Brewton-Parker College Sports Medicine
Student Athlete - Medical Policies & Procedures
2014-2015
National Athletic Trainers’ Association Mission Statement
The mission of the National Athletic Trainers’ Association is to enhance the quality of health care for the physically active through education and research in prevention, evaluation, management and rehabilitation of injuries.
Brewton-Parker College Sports Medicine Mission Statement
The Brewton-Parker College Sports Medicine is dedicated to protecting and
enhancing the health, safety, and welfare of the student-athletes of Brewton-Parker College by providing a safe environment and the best possible and most expedient healthcare. This mission is accomplished through the six domains of athletic training as established by the National Athletic Training Association. These domains are:
1. Injury Prevention
2. Recognition and Evaluation of Injuries 3. Management and Treatment of Injuries 4. Injury Rehabilitation
5. Organization and Administration 6. Education and Counseling
A. Pre Participation Physical Examinations
All student-athletes must be examined and approved for participation by a physician before being permitted to practice or compete with an intercollegiate team. While the examination is effective for one year, the Team Physician and/or College physician designee may re-evaluate the athlete's fitness for participation at any time.
All incoming freshman and transfer student-athletes must complete a health history questionnaire before a physical examination is given. Upon satisfactorily completing the physical exam, the student-athlete will be allowed to participate. In the event the
physician requires further examination and/or tests to determine clearance for play, it will be the financial responsibility of the student-athlete to pay for such examination and/or tests. Returning student-athletes will complete a medical history packet and then receive a physical examination by the BPC Team Physician and/or his/her designate.
If one does not have a complete pre participation forms and physical examination, he/she does not have a right to receive any injury evaluation, rehabilitation, or any other medical treatment.
B. Barons Sports Medicine Injury/Appropriate Care Responsibility
The college's responsibility for medical treatment resulting from injuries sustained by the student athlete is limited to:
**Only those student athletes who have completed all required paperwork and have been cleared, by the Athletic Training Staff, to participate with their
respective team will be entitled to appropriate medical coverage under this policy a) Those injuries that occur while participating as a member of an athletic team at Brewton-Parker College in a regularly approved practice session or game; and under the SUPERVISION of their respective coaches.
b) Those injuries while traveling directly to or from such regularly scheduled and approved practice sessions or games with other members of the team as a group provided such group is at the time under the supervision of their respective coach. Responsibility for medical expenses resulting from injuries sustained as listed above is limited to:
1.) Those expenses resulting from medical services which have been authorized by Head Athletic Trainer
2.) Payment of authorized expenses not covered by the athlete’s and/or parent's personal insurance.
The College's policy and/or the College may deny claims for an injury that has resulted from a preexisting condition (i.e., any injury that was incurred prior to enrollment as a student-athlete at Brewton-Parker College). If a student-athlete does not follow the procedures of reporting an injury to the athletic training staff, but decides to go to an outside physician without prior approval from the athletic training staff and Team Physician, the college insurance coverage is null and void. In order for a student-athlete to be covered for expenses of any athletic injury or illness, he/she must go through the athletic training staff and Team Physician by reporting the injury and the athletic training staff will make necessary arrangements with an outside physician.
C. Insurance Guidelines
**All student athletes who do not have adequate health/medical insurance will be required to purchase a policy that has been pre-approved by the athletic training staff.**
**Any student athlete who has been dropped from their respective health/medical insurance policy at any point during the academic year will not be allowed to practice and/or participate in any competition until they have assured
re-establishment on their prior policy and or new re-establishment in a policy approved by the athletic training staff.
All student-athletes will be required to fill out an insurance packet prior to the beginning of their season to show proof of accident/illness insurance. This must be on file with the athletic training department. The university's athletic insurance requires that the athlete's and/or parent's insurance be utilized for primary
coverage of medical and surgical expenses. The Athletic Departments insurance policy is an excess policy which requires payment from the student athlete’s primary health/medical insurance policy. Once the student athlete’s primary insurance has paid, the bill and appropriate EOB (explanation of benefits) must be submitted to the athletic training staff for proper administration. Student athletes with an HMO will be required to follow guidelines and referral processes set forth by that insurance company.
Authorized medical bills are to be handled in the following manner:
a). Submit all bills for medical services to the athletes and/or parent's insurance policy.
b). If the student has no insurance or the athlete's policy does not pay the entire claim, the bills and the "Explanation of Benefits" form should be sent to the business office for processing.
