NAU_Concussion_Management_Plan_7_31_19

Northern Arizona University - Department of Sports Medicine Concussion Management Policy Northern Arizona University Intercollegiate Athletics, in conjunction with the NCAA Executive Committee, will adhere to the following policy in the management of concussions sustained by student athletes “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 concussion 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 their designee according to the concussion management plan In addition, student-athletes must sign a statement in which they accept the responsibility for reporting their injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions During the review and signing process student-athletes should be presented with educational material on concussions.” I Pre-Season Education Student Athletes All student athletes will be provided the NCAA Concussion Fact sheet annually with their pre-participation physical forms and waivers Each student athlete will sign acknowledgement that they have received, read, and understand the signs and symptoms of concussion, and possible consequences of concussion This education also outlines their responsibility for reporting suspected concussions to the sports medicine staff These signed concussion fact sheets are retained in the student athlete’s personal health record Annually, freshman and incoming transfer student athletes will be provided additional education on concussion in sports from the Sports Medicine staff Coaches & Administrators All coaches and the Vice President for Intercollegiate Athletics will be provided the NCAA Concussion Fact Sheet for coaches and a copy of the NAU Concussion Management Policy annually Each coach and the Vice President for Intercollegiate Athletics will sign acknowledgement that they have received, read, and understand the signs and symptoms of concussion, and possible consequences of concussion This education also outlines their responsibility for reporting suspected concussions to the sports medicine staff Last Modified by NAU Sports Medicine April 1, 2019 The Director of Sports Medicine will be responsible for ensuring this education is completed and will retain the signed acknowledgement forms Sports Medicine Staff All Sports Medicine Staff will review the Concussion Management Policy annually All staff will sign acknowledgement that they have received and read the policy and their individual role and responsibility is understood The Director of Sports Medicine will be responsible for ensuring this education is completed and will retain the signed acknowledgement forms All Athletic Trainers and Team Physician’s will be provided the NCAA Concussion Management Policy annually and will sign acknowledgement that they have received, read and understand this policy Additional continuing education for athletic trainers specific to concussion management will be encouraged by The Director of Sports Medicine The policy will be revised on an annual basis by the Team Physician and sports medicine staff to reflect the best evidence for management of concussion Definition: A Concussion is defined as “trauma induced alteration in mental status that may or may not involve loss of consciousness” It may be caused by direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head This typically results in the rapid onset of short-lived impairment of neurological function and a graded set of clinical symptoms These symptoms include, but are not limited to nausea, headache, feeling foggy, vomiting, and dizziness The resolution of these symptoms typically follows a sequential course and recovers spontaneously if managed appropriately within a 7-10 day period It is important to recognize that in some cases these symptoms may be prolonged (4th consensus on concussion) Clinical manifestation of concussion is highly variable between patients and may range from a mild headache to extreme disorientation and dizziness This range in presentation can make it difficult to diagnose a concussion and requires an astute clinician to identify when brain function has been altered from a direct or indirect blow Whenever a concussion is suspected it is vital to rule-out any life-threatening emergencies that may have occurred, such as subdural hematoma, post –concussive syndrome, or secondary impact syndrome When evaluating a suspected concussive injury, observations will be made for the following signs and symptoms disorientation loss of consciousness (LOC) problems concentrating dizziness neuropsychological changes loss of coordination headache loss of balance (+) Rhomberg sign inability of eyes to track blurred vision Last Modified by NAU Sports Medicine April 1, 2019 photophobic- sensitive to light amnesia nausea / vomiting pupils unequal or react differently slurred speech tinnitus- ringing in the ear altered or exaggerated emotion memory deficits II Pre-Participation Assessment Concussion History All student-athletes will undergo a pre-participation history and physical examination by an NAU Team Physician which includes brain injury and concussion history Team physician judgment will determine pre-participation clearance and/or the need for additional consultation or testing based upon known individual concussion modifiers Baseline Testing Because signs and symptoms of concussion are highly variable there is no single test to identify injury and progress of recovery, testing should be multifactorial and should include, neurocognitive testing, balance testing and evaluation of signs and symptoms All student athletes who participate in sports are required to perform a preseason baseline assessment involving, ImPACT testing and the SWAY Assessment These results will be used for comparison if an athlete sustains a head injury and concussion is suspected These assessments in conjunction with clinical assessment will also be utilized to make appropriate return to play decisions All student athletes will have baseline testing conducted annually prior to the start of their sport season III Recognition and Diagnosis of Concussion A licensed athletic trainer will be present at all collision sport practices and competitions Football, men’s and women’s basketball, soccer, and pole vault