Concussion Protocol Dan Boivin OSZ President, Mont Ste Marie This first slide could be read entirely. We need to underline the great work of the majority while bringing the fact that we are seeing an increase number of weakness in our overall delivery. October 29, 2016 FIS TD Update - TD Responsibilities

Concussion 2017 Coach Responsibilities – Coach has Duty of Care, Coach stands in shoes of parent for minors, Coach has total control over their athletes – training and competition, always err on side of being conservative.

Concussion Definition: Simple Definition: Any direct or indirect force applied to the head or body that causes intracranial movement of the brain and results in complex vascular, neurochemical and processing injuries resulting in concussive symptoms. Simple Definition: Force Applied + Symptoms = Concussion

Concussion Statistics May Be As Many As 1.9 Million Concussions For Children Under 18 In The US Yearly (AAP) 500% Increase In Diagnosis Of Concussion In Children And Young Adults Since 2010 (Under 22 y/o) Boys Tend To Have A Higher Incidence Of Concussion Than Girls (Statistics Are Nearly Even In States With Certain Girls Sports Such As Field And Ice Hockey, Lacrosse and Soccer)

Concussion Statistics Football, Soccer And Hockey Have Had A Greater Than 40% Increase In Reported Head Injuries From 2004-2014 In Canada. Up To 23% Of Adolescents In Canada Reported A Head Injury In The Last Year 1 In 5 Sports Related Injuries In Canada Is A Concussion Among Ages 10-18 Visiting A Canadian ER For A Sports Related Head Injury, 39% Were Diagnosed With Concussion. An Additional 24% Had Possible Concussion

Concussion Facts Usually Last 1-4 Weeks (Vestibular-Ocular Symptoms 3-4 Weeks) Symptoms Can Sometimes Last For Months To Years (Post Concussive Syndrome) Can Be Catastrophic Resulting In Death Or Disability (Second Impact Syndrome) Onset, Type And Severity Of Symptoms Can Vary Widely No Two Are Alike, Therefore Treatment Should Be Individualized

Concussion May Not Be An Isolated or Mild Injury! Need To Rule Out More Significant Traumatic Brain Injury – Urgent ER Evaluation? Significant Association Of Neck Injuries With Concussion Beware Of Distracting Injuries! Loss Of Consciousness Is Not Required To Have A Significant Concussion (May Actually Predict Shorter Recovery Along With Vomiting)

Importance of Identification of Concussions Athletes Are At Risk For Much More Severe Injury Or Prolonged Recovery If Not Treated Appropriately Major Cause Of Both Short And Long Term Disability Relationship To Dementia And Neurological Conditions Later In Life May Cause Short And Long Term Psychological Changes

Importance of Identification of Concussions

Challenges of Identifying Concussions Symptoms Can Be Subtle The “Field Of Play” Can Be Chaotic/Busy Athletes Report Only A Small Percentage Of Injuries Overzealous Parents And Coaches Lack Of Education In Officials, Coaches, Parents And Athletes Lack Of Consistent Reporting To Sport’s Governing Body And Organizer’s Failure To Check Hold List

Sometimes Its Easy To See The Outward Signs

More Often It Is Not Moods of an Irish Setter by Gary Larson

Signs Observed In The Athlete By Others Appears Dazed Or Stunned Moves Clumsily Answers Questions Slowly Loses Consciousness (Even Briefly) Shows Behavior Or Personality Changes Can’t Recall Events Prior To Hit Or Fall Can’t Recall Events After Hit Or Fall

Symptoms Reported By The Athlete Headache Or Pressure In Head Nausea Or Vomiting Balance Problems Or Dizziness Double Or Blurry Vision Sensitivity To Light Or Noise Feeling Sluggish, Hazy, Foggy Or Groggy Concentration Or Memory Problems Does Not Feel Right Confusion

