HB-2038 ~ Natasha’s Law

Who is Natasha Natasha Helmick- Allen High School

Allen, Texas

Played soccer

Scholarship to Texas State- forfeited

First diagnosed concussion 8th grade

Who is Natasha Sustained 4 concussions in 5

years.

Played a game without vision in her left eye.

Sustain brain damage-her mother, Micky Helmick says that academically everything is 3 times harder for her.

Unable to recall much of her childhood.

Course Outline Introduction: This syllabus contains an outline of the required elements for

the two hour coaches’ concussion education training mandated by HB 2038 (Sec. 38.158). The purpose of this syllabus is to provide guidance and consistency for licensed health care providers as they develop the coaches’ education course. The most current information about brain injuries in sports should be imparted during the course.

Note: The mandated coaches’ concussion education course must be fulfilled by September 1, 2012. However, the duration of each educational session is left up to the discretion of the provider. Coaches must complete a total of two hours to fulfill the requirement. This may be in one session or multiple sessions. The coach must provide proper documentation of attendance to the ISD superintendent or the individual designated by the ISD superintendent. Two hours of concussion education training is required every two years and must be completed no later than September 1, 2012 and each subsequent two year period (2014, 2016 etc…)

Course Outline 1. Intent of Law

2. Definitions and Facts

3. Mechanism of Injury

4. Brain Physiology

5. Who is at Risk

6. Signs and Symptoms of a Concussion

7. Sideline Evaluation

8. Return to Play Protocols

9. Required Student/Parent RTP Documentation

10. Educational Considerations

11. Prevention Strategies

Intent of Law Sec. 38.153- Appoint Concussion Oversight Team (COT)

OVERSIGHT OF CONCUSSIONS BY SCHOOL DISTRICTS AND CHARTER SCHOOLS; RETURN-TO-PLAY PROTOCOL DEVELOPMENT BY CONCUSSION OVERSIGHT TEAM.

(a) The governing body of each school district and open-enrollment charter school with students enrolled who participate in an interscholastic athletic activity shall appoint or approve a concussion oversight team.

(b) Each Concussion oversight team shall establish a return-to-play protocol , based on peer-reviewed scientific evidence, for a student's return to interscholastic athletics practice or competition following the force or impact believed to have caused a concussion.

Intent of Law Sec. 38.154- COT Membership

Each concussion oversight team must include at least one physician and, to the greatest extent practicable, considering factors including the population of the metropolitan statistical area in which the school district or open-enrollment charter school is located, district or charter school student enrollment, and the availability of and access to licensed health care professionals in the district or charter school area, must also include one or more of the following:

(1) an athletic trainer

(2) an advanced practice nurse;

(3) a neuropsychologist; or

(4) a physician assistant.

SISD COT Dr. Tony Islas – Texas Tech

Dr. Justin Wright – Texas Tech

Athletic Trainers

Michelle Moe – Americas

Americas

Dennis Brown – Eastlake

Phillip Allen – Eastlake

Evan Dupuis – El Dorado

Patrick Solis – El Dorado

Christopher Lopez – El Dorado 9th Grade

Bernadette Nunez – Montwood

Montwood

Marcie Strutz – Socorro

Juan Renteria - Socorro

Intent of Law Sec. 38.154- COT Membership

If a school district or open-enrollment charter school employs an athletic trainer, the athletic trainer must be a member of the district or charter school concussion oversight team.

Each member of the concussion oversight team must have had training in the evaluation, treatment, and oversight of concussions at the time of appointment or approval as a member of the team.

Intent of Law Sec. 38.155- Required Annual form Acknowledging

concussion information (UIL Approved Form) REQUIRED ANNUAL FORM ACKNOWLEDGING

CONCUSSION INFORMATION. A student may NOT participate in an interscholastic athletic activity for a school year until both the student and the student's parent or guardian or another person with legal authority to make medical decisions for the student have signed a form for that school year that acknowledges receiving and reading written information that explains concussion prevention, symptoms, treatment, and oversight and that includes guidelines for safely resuming participation in an athletic activity following a concussion. The form must be approved by the University Interscholastic League.

Required Annual form Acknowledging concussion information (UIL Approved Form)

Yearly Paperwork UIL Pre-Participation Physical

2012-2013 UIL Steroid Form (HS only)

2012-2013 UIL Concussion Acknowledgement Form

UIL Acknowledgement of Rules Form

SISD Failure to Warn

SISD Release of Liability

Intent of Law Sec. 38.156-Removal from play in practice or competition

A student shall be removed from an interscholastic athletics practice or competition immediately if one of the following persons believes the student might have sustained a concussion during the practice or competition:

(1) a coach;

(2) a physician;

(3) a licensed health care professional (Athletic Trainer), or

(4) the student's parent or guardian or another person with legal authority to make medical decisions for the student.

