Romeo High School Athletic Training Department · selection, fit, function and maintenance of athletic equipment; develop and imply a comprehensive emergency action plan; facilitate

RomeoHighSchoolAthleticTrainingDepartment

Includes:

WhatisanAthleticTrainer?InjuryReporting

PolicyfortheEvaluationandManagementofConcussionsReferralsHeatIndex

EmergencyActionPlan

KaylaPhillips,ATCRomeoAthleticTrainer

[email protected]#(586)281-1146

RomeoHighSchoolAthleticTrainingDepartmentWhatisanAthleticTrainer?

AsdefinedbytheNationalAthleticTrainers’AssociationAthletictrainers(ATs)arehighlyqualified,multi-skilledhealthcareprofessionalswhocollaboratewithphysicianstoprovidepreventativeservices,emergencycare,clinicaldiagnosis,therapeuticinterventionandrehabilitationofinjuriesandmedicalconditions.Certifiedathletictrainersprovideon-siterecognition,evaluationandimmediatetreatmentofillnessesandinjuries–bothacuteandcatastrophic;determineanindividual’sreadinesstoparticipateinactivities;promotesafeandappropriatepracticeandcompetitions;educatestudentsabouthealthylifestylesandpropernutrition;developexerciseregimens;developinjuryandillnesspreventionstrategies;advisehowtopreventillnessorinjuryduringphysicalactivity;providequality,adviseontheselection,fit,functionandmaintenanceofathleticequipment;developandimplyacomprehensiveemergencyactionplan;facilitateandperformrehabilitationandreconditioning;andparticipateinthedevelopmentandimplementationofacomprehensiveathletichealthcaresystem.BenefitsATsprovideforParents

• Createaninvaluableresourceforaccessingthemedicalcommunity.• Facilitateopencommunicationbetweenthestudent-athletes,parents,physicians,

coaches,andschooladministrators.• Provide“in-house”medicalcare,savingmoneyandtimeoffworktotransportthe

student-athleteelsewhere.• Serveasanothersetofeyesandearstomonitorthestudent-athletesbothonandoff

thefield.o AthleticTrainersareoftenthefirsttonoticeorhearwhensomethingiswrong.o Alsouniqueopportunitytoknowthestudent-athlete’spersonalityinaway

othermedicalprovidersareunableto,allowingtoknowwhentheyaren’t“actingthemselves.”

BenefitsATsprovideforStudent-Athletes• Providequick,accessiblecaretoallowreturntosportquickerandsafer.• Giveadviceonhealthylifestyles,propernutrition,anddevelopingindividualized

exerciseregimens.• Offerlifeskillseducation.

o Ex.Questionsregardingcareerchoicespertainingtothemedicalfield.• Assistwithcommunicationwithcoachesandparents.• Encouragement,support,anddedicationtoeachandeverystudent-athletebothonand

offthefield!!

FormoreinformationvisittheNationalAthleticTrainers’Associationwebsite.

