Brevard College Sports Medicine Policies and Procedures: Concussion Management

Transcription

1 POLICY (Updated ) The purpose of this policy is to establish the manner in which to manage sports related head injuries and return to play considerations. A concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Included are recommendations for the progression of a student-athlete to full participation and disqualification criteria from participation at Brevard College. PROCEDURE 1. Evaluation The Brevard College Sports Medicine Team should approach the evaluation of sports related head injuries with a systematic and collaborative approach. On Field Assessment o Check for responsiveness If not responsive, assess ABC s Assume C-spine injury Ammonia capsules should NOT be used o Rule out C-spine injury o Rule out cranial and facial fractures o Check for cerebral spinal fluid o Ask for mechanism of injury o Check for mobility o If mobile, assist student-athlete off playing surface When it is determined that the situation in not a medical emergency, a proper sideline assessment should take place. Sideline Assessment o History o SCAT 2 Card or Pocket SCAT 2 (Concussion Vital Signs ) Symptoms Memory Balance o Cranial Nerves 1-12 o Pupil Response PEARL Nystagmus o Battle Sign o Recheck for CSF

2 The injured student-athlete should be closely monitored on the sideline. Serial assessments should follow on the sideline every 5 minutes until symptoms stabilize. All findings should be recorded to compare with follow-up assessments. At the conclusion of play the student-athlete should be escorted to the Athletic Training Room by the Athletic Trainer where a follow up assessment should be performed. The evaluation should be a more thorough examination than the on field but should include the same tests performed to compare objective findings. In addition, a Sport Concussion Assessment Tool 2 (SCAT 2) should be administered and any deficits should be noted. All symptoms should be recorded on Concussion Vital Signs and completed at every 24 hour assessment. Brevard College Take Home Instructions should be given to the party that will be monitoring the student-athlete over the next 24 hours (i.e. parents, roommate). Verbal communication should take place between that party and the Athletic Trainer to make sure they understand the instructions and who to contact in an emergency. If a responsible party is not going to be with the student-athlete at all times over night, then the student-athlete should be admitted to the hospital to ensure the student-athlete s safety. An or phone call should be sent to the Head Athletic Trainer by the responsible Athletic Trainer informing of the concussion and any limitations to be shared with the Student Intervention Team (SIT). The student-athlete should be instructed to report to the Athletic Training Room prior to class the following morning. A final Concussion Vital Signs Test should be performed prior to introducing the student-athlete back to athletic activity to rule out neurological deficits if not within normal limits. 2. Pharmacologic Management Brevard College recognizes that there are no evidence-based pharmacologic treatment options for a student-athlete with a concussion. The Brevard College Sports Medicine Staff recommends acetaminophen is used as directed for the first 24 hours to manage symptoms. The student-athlete is strongly encouraged to not use medications containing aspirin or nonsteroidal anti-inflammatories. 3. Referral The Brevard College Athletic Training Staff should have the unchallengeable authority to refer to members of the Brevard College Sports Medicine Team for any concerns. Following a proper assessment any of the following criteria are deemed medical emergencies: Medical Emergency o Deterioration of neurologic function o Decreasing level of consciousness o Decrease or irregular respirations o Any sign or symptom of injury, spine or skull fracture, bleeding o Unequal, dilated, or unreactive pupils o Mental status change

3 The following criteria indicate a physician should be notified the day of injury. The list includes medical emergency signs and symptoms so adhere to the above guidelines to manage the sport related head injury. Day of Injury Physician Referral o Loss of consciousness on the field o Amnesia lasting longer than 15 minutes o Deterioration of neurologic function o Decreasing level of consciousness o Decrease or irregular respirations o Increase in blood pressure o Unequal, dilated, or unreactive pupils o Cranial nerve deficits o Signs or symptoms of associating injuries, spine or skull fracture, or bleeding o Mental status change o Seizure o Prolonged severe vomiting o Motor deficits o Sensory deficits o Balance deficits o Post-concussion signs and symptoms worsen o Additional severe post-concussion signs or symptoms o Student-athlete is still experiencing moderate to severe symptoms after the game A referral to a Brevard College Sports Medicine Team Physician is warranted when any of the following occur: Next Day Physician Referral o Increase in post-concussion symptoms o Post-concussion symptoms worsen o Post-concussion symptoms interfere with daily activities Delayed Referral o Student-athlete s symptoms not improving 3 days from the injury date o Increase in post-concussion symptoms or symptoms worsen o Post-concussion symptoms begin to interfere with daily activities