Intent of Law Sec. 38.157-RTP in practice and competition

A student removed from an interscholastic athletics practice or competition under Section 38.156 may not be permitted to practice or compete again following the force or impact believed to have caused the concussion until:

(1) the student has been evaluated, using established medical protocols based on peer-reviewed scientific evidence, by a treating physician chosen by the student or the student's parent or guardian or another person with legal authority to make medical decisions for the student;

(2) the student has successfully completed each requirement of the return-to-play protocol established under Section 38.153 necessary for the student to return to play;

Intent of Law Sec. 38.157-RTP in practice and competition (Cont’)

(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; and

(4) the student and the student's parent or guardian or another person with legal authority to make medical decisions for the student:

(A) have acknowledged that the student has completed the requirements of the return-to-play protocol necessary for the student to return to play;

(B) have provided the treating physician's written statement under Subdivision (3) to the person responsible for compliance with the return-to-play protocol under Subsection (c) and the person who has supervisory responsibilities under Subsection (c); and

Intent of Law Sec. 38.157-RTP in practice and competition (Cont’)

(C) have signed a consent form indicating that the person signing:

has been informed concerning and consents to the student participating in returning to play in accordance with the return-to-play protocol;

understands the risks associated with the student returning to play and will comply with any ongoing requirements in the return-to-play protocol;

consents to the disclosure to appropriate persons, consistent with the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191), of the treating physician's written statement under Subdivision (3) and, if any, the return-to-play recommendations of the treating physician; and

understands the immunity provisions

Intent of Law Sec. 38. 158-Training courses for coaches, athletic

trainers, and licensed health care professionals

(a) The University Interscholastic League shall approve for coaches of interscholastic athletic activities training courses that provide for not less than two hours of training in the subject matter of concussions, including evaluation, prevention, symptoms, risks, and long-term effects. The league shall maintain an updated list of individuals and organizations authorized by the league to provide the training.

Intent of Law Sec. 38.159- Immunity Claus

This subchapter does not: (1) waive any immunity from liability of a school district or open-

enrollment charter school or of district or charter school officers or employees;

(2) create any liability for a cause of action against a school district or open-enrollment charter school or against district or charter school officers or employees;

(3) waive any immunity from liability under Section 74.151, Civil Practice and Remedies Code; or

(4) create any cause of action or liability for a member of a concussion oversight team arising from the injury or death of a student participating in an interscholastic athletics practice or competition, based on service or participation on the concussion oversight team.

Intent of Law Sec. 38.159- Immunity Claus (cont)

(b) The Department of State Health Services Advisory Board of Athletic Trainers shall approve for athletic trainers training courses in the subject matter of concussions and shall maintain an updated list of individuals and organizations authorized by the board to provide the training.

(c) The following persons must take a training course in accordance with Subsection (e) from an authorized training provider at least once every two years: (1) a coach of an interscholastic athletic activity; (2) a licensed health care professional who serves as a member of

a concussion oversight team and is an employee, representative, or agent of a school district or open-enrollment charter school; and

(3) a licensed health care professional who serves on a volunteer basis as a member of a concussion oversight team for a school district or open-enrollment charter school.

Intent of Law Sec. 38.159- Immunity Claus (cont)

(d) A physician who serves as a member of a concussion oversight team shall, to the greatest extent practicable, periodically take an appropriate continuing medical education course in the subject matter of concussions.

Intent of Law Sec. 38.159- Immunity Claus (cont)

(e) For purposes of Subsection (c): (1) a coach must take a course described by

Subsection (a); (2) an athletic trainer must take:

a course described by Subsection (b); or a course concerning the subject matter of concussions that has

been approved for continuing education credit by the appropriate licensing authority for the profession; and

(3) a licensed health care professional, other than an athletic trainer, must take: a course described by Subsection (a) or (b); or a course concerning the subject matter of concussions that has

been approved for continuing education credit by the appropriate licensing authority for the profession.

Intent of Law Sec. 38.159- Immunity Claus (cont)

(f) Each person described by Subsection (c) must submit proof of timely completion of an approved course in compliance with Subsection (e) to the school district superintendent or the superintendent's designee or, in the case of a home-rule school district or open-enrollment charter school, a person who serves the function of a superintendent or that person's designee.

