1. SLA Coach Education Program Module 4 Concussion Prevention Policy & Procedures

2. Introduction Mission - To provide the youth of Stafford County the opportunity to learn and play lacrosse at a level commensurate with each individual’s ability, while enjoying the benefits of participating on a sport team. Objectives that support the mission: 1.to play lacrosse in a safe and organized environment, 2.to teach the fundamentals of the game so that each player can enjoy the sport and progress to the next level 3.provide life lessons in accordance with the Positive Coaching Alliance Double coach program

3. Purpose To inform coaches of SLA’s Concussion prevention policy and procedures To inform coaches of the resources available to learn the symptoms of concussions Provide sideline management Provide guidance on proper body checking techniques

4. NASPE National Association For Sport and Physical Education (NASPE) Part of the American alliance for Health, Physical Education, Recreation and Dance (AAHPERD) Publishes the National Standards for Sport Coaches: Quality Coaches, Quality Sports (NASPE, 2012)

5. NASPE Domain 2 Safety and Injury Protection Provide safe facilities Ensure players are properly equipped Monitor environmental conditions Identify physical conditions that predispose injury Recognize injuries and provide immediate care Facilitate a sports health care program Identify psychological implications

6. The Challenge Estimates of 1.6 million sport related concussions per year highest rates of emergency department visits for sports concussion occurring for youth ages 10 to14, followed by those ages 15 to19 (CDC, 2007) Lacrosse has a concussion rate of 2.6 per 1000 athlete exposures (NCAA, 2012) Rates are not decreasing even with significant emphasis on prevention (YSSA, 2011)

7. The Effect Younger players are more vulnerable to the effects of concussion Effects are memory and attention problems after concussion (Field, Collins, Lovella & Maroon, 2003)

8. Responsibility

9. NCAA “Institutions shall have a concussion management plan on file such that a student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be removed from practice or competition and evaluated by an athletics healthcare provider with experience in the evaluation and management of concussions. Student-athletes diagnosed with a concussion shall not return to activity for the remainder of that day. Medical clearance shall be determined by the team physician or his or her designee according to the concussion management plan.” (NCAA, 2012)

10. VHSL The VHSL Handbook (27-2-5) requires that prior to the first practice all coaches must take a recognized course providing both education and prevention regarding concussion as it relates to high school activities. The VHSL further strongly recommends that all participants and parents/guardians take advantage of the NFHS's online video, "Concussion in Sports, What You Need to Know" to learn about the signs, symptoms and treatment of concussions.

11. Youth What governs youth sport? Why is there a knowledge gap in the youth sport coach community Unfortunately, most individuals coaching youth sports rarely receive any type of formal training in concussion management (American Academy of Pediatrics, 2001). There is no national standard or policy

12. Risk Factors The following factors may influence the potential for injury during intentional player contact: – body composition – Technique – physical and mental capacities – Age – Coaching – equipment

13. Risk Factors Lacrosse is a contact sport Body contact and specifically body checking is the leading cause of injury in college lacrosse games and 78% of concussions are the result of player contact; 94% in high school (Dick, Romani, Agel, Case & Marshall, 2007) (Caswell, Lincoln, Hepburn, Dunn, & Almquist, nd).

14. SLAs Policy SLA’s policy is based on the NCAA’s Concussion Management Plan and Best practices from the NCAA, VHSL and U.S. Lacrosse This policy is centered around coach and parent education vice athlete as is done at higher levels

15. SLA Policy All coaches will receive this policy and information brief Coaches will be briefed on the parts of the lacrosse game where an athlete is most vulnerable Coaches will be educated about the signs and symptoms of concussions. Coaches will complete an online concussion training program

16. SLA Policy Coaches are required to conduct a parent meeting to discuss this policy and our sideline management procedures A process that ensures a student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be removed from SLA activities for that day A process that requires the coach to notify the parent and seek permission from that parent for the athlete to participate in the next scheduled event

17. Resources

18. Centers for Disease Control and Prevention Heads Up Concussion Prevention Program http://www.cdc.gov/concussion/heads up/online_training.html

19. Resources The ACTive program was created by the Oregon Center for Applied Science, Inc., and is now available free of charge at http://activecoach.orcasinc.com.http://activecoach.orcasinc.com

20. Contact Sport As a contact sport lacrosse has events that may increase the potential for concussions: Direct Body Checking Loose/Ground Ball Shooting

21. Body Checking As a helmeted sport the potential for head to head contact is present with body checking: Keep the head up Don’t lunge or leave the feet Lead with the stick on the hands Use the lead shoulder to make contact

22. Body Checking Rule 5-3-5 will state that an illegal body-check is one that targets a player in a defenseless position. This includes but is not limited to a)body-checking a player from his "blind side“ b)body-checking a player who has his head down in an attempt to play a loose ball; c)body-checking a player whose head is turned away to receive a pass, even if that player turns toward the contact immediately before the body-check. A minimum of a two- or three-minute non releasable penalty is assessed for this violation.

