AHSAA Medical Advisory Committee Update 2016 James B. Robinson, M. D. Head Team Physician- University of Alabama Co-Chairman- AHSAA Medical Advisory Committee

Important Updates Concussion Heat Illness PPE EAP Telemedicine

Concussion Make sure all of your coaches have taken the on-line training course Know the signs and symptoms of a concussion Never let an athlete return to practice or game on the same day as injury occurred “When in doubt, sit them out” Only a licensed MD or DO can clear an athlete for return to play

AHSAA Concussion Resources Mandatory Training for ALL coaches Links to NFHS on-line learning via web-site Instructional presentations on web-site

Heat Illness

Heat Related Deaths Heat related deaths are on the rise 18 deaths in last 5 years- a record 3rd most common cause of death in High School athletes Usually occurs in first 4 days of practice Death from Exertional Heat Stroke is completely preventable!

EXERTIONAL HEAT STROKE Elevated core temperature ( >104 degrees) associated with signs of organ system failure due to hyperthermia. Total body collapse due to thermoregulatory failure Life threatening! Mortality rates are directly related to time before cooling and length of time core temperature elevated.

EXERTIONAL HEAT STROKE Signs and Symptoms Coma ~ 70% Acute renal failure Mortality ~ 80% Temperature >104 rectal Fast heart rate Low blood pressure Sweating Rapid breathing Altered mental status Vomiting Diarrhea Seizures

EXERTIONAL HEAT STROKE Treatment Measure rectal temperature Lower temperature as rapidly as possible!! Place in a tub of ice water, remove when temp <102°F (0 fatalities if cooled within 10 minutes) If no ice tubs, place iced towels over entire body and replace every 2-3 minutes 911- to Emergency Room only after cooled!

Treat First – Transport Second!! “…no one should die if proper, prompt, and aggressive care begins within 10 minutes of collapse.”

when cooling initiated within 10 minutes Survival Time 100% survival rate when cooling initiated within 10 minutes

HEAT ILLNESS Prevention Emergency Plan Nearest Emergency facility, transportation, communications, cool tub, rectal thermometer Pre-participation physical exam - identify previous heat related problems Adequate acclimatization = 10-14 days Educate - athletes, coaches, parents Well balanced diet, adequate sleep, avoiding drugs and alcohol

ACCLIMATIZATION Physiologic process by which an individual becomes able to tolerate work in a hot environment. Becoming “Thermal efficient” Usually takes 10-14 days - maximum acclimatization takes 3 months. Fluid and salt increase heat acclimatization. Exposure to hot environment for 60-90 minutes/day

AHSAA Acclimatization Rule Section 18 The first day of Fall practice is Monday, August 1, 2016. The first three days of fall football practice must be in shorts. These three days are designed for coaches to determine if the students are conditioned physically for football practice. During the first three days of practice, teams are allowed to use hand-held blocking pads. Helmets may be worn from the first day of practice, full pads from the fourth practice day. The earliest date full pads may be worn is August 8. No matter when a student begins fall football practice, that student must practice for three days in shorts before practicing in pads. During two-a-day practices, only one practice per day may be in full pads. The other practice that day can be only in helmets and shoulder pads. No consecutive days of two-a-days practices 4 Hour break between two-a-days practices

HEAT ILLNESS Prevention Weigh athletes before and after practice. “a pint’s a pound…” Replace fluid lost during activity. Monitor urine color and volume. Have ice bags available Adequate cold fluids available. Rest periods- adjust for temperature and place in shade if possible. “Cool Zone” Remove clothing at rest periods, change shirts

FLUIDS Pre-hydration extremely important, if begin dehydrated, will finish worse. Pre-activity weight should be about the same day to day. Monitor urine color and volume. Consume 17-20 oz 2-3 hours prior to activity Consume 7-10 oz 10-20 minutes prior to activity Consume 7-10 oz every 10-20 minutes of activity Post-activity hydration in 2hours Use a urine color chart to determine hydration status NATA Position Statement: Fluid Replacement for Athletes; J Athl Train; 2000;35(2):212-224

FLUIDS Fluids should: Be cool- 50-59 F⁰ Contain carbohydrate = <8% , no fructose Contain electrolytes- the more the better Palatable - increases intake by 15% Avoid: Caffeine Energy Drinks Alcohol Carbonated beverages

Pre-Participation Physical Exams Not just a “Sports Physical” A very important exam that should be taken seriously and done properly. Mandatory for all school aged athletes: RULE 1, SECTION 14. PHYSICAL EXAMS. In order for a student to be eligible for interscholastic athletics, there must be on file in the Superintendent’s or principal’s office a current physician’s statement certifying that the student has passed a physical exam, and that in the opinion of the examining physician (M.D. or D.O.) the student is fully able to participate in interscholastic athletics (grades 7-12). The AHSAA Physician’s Certificate (Form 5) must be used. Note: A physical exam will satisfy the requirement for one calendar year from the date of the exam.

Mechanics of the PPE Who? In the state of Alabama, only a licensed physician (M.D. or D.O.) can perform and sign off on the PPE. It is felt that only physicians have the clinical training and unrestricted medical license that allows them to deal with the broad range of problems that may be encountered. Other health care providers ( medical students, residents, nurse practitioners, chiropractors) can help perform the exam, however, a licensed physician must review and sign the form, thus taking responsibility for the exam.

EAP Emergency Action Plan Each school is responsible for having an EAP that is venue specific EAP must be signed off by principal, athletic director, and medical director if available EAP should be practiced and updated yearly Each coach should have a copy available and located at each venue.

Sudden Cardiac Death Responsible for 4-5 deaths/year Numbers are decreasing due to early response, AEDs, and EAPs!!! Mandatory on-line course for coaches on the recognition of cardiac issues

Telemedicine for Wrestling Coaches 2014 State Championships 6 wrestlers with potentially disqualifying skin conditions 3 wrestlers were disqualified at championship meet 2015 State Championships 0 wrestlers with skin conditions 0 wrestlers disqualified

Telemedicine Wrestling coaches have the ability to videoconference with a physician to assess whether a skin condition needs to be seen by a physician This allows for rapid treatment to ensure wrestlers are not removed from competition

Telemedicine Network of physicians in each district willing to see athletes on a moments notice Utilized only for Sub-State and State Championships last year Will be available all year this year

Telemedicine 205-394-1410

Thank You QUESTIONS?