AHSAA Medical Advisory Committee Update 2015 James B. Robinson, M. D. Head Team Physician- University of Alabama Co-Chairman- AHSAA Medical Advisory Committee

Important Updates ConcussionConcussion Contact RulesContact Rules Heat IllnessHeat Illness EAPEAP

Concussion AHSAA concussion rule- 2010AHSAA concussion rule AHSAA mandatory training- 2010AHSAA mandatory training Alabama State Law- Act June 2011, Revised May 2012Alabama State Law- Act June 2011, Revised May 2012 Federal Law in the makingFederal Law in the making

(a) Each local school system and governing body of each sport or recreation organization shall develop guidelines and other pertinent information and forms to inform and educate youth athletes and their parents or guardians in their program of the nature and risk of concussion and brain injury including continuing to play after suspected concussion or brain injury. On a yearly basis, a concussion and head injury information sheet shall be signed and returned by the youth athlete and the athlete’s parent or guardian prior to the youth athlete’s initiating practice or competition(a) Each local school system and governing body of each sport or recreation organization shall develop guidelines and other pertinent information and forms to inform and educate youth athletes and their parents or guardians in their program of the nature and risk of concussion and brain injury including continuing to play after suspected concussion or brain injury. On a yearly basis, a concussion and head injury information sheet shall be signed and returned by the youth athlete and the athlete’s parent or guardian prior to the youth athlete’s initiating practice or competition

(b) Each local school system and sports or recreational organization governing body shall ensure that coaches receive annual training to learn how to recognize the symptoms of a concussion and hoe to seek proper medical treatment for a person suspected of having a concussion.(b) Each local school system and sports or recreational organization governing body shall ensure that coaches receive annual training to learn how to recognize the symptoms of a concussion and hoe to seek proper medical treatment for a person suspected of having a concussion.

(c) Each local school system and sports or recreational organization shall establish by rule the requirements of the training which shall be provided by using designated resources to the extent practicable and timeless to ensure that, to the extent practicable, every coach receives the training before the beginning of practice for the school athletic team.(c) Each local school system and sports or recreational organization shall establish by rule the requirements of the training which shall be provided by using designated resources to the extent practicable and timeless to ensure that, to the extent practicable, every coach receives the training before the beginning of practice for the school athletic team.

(d) A youth athlete who is suspected of sustaining a concussion or brain injury in practice or a game shall be immediately removed from participation and may not return to play the day of the injury and until he or she is evaluated by a licensed physician and receives written clearance to return to play from a licensed physician.(d) A youth athlete who is suspected of sustaining a concussion or brain injury in practice or a game shall be immediately removed from participation and may not return to play the day of the injury and until he or she is evaluated by a licensed physician and receives written clearance to return to play from a licensed physician.

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

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

Football Contact Rules New for 2015New for 2015 Limits the amount of full contact practice time in an effort to reduce the number of exposures to concussionLimits the amount of full contact practice time in an effort to reduce the number of exposures to concussion Some feel that repetitive sub-concussive blows to the head may be detrimental to the youth athlete and lead to future problemsSome feel that repetitive sub-concussive blows to the head may be detrimental to the youth athlete and lead to future problems

Football Contact Rules Week 1 The first two days of fall practice must be in shorts: Practice time limited to 90 minutesThe first two days of fall practice must be in shorts: Practice time limited to 90 minutes The 3 rd day of fall practice may include shoulder pads: Practice time limited to 90 minutesThe 3 rd day of fall practice may include shoulder pads: Practice time limited to 90 minutes The 4 th day of fall practice may also include shoulder pads: Practice time limited to 120 minutes.The 4 th day of fall practice may also include shoulder pads: Practice time limited to 120 minutes.