23. Loose Ball Play When the ball is loose it presents the most frequent and highest potential for contact with the head as players lower their body to address the ball Head up and focus on the ball Keep moving and do not stop to pick up the ball Do not check a player who is head down and vulnerable

24. Shooting Recognize that shooters are vulnerable when focusing on the goal and attempting to shoot. They may not see the bodycheck coming

25. Recognizing an Injury (NCAA, 2011, p54)

26. Recognizing an Injury (NCAA, 2011, p55)

27. Sideline Procedures Rules of Thumb (ORCAS, 2011) When in doubt, pull them out (pull a player from a game or practice if concussion is suspected), Stand tall, make the call (it is the coach’s responsibility to keep players safe) and No play without OK (a player should not return to play until cleared by a healthcare provider).

28. Management Procedures Concussion Management Procedures: No athlete should return to play 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.

29. Management Procedures Concussion Management Procedures: Recommend that parents request a baseline retest if one is available at school Require parents to provide written approval for return to play after a concussion assessment After medical clearance, follow a step-wise protocol with provisions based upon return of any signs or symptoms.

30. Conclusion Lacrosse is a contact sport with concussion potential and youth players are at a greater risk to the effects of brain injury SLA has developed a Concussion Prevention and Management Policy based on NCAA, NFHS and US Lacrosse best practices This policy highlights the concussion risk in lacrosse and provides procedures to mitigate the potential for concussions and management process to limit player risk once a concussion is suspected Coaches are responsible for knowledge or and adherence to the policy and procedures

31. Conclusion Knowledge of types or play and proper body checking techniques can help prevent the occurrence of some concussion incidents Proper monitoring of play and sideline assessment procedures mitigate the severity or continued risk of brain injury Coaches are responsible for notification of parents and recommending medical clearance be obtained Use of impact sensors can mitigate concussion risk and procedures to monitor and remove players with indications is required

32. Closing ?

33. References American Academy of Pediatricians, (2001). AAP Policy Committee on Sports Medicine and Fitness and Committee on School Health 107 (6). Caswell, S.V., Lincoln, A.E., Hepburn, L.M., Dunn, R.E., & Almquist, J.L. (nd). Identifying mechanisms of sports-related injuries through video analysis: lacrosse. George Mason University: Medstar Health Research Institute, Baltimore, MD; Fairfax County Public Schools, Falls Church, VA. Centers for Disease Control and Prevention (CDC). (2013). Injury Prevention and Control: Traumatic Brain Injury. Retrieved 16 February, 2013 at http://www.cdc.gov/concussion/headsup/online_training.html Centers for Disease Control (CDC). (2007). Nonfatal traumatic brain injuries from sports and recreation activities 2001—2005. Morbidity and Mortality Weekly Report 56 (29) ; 733-737.

34. References Dick, R., Romani, W.A., Agel, J., Case, J.G., & Marshall, S.W. (2007). Descriptive epidemiology of collegiate men’s lacrosse injuries: National collegiate athletic association injury surveillance system, 1988-89 to through 2003- 04. Journal of Athletic Training. 42(2):255-261. Field, M., Collins, M.W., Lovell, M.R. and Maroon, J. (2003). Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. The Journal of Pediatrics 142, 546-553. Hendricks, S., & Lambert, M. (2010). Tackling in Rugby: Coaching Strategies for Effective Technique and Injury Prevention. International Journal Of Sports Science & Coaching, 5(1), 117-135. NCAA. (2011). The NCAA Sports Medicine Handbook (22 nd ed). The National Collegiate Athletic Association. Indianapolis, IN.

35. References National Association for Sport and Physical Education (NASPE). (2006). National standards for sport coaches: Quality coaches, quality sports (2 nd ed). Reston, VA: NASPE NASPE. (2012) Retrieved from: http://www.aahperd.org/naspe/about/mission.cfm ORCAS. (2011). Brain 101 the concussion playbook: Coach training. Retrieved 14, February, 2013 at http://activecoach.orcasinc.com Youth Sport Safety Alliance. (2011). Statistics on youth sport safety. Retrieved on 7 September, 2012 from http://www.youthsportssafetyalliance.org/docs/stats-

36. Brain Sentry Brain Sentry Impact Sensor: Some players may use the sensor which attaches to the back of their helmet If used follow the following protocol: Check senor is operational before each game or practice Monitor Sensor if Red light has activated remove from play and conduct a sideline assessment Inform parents of activation and that SLA protocol requires removal form play Further information at this system can be found at www.brainsentry.com