RomeoHighSchoolAthleticTrainingDepartmentInjuryReporting

DayofInjuriesTheRomeoAthleticTrainerisresponsiblefortrackingandrecordingofinjuries.Itisvitalthattheathletictrainerismadeawareofanyandallinjuriesthatoccurduringpracticesorgamesregardlessoflocation.Coachesarerequestedtocalltheathletictrainerwheninjuriesoccuriftheathletictrainerisn’tonsitealready.Ifinjuriesoccuratawaygameseitherthecoachorathleteshouldreporttheinjurybeforethenextdayofpractice;ideallythenightoffsorecommendationsonimmediatehomecarecanbeprovided.Thiswillhopefullysavethestudent-athleteandtheirfamiliesfromtakingunnecessarytripstothehospitalorprolonginghealing.Doctor’sVisitsIfastudent-athleteistakentothedoctorsatanypoint,foranything,thereMUSTbeadoctor’snotegiventotheathletictrainerdescribingwhythestudentwasseenandifthereareanyrestrictionsorfullclearanceforactivity.Thisisforliabilityandsafetyreasons.IfthereisnotetheathletewillNOTbeallowedtopracticeuntiloneisproduced.AthletesResponsibilityItisuptotheathleteattheendofthedaytoalerttheathletictrainerofanyinjuriestheyhave.Theyalsoneedtolookoutfortheirteammatesiftheynoticethereisaproblemandmakesuretotellacoachortheathletictrainerimmediately.ParentsResponsibilityIftheirchildisexperiencinganinjury,theyarewelcometoreachouttotheathletictraineratanytime.Ifaninjuryworsensafterbeingsenthomebytheathletictrainer,contacttheathletictrainerforsuggestions.Itisultimatelyuptothefamilyiftheyfeeltheirchildneedstobetakentoanemergencydepartmentortoseeaphysician(remembertheremustbeanote).Ifthereiseveradiscrepancyormisunderstandingregardingthecareoftheathlete,theparentisaskedtocontacttheathletictrainertosetupagoodtimetodiscusstheproblemindetail.DailySign-InRecordsStudent-athletesarerequiredtosigninwhenreceivingtreatmentsintheAthleticTrainingRoom(ATR).Thishelpskeeprecordsoftreatmenttimesandtypes.CurrentlyweareusingaChromebookfromRHS,itmuststayintheATRandanystudentfoundremovingitwillbereportedtotheAthleticDirectorfordisciplinarymeasures.

RomeoHighSchoolAthleticTrainingDepartmentPolicyfortheEvaluationandManagementof

ConcussionsDefinitionAnyheadinjuryshouldbeclassifiedasa“concussion”anytimethereistraumatothehead,faceorneckofanathlete(ortraumatothebodywhichcausesawhippingofthehead)resultinginanyoneormoresymptomslistedbelow.TheredoesNOTneedtobelossofconsciousnessinordertobeclassifiedasaconcussion.Itisimportanttonotethataconcussionor“mildtraumaticbraininjury”(MTBI)isametabolicinjuryaffectingthebrainchemistry;itisNOTastructuralinjury,whichwouldbedetectedonCTscanorMRI.Therefore,referraltoahospitalemergencydepartmentisnotnecessarilywarrantedinmostcasesofMTBI.

• Concussiontypicallyresultsintherapidonsetofshort-livedimpairmentofneurologicalfunctionthatresolvesspontaneously.However,insomecases,symptomsandsignsmayevolveoveranumberofminutestohourstodays.

• Resolutionoftheclinicalandcognitivesymptomstypicallyfollowsasequentialcourse.However,itisimportanttonotethatinsomecasessymptomsmaybeprolonged.

Possiblesignsyoumayobserveifyourchildsustainsaconcussion:Balanceproblems LossofconsciousnessNausea/vomiting Slow,slurredspeech

Abnormalorinappropriateemotions Amnesia(memoryloss)Disorientation Dazedappearance

Changeinmentalstatus Sensitivitytolightand/ornoise

Possiblesymptomsyouchildmaycomplainoffollowingaconcussion:Headache Feeling“foggy”or“fuzzy”intheheadDizziness Lightheadedfeeling

Feelingexcessivelytiredorfatigue RinginginearsDoubleorblurredvision Sensitivitytolightand/ornoiseDifficultyconcentrating Difficultysleeping

Symptomsthatrequireimmediatelytransportationtoemergencydepartment

viaemergencyvehicleLonglastinglossofconsciousness SignsofinjurytospineorskullfractureDecreasinglevelofconsciousness Decreaseorirregularityinpulse

Unequal,dilatedornonreactivepupils DecreaseorirregularityinrespirationSeizureactivity Deteriorationofneurologicfunction

