AHSAA Middle/Junior High School Conference Sept 24, 2014

1. AHSAAMiddle/Junior High School ConferenceSept 24, 2014 Marshall Smith Med, ATC, LAT Sports Medicine Director Southern Bone & Joint Specialist Dothan Al

2. Athletic Health Related Issues • Emergency Action Plans • Heat Illness • Concussions • Hyponatremia

3. Emergency Action Plans • When an Emergency occurs it affects more than just the people on the field or in the school.

4. Emergency Action Plans • Required by the State of Alabama. • Required by AHSAA

5. Emergency Action Plans • Review Annually • New Building Additions • New Buildings • Office Relocations/Staff/Classrooms • Redesigned Fields/Stadiums • Gate Locations

6. Emergency Action Plans AED’s • Know Locations • Boxes? Locked/ Alarms off-on • Batteries - need to be checked frequently • Pads- Check dates and proper sizes

7. Emergency Action Plans • Practice, Practice, Practice!!! • Who should be involved Coaches ATC’s Student Athletic Trainers EMS School Administrators

8. Emergency Action Plans • Scenarios for Practice Injured athlete on Game field Injured athlete on Practice field Injured athlete in Gym/ Basement Injured Student in school/ classroom Every scenario will have different issues to overcome.

9. Emergency Action plans • Encourage your staff to introduce themselves to the EMS staff at your games. • New staff on EMS units • May never have worked an athletic event! • Athletic events are different than MVA’s

10. Heat Illness Dehydration Heat Cramps Heat Exhaustion Heat stroke

11. Dangerous Conditions • Heat Index – Know Temperature and Humidity Level • Test Air with WBGT Heat Index Monitor 65-73 Moderate Risk 73-82 High Risk 82+ Very High Risk • Weather Bug App- Very Good

12. NOAA’s National Weather Service Heat Index Courtesy of NOAA’s National Weather Service www.nws.noaa.gov

13. Signs of Dehydration • Dry mouth • Thirst • Irritable or cranky • Headache • Bored or disinterested • Dizziness • Cramps • Excessive fatigue • Not able to keep up • Dark yellow urine

14. Other factors for Illness from Heat • Low fitness levels • High body fat • Sickness • Previous dehydration or heat illnesses • Inadequate heat acclimatization • Salt deficiency • Medications/Dietary supplements

15. Serious Health Risks • Dehydration Can Result In: • Heat Cramps • Heat Exhaustion • Heat Stroke • Recognize Warning Signs of Heat Illness

16. Heat Cramps • Are a mild heat illness that can be treated easily. • Intense muscle spasms can develop after exercising and losing large amounts of fluid and salt from sweating. • Athletes who sweat a lot or have a high concentration of salt may be more likely to get heat cramps.

17. Heat Cramps • Signs/Symptoms • Intense pain • Persistent muscle contractions • Treatment • Hydration (sports drink and/or water) • Possibly extra sodium • Stretching, relaxation, massage

18. Heat Cramps When can the athlete play again? • As soon as they are symptom free. • Important to continue to monitor. • May need to change eating and drinking habits, become more fit, or get better adjusted to the heat.

19. Heat Exhaustion • Is a moderate Heat Illness that occurs when an athlete continues to be physically active even after suffering from ill effects of the heat. • The body struggles to keep up with the demands, leading to heat exhaustion.

20. Heat Exhaustion • Signs/Symptoms • Loss of coordination, dizziness or fainting • Dehydration • Profuse sweating or pale skin • Headache, nausea, vomiting or diarrhea • Stomach/Intestinal cramps or muscle cramps • Treatment • Shade or air conditioned area • Remove excess clothing and equipment • Lie comfortably with feet above heart level • If not nauseous, rehydrate with water or sports drink • Monitor heart rate, blood pressure, CNS status and core temperature

21. Heat Exhaustion When can the athlete play again? • Should not be allowed to return until all symptoms are gone. • Avoid intense practice in heat for a few days. • If received medical treatment, not until doctor approves and gives specific return to play instructions.

22. Heat Stroke • Is a severe heat illness that occurs when an athlete’s body creates more heat than it can release, due to the strain of exercising in the heat. • Results in rapid increase in core body temperature. • Can lead to permanent disability or death.

23. Heat Stroke • Signs/Symptoms • Core body temperature 104°F+ • CNS dysfunction • Nausea, vomiting or diarrhea • Headache, dizziness or weakness • Hot & wet or dry skin • Increased heart rate, decreased blood pressure or fast breathing • Dehydration • Combativeness • Treatment • 911 • Aggressive whole-body cooling (cold water immersion) • Fans/ice/cold towels over much of the body if immersion is not available.

24. Heat Stroke When can an athlete play again? • When the doctor approves and gives specific return to play instructions. • Parents should work with doctors to rule out or treat other conditions that may cause continued problems. • Should return very slowly under the supervision of health care professional.

25. Prevention • Meet with prospective players and parents to educate them. • Discuss pre-season conditioning program • Avoid mid-day heat • Take regular breaks in shade • Slowly increase practice time and intensity • Pre-participation physical • Emergency action plan • ATC on site if possible.

26. Activity Guidelines • 5-10 minute rest & fluid break after 25-30 minutes of activity • 5-10 minute rest & fluid break after 25-30 minutes of activity/should be in shorts & t-shirt with helmet & should pads. • 5-10 minute rest & fluid break after every 15-20 minutes of activity/shorts & t-shirt only. • Cancel or postpone all outdoor practices. Practice in air conditioned space.