(g) A licensed health care professional who is not in compliance with the training requirements under this section may not serve on a concussion oversight team in any capacity.

Intent of Law Sec. 38.160- Commissioner may adopt rules

SECTION 3. Subchapter D, Chapter 38, Education Code, as added by this Act, applies beginning with the 2011-2012 school year.

SECTION 4. Notwithstanding Section 38.158(f), Education Code, as added by this Act, a person required under Section 38.158(c), Education Code, as added by this Act, to take a training course in the subject of concussions must initially complete the training course not later than September 1, 2012.

SECTION 5. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2011.

Definitions and Facts Concussion

Type of traumatic brain injury that interferes with normal function of the brain.

Occurs when the brain is rocked back and forth or twisted inside the skull as a result of a blow to the head or body.

Definitions and Facts Concussion Myths and Facts

Used to be believed that a player had to lose consciousness or be “knocked –out” to have a concussion. Majority of concussions do not involve a LOC

Less than 10% of players actually lose consciousness with a concussion

The terms “ding” and “bell ringer” were once used to refer to minor head injuries and thought to be a normal part of sports. There is no such thing as a minor brain injury.

Any suspected concussion must be taken seriously.

Definitions and Facts Concussion Myths and Facts

Used to be believed that the night of the injury you must wake up the athlete up every few hours to make sure that they did not fall into a coma.

DO NOT wake them up, let them rest, but you can check on them to make sure they are still breathing.

Rest is the best treatment

Cognitive rest, including staying home from school

Physical Rest

Decrease stimuli such as computer games, TV, iPods, and texting.

Mechanism of Injury: Direct or Indirect blow to the body causing impulsive

forces transmitted to the brain

Direct Blow Indirect Blow

Movement Forces Linear Movement

Rotational Movement

Movement Combinations

Brain Physiology Growth

Adolescent brain

Reaction to Injury

Healing process

Who is at Risk? Gender

Among sports played by both sexes, girls suffer more concussions than boys.

Concussion symptoms last longer in female athletes

Who Is at Risk? Younger Athletes

Greater brain H2O content

Higher brain-blood volume

Degree of myelination

Skull geometry

Less Neck Strength

Learning Disabilities

Sport Specific risks Concussion rate is 40% higher for female soccer players

Concussion rate is 240% higher for female basketball players

Repeat Concussions

Prolonged Symptoms

Headaches

Difficulty concentrating

Poor memory

Sleep problems

Grades worsening/school performance

Might affect School necessary

accommodations ARD might be

needed

Second Impact Syndrome

Avoid at all costs

A player who returns to activity before

healing completely is at higher risk for

repeated concussions

Signs and symptoms are the same just

more sever lasting longer.

Proper recognition with proper care can

help prevent further injury or even

death

Signs and Symptoms of Concussions

Signs and Symptoms of Concussions COACHES

Dazed or Shocked

Confused (doesn’t know play)

Forgets plays

Personality Differences

Can’t recall events

Unsure of game, score, or opponent

Answers questions slowly

Signs and Symptoms Headache

Nausea

Double Vision

Feeling Sluggish

Feeling foggy

Sensitivity to light

Sensitivity to noise

Concentration problems

Signs and Symptoms of Concussions Sideline Evaluation

Remove from play

Assessment by Athletic Trainer (if applicable)

Medical Referral

NEVER RETURN TO PLAY on same day

Signs and Symptoms of Concussions

Physical Symptoms

Cognitive Symptoms

Emotional Symptoms

Physical Signs

Headache Dizziness Nausea Feeling “Unsteady” Feeling “Stunned” Feeling “Dazed” Feeling “Bell Rung” Feeling “dinged” Visual Disturbances Tinnitus (ringing in ears) Diplopia (Double Vision)

Confusion Amnesia Disorientation Poor Concentration Memory Disturbance

Depression Irritability Moodiness

Loss Of Consciousness Poor Coordination Easily Distracted Poor Concentration Slow Responses Vomiting “Glassy eyed” Photophobia (sensitive to light) Aphasia Personality Change Inappropriate behavior Impaired Physical Activity

Concussions interfere with

School, Work and social interactions

Students may have difficulty with

◦Short and long term memory

◦Concentration

◦Organization

Symptoms may last a week or two but some may

last for months. Returning to quickly can prolong

symptoms.

