RM12: A Crash Course in Concussion Management and Safe Return to Play

1. APRIL 3-6, 2013, LONG BEACH, CA RM12: A Crash Course in Concussion Management and Safe Return to Play These materials have been prepared for the CASBO Risk Management Professional Council Workshops. They have not been reviewed by State CASBO for approval, so therefore are not an official statement of CASBO.

2. What You Need To Know About Concussions & Other Athletic Risk Management Issues Roger L. Blake, Executive Director, California Interscholastic Federation

3. 400,000 concussions occurred in HS athletics in the 2010-2011 school year. Diagnosis and treatment has changed dramatically over the last several years. School District risk management responsibilities have also changed and increased

4. NATIONAL HEADLINESMore stringent and individualized “return to play” guidelines based on clinical experience and science have been instituted in professional, collegiate and CIF Sports. Heighten Awareness Raises School District Expectations

5. Concussions & Irish Setters they are the same

6. Modern high velocity competition poses variable risk of head injury H.S. boys and girls are bigger, faster and stronger than ever before.

7. Adolescent athletes are at greater risk than adults, but often receive less than optimal concussion management.

8. Differences between an Adolescent Brain and Adult Brain Recovery In College Athletes and adults is quicker. Recovery In High School Athletes takes substantially longer. N=92 Athletes . Field M, Collins M, Lovell M, Maroon J. J of Pediatrics 142(5):546-53, 2003

9. WEEK 5 WEEK 1 WEEK 2 WEEK 3 WEEK 4 80% ARE BETTER 90% ARE BETTER 70% ARE BETTER 40% ARE BETTER Collins M et al, Neurosurgeon 2006

10. Mechanism of Concussion • Acceleration-deceleration motion • Linear plane • Rotational direction • Sudden momentum change results in tissue damage • Contusion • Diffuse axonal injury (stretching/tearing of axons)

11. The National High School Sports Injury Surveillance Study: High School RIOTM R. Dawn Comstock, Ph.D. Center for Injury Research and Policy, Nationwide Children’s Hospital The Ohio State University, College of Medicine, Department of Pediatrics and College of Public Health, Division of Epidemiology

12. Burden of Concussions by Sport

13. States with Youth Concussion Laws Dec 2012 http://www.edweek.org/ew/section/infographics/37concussion_map.html

14. CALIFORNIA LEGISLATIONCIF Bylaw 313 A.B. 25 • CONCUSSION PROTOCOL • A student-athlete who is suspected of sustaining a • concussion or head injury in a practice or game shall • be removed from competition at that time for the • remainder of the day. A student-athlete who has been • removed from play may not return to play until the • athlete is evaluated by a licensed health care provider • trained in education and management of concussion • and receives written clearanceto return to play from • that health care provider. • On a yearly basis, a concussion and head injury • information sheet shall be signed and returned by • ALL athletes and the athlete's parent or guardian • before the athlete's initiating practice or • competition. • (Approved May 2010 Federated Council) • Q: What is meant by “licensed health care provider?” • A: The “scope of practice” for licensed health care providers and medical professionals is defined by California state statues.  This scope of practice will limit the evaluation to a medical doctor (MD) or doctor of osteopathy (DO). • Section 49475 is added to the Education Code, to read: • 49475. (a) If a school district elects to offer an athletic program, the school district shall comply with both of the following: • (1) An athlete who is suspected of sustaining a concussion or head injury in an athletic activity shall be immediately removed from the activity for the remainder of the day, and shall not be permitted to return to the activity until he or she is evaluated by a licensed health care provider, trained in the management of concussions, acting within the scope of his or her practice. The athlete shall not be permitted to return to the activity until he or she receives written clearance to return to the activity from that licensed health care provider. • (2) On a yearly basis, a concussion and head injury information sheet shall be signed and returned by the athlete and the athlete's parent or guardian before the athlete's initiating practice or competition.

16. Why is Education of the High School Coach, Parent and Athlete are Important? • Athlete either unaware of or minimized symptoms • 53% did not report symptoms • 66% did not feel it was serious • 41% did not want to be held out • 36% not sure what a concussion was McCrea M et al, CJSM 2004

17. Assembly Bill 1451 • Passed August 17, 2012; took effect January 1, 2013 • Requires high school coaches to receiving training every two years on recognizing the signs of concussions and responding to them appropriately. The training can be acquired online.

20. “Concussion in Sports - What You Need to Know”www.nfhslearn.com

21. Helmets and Concussion Prevention • Helmets: • 1st used in Army-Navy football in 1893. • Used since early 1900s in NFL. • Mandatory in NFL since 1940. • Injury Prevention Effects? http://s3.hubimg.com/u/790610_f496.jpg,accessed 2/2011 http://s1.hubimg.com/u/790612_f496.jpg,accessed 2/2011

22. Football Helmets • Helmets are designed to prevent skull fractures, not concussions. • “New helmet technology” offers no proven protection from concussion. • VA Tech study (May, 2011) has many limitations. • Proper fit is most important aspect of a • helmet. To reduce concussion risk, COACHES need to emphasize proper technique.

23. How about helmet covers? • No medical studies show decreased injury risk • From the Guardian Helmet Pad website: • “NO HELMET OR PRACTICE APPARATUS CAN REDUCE OR PREVENT CONCUSSIONS.”

24. Football Helmets • CA. Education Code(s) • 17578 – Annual cleaning, sterilizing and repair of football equipment. • 17579 – Equipment used in spring shall be cleaned and sterilized before use in succeeding fall.

25. Concussion PreventionDo mouth-guards  risk of concussion? NO • Mouth guards • Mandatory since 1960s in multiple sports. • Football, lacrosse, field hockey, boxing • Proven protection against dental and orofacial injury. http://archives.starbulletin.com/98/06/03/news/artd.gif,accessed2/2011

26. OUT OF SEASON PLAYArticle 50 – General Rules • CIF BYLAW 500 • 500.     AUTHORIZED PARTICIPATION • During the school year, all athletic activities in CIF-approved sports involving CIF-member schools must be held under the rules and regulations of the participating school’s respective league, Section and the CIF, during the established school year (district, section, league).

27. OUT OF SEASON PLAYArticle 50 – General Rules • 511. SEASON OF SPORT DEFINITION • Sections have the responsibility to work toward equity relative to length of season, number of contests, and number of opportunities for participation by students. The “seasons of sport” for State championships are: • Fall - Volleyball (girls) Winter - Wrestling • Fall - Cross Country Winter - Soccer • Fall - Football Spring - Track • Fall - Golf (girls) Spring - Golf (boys) • Fall - Tennis (girls) Spring - Tennis (boys) • Winter - Basketball Spring - Volleyball (boys) • Who is taking on the “Risk & Liability?”

28. Athletic Risk Minimization • Have Board Policy and Admin. Regulations on Concussions (AB 25). • CSBA

29. Athletic Risk Minimization • Have Board Policy and Admin. Regulations and ensure all coaches complete concussion training. (AB 1451). • CSBA

30. Risk Minimization 3. Ensure process at school site to collect SIGNED “Informed Consent” and “Concussion Awareness” forms. CIF

31. Risk Minimization • Safety Equipment – do you have documentation -PO’s and recertification. D.O. and School Site

32. Risk Minimization 5. Who is using your district and school facilities and equipment when it is NOT the CIF approved season of sport? D.O. and School Site

33. State CIFServing Schools and Students • www.cifstate.org Roger Blake 916-239-4477