May 29, 2012 Diana L. Malone, Ph.D. AIU Training & Consultation Coordinator

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Concussion Management for Student AthletesSafety in Youth Sports Act P.L. 411 No. 101 Cl. 24May 29, 2012Diana L. Malone, Ph.D.AIU Training & Consultation Coordinator

Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24

Signed into law on November 9, 2011

Effective July 1, 2012

Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24Purpose of the legislation is to ensure the safety of student athletes

1) Includes certain requirements for:Pennsylvania schoolsPersonnel who supervise schools student athletesMedical personnel who support them

2) Establishes standards for managing concussions and traumatic brain injuries to student athletesSafety in Youth Sports Act P.L. 411 No. 101 Cl. 24Our hope is that this bill will reduce the risk of long-term damage for student athletes who suffer concussions or other brain-related trauma while participating in sports. By signing this bill, Pennsylvania joins 31 other states in establishing legislation.

Governor Tom CorbettPRNewswire-US Newswire

Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24FactsA concussion is a brain injury.All concussions are serious and can occur in any sport.Most concussions occur without loss of consciousness.Children and teens are more likely to get a concussion and take longer to recover than adults.Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24Facts1.6 to 3.8 million sports related concussions in US per year. BIAA 2009Football is responsible for more than 250,000 head injuries in the United States. In any given season 10% of all college and 20% of all high school players sustain brain injuries.High school players also have a three times higher risk of getting a second concussion once they have had one. 2009 Brain Injury Research InstituteSafety in Youth Sports Act P.L. 411 No. 101 Cl. 24FactsApproximately 10% of all contact sport athletes sustain concussions yearly.Effects of concussion are cumulative in athletes who return to play prior to complete recovery. 2011 Sports Concussion InstituteRecognition/proper management when they first occur can help prevent further injury or even death. CDC

Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24Requirements of the Law

Safety in Youth Sports Act Elements of PA LegislationSection 1. Name (Safety in Youth Sports Act P.L. 411, No. 101, Cl24.)

Section 2. Definitions

Section 3. Concussion and Traumatic Brain Injury (TBI)

Section 4. Effective Date July 1, 2012Safety in Youth Sports Act Elements of PA LegislationSection 2. DefinitionsAppropriate Medical ProfessionalLicensed Physician trained in the evaluation and management of concussions

Licensed or certified health care professional trained in the evaluation and management of concussions and designated by such licensed Physician

Safety in Youth Sports Act Elements of PA LegislationSection 2. DefinitionsAppropriate Medical ProfessionalLicensed Psychologist neuropsychologically trained in the evaluation and management of concussions or who has postdoctoral training in neuropsychology and specific training in the evaluation and management of concussions.Safety in Youth Sports Act Elements of PA LegislationSection 2. DefinitionsAthletic Activities

What activities are covered?Interscholastic athleticsContest or competition sponsored by or associated with a school entityIncludes cheerleading, club sports or activities sponsored by school affiliated organizationsNoncompetitive cheerleadingPractices and scrimmages

Safety in Youth Sports Act Elements of PA LegislationSection 2. DefinitionsSchool EntityA public school, school district, nonpublic school or private school in this Commonwealth other than a private or nonpublic school which elects not to become a member of the association.Safety in Youth Sports Act Elements of PA LegislationSection 2. DefinitionsInterscholastic athleticsAll athletic contests or competitions conducted between or among school entities situated in counties of the second class, second class A, third class, fourth class, fifth class, sixth class, seventh class and eighth class.

Safety in Youth Sports Act Elements of PA Legislation

Section 3 Concussion & TBI

Educational MaterialsInformational MeetingRemoval From PlayReturn to PlayTraining CoursePenaltiesYouth Athletic ActivitiesConstructionCivil Liability

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(a) Educational MaterialsDepartment of Health, PA Department of Education & CDC websites offer guidelines & other relevant educational materials for students, parents, and coaches.PA Departments of Heath and Educationwww.health.state.pa.us www.education.state.pa.usCenter for Disease Control and Preventionhttp://www.cdc.gov/concussion/HeadsUp/youth.html

Keeping Quiet Can Keep You Out of the Game www.cdc.gov

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(a) Educational MaterialsParents and student athletes must sign acknowledgement of receipt and review of Concussion and Traumatic Brain Injury Information sheet.

