1. Concussion in Sports Becky Oakes NFHS Director of Sports NISCA Convention Indianapolis, IN March 29, 2013

2. National Federation of State High School Associations
About the National Federation of State High School Associations (NFHS):
The NFHS Office is located on the White River State Park next to the National Collegiate Athletic Association (NCAA) and the Indiana State Museum in downtown Indianapolis, Indiana.
The first full-time executive director, H.V. Porter, was appointed in 1940 and established the first office in Chicago, Illinois. Cliff Fagan replaced H.V. Porter as executive director in 1958, and the national office was moved from Chicago to suburban Elgin, Illinois, in Brice Durbin became the organization’s third executive director in 1977, and the national office was moved to Kansas City, Missouri, in Bob Kanaby was named the NFHS’ fourth executive director in 1993, and the office was moved to Indianapolis, Indiana, in In 2010, Bob Gardner was named the organization’s fifth executive director.

3. National Federation of State High School Associations
NFHS:
National leadership organization for high school sports and fine arts activities;
Writes playing rules for 17 boys and girl sports at the high school level;
National authority on interscholastic activity programs.
Conducts national meetings;
Sanctions interstate events;
Produces publications for high school coaches, officials and athletic directors;
National source for interscholastic coach training; and national information center.
About the National Federation of State High School Associations (NFHS) cont:
The NFHS, based in Indianapolis, Indiana, is the national leadership organization for high school sports and fine arts activities. Since 1920, the NFHS has led the development of education-based interscholastic sports and fine arts activities that help students succeed in their lives. The NFHS sets direction for the future by building awareness and support, improving the participation experience, establishing consistent standards and Rules for competition, and helping those who oversee high school sports and activities. The NFHS writes playing Rules for 17 sports for boys and girls at the high school level. Through its 50 member state associations and the District of Columbia, the NFHS reaches nearly 19,000 high schools and 11 million participants in high school activity programs, including more than 7.6 million in high school sports.

4. National Federation of State High School Associations
Membership = 50 member
state associations and D.C.
NFHS reaches nearly 19,000 high schools and 11 million participants in high school activity programs, including more than 7.6 million in high school sports.
About the National Federation of State High School Associations (NFHS) cont:
The NFHS, based in Indianapolis, Indiana, is the national leadership organization for high school sports and fine arts activities. Since 1920, the NFHS has led the development of education-based interscholastic sports and fine arts activities that help students succeed in their lives. The NFHS sets direction for the future by building awareness and support, improving the participation experience, establishing consistent standards and Rules for competition, and helping those who oversee high school sports and activities. The NFHS writes playing Rules for 17 sports for boys and girls at the high school level. Through its 50 member state associations and the District of Columbia, the NFHS reaches nearly 19,000 high schools and 11 million participants in high school activity programs, including almost 7.5 million in high school sports.

5. NFHS SPORTS MEDICINE ADVISORY COMMITTEE
Mission Statement
The Sports Medicine Advisory Committee (SMAC) shall advise the NFHS concerning sports medicine issues as they relate to rules writing, as well as the other programs and services of the NFHS. It will monitor and disseminate current information to the NFHS and its membership relative to the sports medicine field. Through this committee, the NFHS will work to educate its constituency concerning sports medicine issues. The committee will proactively address health and safety issues of general concern to the NFHS membership.

6. Member State Associations Sports Medicine Advisory Committees

7. State Concussion Legislation (As of March 2013)

8. NFHS Rules Books Baseball Basketball Cross Country Field Hockey
Football
Girls Gymnastics
Ice Hockey
Boys Lacrosse
Soccer
Softball
Spirit
Swimming and Diving
Track and Field
Volleyball
Water Polo
Wrestling

9. 2010-11 NFHS Rule Book Changes on Concussion
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. (Please see NFHS Suggested Guidelines for Management of Concussion).
Approved by NFHS Sports Medicine Advisory Committee – October 2009
Approved by the NFHS Board of Directors – October 2009

10. Member State High School Associations
Need to be aware of current state laws on concussion.
Need to define who is an appropriate health-care professional.
Need to define return to play criteria.
Need to determine the mechanics for removal or re-entry for return to play for the same contest.
Need to educate member schools on concussion recognition and management.
Need to educate officials, parents, athletes and the media on concussion.