Lifting weights at home or school

conditioning etc. all activities have to STOP

Rest for student with concussion

School

Stay home or attend school half day

Take naps or allow rest time

Extend time to complete assignments/tests

Allow time to visit school nurse for treatment of

Written instructions for homework

Repeat and present new information slowly

Share progress and difficulties

Rest for Home

Sleep often

Limit brain stimulation

◦Phone

◦Computer

◦Music

◦TV

◦Texting

◦Gaming

Sideline Evaluation Remove from Play

Assessment by Athletic Trainer

Medical Referral and evaluation

DO NOT return to play the same day

Return to play only after satisfying requirements of TEC 38.157

Emergency Loss of consciousness

Decreasing level of consciousness

Unusual Drowsiness

Unable to be awakened

Difficulty getting attention

Irregular breathing

Persistent vomiting

Worsening headache

Seizures

Removal from Activities When in doubt sit them out

Notify athletic trainer if available

Notify parent or guardian

Advise parents to seek medical attention with the Dr. of their choice

Notify school administrator

DO NOT allow student to return to any activity until all requirements have been met and check list is on file. (Coach can not sign off)

Return to Play Protocols Determined by the COT for the applicable ISD

Daily Assessment Tools

Activity Progressions

Neurocognitive Testing

Balance Testing

Required Student/Parent RTP Documentation Signed HIPPA consent form

Written Physical clearance by doctor

Signed Acknowledgement of immunity clause

Signed Acknowledgement of successful completion of RTP protocol

Signed Acknowledgement of risk for RTP after concussion

Our Protocol No activity for one week after injury & until athlete is 24

hours symptom free

Physician clearance to begin activity

Day 1- Light aerobic exercise with no resistance training

5-10 min on a stationary bike

Day 2- Sport specific activity

Day 3- Non-contact training drills with resistance training

Day 4- Full contact training drills

Cont.

Our Protocol Note – Athlete progression continues as long as the

athlete is asymptomatic at current activity level. If the athlete experiences any post concussion symptoms, he/she will wait until they are symptom free for 24 hours and start the progression again at the last symptom free step.

Day 5- Once the student has completed steps a-f as listed above, he/she may return to their sport activity with no restrictions.

Educational Considerations Academic accommodations

Taking day off from School

Informing the athletes’ Teachers

Privacy considerations

Prevention Strategies Equipment

Helmets

Pads

Mouth Pieces

Coaching/Teaching

Rule compliance/changes

Aggression

Education

HB 2038 FAQ’s http://uiltexas.org/files/health/UIL-CMP-FAQ-Resources.pdf

HB 2038 Document http://www.capitol.state.tx.us/tlodocs/82R/billtext/html/HB02038F.htm

13. When is the student athlete removed from

activity if a concussion is suspected?

A student athlete shall be removed from a practice or competition

immediately if a coach, a physician, a licensed health care

professional, or the student’s parent o rguardian or another person who

has authority to make legal decision for the studen tbelieves the

student athlete might have sustained a concussion. Coach means the

coach of the student’s team.

Coaches are encouraged to use the utmost caution regarding a

suspected concussion, including calling the student athlete over to the

sideline so that the coach can form a belief that the student may have

suffered a concussion. 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. (See attached legislative intent letter from the

author and the sponsor of the new law).

14. When is the student athlete allowed to

return to activity?

A student athlete shall not return to practice or competition

until the student athlete has been evaluated and cleared in

writing by his or her treating physician and all other notice

and consent requirements have been met. The student

athlete must satisfactorily complete the protocol established

by the school district’s COT or charter school’s COT.

16. May a licensed health care professional sign the

treating physician's written release?

No, the law requires that written release must be signed

by the treating physician.

Treatment decisions are solely within the

physician/patient relationship

19. Can a coach monitor a student athlete's compliance

with the return-to-play protocol if the school district does

not employ an athletic trainer?

Yes.

The superintendent or his/her designee has supervisory responsibilities of

the athletic trainer, coach (as outlined above), or other person responsible

for the compliance with the return-to-play protocol. This provides a second

person for checks and balances purposes. The superintendent or his/her

designee is also responsible for distributing and collecting the required

forms, including the physician’s written authorization for

return to play.

Note: A superintendent is not able to appoint a coach as the

supervisory designee because Education Code, Section 38.158(c)

specifically, in part, states: "The person who has supervisory

responsibilities of under this subsection may not be a coach of an

interscholastic athletics team."

20. Can a coach authorize the return to play of the

student athlete?

No.

Under no circumstance can a coach authorize a student athlete's

return to play.

Education Code, Section 38.158(b).

Any Questions?