27. Acclimation to Heat • Promote conditioning • Usually takes 10-14 days • Carefully observe athletes

28. Hydration • Encourage athletes to drink before, during and after exercise • Take regular drink breaks in shade • Helpful Beverages: water and sports drinks with adequate electrolytes • Harmful Beverages: fruit juice, CHO gels, soda, sports drinks 8%+CHO, caffeinated drinks

29. Monitor Weight Loss • Athletes should weigh before and after practice • Check weight charts • Up to 3 percent weight loss through sweating is normal

30. Heat Illness Prevention Teach Nutrition Teach Hydration Instruction in Proper Pre-Game Meal Education and Support Korey Stringer Institute CDC

31. What is a Concussion? • A traumatic injury that alters normal brain function • It is a problem with function, not structure: can’t see it or x-ray it • Any force applied to the body that causes the brain to shift or rotate, causing damage to brain cells that results in chemical changes that renders the brain vulnerable to subsequent injury and may take weeks to heal

32. What is a Concussion? • A common problem in ALL sports • Potential for serious complications including death • Can even occur with a mild jolt or hit; Do not have to lose consciousness- <10% • Occurs at all levels of play, but risk of serious injury is more significant in adolescents • Trained medical personnel are not always available to evaluate these injuries

33. Definition of Concussion • “Concussion is a brain injury defined as a complex pathological process affecting the brain…Featuring pathologic and biomechanical injury.” • Zurich,2012

34. Concussions • International Conferences on Concussions in Sport:Vienna 2001Prague 2004Zurich 2008Zurich 2012

35. State Focus • AHSAA – Point of emphasis rule for 2010 for all sports • “Any player who shows signs, symptoms or behaviors of a concussion must be removed from the game and shall not return to play until cleared by an appropriate health care professional (a medical doctor under AHSAA rules)” • Previous rule stated athlete had to be unconscious or apparently unconscious

36. State Focus Continued: 2011 Alabama Concussion Law • Any athlete who receives a concussion must immediately be removed from play and not be allowed to return until a doctor says its safe and gives written permission • All youth sports programs and recreational organizations must distribute information sheets detailing the symptoms and risks of concussion and other forms of traumatic brain injury

37. State Focus Continued: 2011 Alabama Concussion Law • Athletes and their parents or guardians must sign the information sheets acknowledging they have read and understand the material • Coaches must also receive annual training on how to recognize concussion symptoms and how to treat an athlete with a concussion

38. Why Such a Concern in High Schools • Adolescents are more vulnerable to sustaining concussions and their brain takes longer to heal after sustaining an injury • Most high schools in Alabama do not have a licensed certified athletic trainer or physician available at all practices or games so coaches are responsible for the health and safety of their team

39. Common Signs and Symptoms Physical • Headache • Nausea/Vomiting • Dizziness • Balance Problems • Visual Problems • Fatigue/Feeling Tired • Light & Noise Sensitivity • Numbness/Tingling Cognitive • Feeling mentally foggy • Feeling slowed down • Difficulty remembering • Difficulty concentrating

40. Common Signs and Symptoms Emotional • Irritability • Sadness • More emotional • Nervousness Sleep • Drowsiness • Sleeping less than usual • Sleeping more than usual • Trouble falling asleep

41. Vestibular Using Concussion Clinical Trajectories to Inform Targeted Treatment Pathways Ocular Cervical Concussion Clinical Trajectories Treatment and Rehab Pathways Risk Factors Concussion Previous Concussions Anxiety/Mood Cognitive Migraine Migraine LD/ADHD Sex Age Motion sensitivity, Ocular Hx?

42. New Advances in Concussion Treatment • Vestibular and Ocular Motor Assessment • Balance Assessment

43. Recognize Balance Problems BESS Test(Balance Error Scoring System) University of North Carolina Sports Medicine Research Laboratory Chapel Hill, NC 27599-8700

44. Vestibular and Ocular Motor Assessment • Smooth Pursuits- H test • Saccades- Horizontal (eyes only) • Saccades – Vertical ( eyes only) • Convergence (near point) less than 8cm • VOR- Horizontal ( head with eyes) • VOR- Vertical ( head with eyes) • VMR- Horizontal ( body, head and eyes) • Headache, dizziness, nausea, fogginess

45. Comprehensive Assessment and treatment Approach

46. Hyponatremia • Commonly referred to as a low level of sodium in the blood. • Water Intoxication-without Na replacement during strenuous exercise. • Can result from excess fluid in the body relative to the normal amount of sodium, or it may be due to a loss of sodium and body fluid.

47. Hyponatremia Symptoms may consist of: Mental Changes- Confusion Headache Nausea Tiredness Muscle Spasms Seizures Vomiting

48. Hyponatremia Mechanics of Hyponatremia • When the sodium levels in the blood are low, water tends to enter cells causing them to swell. • When this occurs in the brain it causes Cerebral Edema. (Swelling in the Brain) • Causes increased pressure in the brain. • Only occurs in Severe cases

49. HyponatremiaTreatment and Prevention • Treated with IV fluids and Electrolyte replacements. • Gradual replacement of fluids during exercise and following exercise. • Monitor diet and lifestyle • Gradual Hydration and Food intake prior to athletic event and exercise to increase sodium levels.

50. Thank You