S PORTS M EDICINE E DUCATIONAL P LAN Hillsborough County Public Schools Committee Members: Lauren Otero, APA, Leto High School Evanitta Omensetter, APSA,

SPORTS MEDICINE EDUCATIONAL PLAN

Hillsborough County Public Schools

Committee Members:Lauren Otero, APA, Leto High School

Evanitta Omensetter, APSA, Leto High School

William Sargable, Wrestling Coach, Riverview High School

Jayson Roberts, Football Coach, Tampa Bay Tech High School

Joel Kennedy, ATC, Plant High School

HYDRATION HYDRATE TO ELEVATE

Are you hydrated? Dehydrated?

If you are thirsty, you are already dehydrated.

What are you drinking?

HYDRATE TO ELEVATE

HYDRATED: HAVING ADEQUATE FLUIDS THAT ALLOW THE BODY TO FUNCTION AT MAXIMUM CAPACITY

Dehydrated: is a deficiency of body water, with an accompanying

disruption of metabolic processes, performance and may lead to heat-

related illnesses

HYDRATE TO ELEVATE

WHAT EFFECTS HYDRATION LEVEL?

Stool, urination, breathingand most significantly……

SWEATINGHYDRATE TO ELEVATE

WHAT EFFECTS ONE’S SWEAT RATE?

Ambient temperature Humidity Genetics Gender Body weight Fitness level Intensity

HYDRATE TO ELEVATE

SIGNS & SYMPTOMS OF DEHYDRATION

Headache, Fatigue, Confusion, Nausea, Cramps, Dizziness

Decrease of Stamina, Speed, Energy, and Muscular Strength

HYDRATE TO ELEVATE

MONITOR YOUR HYDRATION

Check your urine color Measure your water weight loss

BEFORE

PRACTICE

GAME

AFTER

HYDRATE TO ELEVATE

DECREASE IN ATHLETIC PERFORMANCE

2-4% weight loss - reduced muscular endurance time

4-6% weight loss - reduced muscular strength & endurance, heat cramps

6% weight loss - severe heat cramps, heat exhaustion, heat stroke, coma, DEATH

HYDRATE TO ELEVATE

HOW TO GET AND STAY HYDRATED…

Drink plenty of water EVERYDAY

AVOID or LIMIT sugary and caffeinated drinks

HYDRATE TO ELEVATE

GAME DAYGENERAL RULE OF THUMB

NOTE: Room temperature fluids

absorb more quickly.

Pre-Game

16 oz. 4 hours BEFORE game time &

8 oz. 2 hours BEFORE game time

During Game: 7-10 oz. every 15 minutes throughout the game

Post Game: 16 oz. bottle of sports drink (Gatorade) to replace carbs & sodium

HYDRATE TO ELEVATE

HYDRATE TO ELEVATEYOUR PERFORMANCE

THINK TO DRINK

PROPOSED ACTION STEPS

Chart containing timeline of hydration for pre-game, during game, and post-game measures.

Emphasis to players of how hydration is directly tied to athletic performance.

Explanation to athletes of what not to drink and limitations on caffeine.

HYDRATE TO ELEVATE

HEAT ILLNESSCool first, treat second!

HOW HEAT EFFECTS YOUR BODY Places extra stress on the body Increases core body temperature Increases heart rate

Cool first, treat second!

HEAT INDEX


HEAT RELATED ILLNESS

Body temperatures can rise to dangerous levels.

Types of Illnesses Across a Spectrum:Heat RashHeat CrampsHeat ExhaustionHeat Stroke


HEAT RELATED ILLNESS: HEAT RASH Occurs when pores

are blocked and perspiration is trapped under skin

Symptoms include: Superficial blisters,

itchy or prickly in feeling

Mainly found on neck, shoulders and chest.

Usually develops where clothing causes friction.

Methods of Treatment: Symptoms usually

go away on their own when skin is cooled.


HEAT RELATED ILLNESS: HEAT CRAMPS Symptoms

Painful, involuntary muscle spasms.

Most likely to occur in arm, calf, abdomen and back.

Affected muscles firm to touch.

Body temperature may be normal

Method of Treatment: Rest briefly and cool

down. Drink clear juice or

electrolyte-containing drink

Gently stretch and massage affected area

Contact medical personnel if cramps do not subside within an hourCool first, treat second!