AthleticManagement“PostConcussionSyndrome,”orPCS(anabnormallylongrecoverytime)canoccurifanathletecontinuestoengageinphysicalactivity,orexcessivementalactivitywhilethebrainisstillrecoveringfromtheinitialconcussion.Therefore,accordingtoMichiganstatelaw,itisthepolicyoftheRomeoSchoolAthleticTrainingDepartmentthatanyathletewhoexhibitssigns,symptoms,orbehaviorsconsistentwithaconcussionshallbeimmediatelyremovedfromthecontestandshallnotreturntoplayuntilclearedbyanappropriatehealthcareprofessional.Aconcussedstudent-athleteisineligibletoreturntoanyathleticmeetorcontestonthesamedaytheconcussionissustained.Aslongastheathleteisexperiencinganyconcussionsymptoms,itisrecommendedthatheorsheNOTengageinanyphysicalexertion,includingrunning,weightlifting,andPhysicalEducationclasses,untildirectedtodosobyhisphysicianandtheRomeoAthleticTrainer.Suchexertioncanimpedethebrainchemistryfromreturningtonormal.EveryonehasaRoleCoachesneedtorecognizewhenathlete’sperformanceorbehaviorchangesandimmediatelyremovethemfromharmsway.Thenalerttheathletictrainerofconcerns.Thecoachmustnotallowtheathletetoreturntoplayunlessapprovedtodosobytheathletictrainer.Athletesneedtorecognizewhenateammate’sperformanceorbehaviorchangesfollowingatraumaticeventandalertacoachorathletictrainer.Parentsneedtorecognizesignsandsymptomsofaconcussionandreportconcernsasappropriate.Supportingappropriatephysicalandcognitiverest,especiallywhileathome.CertifiedAthleticTrainerneedstoeducatestaff/parents/coaches/athletesonconcussions.Theyareresponsibleforsidelineassessmentsandmakingindividualizedposttraumaclinicalassessmentsinthebestinterestoftheathlete’shealth.ItistheirjobtovalidateasymptomaticreportandapprovecontinuationontoReturn-to-Play(RTP)progression.TheymustoverseetheRTPandperformre-assessmentseachday.Finalreleasetofullparticipationisuptotheathletictrainersallowance.CareNotesforHomeFollowingaconcussionthatdoesnotrequireimmediatetransfertoaemergencydepartment(whicharemost)theathleteshouldnotbeleftaloneforthefirstfourhourstobeobserved.Ifanyofthesymptomsworsenparentsarewelcometocontacttheathletictrainerforrecommendationsortaketheirchildtotheemergencydepartment.Pleaseallowtheathletetosleepunlessdirectedotherwise,thereisalsononeedtowakethemupthroughoutthenight;theirbrainneedsrest.Computer,tablet,phone,andtelevisionscreentimeshouldbelimitedtoallowfullrestofthebrain.Excessivenoiseandlightshouldbeavoided.AllformsofphysicalactivityshouldbediscontinueduntilapprovedbyRomeoAthleticTrainer.

CommunicationGuidelinesWhentheathletictrainerisnotifiedofaconcussion,theywillnotifytheparents,andarrangefortransportationhomeifneeded.Onthatsameday,theywillnotifythestudent-athlete’sschoolcouncilorandcoachifneeded.Itisrequestedthatthecouncilorthenalerttheindividualteachersthattheinjuryhasoccurred.Theathletictrainerwillfollow-upwiththeparentsorathletethenextday.Asnewinformationismadeavailable,theathletictrainerwillcommunicatetocouncilorandcoaches.AcademicManagementInsomecases,itmaybenecessarytomakemodificationstothestudent-athlete’sacademicdemands,suchasallowingextratimeforassignmentsandexams,avoidanceofloudhallwaysandlunchrooms,andminimizingtheamountofreadingandhomeworkthatisrequired.Thiswillbedeterminedonacase-by-casebasis,andwillbecommunicatedbytheathletictrainersthroughthestudent-athlete’scouncilor.NeurocognitivetestingTheRomeoSchoolAthleticTrainingDepartmentutilizesaneurocognitivetestingsoftwareprogramknownas“ImPACT.”Thisisacomputer-basedtest,whichassessesneurocognitivefunctionsuchasimmediateanddelayedmemory,reactiontime,andmotorprocessingspeed.Werequireeveryathletetotakeabaselinetestbeforeparticipatinginanycompetitiveplay.All9thgraders,11thgraders,andnewRomeoathleteswilltakeabaselinetestduringtheirfirstseasonofparticipating.Ifaconcussiondoesoccur,theathletewilltakeapost-injurytestoncesymptomfreeforatleast24hours.Dr.MichaelMcMillanwillcomparetheresultsofthepost-injurytesttothebaselinetesttohelpdetermineiftheathleteisreadytobegintheReturn-to-Playprogression.PhysicianReferralBecausephysicalrestandmentalrestaretheprimarytreatmentsinthefirstfewdaysofaconcussion,itisnotalwaysnecessarytobeseenbyaphysicianimmediatelyafteraconcussion.Anathlete’sfamilymaychoosetoseeaphysicianafteraconcussionissustained;however,theMHSAAPost-ConcussionConsentForm(whichwillbegiventoathleteand/ortheirparent/guardianfollowingtheconcussionbytheRomeoAthleticTrainer;picturedbelow)mustbecompletedandhavesignedoffunconditionalclearancetounrestrictedactivity.DuetothisrequirementitmaybeinthefamiliesbestinteresttowaituntiltheImPACTtestispassedandReturn-to-Playhasstarted.TheformmustbeonfileintheAthleticTrainingroombeforereturntogameplayisallowed.RomeoAthleticDepartmentrequiresaM.D.orD.O.tograntpermissionandsignoffontheconsentform.TreatmentPlanEveryconcussionisdifferentandthereforetreatmentplanswillbeindividualizedbutwillfollowtheoutlinedReturn-To-Play,itmaytakedifferentstudent-athletesshorterorlongerthanotherstocomplete.Finalclearanceisuptotheathletictrainer.