D. Student Athlete Injury/Illness Procedure
The student-athlete must report all athletic injuries or illnesses to a representative of the athletic training staff as soon as possible, so an early and thorough evaluation can be accomplished. The staff athletic trainer will make the necessary medical referral as indicated. If the athlete desires to the see the school’s Health Services, they must first come through the athletic training staff to insure proper tracking and documenting of evaluation. Failure to comply with these procedures may cause the student athlete to become responsible for any medical bills that may be incurred.
In the event of an emergency or medical problem, outside of training room hours, contact a member of the athletic training staff for the necessary advice or assistance, regardless of the time of day. If unable to contact a member of the athletic training staff and you live on/off campus you should go to the Emergency Room at Meadows Regional Hospital in Vidalia.
In any case, the athlete should report the emergency incident to the athletic training staff as soon as possible. The athlete is not permitted to seek medical attention without the prior authorization from the athletic training staff and/or Team Physician, except in cases of emergencies.
E. Athletic Training Room Policies
It is the goal of the Brewton-Parker College Sports Medicine staff to provide the highest and most effective level of sports medicine healthcare possible to the athletes under our care. We intend to work as hard for you as you work for us. In order to accomplish this goal we need for our athletes to follow some simple rules, we ask that all athletes adhere to these rules at all times.
• No food or drink is allowed in the athletic training room for any reason. • Treat athletic training staff and students with the up most respect at all times. • Cell phone use should be limited.
• Do not touch any equipment or supplies in the athletic training room unless instructed to do so by athletic training staff.
• Athletic training office is entirely off limits to everyone, but athletic training staff.
• Athletes, receiving medical care, must be appropriately dressed (shorts and t-shirt) at all times while in athletic training room.
• Punishment for missing treatment will be handled by head coach without discussion or argument from athletic training staff.
• Equipment which is lent out to athletes (braces, sleeves, ace bandages, crutches, shoulder slings, rehab equipment, etc.) must be signed in and out by the date instructed by the athletic training staff. If it is not returned it will be reported to your coach and a hold will be placed on your account.
• Report injuries or conditions as soon as possible. There is a time frame in which an injury has to be reported to our insurance company, and if this time period has elapsed you may be responsible for paying the concurring medical bills.
• All sexually transmitted diseases should be reported immediately to the Montgomery County Health Department.
• Do not wear cleats inside the athletic training room. • Shower or clean yourself up before receiving treatment. • Sign in the treatment log before you receive any treatment. • Do not loiter in the athletic training room.
• Athletes must exhibit appropriate behavior in the athletic training room (i.e. no foul language, disrespectful behavior, horseplay). This WILL NOT be
tolerated in any way. F. Treatments/ Rehabilitation
Injured athletes must report for treatment according to the schedule identified by the athletic training staff. Failure of the athlete to keep treatment appointments will be reported to their respective coach.
G. Injury Evaluations
The evaluation of injured athletes is the sole responsibility of the athletic training staff and Team Physician. When an injury occurs, the coaches should refer the athlete to the athletic training staff for evaluation, treatment, and/or rehabilitation of the injury or condition. This includes concussion and skin condition.
H. Referrals to Medical Specialists
If, in the opinion of the Athletic Trainer and Team Physician, an athlete should be referred to a medical specialist for consultation due to an athletic injury, the following procedures will be followed:
a) The athletic training staff and/or Team Physician will make the appointment with the consultant.
b) Any expenses occurred (travel, mileage, etc.) will be the responsibility of the student-athlete.
I. Participation Following Injuries
Decisions regarding the return of an injured athlete to practice and competition will be the sole responsibility of the athletic training staff or Team Physician.
J. Emergency Procedures
Emergency Action Plans are posted at all athletic venues with corresponding emergency telephone numbers, contacts, and directions to venues. In the event of an injury that requires immediate transportation to a medical facility, the following procedure should be used:
a) Begin immediate first aid b) Call 911.
c) When the ambulance arrives, someone (athletic trainer – if possible) should accompany the athlete to the hospital.
d) The athletic training staff should be notified as soon as possible. K. End of the year questionnaire/ exit physical evaluations
At the end of the school year, each student-athlete will be required to fill out an end of the year questionnaire. This questionnaire will address any medical problems that the student-athlete may still be experiencing after their season has been completed. Student athletes will also be required to participate in exit physical evaluations prior to their departure from school that academic year. Failure to participate/completely disclose any continuing injury will make the student-athlete financially responsible for any medical treatment that might occur as a result of the injury
L. Non-emergency Transportation
Transportation for non-medical emergencies will be arranged through the coaching staff. Under no circumstances should a student athletic trainer transport an athlete in a
personal vehicle.