4 4. Coach Role in Sport Related Head Injury The NCAA mandates that the healthcare provider should have the unchallengeable authority to make a participation status. At no time should a coach, administrator, or any other Brevard College representative interfere with an on field assessment. The coach may approach the injured student-athlete with the Athletic Trainer to assist with any needs. If other players or bystanders are approaching the scene, the coach then acts as crowd control. The game day supervisor assists with crowd control in the stands and keeps emergency exits clear for transport. 5. Return to Play Criteria The return to play decision is one of the most important factors when managing sports related head injuries. The Brevard College Sports Medicine Staff should be very cautious not to return a studentathlete to activity too soon. Brevard College takes a strong stand to be committed to eliminate second impact syndrome in our student-athletes. Progressing a student-athlete back to full participation should be a slow progression and follow the below steps. Each step in the Post-Concussion Clearance Form including an exercise test must be fulfilled and the student-athlete must be within 5% of their baseline scores on the Concussion Vital Signs Test before beginning the Return-To-Play Progression. The exercise test will consist of a minimum of: 5 minutes 50% max effort, 30 seconds push-ups, 30 seconds up-downs, and 3 minutes 100% max effort. Once the student-athlete has been symptom free 24 hours, they will tested for any balance and/or neurological deficits. They will undergo the exertional test, then will be eligible to take the CVS post-concussion test only after being asymptomatic for a further 24 hours after the exertion test. The following gradual return to play steps can be followed after passing the CVS test within 5% of their baseline: 1. Light aerobic exercise, no resistance training 2. Sports specific exercise without training 3. Non-contact training drills 4. Full contact training drills 5. Game play All steps cannot be performed on the same day but do not have to be performed on five separate days. The concussion history and severity of concussion should be considered during the progression to return to participation activities. The student-athlete will only return to full participation when the Brevard College Post Concussion Clearance Form signed by a Team Physician or Athletic Trainer. The studentathlete s Athletic Trainer will notify the Head Athletic Trainer of the status of the student-athlete and any considerations for the Student Intervention Team (SIT).

5 6. Baseline Testing The following sports will be baseline tested: Football, Men s Basketball, Women s Basketball, Men s Soccer, Women s Soccer, Baseball, Softball, Cheerleading, Volleyball, Men s Lacrosse, and Women s Lacrosse. The baseline testing will consist of a Balance Error Scoring System (BESS) test and a Concussion Vital Signs Test. The purpose for baseline testing will be to compare data collected during concussion assessments and ensure student-athletes are returning to participation safely. Baseline testing will be performed before student-athletes participate in activity. 7. Disqualification Criteria Game Day o Any student-athlete exhibiting signs or symptoms of a concussion will be removed from play and not allowed to re-enter the competition or practice that day Season o Career o 8. Away Game Protocol After a student-athlete suffer from 3 documented concussions in the same season they will be removed from participation as a Brevard College student-athlete; the studentathlete must receive clearance from a Brevard College Team Physician to participate in the following season The decision to disqualify a student-athlete s career should be made by conference with the student-athlete, Athletic Trainer, and Physician. The student-athlete s concussion history, physical exam, brain images, healing time between concussions, sport, and current neurological status will be considered in making an informed decision. The Athletic Trainer will apply the same evaluation and referral criteria used for home completion to a sports related head injury sustained during an away completion. The coach is instructed to call the assigned Athletic Trainer immediately so proper follow up is performed and the correct parties are notified.

