and care options to all HS athletes • local school districts and community groups respond to Athletic accidents among the uninsured via fundraisers, booster club donations, and the provision of free care by health care providers such as physicians and clinics

7. Concussion Prevention Steven Connors

8. Development of Safer Equipment • Former Harvard quarterback Vin Ferrara set out to make a helmet that fights what he and his company refer to as a "silent epidemic.“ • With his focus solely on helmets, Ferrara founded Xenith, and created, tested and launched the X1 -- which ditched the typical in-helmet padding for shock absorbers that, as Ferrara puts it, work like an airbag in a car, reducing the speed with which the head moves on every hit. • Robert Cantu, chief of neurosurgery service and director of sports medicine at Emerson Hospital in Concord, Mass., and co-director of the Neurologic Sports Injury Center at Brigham and Women's Hospital in Boston, has called the helmet "perhaps the greatest new head protection system to emerge in the last 30 years."

9. No Helmet Manufacturer Believes Equipment to be the Cure-all • Proper tackling technique -- keeping the head up and avoiding helmet-to-helmet collisions -- is the other element of prevention. • "As far as warding [concussions] off, the biggest thing is teaching the game properly so that the technique does not allow itself to have concussions," said Mike Kirschner, coach at Ben Davis High School in Indianapolis. • Reduction, not elimination, is the key word when it comes to concussions.

10. Gfeller-Waller Concussion Awareness Act • Signed into North Carolina law on June 16, 2011 • 1. Education: Every public middle school and high school athlete must read and sign a concussion awareness form. All coaches, school nurses, volunteers and the parents of athletes also must read and sign a concussion awareness form. The form has a checklist that must be initialed item by item, including a pledge to report injuries and symptoms. • 2. Emergency action: Every public middle school and high school has to establish an emergency action plan for each venue a school uses. The plan includes communication, emergency transportation, medical equipment and requires schools to plan for situations involving heat illness, sudden cardiac arrest, head and neck injuries, and other emergencies. • 3. Post concussion protocol and return to play: If an athlete exhibits signs and symptoms consistent with a concussion, the athlete is removed from play and is not allowed to return to game, practice or conditioning that day. In order for the athlete to return to participation, the athlete must have written clearance from appropriate medical personnel. • Other changes since 2008 • 4. Baseline testing: Many high schools now conduct tests in the preseason to establish a baseline for the normal brain function of each athlete. The test is repeated following an injury to determine if the brain has returned to its normal function. Some schools also establish baseline balance tests. • 5. Athletic trainers: The percentage of certified athletic trainers in high school s has increased. Last season about 200 of the NCHSAA’s 356 football-playing schools had access to certified athletic trainers during games and 110 schools employed certified athletic trainers as part of the staff.

11. Reporting Concussions Derek Habershaw

12. Why should concussions be reported? • Even if unsure, an impact test can provide an accurate diagnosis. • After three concussions there is an increased risk for permanent brain damage and future medical issues. • Minor concussions still cause post concussion syndrome.

13. Statistics on Concussion Reporting • In 2004 75% of student athletes surveyed stated they would not report concussion symptoms. • In 2012 72% of athletes with proper education stated they would report symptoms. • On average, one concussion is suffered every game of football. • Percentage of reported concussions increase every year. • Headaches and Dizzyness are the most common symptoms.

14. Why Do Concussions Go Unreported? • Athletes want to step up for the team. • Playing through injury is praised. • Possible loss of starting position if backup performs well. • Poor knowledge of concussion symptoms. • Unaware of long term effects and post concussion symptoms.

15. Concussions Assessment Daniel Murray

16. Immediate Signs and Symptoms • Typical Symptoms • Headache • Dizziness • Nausea • Unsteadiness/loss of balance • Confusion • Unaware of period, opposition, etc. • Ringing in the ears • Physical signs • Loss of consciousness • Concussive convulsion • Slow to answer questions • Easily distracted, poor concentration • Displaying inappropriate emotions • Nausea/vomiting • Vacant stare/glassy eyed

17. Concussion Assessment • If a patient reports any symptoms, assume they have been concussed until proven otherwise. • Diagnosis of concussion must include a formal evaluation such as the Maddocks questions or the Standardized Assessment of Concussion (SAC). (See next slides) • All patients suspected of concussion should undergo formal medical evaluation by a qualified physician. • All patients suspected of concussion must be serially monitored until they fully recover. • Never return a patient suspected of concussion to the field of play on the day of the injury. • When in doubt, refer the patient to the nearest hospital emergency department.

18. Questions • Which field are we at? • Which team are we playing? • Who is your opponent at present? • Which half/period is it? • How far into the half is it? • Which side scored the last touchdown/goal/point? • Which team did we play last week? • Did we win last week? Maddocks Questions The Maddocks questions combine scientific validity with a quick simple and practical tool which can be administered either on-field or on the sidelines. Any incorrect response indicates concussion and requires removal from the playing field for further medical evaluation.

19. The Standardized Assessment of Concussion • The Standardized Assessment Of Concussion (SAC) takes 5-10 minutes to administer and includes measures of orientation, immediate memory, concentration and delayed recall. • The SAC also includes a brief neurological screen including questions about Loss of Consciousness (LOC) and Post-Traumatic Amnesia (PTA), and some co-ordination and movement tests. • The outcome of the SAC is a ‘summary score' out of 30.

20. Further Evaluation and Referral to Hospital • Further post-injury assessment is best performed in a quiet medical room rather than in the middle of a sports field. • The major priorities at this stage are to establish an accurate diagnosis and exclude a catastrophic intracranial injury. • A full neurological examination should be conducted. • Having determined the presence of a concussive injury, the patient needs to be serially monitored until they recover fully.

21. The End • Any Questions?