M. Prescription medications
Student-athlete must notify the athletic training department of ANY medication that he/she is taking as soon as prescribed, with a copy of the prescription to be kept on file by the athletic training staff.
O. Lightning Policy Statement
“At all events covered by a Meadows Regional Certified Athletic Trainer (AT), the AT has the unchallengeable authority to postpone any contest or practice due to the threat of lightning. Additionally, the AT has the lone authority to restart the postponed contest after consulting with game administrators and officials.”
Purpose
The keys to lightning safety are education and prevention. Education begins with learning appropriate lightning safety tips. Prevention of lightning injuries or casualties should begin long before any athletic event. This policy will outline lightning safety terminology, procedures, and decision making policies.
Scope
This policy governs all athletic events and practices covered by a Meadows Regional Certified Athletic Trainer.
I. Monitor Weather Conditions
Athletics personnel (ATs and coaches) should check weather reports each day before any practice or event. The National Weather Service (NWS) issues severe weather and/or thunderstorm watches and/or warnings. A “watch” means conditions are favorable for severe weather to develop in a particular area. A “warning” means the NWS has reported severe weather in an area and for anyone in that area to take the necessary precautions.
Athletics personnel should be aware of the signs of thunderstorms developing nearby. Thunderstorms can grow from towering, “fluffy” cumulus clouds to lightning producers in as little as (30) thirty minutes. Lightning and thunder activity in the local area are the “alarms” for athletics personnel to begin monitoring thunderstorm activity, such as directions of storm movement and distance to the lightning flashes.
II. Evacuation Criteria a. Flash to Bang Time
To use Flash to Bang Time, count the seconds from the time lightning is sighted to when the clap of thunder is heard. Divide this number by five (5) to obtain how far away (in miles) the lightning is occurring. (Ex. 30 sec. count / 5 = 6 mile distance) A Flash to Bang Time of thirty (30) seconds or less dictates the
immediate suspension of practice/events and evacuation of all athletes and spectators to a safe area. (This is equivalent to 6 miles away or less.) Once it has been decided to stop an athletic practice/event, it is strongly recommended that all persons involved wait at least thirty (30) minutes after all lightning and thunder activity has ceased before resuming any athletics activity.
b. Activity Stoppage
Practice: The decision regarding stoppage of a practice is for the on-site AT to make only.
Sanctioned Event: The decision regarding stoppage of play of an official game or contest is the domain of the on-site AT to make after consulting with game administrators and officials. This authority is unchallengeable.
All coaches, officials, and administrators need to abide by this to ensure the safety of all athletes, coaches, games management, spectators, and all others who may be present.
**It is important to note that blue skies and no rain are not protection from lightning. Lightning can strike from a distance as far as 10 miles.** c. Shelter
1. Safe areas include: - enclosed buildings
- fully enclosed metal vehicles with a hard metal roof and windows up - low ground areas as a last resort(ditches, bottom of hill) – assume a crouched position – minimize your body area – do not lie flat 2. Unsafe areas include:
- open fields - golf carts / gators
- metal bleachers (on or under) - fences
- umbrellas, flag poles, light poles - tall trees
- pools of standing water.
- Avoid using a telephone (except cellular), showers, use of electrical machines (computers, fax, etc.)
III. Emergency Action Plan
In the event that someone is struck by lightning; the following protocol will be executed.
- Any person struck by lightning does not carry an electrical charge – there is no danger presented to the healthcare provider.
- Assess the scene to ensure safety for qualified healthcare personnel to enter. This may include transporting the victim to a safe environment before initiating first aid procedures.
- A Certified Athletic Trainer will evaluate the victim, activate Emergency Medical Services, and provide necessary first aid, which may include CPR and Rescue Breathing.
P. Concussion Management Guidelines
Brewton-Parker College has established protocols to care for student-athletes who have sustained a concussion which includes sideline assessment, symptom monitoring, balance and postural stability assessment, and cognitive assessment.
Policy 1.0: Preseason: Student-athletes
All Student-athletes will undergo the basic education regarding the signs and symptoms of concussions, what to look for and how to report them to the
appropriate medical personnel (documentation is upload to our athletic website
http://www.gobaronsgo.com under Sports Medicine section). All student-athletes will then be required to sign an agreement indicating they will report any and all signs and/or symptoms of concussion to the appropriate medical personnel. BPC Athletic Training Department will administer a preseason test called SCAT3 for those who had one or more concussions in last 5 years.