6 Post-Concussion Take-Home Instructions Name: Date: You have had a head injury or concussion and need to be watched closely for the next hours. It is OK to: There is no need to: DO NOT: Use Tylenol Check eyes with a light Drink alcohol (acetaminophen) Wake up every hour Eat spicy foods Use an ice pack to head/neck Stay in bed Drive a car for comfort Use aspirin, Aleve, Advil or Eat a light meal other NSAID products Go to sleep You may experience the following normal signs and symptoms of a concussion: Headache Pressure in head Neck pain Nausea Dizziness Balance problems Sensitivity to light Difficulty concentrating Sensitivity to noise Feeling slowed down Fatigue Difficulty remembering Confusion Drowsiness Irritability Trouble falling asleep More emotional Sadness Nervous or anxious Feeling in a fog Watch for any for any of the following significant problems: Worsening or intolerable headache Stumbling/loss of balance Vomiting Weakness in one arm/leg Decreased level of consciousness Blurred vision Dilated or unequal pupils Increased irritability Increased confusion If any of these serious problems develop or you are considering obtaining urgent care (e.g., going to the emergency room), please notify your Athletic Trainer first. Athletic Trainer: Student-Athlete: Phone: Date: You will have a follow-up evaluation at: Date: Time: Location:

7 Post-Concussion Clearance Form Last Name, First Name M.I. Sport Date of Birth Grad. Year Date of Concussion: Date of Initial Evaluation: Clearance Checklist Date: S-A Initial ATC Initial Date of Last Symptoms BESS / Balance Tests Within Normal Limits or 5% of Baseline Vital Signs, Neurologic Screen - Within Normal Limits Date of Exertion Test (After Asymptomatic for 24 hrs.) Asymptomatic for 24 hrs. After Exertion Test Concussion Vital Signs (CVS) Post-Injury Test Within 5% of Baseline Return to Play Progression (Asymptomatic) Date: S-A Initial ATC Initial 1. Light to Moderate Aerobic Exercise Weight Training, High Intensity Exercise Non-Contact Or Partial-Contact Training / Practice 4. Full-Contact Training / Practice 5. Unrestricted Practice / Game Participation Has the Student-Athlete been evaluated by a Physician, gone to an Emergency Room/Urgent Care, or undergone any further testing? YES / NO If Yes, one of the following must options be completed: 1. Documentation that is signed by a Licensed Physician clearing the Student-Athlete to resume athletic activity is on file with the Sports Medicine Department. ATC Initial: 2. Signature of Physician Releasing Student-Athlete to resume athletic activity: Signature: Name: Address: Phone: Student-Athlete Statement: I have not experienced any signs or symptoms related to a concussion since the Date of Last Symptoms documented on this form. I have completed all of the requirements of this Post-Concussion Clearance Form truthfully and honestly. Student-Athlete Signature: Date: The Student-athlete has completed the Post-Concussion Clearance Checklist and completed the Return to Play Progression with no return of concussion signs or symptoms. He/she is cleared to return to full athletic participation. ATC / Physician Signature: Date:

8 Concussion Awareness Letter The Brevard College Sports Medicine Department would like to inform you that sustained a concussion on. He/She was evaluated by and will undergo follow-up testing daily. A concussion or mild traumatic brain injury can cause a variety of physical, cognitive, and emotional symptoms. Concussions range in significance from minor to major, but they all share on common factor they temporarily interfere with the way your brain works. We would like to inform you that the next few weeks this student-athlete may experience one or more of these symptoms: Headache Nausea Dizziness Balance problems Diplopia (double vision) Confusion Photophobia (light sensitivity) Difficulty sleeping Blurred vision Misophonia (noise sensitivity) Feeling sluggish or groggy Memory problems Difficulty concentrating As a department, we wanted to make you aware of this injury and the related symptoms that the student-athlete may experience. Although the student-athlete is attending class, please be aware that the side effects of the concussion may adversely impact his/her academic performance. Any consideration you may provide academically during this time would be greatly appreciated. We will continue to monitor the progress of this student-athlete and anticipate a full recovery. Should you have any questions or require further information, please do not hesitate to contact us. Thank you in advance for your time and understanding with this circumstance. Colin Covelli, MSEd, LAT, ATC, CSCS Head Athletic Trainer Brevard College Athletic Department One Brevard College Drive Brevard, NC (office)