11. Appropriate Health-Care Professionals
Need to be aware of current NFHS rules, state laws and state association rules in regard to concussion management.
Need to understand that they share a responsibility for recognition, removal and proper management of concussion in competition.
Need to update knowledge!

12. Appropriate Health-Care Professional
Who should it be??
MD/DO
Athletic Trainer
Nurse Practitioner
Physician Assistant
Neuropsychologist?
???????
Ideally
Should have knowledge and extra training in sports-related concussion management

13. Coaches Need to be educated in concussion recognition and management.
Need to understand the role of the official and appropriate health-care professional.
Need to understand that they share a responsibility in recognition of concussion in competition and practice.
Need to follow school district and state association policies on return to play.

14. Officials Responsibility
Recognize the signs or symptoms of a possible concussion and remove the athlete from play
The responsibility of the official is limited to activities that occur on the field, court, pool or mat
Once the participant has been removed from a contest due to a suspected concussion, the coach or appropriate health-care professional(s) assumes full responsibility for that athlete’s further evaluation and safety
No signed document is needed nor is verification of the appropriate health-care professionals’ credentials
Need to be aware of current NFHS rules, state laws and state association rules in regard to the signs and symptoms of a concussion.
Follow protocol from state association for compliance with concussion rule.

15. PIPER
NFHS Injury Surveillance System The National High School Sports Injury Surveillance Study: High School RIOTM
R. Dawn Comstock, PhD
Associate Professor
Pediatric Injury Prevention, Education, and Research (PIPER) Program
Colorado School of Public Health, Epidemiology

16. Swimming and Diving Injury Data
Boy’s and Girls’ swimming and diving had the lowest injury rates of the 20 sports under the NFHS Injury Surveillance System in
About 50% of all injuries were overuse type injuries with 44-49% of the injuries involving the shoulder in
Boys: Diving accounted for 9.2% of all injuries, swimming for 69.7% and other for 21.1% from 2008/09 – 2011/12.
Girls: Diving accounted for 4.3% of all injuries, swimming for 78.6% and other for 17.1% from 2008/09 – 2011/12.

17. Girls’ Swimming and Diving Injury Rates
In 2011/12, girls’ swimming and diving had the second lowest injury rate (after boys’ swimming and diving) in the 20 sports under surveillance.
28 injuries during 73,788 athlete exposures overall
-Overall injury rate 0.38 per 1,000 AE
2 competition injury during 13,841 competition exposures
-Competition injury rate 0.14 per 1,000 competition AE
26 practice injuries during 59,947 practice exposures
-Practice injury rate 0.43 per 1,000 practice AE

18. Boys’ Swimming and Diving Injury Rates
In 2011/12, boys’ swimming and diving had the lowest injury rate in the 20 sports under surveillance.
12 injuries during 63,883 athlete exposures overall
-Overall injury rate 0.19 per 1,000 AE
1 competition injury during 12,231 competition exposures
-Competition injury rate 0.08 per 1,000 competition AE
11 practice injuries during 51,652 practice exposures
-Practice injury rate 0.21 per 1,000 practice AE

19. Extent of the Problem Concussions
About 9% of all sports injuries
Likely at least 140,000 concussions in HS athletes yearly based on High School RIO estimates

20. Burden of Concussion by Sport, 2008/09 -2011/12
Girls’ and boys’ swimming and diving are both here among these tiny slices of the pie.
*Girls’ swimming and diving accounted for 0.2% (n=8) of all concussions while boys’ swimming and diving accounted for 0.1% (n=6) of all concussions.

21. Swimming and Diving Injury Data Concussions* * * *
Overall
# of concussion (rate/10,000 AEs)
Boys’ Swimming & Diving total
2 (0.17)
0 (0.00)
1 (0.13)
3 (0.47)
6 (0.18)
Competition
1 (0.65)
1 (0.15)
Practice
2 (0.21)
3 (0.58)
5 (0.18)
Girls’ Swimming & Diving total
3 (0.23)
1 (0.10)
1 (0.12)
3 (0.41)
8 (0.21)
1 (0.40)
1 (0.48)
1 (0.63)
1 (0.72)
4 (0.53)
2 (0.19)
2 (0.33)
4 (0,13)