Return-to-Play(RTP)GuidelinesOnceaconcussionhasresolved,thestudent-athletemaybegintoworktowardsreturningtohissportThismustbeagradualprocesstomakesurethathe/sheisabletohandlethephysicalexertionaswellasthebalanceandcoordinationdemandsofthesport.Followingaconcussion,astudent-athletemustmeetthefollowingcriteriabeforetheyareabletobegintheRTP:

1. He/shehasreturnedtofulldaysinschoolwithnoreturnofsymptomsandisabletohandlefullacademicworkloadwithnoaccommodations.

2. Satisfactoryreturntobaselinestatusonapost-injuryImPACTtest

Return-to-PlayProgressionNOACTIVITY

Completephysicalandcognitiverestuntilclearedbyathletictrainer

Step1 Lightaerobicexercise(e.g.,stationarybicycleorlightjogging)• 10-20minutes,lightresistance,lowspeed• Abdominalworkout

Step2 Individual,Sport-Specifictraining• Sport-specificdrills(individualorwithonpartner,NONcontact)• Throwing/catchingshootingongoal/basket,running,dribbling

andshootingbaskets/lay-ups,skatingwithstick/puckhandlingdrills,volleying

• Agilitydrills• Noheadimpactactivitiesallowed.

Step3 NON-contactpractice/drillswithteam.Thisstageconsistsofanythingthatthestudent-athletecandoinpracticewithouttheriskofcontactorcollisionwithanotherplayerorreceivingaball(batting,headersinsoccer,etc.).Resistance(weight)trainingmaybeinginthisstageaswell.

Step4 FULL-contact,full-intensitypracticewithteamStep5 Full-contactgameplayassumingMD/DOhassignedoffonfull

activity.*Student-athleteswillonlycompleteonestageperday.IfANYsymptomsreturn,thereturntoplayprogressionisimmediatelysuspended.Oncesymptomfreetheprogressionisstartedonthestepleftoffat.

RevisionsofPolicyThispolicyhasbeencreatedbasedoffinformationgatheredfromthe“Consensusstatementonconcussioninsport:the4thInternationalConferenceonConcussioninSportheldinZurich,November2012,”AmericanAcademyofPediatrics,NationalAthleticTrainers’AssociationandMHSAAPolicies.Thepolicyiscontinuallybeingupdatedasnewinformationandrecommendationsaremade.