Policy 2.0: Diagnosis of Concussion
For the purpose of this protocol, sports concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic
biomechanical forces. Several common features that may be utilized in defining the nature of a concussive head injury include:
1. Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an 'impulsive' force transmitted to the head.
2. Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. 3. Concussion may result in neuropathological changes but the acute
clinical symptoms largely reflect a functional disturbance rather than structural injury.
4. Concussion results in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course.
5. Concussion is typically associated with grossly normal structural neuroimaging studies.
A concussion will be diagnosed by the Brewton-Parker College Athletic Training Department that includes team physicians, certified athletic trainers, or healthcare providers that are experienced in the evaluation and management of concussions when a student-athlete reports one or more of the following signs and/or
symptoms following a suspected direct or indirect blow to the head: 1. Cognitive Features:
- Unaware of period, opposition, score of game (Maddock’s questions) - Confusion
- Amnesia
- Loss of consciousness - Unaware of time, date, place 2. Typical Symptoms:
- Headache - Dizziness - Nausea
- Unsteadiness/loss of balance
- “having my bell rung”
- Seeing stars or flashing lights - Double vision 3. Subjective Symptoms: - Sleepiness - Sleep disturbances - Slowness/fatigue 4. Physical Signs:
- Loss of consciousness/impaired conscious state - Poor coordination or balance
- Concussive convulsion/impact seizure - Gait unsteadiness/loss of balance
- Slow to answer questions or follow directions - Easily distracted, poor concentration
- Displaying inappropriate emotions (laughing, crying) - Nausea/vomiting
- Vacant stare/glassy eyed - Slurred Speech
- Personality Changes
- Inappropriate playing behavior (running in the wrong direction) - Significantly decreased playing ability
Policy 2.1 Diagnosis of Concussion
Any student-athlete showing signs and/or symptoms of a concussion will be removed from all physical activities/competition for evaluation for the remainder of the day. Signs and symptoms of concussion have the tendency to clear quickly but the student-athlete may experience delayed symptoms or depressed
neurocognitive levels.
Activities indicated include ANY activities on/off the field. The student-athlete will be evaluated through a series of tests that may or may not be limited to the following: thorough history to determine signs/symptoms, ImPact Post Injury Testing, SCAT3, SAC, GSC, BESS and possible exertion activities. Once the athlete has been diagnosed with a concussion by an athletics healthcare provider with experience in the evaluation and management of concussions, the student- athlete will be removed from participation for the remainder of the day.
Neurocognivitive/neuropsychological testing must follow the steps below:
- ImPact, SCAT3, SAC, GSC, or BESS must be administered within 24-48 hours - SCAT3, SAC, GSC, or BESS must be administered daily until they meet B-Line - ImPact is NOT to be administered again until the student-athlete is symptomatic -Once the student-athlete is asymptomatic, SCAT3 can be administered daily until
B-Line has been met
- If student-athlete has passed and all tests reach B-Line, and they remain asymptomatic the step a day protocol can begin.
Policy 3.0: Referral
Any student-athlete diagnosed with a concussion will NOT return to play in the same day, and must pass a series of tests in order to return to play. The student-athlete must follow up with athletic training staff and follow the appropriate concussion management return to play protocols.
The student-athlete will be referred to the emergency room or 911 will be activated if the following occur:
• Inability to waken patient/unconsciousness-if they have regained
consciousness R/O cervical spine injury and continue with transportation to the ER.
