Sports Medicine Educational Plan

1. Sports Medicine Educational Plan Hillsborough County Public Schools Committee Members: Lauren Otero, APA, Leto High School EvanittaOmensetter, APSA, Leto High School William Sargable, Wrestling Coach, Riverview High School Jayson Roberts, Football Coach, Tampa Bay Tech High School Joel Kennedy, ATC, Plant High School

2. HYDRATION HYDRATE TO ELEVATE

3. Are you hydrated? Dehydrated? If you are thirsty, you are already dehydrated. What are you drinking? • HYDRATE TO ELEVATE

4. Hydrated: having adequate fluids that allow the body to function at maximum capacity Dehydrated: is a deficiency of body water, with an accompanying disruption of metabolic processes, performance and may lead to heat-related illnesses • HYDRATE TO ELEVATE

5. What effects hydration level? Stool, urination, breathing and most significantly…… SWEATING • HYDRATE TO ELEVATE

6. What effects one’s sweat rate? • Ambient temperature • Humidity • Genetics • Gender • Body weight • Fitness level • Intensity • HYDRATE TO ELEVATE

7. Signs & Symptoms of Dehydration Headache, Fatigue, Confusion, Nausea, Cramps, Dizziness Decrease of Stamina, Speed, Energy, and Muscular Strength • HYDRATE TO ELEVATE

8. Monitor Your HYDRATION Check your urine color Measure your water weight loss GAME PRACTICE BEFORE AFTER • HYDRATE TO ELEVATE

9. Decrease in Athletic Performance • 2-4% weight loss - reduced muscular endurance time • 4-6% weight loss - reduced muscular strength & endurance, heat cramps • 6% weight loss - severe heat cramps, heat exhaustion, heat stroke, coma, DEATH • HYDRATE TO ELEVATE

10. How to GET and STAY hydrated… Drink plenty of water EVERYDAY AVOID or LIMIT sugary and caffeinated drinks • HYDRATE TO ELEVATE

11. NOTE: Room temperature fluids absorb more quickly. GAME DAYGeneral Rule of Thumb • Pre-Game 16 oz. 4 hours BEFORE game time & 8 oz. 2 hours BEFORE game time • During Game: 7-10 oz. every 15 minutes throughout the game • Post Game: 16 oz. bottle of sports drink (Gatorade) to replace carbs & sodium • HYDRATE TO ELEVATE

12. HYDRATE to ELEVATEyour performance THINK TO DRINK

13. Proposed Action Steps • Chart containing timeline of hydration for pre-game, during game, and post-game measures. • Emphasis to players of how hydration is directly tied to athletic performance. • Explanation to athletes of what not to drink and limitations on caffeine. • HYDRATE TO ELEVATE

14. Heat Illness Cool first, treat second!

15. How Heat Effects Your Body • Places extra stress on the body • Increases core body temperature • Increases heart rate Cool first, treat second!

16. Heat Index Cool first, treat second!

17. Heat Related Illness • Body temperatures can rise to dangerous levels. • Types of Illnesses Across a Spectrum: • Heat Rash • Heat Cramps • Heat Exhaustion • Heat Stroke Cool first, treat second!

18. Heat Related Illness: Heat Rash • Occurs when pores are blocked and perspiration is trapped under skin • Symptoms include: • Superficial blisters, itchy or prickly in feeling • Mainly found on neck, shoulders and chest. • Usually develops where clothing causes friction. • Methods of Treatment: • Symptoms usually go away on their own when skin is cooled. Cool first, treat second!

19. Heat Related Illness: Heat Cramps • Symptoms • Painful, involuntary muscle spasms. • Most likely to occur in arm, calf, abdomen and back. • Affected muscles firm to touch. • Body temperature may be normal • Method of Treatment: • Rest briefly and cool down. • Drink clear juice or electrolyte-containing drink • Gently stretch and massage affected area • Contact medical personnel if cramps do not subside within an hour Cool first, treat second!

20. Heat Related Illness: Heat Exhaustion • Definition: • Body Temperatures rise as high as 104° • Causes stem from exposure to high temperatures, particularly when combined with high humidity, and strenuous physical activity • Can lead to heat stroke if left untreated • Symptoms: • Often begin suddenly • Resemble those of shock • Cool, moist skin with goose bumps when in the heat • Heavy sweating • Faintness/Dizziness • Nausea • Low blood pressure upon standing • Muscle cramps • Dark-colored urine Cool first, treat second!