Safety in Youth Sports Act Elements of PA LegislationThe Pennsylvania Department of Education (PDE) sample Concussion Information and Acknowledgement Form which has been reviewed and adopted by the PIAA.

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(b) Informational MeetingSchool entity may hold Informational Meetings prior to the start of each athletic season for all ages of competitors regarding:concussions and other head injuries, the importance of proper concussion management and how preseason baseline assessments can aid in the evaluation, management and recovery process.

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion & TBI(b) Informational MeetingIn addition to students, parents, coaches and other school officials, Informational meetings may include physicians, neuropsychologists, athletic trainers and physical therapists.

Video:Preston Plevretes Story http://espn.go.com/video/clip?id=5163151

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(c) Removal From Play

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(c) Removal From PlayStudent athlete exhibits signs or symptoms of concussion shall be removed from play andpractice

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(c) Removal From PlayDetermination may be made by game official,coach, certified athletic trainer, physician, physical therapist, or other designated by school

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(d) Return to PlayAppropriate medical professional (as defined in the ACT) must evaluate and clear athleteDr. Micky Collins, Director UPMC Sports Medicine Concussion Program

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(d) Return to PlayAppropriate Medical Professional (as defined in the ACT) must provide written clearance for return to participation

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(d) Return to PlayTo help determine whether a student is ready to return to participation, an appropriate medical professional may consult any other licensed or certified medical professionals.

Safety in Youth Sports Act Elements of PA LegislationPennsylvania Department of Education has developed a sample Return To Play Form

Recommended Procedures Return to Play ProtocolThe following graduated return to play is recommended:Completion of a full day of normal cognitive activities without symptomsLight aerobic exerciseSport-specific exerciseNon-contact training drillsParticipation in normal training activitiesReturn to play involving normal exertion

Recommended Procedures Return to Play ProtocolIf concussion symptoms recur during the graduated return to play protocol, return to the previous level of activity that caused no symptoms

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(d) Return to PlayBaseline testing is recognized as valuable tool

Dr. Mark Lovell, CEO ImPACT

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(e) Training CourseAll Coaches must complete concussion management certification course annually. (Beginning July 1, 2012 for 2012-2013 school year)

A coach shall not coach any athletic activity until completing the required training course. Safety in Youth Sports Act Elements of PA LegislationCertification Training for Coaches and Medical Professionals3 Provider(s) approved by PA Department of Health Center for Disease Control (CDC)

National Federation of State High School Associations (NFHS)

PA Athletic Trainers Association (PATS) ConcussionWise Pennsylvania:Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(f) Penalties for Coaches (Required July 1, 2014)

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(f) Penalties for Coaches(1) 1st violation Suspension from coaching for remainder of season(2) 2nd violation Suspension from coaching for remainder of current season and for the next season(3) 3rd violation Permanent suspension from coaching any athletic activity

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(g) Other Youth ActivitiesThe sponsors of youth athletic activities not specifically addressed by this act are encouraged to follow these guidelines.

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(h) ConstructionNothing in this act shall be construed to abridge or limit any rights provided under a collective bargaining agreement or Public Employee Relations Act.

Safety in Youth Sports Act Elements of PA LegislationSection 3 Concussion and TBI(i) Civil Liability

(1) Except as provided under paragraph (2) nothing in this act shall be construed to create, establish, expand, reduce, contract or eliminate any civil liability on the part of any school entity or school employee.

(2) Protection for Compliance - Any coach acting in accordance with subsections ( 3c ) and (3d) shall be immune from any civil liability.

Safety in Youth Sports Act Elements of PA LegislationSection 4 Effective Date

The Safety In YouthSports Act shall take effect on:

July 1, 2012.

Recommended Return to SchoolBest PracticesReturn to SchoolBest Practices Protocol

Recommended Return to SchoolBest PracticesREST is the best medicine for healing concussions or other head injuries.

Impaired memory, attention span, concentration, processing speed significantly impact learning.

Exposing the concussed student athlete to the stimulating school environment may exacerbate symptoms and delay the resolution of symptoms needed for recovery.Recommended Return to SchoolBest PracticesConsideration of the cognitive effects in returning to the classroom is an important part of treatment .

