Culpeper County Public Schools

1. Culpeper County Public Schools Eastern View Athletic Training Jordan Nougaret, MS, ATC, VATL www.easternviewathletics.org “Athletic Training” Link

2. Certified Athletic Trainer (ATC) • Health care providers who specialize in the prevention, assessment, treatment and rehabilitation of emergency, acute and chronic injuries and illnesses • Licensed by the Board of Medicine to practice Athletic Training

3. Athletic Injuries • All injuries & illnesses must be reported to the Athletic Trainer • All injuries must be reported prior to return to activity regardless of severity or physician consultation • Our philosophy is to return injured athletes to participation in the quickest and SAFEST manner possible using a progressive return to activity

4. Return To Play • If you take your child to a physician, it is REQUIRED that a note is provided to the Athletic Trainer for any sport stating the INJURY DIAGNOSIS, TREATMENT, SPORT RESTRICTIONS, and RETURN TO PLAY STATUS. If your child has been to a doctor and does not produce a physician note, he or she will not participate until one is provided

5. Sport Coverage • ATC can only be in one place at a time!

6. Sport Coverage • “Assumption of Risk” • Not all injuries can be prevented • Catastrophic injuries can occur in any sport • Based on the number and severity of catastrophic injuries, the following collision sports require ATC supervision at all times: Football, Boys Lacrosse and Wrestling

7. Sport Coverage • The Athletic Trainer will be available for evaluations, treatments, rehabilitation, and questions from student athletes, parents, and physicians each school day afternoon from 3:20-4:00 or by appointment

8. Topic of Interest Concussions The Virginia Board of Education, National Federation of State High School Associations (NFHS), Virginia High School League (VHSL) and National Athletic Trainers Association (NATA) have put out the following guidelines that will be discussed

9. Face of Concussions

10. Face of Concussions…

11. Concussions • Brain is violently rocked back and forth or twisted inside the skull from a direct blow to the head, face, neck or elsewhere on the body • “Egg Yolk in Egg Shell Analogy”

12. Baseline Testing • http://www.cces.ca/files/pdfs/SCAT2%5B1%5D.pdf

13. Recommendations for Coaches • “Recognize, Remove, Refer” • 1. Recognize the Signs and Symptoms of a Concussion • 2. Remove individual from practice or game • 2. Refer the individual for medical evaluation and attention right away

14. “Recognize”You might be a Concussion if… • Dazed Look • Vacant Stare • Amnesia • Blurred vision • Dizziness • Drowsiness • Excess sleep • Easily distracted • Feeling in “a fog” or slowed down • Headache • Inappropriate emotions (sad, angry, aggressive, restless) • Irritability • Loss of consciousness • Loss of orientation • Just “don’t feel right” • Slowed/Incoherent Body Movements or Reaction Time • Memory problems • Nausea • Nervousness • Personality changes • Poor balance/coordination • Poor concentration • Ringing in ears • Seeing stars • Fatigue/Low Energy/Lethargic • Sensitivity to light/noise • Sleep disturbance • Vacant stare/glossy eyes • Vomiting • Confusion • Pressure in Head

15. “Recognize” • The signs and symptoms of a concussion can show up immediately after the injury or may not appear for hours or days after the injury

16. “Remove” • Any athlete with a suspected Concussion should be removed from the practice or game immediately and NOT allowed to Return to Play the Same Day

17. “Refer” • Refer the individual to the appropriate healthcare professional (Physician, Athletic Trainer, etc.) who is experienced in evaluating and managing a Concussion

18. Concussion Advice • Avoid giving concussed individuals Ibuprofen, Tylenol, Aspirin, etc. for the first 24-48 hours • These medications can “mask” the real signs and symptoms the athlete is experiencing and we need to know what’s going on!

19. Things that should not be allowed after sustaining a Concussion • Driving (especially if individual experiences dizziness) • Watching TV • Listening to ipod or talking on the phone • Reading • Texting • Using a computer • Playing Video Games • Exposure to bright lights or loud noises • Any Strenuous Activity (Physical Education, yardwork, household chores, etc.) • School/Homework

20. Things there is no need to do: • Check eyes with a flashlight • Wake them up every hour *It is OK to check on child’s breathing and pulse but not necessary to constantly wake them up • Set alarm clock (“Kill the Clock” to allow them to sleep and awake naturally)

21. Return to Play • PHYSICAL and COGNITIVE Rest are key after a Concussion • The Brain needs time to Heal • Continuing to play with the signs and symptoms of a Concussion leaves the young athlete especially vulnerable to greater injury

22. Second Impact Syndrome • Blow to the head of an individual still symptomatic from previous mild brain injury • Rapid, swelling of the brain, increase in intracranial pressure, often resulting in death • If athlete sustained one concussion, they become 3x more likely to sustain another • Usually occurs in younger athletes (under the age of 20)

23. Return to Play • Once cleared by a healthcare professional to begin activity AND once the athlete is symptom free, he or she will start a progressive, graded, step-by-step procedure outlined in the following chart:

24. *The progressions will advance at the rate of one step per day *Athlete’s progression continues as long as he or she is asymptomatic at current activity level *If the athlete experiences ANY post concussion symptoms, he/she will wait 24 hours and start the progressions again at the previous step

25. Concussions • This First Week is Critical • Most kids average 7 days for full recovery • 75% of Repeat Concussions occur within these first 7 days when a child returns to play too early • 92% of Repeat Concussions occur within the first 10 days

26. Cognitive Rest • No Activity, Full Rest • Decrease Energy Demands on the brain to allow it to fully recover • Limit classwork, homework, reading, math, writing, etc. that require attention, concentration and memory skills • Things that are OK to do: • Sleep/Rest • Ice Pack on Head or Neck as needed for comfort • Light Diet

27. Return to Play Protocol • Cognitive Return to School Protocol after an Athlete sustains a Concussion: • Day 1: No School (until Symptom Free) • Day 2: Half Day, no homework • Day 3: Full Day, no homework • Day 4: Full Day, homework for 30 minutes • Day 5: Full Day, homework for 60 minutes • Day 6: Full Day, homework for more than 90 minutes

28. Videos • ESPN “Outside the Lines” and “E60” have a number of short, but informative videos on Concussions including: • 1. “OTL High School Concussions” • 2. “OTL Future of Football” • 3. “OTL Second Impact Syndrome” • 4. “E60 Unprotected” • http://espn.go.com/video/clip?id=5163151

29. Recommendations • Over 50% of Concussions go unreported (possibly up to 75-80%) • Educate Parents and Kids it’s not smart to play with a Concussion • Do Not let your kids convince you they are “fine” • Teach proper tackling techniques: • Head Up…See what you Hit • No Spear Tackling with the Crown of the Helmet • Make sure equipment is properly fitted (Helmet, mouthpiece, shoulder pads, etc.) • “When in Doubt, Sit them Out”

30. Questions?

31. Links • http://www.sportconcussions.com/html/Zurich%20Statement.pdf • http://www.vahealth.org/injury/TBI/documents/2011/pdf/Outlines%20of%20current%20state%20of%20knowledge.pdf • https://www.castilleja.org/uploaded/Athletics/Documents/Sports_Med/ACE_Care_Plan_School_Version.pdf