21. Heat Illness: Heat Exhaustion • Treatment: • Stop all activity and rest in a cool place • Drink cool water or sports drink • Apply cool water to your skin • Submerge in ice bath • Loosen/Remove excess clothing • Contact doctor if signs/symptoms do not improve or worsen within one hour. • Seek immediate attention if body temperature reaches 104° or higher. Brain damage occurs when body temperature reaches 106°. Death can occur when body temperature reaches 108°. Cool first, treat second!

22. Risk Factors of Heat Exhaustion • Certain Factors Increase Sensitivity to Heat: • Young or old age • Certain medications • Obesity • Sudden temperature changes • High heat index Cool first, treat second!

23. Heat Illness: Heat Stroke • Results from untreated heat exhaustion • Life-threatening condition that occurs when a person’s body temperature reaches 104° or higher • Skin may be hot, but body may stop sweating to help cool itself • Person may develop confusion and irritability • Seek immediate medical attention to prevent brain damage, organ failure, or even death. Cool first, treat second!

24. Preventing Heat Related Illness • Wear loose fitting, lightweight, light-colored clothing • Avoid sunburn • Seek shelter/cooler places • Drink plenty of fluids • Take extra precautions with medications • Avoid hot spots • Allow your body to acclimate to the heat • Know your fitness level • Avoid mid-day sun (10am-4pm) • Wear sunscreen • Have a back up plan Cool first, treat second!

25. Cooling Protocols • Move victim to a cool spot • Lay the victim down • Elevate their feet • Loosen/remove excess clothing • Give cool (NOT ice) water • Cool victim until body temperature is between 100°-102° degrees •  Call 911 to transport Cool first, treat second!

26. Proposed Action Steps • Purchase of thermometers for use at practices and games • Expanded use of cooling methods • “Dipping” into ice baths to be routine at practice • Coolers at practice filled with iced towels • Display of signs and symptoms posters to be hung in restroom stalls and above urinals • Examples of proper clothing to combat heat illness Cool first, treat second!

27. SICKLE CELL DISEASE Be aware. Understand. Monitor. Prevent.

28. What is Sickle Cell Disease? • Sickle Cell Disease is an inherited genetic disorder that affects the red blood cells. • Red blood cells in a person with sickle cell disease have an abnormal version of a protein called hemoglobin. • This abnormal protein causes the blood cell to have a crescent or sickle shape instead of the normal round shape that red blood cells should have. Be aware. Understand. Monitor. Prevent.

29. Who Gets Sickle Cell Disease? • Sickle cell disease affects almost only people of African, South American, Caribbean, or Mediterranean countries decent. • A person can only have sickle cell disease from genetic inheritance from parents. Be aware. Understand. Monitor. Prevent.

30. Sickle Cell Trait vs Sickle Cell Disease • Sickle Cell Trait Child inherits a recessive sickle cell gene from one parent and a dominant normal cell gene from the other. • Sickle Cell Disease Child inherits a recessive sickle cell genes from both parents. Be aware. Understand. Monitor. Prevent.

31. Sickling in Sickle Cell Trait Carriers • Under normal non-stressful conditions, people with sickle cell trait have virtually no health issues from the trait. • Sickle cell trait carriers can have issues when dehydrated, under heavy physical demand, or at high altitudes due to cells starting to sickle. Be aware. Understand. Monitor. Prevent.

32. The Problem With Sickle Cell Trait • Many athletes have no idea that they are sickle cell trait carriers. • If an athlete does know they are sickle cell trait carriers, many are under the impression that they have no risk of sickle cell crisis. • In either scenario the athlete is at risk of physical overexertion, leading to sickling of red blood cells. Be aware. Understand. Monitor. Prevent.

33. Effects and Complications from Sickle Cell • The sickled red blood cells become problematic due to their shape causing the cells to become blocked and stuck in blood vessels. The sickled shaped renders them unable to carry adequate oxygen as well. Be aware. Understand. Monitor. Prevent.

34. Effects and Complications from Sickle Cell • Sickle cell disease can affect the body in 2 ways: 1. Anemia – reduced amounts of oxygen that can be carried by the sickled shaped cells, causing the following: 1. Fatigue 2. Paleness 3. Shortness of breath 4. Rapid heart rate 5. Yellowing of Skin Be aware. Understand. Monitor. Prevent.

35. Effects and Complications from Sickle Cell 2. Sickle Cell Crisis – blockage of blood vessels taking blood to the limbs and organs due to the sickle shaped cells causing : 1. Pain in extremities and lungs 2. Small strokes (lack of oxygen causing interruption of blood flow)in brain 3. Ulcers on lower legs 4. Enlarged Spleen Be aware. Understand. Monitor. Prevent.