After suffering a concussion/mTBI, a student may need Temporary Learning Support Accommodations:1. Shortened school day2. Take rest breaks as needed3. More time for tests and assignments4. Assistance with schoolwork

Recommended Return to SchoolBest PracticesTemporary Learning Support Accommodations

5. Reduce time spent on the computer, reading, and writing.6. Early dismissal from each class to avoid crowded hallways.7. No standardized testing (PSSA, SAT, etc.) during the initial recovery window of 2-4 weeks.Recommended Return to SchoolBest PracticesBrainSTEPS School Re-Entry Program www.brainsteps.net

Consulting teams are available to secondary schools and families throughout Pennsylvania

The school should initiate a referral to the BrainSTEPS team if after 2 weeks return to school causes concussion symptoms to re-occur or if the student demonstrates uncharacteristic performance.

Teams work with local school staff to develop educational programs, academic interventions and systems for monitoring students

AIU BrainSTEPS Consultants Jamie Moder, MHPE, CHES - AIU Adaptive Recreational Educational & BrainSTEPS ConsultantMichelle Lubetsky,M.Ed., BCBA - AIU TaC, BrainSTEPS Consultant

Safety in Youth Sports Act P.L. 411 No. 101 Cl. 24ResourcesCDC Initiatives on the Management of ConcussionHeads Up: Brain Injury in Your Practice booklet on diagnosis and management of TBIpatient assessment toolcare plan guidefact sheetsCD with kit materials and TBI resources

http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.html

CDC Initiatives on the Management of ConcussionHeads Up to Schools: Know Your Concussion ABCs Signs and symptoms checklists, posters, magnets, laminated cardsFact sheets for school nurses, teachers, counselors, parents

http://www.cdc.gov/concussions/HeadsUp/schools.html

CDC Initiatives on the Management of ConcussionHeads Up: Concussion in High School Sports

http://www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.html

CDC Initiatives on the Management of ConcussionHeads Up: Concussion in Youth Sports Online training for coachesFact Sheets for coaches, athletes, parentsClipboardsMagnetsPosters

http://www.cdc.gov/concussion/HeadsUp/youth.html

DOH ApprovedOnline Training CoursesCDC Heads Up Online Training Course - Concussion - Traumatic Brain Injury - Injury Center http://www.cdc.gov/concussions/headsup/online_training.html

National Federation of State High Schools Association (NFHS)- Online Concussion in Sports training program.www.nfhs.org

PA Athletic Trainers Association (PATS) Online ConcussionWise Pennsylvania: ConcussionWise http://concussionwise.com/Pennsylvania

CliniciansOnline TrainingHeads Up to Clinicians: Addressing Concussion in Sports among Kids and Teens

Online training for Health Care Professionalswww.cdc.gov/concussion

Additional ResourcesPennsylvania Athletic Trainers Society (PATS) www.gopats.org National Collegiate Athletic Association (NCAA)www.NCAA.org/health-safety Pennsylvania Interscholastic Athletic Association (PIAA) www.piaa.orgBrain Injury Association of Pennsylvania (BIAPA) www.biapa.org PA School Boards Association (PSBA)www.psba.org

Safety in Youth Sports Act Local Policy DevelopmentModel Policy and Guidance for Pennsylvania Schools for Sports-Related Concussion/Mild Traumatic Brain Injury

The Brain Injury Association of Pennsylvania (BIAPA)Pennsylvania Athletic Trainers Society (PATS) Pennsylvania Physical Therapists Association (PPTA)

Developed Model Policy for consideration by school boards to help them comply with the Safety in Youth Sports Act in the care and treatment for student-athlete suspected of sustaining a sports-related concussion or head injury.Safety in Youth Sports Act Local Policy DevelopmentPennsylvania School Boards Association123.1 Concussion Management123.1 AR (Administrative Regulation) Sports-Related Concussion/Mild Traumatic Brain Injury

Davelyn S. SmeltzerDirector of Policy Services PASBA

Thank YouAllegheny Intermediate UnitDiana L. Malone, Ph.D.Training and Consultation Coordinator/Interagency [email protected]: 412-394-4932Fax: 412-394-1340

Ryan Malone