Football Contact Rules Week 1 Full football gear/pads can be worn on day 5 (August 7, 2015): Practice time limited to 90 minutes of full-speed contact.Full football gear/pads can be worn on day 5 (August 7, 2015): Practice time limited to 90 minutes of full-speed contact. Only one practice/day in full padsOnly one practice/day in full pads Two-a-day practices cannot occur on consecutive daysTwo-a-day practices cannot occur on consecutive days There must be at least a 4 hour break between practices on days designated two-a-daysThere must be at least a 4 hour break between practices on days designated two-a-days

Football Contact Rules Week 2 May alternate days of full-speed contact practice not to exceed 120 minutes of full speed contact per week.May alternate days of full-speed contact practice not to exceed 120 minutes of full speed contact per week. One intra-squad scrimmage is allowedOne intra-squad scrimmage is allowed

Football Contact Rules Week 3 Alternating days of full-speed contact practice, not to exceed 120 minutes of full contact per week is allowedAlternating days of full-speed contact practice, not to exceed 120 minutes of full contact per week is allowed One intra-squad scrimmage is allowedOne intra-squad scrimmage is allowed

Football Contact Rules Week 4 - End of Season A total of 90 minutes of full-speed contact per week is allowed.A total of 90 minutes of full-speed contact per week is allowed.

Football Contact Rules Full pads may be continued during practice, only full-speed contact is limited.Full pads may be continued during practice, only full-speed contact is limited. When in shells, no live action, full-speed contact should occur.When in shells, no live action, full-speed contact should occur. May participate in : “air”, “bags”, ”wrap”, and “thud” at anytime.May participate in : “air”, “bags”, ”wrap”, and “thud” at anytime.

Football Contact Rules Definitions Full Contact:Full Contact: Any simulations in which live action occurs. Live Action: Air: Players run unopposed without bags or oppositionLive Action: Contact at game speed in which players execute full blocking and tackling at a competitive pace, taking players to the ground. Air: Players run unopposed without bags or opposition

Football Contact Rules Definitions Bags: Activity is executed against a bag or pad to allow soft-contactBags: Activity is executed against a bag or pad to allow soft-contact Wrap: Drills run at full-speed until contact above the waist and players remain on their feetWrap: Drills run at full-speed until contact above the waist and players remain on their feet Thud:Thud: Any live action or full-speed contact with no pre-determined winner or without taking a player to the ground.

Heat Illness

Heat Related Deaths 29 deaths in High School sports from deaths in High School sports from deaths in last 5 years- a record18 deaths in last 5 years- a record 3rd most common cause of death in High School athletes3rd most common cause of death in High School athletes Usually occurs in first 4 days of practiceUsually occurs in first 4 days of practice Death from Exertional Heat Stroke is completely preventable! 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.Elevated core temperature ( >104 degrees ) associated with signs of organ system failure due to hyperthermia. Total body collapse due to thermoregulatory failureTotal body collapse due to thermoregulatory failure Life threatening! Life threatening! Mortality rates are directly related to time before cooling and length of time core temperature elevated.Mortality rates are directly related to time before cooling and length of time core temperature elevated.

EXERTIONAL HEAT STROKE Signs and Symptoms Temperature >104 rectalTemperature >104 rectal Fast heart rateFast heart rate Low blood pressureLow blood pressure SweatingSweating Rapid breathingRapid breathing Altered mental statusAltered mental status VomitingVomiting DiarrheaDiarrhea SeizuresSeizures Coma ~ 70%Coma ~ 70% Acute renal failureAcute renal failure RhabdomyolysisRhabdomyolysis Bleeding (DIC)Bleeding (DIC) Pancreatitis/ GI bleedPancreatitis/ GI bleed Mortality ~ 80%Mortality ~ 80%

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

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

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

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

AHSAA Acclimatization Rule Section 18 The first day of Fall practice is Monday, August 3, The first two days of fall football practice must be in shorts. Shoulder pads may be worn on day 3 and day 4. These four 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 fifth practice day. The earliest date full pads may be worn is August 7.The first day of Fall practice is Monday, August 3, The first two days of fall football practice must be in shorts. Shoulder pads may be worn on day 3 and day 4. These four 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 fifth practice day. The earliest date full pads may be worn is August 7. No matter when a student begins fall football practice, that student must practice for three days in shorts before practicing in pads.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.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 practicesNo consecutive days of two-a-days practices 4 Hour break between two-a-days practices4 Hour break between two-a-days practices

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

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

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

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

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