Catherine “Cat” Marr- MEd, ATC/LKlein Collins High School

Defines Concussion Immediate Removal from Play Concussion Oversight Committee New paperwork/ documentation

UIL Concussion Acknowledgement Form (PRIOR to play) Concussion injury paperwork:

▪ Medical info release (HIPAA/FERPA) ) ▪ Notice of Immunity▪ Signs/ Symptoms & management information (school & home)▪ Notification of School Personnel▪ MD referrals & notes

RTP protocol▪ Management during the RTP ▪ MD release form after completing RTP

UIL RTP Form ▪ Informed & consented ▪ RTP guidelines▪ Risks

Training/ Education

This bill applies to interscholastic athletic activity, including practice and competition, sponsored or sanctioned by a school district, a public school, including a charter school, or the University Interscholastic League (UIL).

does not apply to private schools that are members of TAPPS Or Club sports

Immediate Removal of student-athlete from athletics practice or competition if a head injury is suspected by:    a coach;                 a physician;                 a licensed health care professional; or                 the student's parent or guardian or another person with legal

authority to make medical decisions for the student.

Have the student-athlete evaluated by an appropriate health care professional as soon as practicable. Call the student athlete over to the sideline so that the athlete

may be evaluated- The act of calling a player over to the sideline does not by itself constitute a belief that the student athlete might have sustained a concussion.

If it is determined that a concussion has occurred, the student-athlete shall: • NOT be allowed to return to participation that

day regardless of how quickly the signs or symptoms of the concussion resolve

• Be kept from activity until a physician indicates they are symptom free and gives clearance to return to activity.

• Must complete the District’s RTP Protocol • A coach of an interscholastic athletics team may not authorize a

student’s return to play.

Inform the student-athletes parent/guardian about the possible concussion and give them information on concussion. (PAPERWORK-Packet!)

Concussion Oversight Team (COT) Appointed & Approved by each school district or charter school Headed by at least one physician with concussion management

training. To the greatest extent possible, COT must also include one or

more: ▪ An athletic trainer;

If the school district employs an athletic trainer they must be a member▪ An advanced practice nurse;▪ A neuropsychologist; or▪ A physician assistant

▪ Administrators, coaches or other school officials can not serve on the COT All COT need to show proof of Concussion Training

▪ Physicians are not required to take specific training or submit proof however they shall to the greatest extent practicable, periodically take an appropriate continuing education course in concussions

Establish a Return to Play Protocol based on peer-reviewed scientific evidence

In developing a RTP Protocol, at a minimum- adopt the UIL Concussion

Management Protocol ▪ http://www.uiltexas.org/health/info/concussions

If the local COT wishes to be more restrictive than the UIL Concussion Management Protocol, that is within their local discretion.

Each Athlete MUST complete the districts’ approved RTP protocol prior to being able to participate. Examples:

DISD- also progresses in 24 hr/ increments & utilizes ImPact Testing

ImPacImPact t TestinTestingg

Friendswood ISDFriendswood ISD*The St. John Concussion Center puts together a binder of RTP for each sport*http://www.christusstjohn.org/body.cfm?id=26&eformid=8

Must be symptom free for 48-72 hours: •Days 1 and 2

•no more than 15 minutes of cardio work

•Days 2-4 •no more than 25 minutes of cardio work

•Days 3-5 •Continue Cardio but add in strength training or any non contact individual drills

•Days 4-6 •Progress to non-contact drills

•Days 5-7 •Progress to controlled contact

•Days 6-8 •Full play

Lufkin Lufkin ISDISD

Klein Klein ISDISD

If the school district or charter school employs an athletic trainer, he/she is responsible for the compliance of the athlete with the return to play protocol. A coach of an interscholastic athletics team may not authorize a

student’s return to play. AT not available:

a supervising adult approved by the school district with appropriate training in the recognition of the signs and symptoms of a concussion in athletes could serve in that capacity. ▪ This person is also then responsible for creating the

appropriate documentation related to the injury event

UIL approved continuing concussion education required for coaches, licensed health care professionals and recommended for physicians Must be at least 2 hours, every 2 years. Must be done by Sept, 1, 2012 ▪ This CME event qualifies

Concussion educationConcussion education Parent Student-Athlete Teachers/ School Personnel ▪ In-service prior to school

And even to other Medical Professionals

Prior to Athletic Participation UIL Concussion information and

acknowledgement form (April 15th) ▪ written information about concussions and relevant

safety policies was received and read (signature required)

▪ Complete a new form each academic year . Post Head Injury

the student athlete, parent/guardian, and other appropriate school employees must receive a written copy of the concussion oversight team’s RTP protocol.

Post concussion Instructions / Management Plan

School/Academic Adjustments & Modification Following Concussion Notify all school personnel regarding the

student-athlete’s condition▪ Advise teachers of post concussion symptoms &

modifications▪ Examples of modifications

Academic restrictions ▪ Difficulties

▪ Sandbagging and faking symptoms ▪ What to do?

▪ Teachers Reactions▪ Compliance

4 Basic Steps Involved 4 Basic Steps Involved are:are:

(1)  The student has been evaluated by Physician using established medical protocols

based on peer-reviewed scientific evidence

chosen by the student/parent/ guardian▪ KISD- “a physician skilled in Concussion

Management” ▪ ImPact/ Cognitive Testing

(2) The student has successfully completed each requirement

of the RTP protocol Previous Examples Varies per athlete Pitfalls

▪ Many things cause headaches▪ handle each student-athlete individually

(see KISD Questionnaire)

S/S Questionnaire Completed by

student Reviewed/

Discussion by LAT

Compliance/ Supervision Responsible party

signature (LAT) Fax to MD MD clearance

signature▪ See also #3

(3) The treating physician has provided a written statement indicating that, in the physician's professional judgment, it is safe for the student to return to play

▪ (Example- see KISD Questionnaire)

(4)  the student and parent/guardian:           (A) Acknowledgement form stating they

completed the requirements of the RTP protocol;                      

(B) provide the AT with the MD note                     (C) have signed a consent form indicating (UIL (UIL

Form):Form):  ▪ informed about the RTP protocol;                          ▪ understands the risks of athletic participation ▪ will comply with any ongoing requirements of the RTP

protocol; ▪ consents to the disclosure to appropriate persons (HIPAA/

FERPA)▪ understands the immunity provisions

Compliance Club Sports Social life▪ Movies, texting, etc...

Isolation issues Care of the whole athlete▪ Practice time

Hiding or inflation of S/S Education (everyone!) Knowing your athletes

“Doctor said that my MRI is clear so I don’t have a Concussion!” CT or MRI- not diagnostic tool for a concussion ImPact/ Cognitive Testing

Athlete evaluated on sidelines & has S/S of a concussion, they may not present with those same S/S when they see the MD several days later Doesn’t mean they do not have a concussion They still need to go through RTP

Athlete plays club sport, ER diagnosis with a Concussion- doesn’t let the AT or HS coach know. We can only do the best we can with the info we have UIL Yearly Acknowledgement form

This is the law - not an option Many are unaware of the new protocols

RTP Protocol Can’t be circumvented regardless Each District’s RTP will differ An athlete must complete a school district’s RTP

protocol even if the physician writes a clearance note

The athlete must then have a final written clearance note after they have completed the RTP protocol clearing them for a full release back to practice and game

UIL Form with parent signature for full release We need to be proactive

Education & Good communication = difficulties

Thank you