Symptoms Of Concussion Most Common Symptoms Reported In First 3 Days Headache 71% Feeling Slowed Down 58% Difficulty Concentrating 57% Dizziness 55% Fogginess 53% Fatigue 50% Visual Symptoms 49% Light Sensitivity 47% Memory Dysfunction 43% Balance Problems 43%

Can We Trust The Injured Athlete? Answer: Some Athletes Notoriously Under Report Concussion Injuries. Estimates Are Approximately 20% Will Self Report After Injury. This Is Due To Both A Desire To Compete And A Desire To Please. Hopefully Education And Awareness Of Athletes, Coaches, Officials, And Parents Can Improve Diagnosis And Prevent More Severe Or Long-Standing Consequences.

Management Guidelines Based on Four International Symposiums on Concussion in Sport “When in Doubt, Sit Them Out” No Athlete Should Play with Symptoms (either at rest or with exertion) Neurocognitive Testing Should Return to Normal Before Being Cleared for Activity A Youth Athlete Should Never be Returned to Sport the Same Day of Concussion No Matter How Brief the Duration of Symptoms Every Injury and Athlete are Different and No Standard Timeline or Grading System Predicts Recovery

Checklist for Athlete Injury Specifically Concussion The information below is to provide the competition Jury and LOC with suggested protocol in the event of a suspected concussion. As a reminder it must be noted that the handling of suspected concussion should always be a shared responsibility between Officials, Coaches, Trainers, Parents and athlete. At Team captains meeting Upon completion of roll call for Jury / TD should ask if all athletes presently on the board are fit medically to participate in the event. A reminder that ski racing is a physically demanding sport. DURING EVENT   A concussion should always be suspected if an athlete sustains a significant impact to the head, face, neck, or body and demonstrates ANY of the visual signs or reports to his/her peers ANY concussion symptoms. Athletes Team Captain should be made aware of the potential for a concussion arising from the reported or observed accident. Normally, if a concussion is suspected medical treatment and intervention will be required. Onsite Medical Treatment In cases where an athlete loses consciousness or it is suspected an athlete might have a more severe head or spine injury, Emergency Medical Assessment by emergency medical professionals should take place immediately. Even if the athlete did not lose consciousness but complains of dizziness, and other injury symptoms it is recommended that the athlete should undergo Sideline Medical Assessment or a Medical Assessment, depending on availability of a licensed healthcare professional present at the event. SIDELINE ASSESSMENT If a licensed Healthcare professional is present, a SCAT 5 assessment can be conducted. If a concussion is suspect from the SCAT 5 assessment the athlete should be removed from competition by his coach or team officials. If a licensed healthcare professional is not present the athlete should be referred by his coach, team officials or parent to a licensed healthcare professional for assessment and determination before there is any return to competition . The Jury may wish to question any decision to return to play where there has been no intervention or independent assessment Where an athlete is diagnosed with a concussion he/she should not return to play until the RETURN TO PLAY strategy as recommended by CSA/Alpine Canada has been followed and a MEDICAL CLEARANCE LETTER has been completed. Note: Normally Athletes who have been provided with a Medical Clearance Letter may return to full sport activities as Tolerated and as instructed by the Medical Healthcare Professional. If the athlete experiences any new concussion-like symptoms while returning to play, they should be instructed to stop playing immediately, notification provided to their parents, coaches, trainer or teachers, and undergo follow-up Medical Assessment.

Policies and Protocols ACA

Policies and Protocols ACA

Policies and Protocols ACA

Policies and Protocols ACA

Policies and Protocols ACA

Policies and Protocols ACA

Policies and Protocols ACA

Resources Canada Parachute Canada: An organization in Canada dedicated to reducing preventable injuries including concussions http://www.parachutecanada.org/injury-topics/item/concussion Alpine Canada Alpin http://alpinecanada.org/community/docs-forms 5th International Conference, Berlin 2016 SCAT 5 Protocols

Sideline Evaluation SCAT 5

Sideline Evaluation SCAT 5

Sideline Evaluation SCAT 5

Sideline Evaluation SCAT 5