HEAT RELATED ILLNESS: HEAT EXHAUSTION

Definition: Body Temperatures

rise as high as 104° Causes stem from

exposure to high temperatures, particularly when combined with high humidity, and strenuous physical activity

Can lead to heat stroke if left untreated

Symptoms: Often begin suddenly Resemble those of

shock Cool, moist skin with

goose bumps when in the heat

Heavy sweating Faintness/Dizziness Nausea Low blood pressure

upon standing Muscle cramps Dark-colored urine


HEAT ILLNESS: HEAT EXHAUSTION

Treatment: Stop all activity and rest in a cool place Drink cool water or sports drink Apply cool water to your skin Submerge in ice bath Loosen/Remove excess clothing

Contact doctor if signs/symptoms do not improve or worsen within one hour.

Seek immediate attention if body temperature reaches 104° or higher. Brain damage occurs when body temperature reaches 106°. Death can occur when body temperature reaches 108°.


RISK FACTORS OF HEAT EXHAUSTION

Certain Factors Increase Sensitivity to Heat: Young or old age Certain medications Obesity Sudden temperature changes High heat index


HEAT ILLNESS: HEAT STROKE

Results from untreated heat exhaustion Life-threatening condition that occurs when a

person’s body temperature reaches 104° or higher

Skin may be hot, but body may stop sweating to help cool itself

Person may develop confusion and irritability Seek immediate medical attention to prevent

brain damage, organ failure, or even death.


PREVENTING HEAT RELATED ILLNESS

Wear loose fitting, lightweight, light-colored clothing

Avoid sunburn Seek shelter/cooler

places Drink plenty of fluids Take extra

precautions with medications

Avoid hot spots Allow your body to

acclimate to the heat

Know your fitness level

Avoid mid-day sun (10am-4pm)

Wear sunscreen Have a back up plan


COOLING PROTOCOLS Move victim to a cool

spot Lay the victim down Elevate their feet Loosen/remove excess

clothing Give cool (NOT ice) water Cool victim until body

temperature is between 100°-102° degrees

Call 911 to transport



Purchase of thermometers for use at practices and games

Expanded use of cooling methods “Dipping” into ice baths to be routine at

practice Coolers at practice filled with iced towels Display of signs and symptoms posters to be

hung in restroom stalls and above urinals Examples of proper clothing to combat heat

illness


SICKLE CELL DISEASE

WHAT IS SICKLE CELL DISEASE?

Sickle Cell Disease is an inherited genetic disorder that affects the red blood cells.

Red blood cells in a person with sickle cell disease have an abnormal version of a protein called hemoglobin.

This abnormal protein causes the blood cell to have a crescent or sickle shape instead of the normal round shape that red blood cells should have.

WHO GETS SICKLE CELL DISEASE?

Sickle cell disease affects almost only people of African, South American, Caribbean, or Mediterranean countries decent.

A person can only have sickle cell disease from genetic inheritance from parents.

SICKLE CELL TRAIT VS SICKLE CELL DISEASE

Sickle Cell Trait Child inherits a recessive sickle cell gene from one parent and a dominant normal cell gene from the other.

Sickle Cell Disease Child inherits a recessive sickle cell genes from both parents.

SICKLING IN SICKLE CELL TRAIT CARRIERS

Under normal non-stressful conditions, people with sickle cell trait have virtually no health issues from the trait.

Sickle cell trait carriers can have issues when dehydrated, under heavy physical demand, or at high altitudes due to cells starting to sickle.

THE PROBLEM WITH SICKLE CELL TRAIT

Many athletes have no idea that they are sickle cell trait carriers.

If an athlete does know they are sickle cell trait carriers, many are under the impression that they have no risk of sickle cell crisis.

In either scenario the athlete is at risk of physical overexertion, leading to sickling of red blood cells.

EFFECTS AND COMPLICATIONS FROM SICKLE CELL

The sickled red blood cells become problematic due to their shape causing the cells to become blocked and stuck in blood vessels. The sickled shaped renders them unable to carry adequate oxygen as well.


Sickle cell disease can affect the body in 2 ways:

1. Anemia – reduced amounts of oxygen that can be carried by the sickled shaped cells, causing the following: 1. Fatigue 2. Paleness 3. Shortness of breath 4. Rapid heart rate 5. Yellowing of Skin


2. Sickle Cell Crisis – blockage of blood vessels taking blood to the limbs and organs due to the sickle shaped cells causing : 1. Pain in extremities and lungs 2. Small strokes (lack of

oxygen causing interruption of blood flow)in brain 3. Ulcers on lower legs 4. Enlarged Spleen

SICKLE CELL CRISIS VS HEAT ILLNESS

Person has heat cramps. They hobble to the ground and cry out in pain

Muscles are locked and rock hard

Person falls to the ground immediately from weakness and doesn’t cry out in pain

Muscles look and feel normal

Heat Illness Sickle Cell Crisis

Sickle cell crisis in a person with the trait and heat illness can appear very similar in their symptoms.