RomeoHighSchoolAthleticTrainingDepartmentReferrals

HealthQuestPhysicalTherapyDuetoanamazingrelationshipwithHealthQuest,itisrecommendedthatanystudent-athletesneedingphysicaltherapygothere.Theirphysicaltherapistsprovideone-on-oneattentionandpersonalizedtreatmentplansthatincludemanualtherapy,thesofttissuework(GrastonTechnique®),exerciseandstretches,ahomeprogramtospeed-uphealing,andmuchmore.TheRomeoAthleticTraineralsoworksattheclinicthroughouttheweekandhasrelationswiththephysicaltherapistsallowingforamoreconnectedcareplanbetweentheschoolandtheclinic.ThroughthisrelationshipweareabletogetRomeoathletesinquickertobegintreatmentsasquicklyaspossible.HealthQuestassistsinprovidingtheathletictrainingserviceforRomeoSchools,wethankthemfortheirsupportandservicesprovided.SportsMedicinePhysicianRomeoAthleticDepartmenthasarelationshipwithDr.YusaffromCenterforAdvancedOrthopedics.RomeoathleteswhoarereferredforfurtherevaluationwillbegivenDr.Yusaf’snumber.Whencallingtosetupanappointment,mentiontheathleteisaRomeoathleteforquickerscheduling.OtherReferralNeedsTheRomeoAthleticTrainerwillassistinfindinganyotherreferralneedsstudent-athletesmayneed.

RomeoHighSchoolAthleticTrainingDepartmentInclementWeatherProtocol

ThisprotocolisbasedoftherequirementsoftheMHSAAandisaRomeoDistrictpolicy.Thesoundofthunderand/orthesightoflightningareanautomaticgamesuspension.Thefieldmustbeclearedandthespectatorsarerequiredtoseekshelter.Thedelayinthecontestwilllastaminimumof30minutesfromtheLASTsoundofthunderoroccurrenceoflightening.Thispolicymustbestrictlyfollowed.Thereisnodebate.Severeweatherintheformofrainorsnowmaymakethefieldunplayableandthereforefollowsthesamepolicies.Thesuspension/delaytimeforcontestsstartbetween10:00a.m.and3:00p.m.cannotexceed3hours;forcontestsstartedbetween3:01p.m.and6:59p.m.thedelaycannotexceed1½hours;and,contestsstartedafter7:00p.m.shouldnotexceedonehour.Contestspostponedwillbemadeupatthenextavailabledate.AnyquestionsorconcernsshouldbedirectedtotheAthleticDirector.

RomeoHighSchoolAthleticTrainingDepartmentHeatIndex

ThisprotocolisbasedoftherequirementsoftheMHSAAandistodecreasethechancesofstudent-athletessufferinganyheatrelatedillnesses.Certaincoacheswillbeprovidedadigitalslingpsychrometertotaketemperatureandhumidityreadingsatthesiteoftheactivity.Theywillberesponsibleformeasuring,recording,andturningincompletedformsintotheathleticofficeeveryweek.TheAthleticTrainerandAthleticDirectorwillalsobetrackingheatindex,butduetonotbeingabletobeateachindividualsite,itisuptothecoachtoknowthepolicyaswell.

• Watermustbeavailableatallgames,practices,andcompetitions.Restperiodsshouldbegivenevery45-60

• HeatIndexbelow80degrees-thereisnocombinationofheatandhumiditythatwillresultinneedtocurtailactivity.

• HeatIndexabove80degrees:mustbechecked30minutesbeforestartand60minutesafterstart.LEVEL1

• HeatIndex95-99:amplewatermustbeavailabletheentiretime,waterbreaksevery30minforatleast10mininlength,icewatertowelsavailable,(helmetsoff)LEVEL2

• HeatIndex99-104:amplewatermustbeavailabletheentiretime,waterbreaksevery30minforatleast10mininlength,icewatertowelsavailable,alteruniforms,alwayschangetodryt-shirtandshort,reducepracticetimeandorchangepracticetimes,helmetsshouldberemovedwhennotincontact,recheckHeatIndexevery30min,orsuspendactivity.LEVEL3

• HeatIndexabove104:NOACTIVITYinnon-airconditionedarea.LEVEL4Therecordsheethasroomfortwoheatindexchecksperdayoftheweek.Ifmorere-checksarecompletedtheyshouldstillberecordedbelow.