Concussion Management Todd Nelson Assistant Director, NYSPHSAA

NYSPHSAA Concussion Initiative Dennis Fries Concussion Management Coordinator Lloyd Mott, Asst Director Safety Committee Chair Senator Kemp Hannon NYS Senate Health Committee

NYSPHSAA Concussion Team NYSPHSAA Safety Committee Chair NYSAAA Representative Physicians Psychologists & Neuropsychologists Athletic Trainers Athletic Directors Parent Section CMT formed

Principles of Concussion Management Avoid re-injury until recovered Avoid over-exertion during recovery Early education and reassurance improves outcome Return to school gradually with accommodations as needed Return to play must follow a medically supervised process

3rd International Conference on Concussion in Sport Zurich 2008 Guidelines No grading of injury Treat every concussion seriously Recovery may take longer in children and adolescents 3rd International Conference on Concussion in Sport FIFA IOC IIHF 5

Zurich Return to Play Guidelines Any athlete who show ANY symptoms or signs of a concussion: Athlete should not return-to-play in the current game or practice Athlete should be monitored for deterioration for 24 hours return-to-play must follow a medically supervised stepwise process athlete must be symptom-free at rest and after exertion 6

Medical Protocol Any athlete who suffers a concussion should undergo medical evaluation within 24 hours Anyone with LOC should be evaluated that day If confused or not fully conscious, transport by EMS with immobilization Follow athlete until asymptomatic First medical clearance is to begin RTP progression If no return of symptoms with exertion, then final clearance for game play 7

Zurich Return to Play Progression No activity, complete rest Light aerobic exercise but no resistance training Sport specific exercise and progressive addition of resistance training Non-contact training drills Full contact training and scrimmage after medical clearance Game play Also should be symptom-free after mental exertion and have normal neruocognitive test results 8

NYSPHSAA Concussion Initiative $145K in 3 phases over 3 years Presentations at athletic director meetings in all 11 sections Webcast, DVD, and website CME credit for school physicians List of identified resources state-wide Partnership with ImPACT – 220 member schools Dick’s Sporting Goods – FREE base line testing Concussion team in every section & every school Sideline cards – distributed to all schools

NYSPHSAA Resources NYSPHSAA Sample Concussion Policy Modeled on policies, procedures, and protocols already in use in some schools Approved by NYSPHSAA Executive, available on website Concussion Checklist Completed by coach or trainer on the sideline Follows athlete until cleared to RTP Reviewed by school ATC and MD after clearance Improves communication and helps enforce policy

Other Resources Free Educational Materials CDC Heads up in High School Sports kits NFHS – Concussion Management Course CDC web based training video for coaches SED Required First Aid for Coaches outline NCAA web-based education video SUNY Upstate Concussion in the Classroom video and brochure on-line

Lessons Learned Coaches and athletic directors will attend . . . if required Athletic trainers and school nurses are good advocates Parents rely on advice of physicians Primary complaint from trainers and nurses is lack of knowledge among physicians Little awareness of academic consequences

National Federation of High Schools Concussion Guidelines 2010 - 2011 Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional

Concussion Management Awareness Act – July 1, 2012 NYSPHSAA met with many legislators on potential Bills. Fully supports the Bill passed by both the Senate and Assembly NYSPHSAA named as a stakeholder in the Law

Steps to Success Form a school Concussion Team to oversee education and protocols Educate athletes, parents, coaches, teachers, administrators and school health professionals including the medical officer Develop and implement a concussion management policy and protocol (use of concussion checklist recommended) Consider other steps such as hiring an athletic trainer or using a computerized testing program

It’s the right thing to do ! Summary NFHS, CDC, NYSPHSAA and NYS legislature now recognize sports concussion as a significant health concern Proper recognition and management of concussion can prevent serious problems Athletes must avoid re-injury and over-exertion until recovered Every school should have a concussion management policy and a concussion management team It’s the right thing to do ! 16

Todd Nelson, Assistant Director Contact information Todd Nelson, Assistant Director Email: tnelson@nysphsaa.org Phone: (518) 690 - 0771 17