However there are a few key difference in symptoms that allow you to differentiate between the two.

vs.

RECOMMENDATIONS FOR MANAGING ATHLETES WITH SICKLE CELL TRAIT

If coaches are aware that they have an athlete with sickle cell trait there are some recommendation on how to manage them to reduce chances of a crisis

• Do not allow the athlete to condition heavily• Monitor the athlete’s body temperature on warm

humid days• Be aware of the altitude that the athlete is

participating at • Allow the athlete to drink water whenever they feel

the need


Collaborating with FHSAA to add doctor’s sign off on EL2 physical form

Signs and symptoms poster to be hung in locker rooms

Addition of lines to medical release card for parent(s) to write in “medical conditions” and allergies

Adjustment of practice and drills

CONCUSSIONSWhen in doubt, sit them out.

WHAT IS A CONCUSSION?

A Traumatic Brain Injury (TBI) Your brain jarring against your skull No grades of concussions. No mild or severe. Use to be called “Dinged” or “Bell rung” Treatment: REST!

A concussion is an interruption of the

brain’s ability to work properly.

When in doubt, sit them out.

SIGNS AND SYMPTOMS

Headache Dizziness Nausea Balance problems Sensitivity to light and sound Amnesia Difficulty concentrating

Every concussion has different signs and symptoms,

it does not determine the severity.When in doubt, sit them out.

STATISTICS 2013: 11.2 concussions/10,000 games & practice in high

school football

2008-2009: 400,000 TBI in high school athletics

2/3 of concussions occur in events, 1/3 at practice

2011: 15% of injuries reported in high schools with a certified athletic trainer (ATC) were concussions

15.8% of athletes who suffered Loss of Consciousness (LOC) returned to play the same day!!

Three times more likely to suffer a 2nd concussion in the same season.


2ND IMPACT SYNDROME (SIS) What is it? Experiencing a second concussion

before the original signs and symptoms are gone from the first concussion.

Adolescents are particularly susceptible to SIS

Athletes who suffer multiple TBI within a short period of time(days or weeks) may suffer catastrophic or fatal reactions

In a 13 year study, out of 92 high school athletes with SIS, 71% had a previous concussion in the same year and 39% were playing with symptoms


PROPER PROTOCOLS—RETURN TO LEARNING

Limit visual stimulants, such as texting and computer use

Allow extra time for tests/assignments

Break assignments into smaller chunks

Provide alternative methods to learning

Set reasonable expectations


PROPER PROTOCOLS—RETURN TO PLAY Athlete must be seen & evaluated by medical

doctor If athlete has no symptoms and is cleared by

physician, then FHSAA’s AT18 form is initiated and a step-by-step process can begin for athlete to return. Aerobic activity: bike, jog, etc. Increase activity to include sport-specific exercise Non-contact practice Full practice

Athlete must get steps signed off on by an ATC, coach or Athletic Director on the AT18

Athlete then returns to physician, is re-examined and AT 18 is signed off to return to play (RTP)

AT18 is filed in student’s athletic packetWhen in doubt, sit them out.

PROPOSED ACTION STEPS SCAT cards to all coaches

(tests to determine if an athlete has a concussion)

Handouts to parents/coaches on signs & symptoms of concussions

In-service by medical doctor on concussions (pre-season or summer)

Review/discuss Return to Play (RTP) protocols (per FHSAA) with coaches/parents.

Must see a medical doctor (preferably one with experience in diagnosing concussions).

Complete 5-step process with coach or ATC

Follow up with medical doctor to RTP. Must be cleared by medical personnel on FHSAA’s AT18

A neuro/cognitive computer baseline test (example: ImPact) on athletes


IN CONCLUSION:

• Hydrate to Elevate

• Cool First, Treat Second

• Be aware. Understand. Monitor. Prevent.

• When in doubt, sit them out.

S PORTS M EDICINE E DUCATIONAL P LAN Hillsborough County Public Schools Committee Members: Lauren Otero, APA, Leto High School Evanitta Omensetter, APSA,

Documents

drink slide

hydration hydrate

game post game

plant high school slide

game time

death hydrate

pre game

practice game