Club Responsibilities January 30, 2016 Concussions - Club Responsibilities Managing the education and recordkeeping necessary to comply with Oregon law and risk concerns

Concussion – Club Responsibilities What is a concussion?

Concussion – Club Responsibilities Sources for medical information about concussions: Centers for Disease Control and Prevention website - http://www.cdc.gov/headsup/basics/index.html Moms Team website - http://www.momsteam.com/health-safety/concussion-safety US Soccer’s Recognize to Recover site – http://www.ussoccer.com/about/federation-services/recognize-to-recover OYSA Risk Management page has links to additional resources - http://www.oregonyouthsoccer.org/risk_management

Concussion – Club Responsibilities History Concussions have always been present in sports Sports organizations have worked together to enhance player safety The 1st international conference on concussion was in 2001 in Vienna The 2nd conference was held in Prague in 2004 and every 4 years since then, most recently in Zurich in 2012 Consensus Statements on concussion have been the basis for concussion management protocols Attention to concussions in public perception has changed recently – mostly driven by media attention The legal landscape has changed dramatically since 2009 First state law was Zackery Lystedt law in Washington in 2009 Oregon adopted Max’s law (ORS 336.485) in 2009 Now all 50 states have some law that covers management of concussion Lawsuit against FIFA, US Soccer, US Youth Soccer, etc. Most state laws only apply to school sports Zack Lystedt was a middle school football player. Suffered a concussion, went back into a game after a concussion and suffered permanent brain damage. Max Conradt was a high school quarterback from Warrenton. Suffered concussion and then another one in the next game. Permanent brain damage – coma for 4 months, slow recovery in long term care facility. Almost all state laws on concussion only cover school players/teams The lawsuit against FIFA, USSF, et al was partly based on the existence of the consensus statements on concussion and the failure of sport governing bodies to make the recovery recommendations mandatory across the sport. The suit was dismissed, but could have been amended and refiled. The settlement with USSF, USYS, and others made the plaintiffs go away, but has made changes that affect youth soccer in the US. Details later.

Concussion – Club Responsibilities Oregon Legal Framework ORS 336.485 – Max’s Law Adopted in 2009 Applies only to school sports Requires State School Board to adopt rules to implement OAR 581-022-0421 Administrative Rules of the Department of Education about concussions in school sports Defines “Health Care Professional” for allowing return to play Spells out coach, student, and parent education requirements Authorizes return to play decisions by registered Certified Athletic Trainers for school/school district ORS 417.875 – Jenna’s Law Adopted in 2013 There are no administrative rules implementing the law Applies to non-school athletic teams (not affiliated with a public school) Applies to all OYSA members and affiliates (non profit organization) Jenna Sneva was a ski racer from Sisters. She had several concussions from her sport. She was one of the people whose testimony caused the legislature to extend concussion laws to youth sports outside of schools. Oregon legislature did not extend the previous law – they wrote a new law for non school athletes ORS 336.485 is part of the education statutes under the jurisdiction of the Department of Education ORS 417.875 is part of the Juvenile Code dealing with interstate movement of juveniles, adoptions, and services to children and families. If there were administrative rules, they would be the responsibility of the Department of Human Services. Private schools seem to be covered under the new statute, not the prior one For profit organization

Concussion – Club Responsibilities Differences Between School and Non-school Teams: The Oregon legislature created several important differences in concussion management between public school teams and non-school teams with the adoption of ORS 417-785 in 2013. School Teams Administrative rules provide details about implementation Health Care Professional is defined Only applies to public school teams Coaches annual training No return same day, except - Certified Athletic Trainer may determine no concussion and allow return to play in same game Non-School Teams No administrative rules Applies to teams not associated with a public school Applies to nonprofit organizations Referee annual training Information to parent of player under 18 and player 12 and older Parent of a player under 18 must acknowledge receipt No return on same day, except - Certified Athletic Trainer may determine no concussion and allow return to play in same game No liability for coach or referee who complies

Concussion – Club Responsibilities What ORS 417.875 requires clubs to do: Make sure that all coaches receive concussion training every year [ORS 417.875(2)(a)] Have a policy that establishes: [ORS 417.875(2)(b)] What training will be used [ORS 417.875(2)(b)(A)], and Ensures that coaches receive the training [ORS 417.875(2)(b)(B)] Distribute educational materials [ORS 417.875(5)] To parents of players under 18, and Players age 12 and older Obtain acknowledgement from at least one parent of a player under age 18 that: [ORS 417.875(6)] The parent has received the required educational materials, and The parent has reviewed the educational material, and The parent’s child age 12 and older has reviewed the educational material

Concussion – Club Responsibilities Educating Coaches There are several readily available online training courses for coaches The Centers for Disease Control and Prevention has an online training course on their website at http://www.cdc.gov/concussion/HeadsUp/Training/index.html This is a video based course with questions A printable certificate is generated at the end of the course The CDC does not retain a database of the persons who have completed the course The National Federation of High Schools has an online course at http://nfhslearn.com/courses/61037/concussion-in-sports The video and questions are based on the CDC course Registration is required A certificate can be printed The NFHS maintains a database where a coach or administrator can confirm taking the course and print copies of the certificate A relatively new online course is available through the Oregon Center for Applied Science at http://activecoach.orcasinc.com/ Material is presented by video and interactive quizzes A Certificate can be generated There is no database of coaches who have completed the course

Concussion – Club Responsibilities Record Keeping for Coaches The law does not say what records to keep If you don’t keep records, how can you show coaches completed their annual training? Without records how would you defend a claim that an untrained coach caused a health problem for a player? You should get a copy of the certificate the coach gets for completing a course You can collect paper copies You can collect a pdf copy from the coach You can require the coach to upload a copy of the certificate into the coach’s profile in Affinity The training should be completed before the coach begins working with players/teams in the seasonal year The statute does not require this for non-school teams It is required for school based teams