• Severe or worsening headache
• Disorientation or confusion that increases with time • Drowsiness that increases with time
• Restlessness, unsteadiness that lasts longer than 15 minutes • Seizures
• Difficulties with vision that lasts longer than 15 minutes • Vomiting, fever, or stiff neck
• Urinary, bowel incontinence
• Amnesia lasting longer than 15 minutes Policy 4.0: Return to Play
Once a concussion has been determined a step/day protocol will be followed based on the length of the student-athlete’s signs/symptoms. The student-athlete will be permitted to move to the next step if they remain asymptomatic. The following protocol will be implemented once a concussion has been determined as the appropriate diagnosis:
Concussion with S/S lasting < 30 minutes:
Diagnosis day: OUT, rest for 24 hours, must be asymptomatic, All tests must be administered within 24-48hours of the injury and return to baseline scores
Day 1-Post Injury: Bike 10-15 minutes
Day 2-Post Injury: Elliptical 15-20 minutes and light weight lifting 20 minutes Day 3-Post Injury: Treadmill 15 minutes and Exertional drills in controlled
environment
Day 4-Post Injury: Non-contact practice 50-75%, weight lifting (non-contact) Day 5-Post Injury: Non-contact practice 80-90%, weight lifting/plyometrics
Day 6-Post Injury: Contact Practice 100% – Full Go, CANNOT BE GAME DAY!!! Day 7-Post Injury: Released for Full Go activities
Concussion with S/S lasting > 30 minutes:
Diagnosis day: OUT, rest 48 hours. All tests must be administered within 24-48 hrs of the injury and return to baseline scores. Day 1-(Asymptomatic): Bike 10-15 minutes
Day 2-(Asymptomatic): Elliptical 15-20 minutes and light weight lifting 20 minutes Day 3-(Asymptomatic): Treadmill 15 minutes and Exertional drills in controlled
environment
Day 4-(Asymptomatic): Non-contact practice 50-75%, weight lifting (non-contact) Day 5- (Asymptomatic): Non-contact practice 80-90%, weight lifting/plyometrics Day 6- (Asymptomatic): Contact Practice 100% – Full Go, CANNOT BE GAME
DAY!!!
Day 7- (Asymptomatic): Released for Full Go activities Policy 4.1: Return to Play
Once a concussion has been determined and the step/day protocol has begin 1. Certified Athletic Trainer must be seen and clear the student-athlete to begin the protocol.
a. For severe cases, team physician or neurologist must be seen and clear the student-athlete to begin the protocol
2. All tests must return to baseline readings.
3. The student-athlete must remain asymptomatic to advance to the next step in the protocol.
4. If the student-athlete advances to a step and begins experiencing
signs/symptoms, they must discontinue ALL activities for the remainder of the day and they must regress back to the previous step the next day. See Policy 4.2
5. If the student-athlete remains asymptomatic throughout the protocol and able to advance step/day without complications, they must see a certified athletic trainer prior to be released for ‘full go’ status. Policy 4.2: Return to Play
Once a concussion has been determined and the step/day protocol has begun: SYMPTOMS RETURN AFTER PROTOCOL HAS BEGUN:
1. A certified athletic trainer must be seen and clear the student-athlete to begin the protocol.
2. All tests must return to baseline readings. If tests have not returned to baseline see Policy 4.3.
3. The student-athlete must remain asymptomatic to advance to the next step in the protocol.
4. If the student-athlete advances to a step and begins experiencing
signs/symptoms, they must discontinue ALL activities for the remainder of the day and they must regress back to the previous step the next day. 5. If the student-athlete reports the following day still complaining of S/S, the protocol is discontinued and the student-athlete must REST until they are asymptomatic.
6. Once the student-athlete has returned asymptomatic, the athlete must be administered ImPACT, SCAT3, BESS, SAC or GSC again.
7. The athlete may only restart the protocol if all tests return to baseline AND the athlete has been seen and cleared to restart the step/day protocol by a certified athletic trainer. If tests have not returned to baseline see Policy 4.3.
Policy 4.3: Return to Play
Once a concussion has been determined and the step/day protocol has begun: SYMPTOMS DO NOT RETURN BUT IMPACT IS NOT BACK TO BASELINE, ALL OTHER TESTS ARE @ BASELINE:
1. A certified athletic trainer must be seen and clear the student-athlete to begin the protocol.
2. All tests return to baseline readings.
3. The student-athlete must remain asymptomatic to advance to the next step in the protocol.
4. If the student-athlete advances to a step and begins experiencing S/S, they must discontinue ALL activities for the remainder of the day and they must regress back to the previous step the next day.
5. If the student-athlete reports the following day still complaining of S/S, the protocol is discontinued and the student-athlete must REST until they are asymptomatic.
6. Once the student-athlete has returned asymptomatic, the protocol will start over from the rest period.
7. If the student-athlete is asymptomatic, all tests have returned to baseline they must remain at cardio, exertional drills in controlled environment until SCAT3 has returned to baseline test scores.
8. SCAT3 will be taken daily until it reaches baseline testing score at this time.
Policy 5.0: 2nd Concussion of the season:
If a student-athlete with a documented concussion for the season is diagnosed with a second concussion in the same season or within 3 months of the previous concussion, the student-athlete should be removed for twice the maximum amount of time (Rest 1 week, can begin step/day protocol 2nd week as long as asymptomatic).
Policy 6.0: 3rd Concussion of the season:
If a student-athlete with 2 documented concussions for the season is diagnosed with a third concussion in the same season, the student-athlete will be disqualified from competition for the remainder of that respective season.