events will be under the direct supervision of a licensed athletic trainer who is trained in concussion management As Concussions are complex injuries evaluation will also include a comprehensive physical and neurologic examination, cognitive assessment, and balance exam The first priority is clinical assessment to rule out cervical spine trauma, skull fracture or intracranial bleeding When those emergent/urgent diagnoses are ruled out and a concussion is suspected, the athlete will be removed from activity immediately and monitored every few minutes to assess any deteriorating signs or symptoms that may indicate a more serious injury The athlete will be removed from participation Last Modified by NAU Sports Medicine April 1, 2019 and will not be allowed to return to play on the day of injury even if symptoms subside As soon as a concussion is diagnosed the student athlete will immediately enter the NAU concussion protocol and will not return to play until they are completely asymptomatic and baseline measures return to normal The only person or persons qualified to evaluate a concussion is an Athletic Trainer or Team Physician trained in concussion management The procedure below will be followed with all student athletes who have sustained a concussion: An NAU Team Physician will be notified and the student athlete will be referred to them for follow-up evaluation Post-Concussion instructions will be provided to a parent, guardian, spouse, or roommate Return to Learn notification will be provided to the Student -Athlete informing their academic coordinator of potential limitations in academic settings IV Post-Concussion Management Suspected Head Trauma and/or Cervical Spine Injury If a student athlete has sustained a suspected cervical spine injury and/or severe head injury (skull fracture/ intracranial bleed), the Certified Athletic Trainer or team physician will be the director of all spine boarding and movement of the victim The Certified Athletic Trainer will be in charge of cervical stabilization The Certified Athletic Trainer will make all decisions pertinent to removal of equipment and helmet The AT will direct one person to call 9-1-1 and direct EMS to the facility based on the facility EAP Another person will be directed to get the universal precautions, AED, and spine board When the spine board arrives, the Certified Athletic Trainer will direct those assisting in spine boarding on movement and placement of the victim If no one else is trained in spine boarding the Certified Athletic Trainer will be responsible for cervical stabilization until EMS arrives and can assist in moving the victim onto the spine board The Certified Athletic Trainer will under no circumstances be removed from cervical stabilization of the victim A student-athlete observed to have a prolonged loss of consciousness or persistently diminished/worsening mental status or other neurological signs/symptoms, Last Modified by NAU Sports Medicine July 30, 2019 especially worsening headache, nausea or repetitive vomiting, Glasgow Coma Scale < 13, focal neurological deficit suggesting intracranial trauma, increased confusion, garbled speech, lethargy or extreme sleepiness, trouble using their arms or legs, convulsions or seizure activity or potential spine injury, will trigger implementation of the emergency action plan including potential transport for further medical care Concussion Protocol When a student-athlete is diagnosed with a concussion they will be placed on physical and cognitive rest and immediately enter into the NAU Concussion Protocol The protocol is outlined below: Graded Symptom checklist performed immediately after injury and every 24 hours until the athlete is asymptomatic Initial assessment to rule out cervical spine trauma, skull fracture, and intracranial bleed Follow- up testing using ImPact online assessment will occur when the student-athlete is asymptomatic Follow- up testing using the SWAY Assessment will also be performed when the student athlete is asymptomatic The student-athlete will be evaluated serially: including a symptom inventory and monitored for deterioration following injury Team Physician evaluation of all concussed athletes, timing dependent on athletic trainer assessment & clinical judgment The athletic trainer should contact the team physician to discuss follow up Upon discharge from medical care, both oral and/or written instructions for home care will be given to the student athlete and another responsible adult (e.g., parent, roommate, or teammate) The concussed student athlete will be instructed to minimize potential cognitive stressors such as school work, video games, reading, texting, and watching television For student athletes with prolonged concussion symptoms, team physician evaluation will consider additional diagnosis and best management options Additional diagnoses may include, but are not limited to: post-concussion syndrome, sleep dysfunction, migraine or other headache disorder, mood disorder such as anxiety and depression, or ocular or vestibular dysfunction 10 Team physician judgment will determine the need for additional consultation, testing or treatment of diagnosed condition 11 Student-athletes who sustain a concussion outside of their sport will be managed for return to play/return to learn in the same manner as those sustained during sport activity All student athletes must return to baseline levels of function on all testing and be completely asymptomatic to progress to the next stage of return to play Last Modified by NAU Sports Medicine July 30, 2019 * ImPACT testing may be done before an athlete is asymptomatic to assess their capability to return to academic settings, this will be the discretion of the athletic trainer V Return to Play Once the athlete is asymptomatic progressive exertional testing may be done to assess if the athlete is ready to return to physical activity The earliest an athlete may return from a concussive injury is seven days The stages of the exertional testing are as follows: Rehabilitation Stage Functional exercise at each stage Objective at each stage No activity Complete physical and cognitive rest Recovery Light aerobic exercise Walking, swimming, or stationary cycling w/ intensity