36. Sickle Cell Crisis vsHeat Illness • Sickle cell crisis in a person with the trait and heat illness can appear very similar in their symptoms. • However there are a few key difference in symptoms that allow you to differentiate between the two. Heat Illness Sickle Cell Crisis • Person has heat cramps. They hobble to the ground and cry out in pain • Muscles are locked and rock hard • Person falls to the ground immediately from weakness and doesn’t cry out in pain • Muscles look and feel normal vs. Be aware. Understand. Monitor. Prevent.

37. Recommendations for Managing Athletes with Sickle Cell Trait • If coaches are aware that they have an athlete with sickle cell trait there are some recommendation on how to manage them to reduce chances of a crisis • Do not allow the athlete to condition heavily • Monitor the athlete’s body temperature on warm humid days • Be aware of the altitude that the athlete is participating at • Allow the athlete to drink water whenever they feel the need Be aware. Understand. Monitor. Prevent.

38. Proposed Action Steps • Collaborating with FHSAA to add doctor’s sign off on EL2 physical form • Signs and symptoms poster to be hung in locker rooms • Addition of lines to medical release card for parent(s) to write in “medical conditions” and allergies • Adjustment of practice and drills Be aware. Understand. Monitor. Prevent.

39. Concussions When in doubt, sit them out.

40. What is a concussion? • A Traumatic Brain Injury (TBI) • Your brain jarring against your skull • No grades of concussions. No mild or severe. • Use to be called “Dinged” or “Bell rung” • Treatment: REST! A concussion is an interruption of the brain’s ability to work properly. • When in doubt, sit them out.

41. Signs and Symptoms • Headache • Dizziness • Nausea • Balance problems • Sensitivity to light and sound • Amnesia • Difficulty concentrating Every concussion has different signs and symptoms, it does not determine the severity. • When in doubt, sit them out.

42. Statistics • 2013: 11.2 concussions/10,000 games & practice in high school football • 2008-2009: 400,000 TBI in high school athletics • 2/3 of concussions occur in events, 1/3 at practice • 2011: 15% of injuries reported in high schools with a certified athletic trainer (ATC) were concussions • 15.8% of athletes who suffered Loss of Consciousness (LOC) returned to play the same day!! • Three times more likely to suffer a 2nd concussion in the same season. • When in doubt, sit them out.

43. 2nd Impact Syndrome (SIS) • What is it? Experiencing a second concussion before the original signs and symptoms are gone from the first concussion. • Adolescents are particularly susceptible to SIS • Athletes who suffer multiple TBI within a short period of time(days or weeks) may suffer catastrophic or fatal reactions • In a 13 year study, out of 92 high school athletes with SIS, 71% had a previous concussion in the same year and 39% were playing with symptoms • When in doubt, sit them out.

44. Proper Protocols—Return to learning • Limit visual stimulants, such as texting and computer use • Allow extra time for tests/assignments • Break assignments into smaller chunks • Provide alternative methods to learning • Set reasonable expectations • When in doubt, sit them out.

45. Proper Protocols—Return to Play • Athlete must be seen & evaluated by medical doctor • If athlete has no symptoms and is cleared by physician, then FHSAA’s AT18 form is initiated and a step-by-step process can begin for athlete to return. • Aerobic activity: bike, jog, etc. • Increase activity to include sport-specific exercise • Non-contact practice • Full practice • Athlete must get steps signed off on by an ATC, coach or Athletic Director on the AT18 • Athlete then returns to physician, is re-examined and AT 18 is signed off to return to play (RTP) • AT18 is filed in student’s athletic packet • When in doubt, sit them out.

46. Proposed Action Steps • SCAT cards to all coaches (tests to determine if an athlete has a concussion) • Handouts to parents/coaches on signs & symptoms of concussions • In-service by medical doctor on concussions (pre-season or summer) • Review/discuss Return to Play (RTP) protocols (per FHSAA) with coaches/parents. • Must see a medical doctor (preferably one with experience in diagnosing concussions). • Complete 5-step process with coach or ATC • Follow up with medical doctor to RTP. Must be cleared by medical personnel on FHSAA’s AT18 • A neuro/cognitive computer baseline test (example: ImPact) on athletes • When in doubt, sit them out.

47. In conclusion: Hydrate to Elevate Cool First, Treat Second Be aware. Understand. Monitor. Prevent. When in doubt, sit them out.