Concussion – Club Responsibilities Education materials for parents and players OYSA has partnered with Providence Children’s Health to prepare a fact sheet for parents Download from OYSA website – http://www.oregonyouthsoccer.org/risk_management Direct link - http://oysa.bonzidev.com/doclib/2013_PHS_OYSA_Concussion_Fact_Sheet_for_Parents.pdf The CDC has a similar document that can be downloaded from the CDC’s Heads Up website - http://www.cdc.gov/headsup/index.html Many of the CDC documents can be downloaded from the Risk Management page of the OYSA website See the handouts or go online

Concussion – Club Responsibilities Recording Delivery and Acknowledgement Club is required to deliver the document to parents and players How do you record that this has happened? Part of online registration Capture a parent acknowledgement as part of online registration Does every family in your club register all players through online registration? If not, how do you reach the parents and players not using your registration software? Team/club meeting Specifically authorized by statute [ORS 417.875(7)] Hand out the information sheet Have a parent sign an acknowledgement form Affinity can create a pdf form for any team that has been formed in the software A Word Document form can be downloaded from the OYSA website - http://www.oregonyouthsoccer.org/risk_management or directly downloaded as http://oysa.bonzidev.com/doclib/Concussion_Handout_Receipt.doc Keep copies of the signed acknowledgements until players turn 21. Keep electronic copies indefinitely. Scan handwritten forms and save Keep access to online registration records

Concussion – Club Responsibilities

Concussion – Club Responsibilities

Concussion – Club Responsibilities OYSA Concussion Toolkit OYSA has partnered with Providence Health Services to create a toolkit of documentation for coaches. Every coach, at all levels of play, should have copies of the documents in the toolkit with them at every practice and game. Documents in the Toolkit: Concussion Management Protocol Provides an overview of recognizing and responding to possible concussions, including return to play protocols Keep one copy at all times and review periodically Sideline Quick Reference Short summary of signs and symptoms Guideline for when to call 911 Concussion Sideline Documentation Questions to complete whenever a player is suspected of a concussion Keep several copies – fill out page one in duplicate whenever there is a suspected concussion Give one copy of page 1to parents and keep a copy Page 2 has a medical release that can be signed and returned if no concussion (parents only) If there is a concussion, HCP indicates where athlete starts return to play Handouts of the kit documents available in the room

Concussion – Club Responsibilities Documents in the Toolkit (cont.) Concussion Care Instructions for Parents Keep several copies Hand to parents with the sideline documentation Graded Return to Participation documentation Tracks symptoms over an extended period To be used as instructed by HCP Keep several copies on hand Give a copy to parents to take with them to HCP If there is a concussion, the HCP should clear the player using the Release on page 2 No play until OK

Concussion – Club Responsibilities Recognize to Recover Announced as part of the settlement of the concussion lawsuit this program provides rule changes and resources for Concussion and other player health and safety issues. Details at http://www.ussoccer.com/about/federation-services/recognize-to-recover US Soccer Federation Initiatives (see http://www.ussoccer.com/~/media/files/federation-services/r2r-recognize-2-recover/concussion-initiative-guidelines-151125.pdf?la=en) Concussion Education All USSF licensed referees must review concussion video each year All USSF licensed coaches must review concussion video each year Parents of players in Development Academies must review video and acknowledge receipt of information each year Players over 13 in national teams and Development Academies must review video and information each year USSF Member Organizations (includes OYSA) are strongly encouraged to require parent and player education Health Care Professionals All national teams and Development Academies are required to have a HCP knowledgeable in emergency medicine and concussions at all games All major youth tournaments strongly encouraged to have HCPs accessible to coaches, referees, and players Major = played over multiple days Major = has age group champions Major = has 64 or more teams at U11 and older

Concussion – Club Responsibilities US Soccer Federation Initiatives (cont.) USSF will require neuropsychological baseline testing for all national team and development academy players Results will be a tool in evaluating return to play USSF member organizations are encouraged to provide information about baseline testing resources to their members, but baseline testing is NOT required USSF national teams and development academies will have HCP at games Suspected concussion will be evaluated on sideline using specified tools If no concussion found, player may be returned to play If concussion is found, no return to play until RTP protocol has been completed USSF recommends that its members use the same tools and RTP protocols at games where an HCP is present US Youth Soccer uses this process at regional and national tournaments When no HCP is present, player does not return to play until evaluated and cleared by HCP When concussion is found graduated RTP should be required

Concussion – Club Responsibilities US Soccer Federation Initiatives (cont.) Rule Change – Substitutions In Development Academy matches with limited substitutions A player suspected of a concussion will be removed from the game for sideline evaluation by HCP A temporary substitution can be made for the injured player The substitution will not count against the number of available substitutes If player evaluated player is found to not have concussion, player can return to play and the temporary substitute will still be available for later substitution US Soccer recommends that its members adopt same substitution rule for matches with limited substitutions Rule Change – Heading Limitations Age 10 and younger – no heading in practice or games Age 11-13 – Limit amount of heading in practices Maximum 30 minutes per week No more than 15-20 headers per player, per week OYSA will implement no heading rule in Developmental League beginning spring 2016 Only USYS competition with limited substitution is National Championships Rule change for temporary injury substitution will not happen before 16-17 year.

OYSA & Its Members Teamwork “Coming together is a beginning. Keeping together is progress. Working together is success.” -Henry Ford

THANK YOU Questions? 7920 SW Cirrus Drive, Beaverton, OR 97008 Phone : 503.626.4625 Fax : 503.520.0302 Site : oregonyouthsoccer.org E-mail : brian@oregonyouthsoccer.org