22. Swimming and Diving Injury Data Concussions
Basic injury mechanism * Sport athlete was participating in Crosstabulation
Sport athlete was participating in
Total
boys swimming and diving
girls swimming and diving
Basic injury mechanism
contact with another person 2 4
33.3%
25.0%
28.6%
contact with playing surface 8
66.7%
50.0%
57.1%
contact with playing apparatus
.0%
14.3% 6 14
100.0%

23. Swimming and Diving Injury Data Concussions
Swimming activity at time of injury * Sport athlete was participating in Crosstabulation
Sport athlete was participating in
Total
boys swimming and diving
girls swimming and diving
diving off board/platform/ block 2
.0%
25.0%
14.3%
swimming 3 5
50.0%
35.7%
touch turn off wall 1
12.5%
7.1%
flip turn off wall
16.7%
other
33.3%
37.5% 6 8 14
100.0%

24. Swimming and Diving Injury Data Concussions
Type of exposure * Sport athlete was participating in Crosstabulation
Sport athlete was participating in
Total
boys swimming and diving
girls swimming and diving
Competition 1 4 5
16.7%
50.0%
35.7%
Practice 9
83.3%
64.3% 6 8 14
100.0%

25. Concussion Management - The Basics
Develop Coach Education
Awareness and Recognition
When in doubt, sit ‘em out!!
Return to Play Policies
No return to activity on the same day of a concussion
No return to activity if having symptoms of a concussion
Appropriate Health-Care Professional Clearance

26. What Can You Do? Coaches
Be educated about concussion recognition and management
Have an Emergency Action Plan
Help schools educate game officials, parents, athletes and the media on concussion
Need to understand the role of the game official and appropriate health-care professionals
Follow school district and state association policies on return to play

27. NFHS Coach Education “Concussion in Sports – What You Need to Know”
On-line training for coaches
NFHS/CDC Heads Up collaboration
Free!!
Coaches, game officials, administrators, parents
Additional resources
Over 725,000 courses
delivered since May ,000 in 2012

28. Concussion in Sports What You Need to Know
FREE
COURSE!

29. Concussion in Sports – What You Need to Know www.nfhslearn.com
FREE!
175,000+ since July 1.

30. Concussion Resources PDFs and Videos
NFHS Suggested Guidelines for Concussion Management
NFHS SMAC - A Parent’s Guide to Concussion in Sport
Athlete Fact Sheet
Coach Guide
Concussion Physiology
Emergency Care Plan
Gender Differences
Main Message Poster
Parents Fact Sheet
NFHS Rules Book Language
Signs and Symptoms Poster
Take Concussion Out of Play
Tracking the Impact of Traumatic Brain Injuries
School Concussion Policy Example
CDC Heads up to Schools
Checklist
Laminated Card
Magnet
Nurses Fact Sheet
Poster
Teachers Fact Sheet
Clipboard Sticker
Position Statement Regarding Soccer Headgear
Wallet Card
Videos:
A Mother’s Perspective
Student’s Concussion Experience
Student Interviews

31. First Aid, Health and Safety for Coaches www.nfhslearn.com

32. First Aid, Health and Safety for Coaches

33. NFHS Equipment Guidelines

34. Concussion Prevention
Mouth guards
No proven benefit in reducing concussion risk – very effective at preventing peri-oral and dental injury

35. NFHS Suggested Guidelines for Management of Concussion
In the Appendix
in all of the
NFHS
Rules Book 35

36. NFHS Suggested Guidelines for Management of Concussion
No athlete should return to play (RTP) or practice on the same day of a concussion.
Any athlete suspected of having a concussion should be evaluated by an appropriate health-care professional that day.
Any athlete with a concussion should be medically cleared by an appropriate health-care professional prior to resuming participation in any practice or competition.
After medical clearance, RTP should follow a step-wise protocol with provisions for delayed RTP based upon return of any signs or symptoms.

37. NFHS Sports Medicine 2011, 4th edition June 2014, *5th edition will be
Concussion chapter
June 2014,
*5th edition will be
released 37

38. Concussion Chapter

39. NFHS SMAC Position Statements

40. NFHS High School Today

41. Future Direction from the High School Perspective
State and Federal Concussion Legislation-
Concussion Education is Very Important-
Playing Rules and Equipment to Minimize Risks-
Injury Surveillance and Concussion Research-
Academic Accommodations After a Sports -related Concussion-

42. Thank You for your support of
High School Athletics!