Catherine “Cat” Marr- MEd, ATC/L Klein Collins High School

 Defines Concussion  Immediate Removal from Play  Concussion Oversight Committee  New paperwork/ documentation  UIL Concussion Acknowledgement Form (PRIOR to play)  Concussion injury paperwork: ▪ Medical info release (HIPAA/FERPA) ) ▪ Notice of Immunity ▪ Signs/ Symptoms & management information (school & home) ▪ Notification of School Personnel ▪ MD referrals & notes  RTP protocol ▪ Management during the RTP ▪ MD release form after completing RTP  UIL RTP Form ▪ Informed & consented ▪ RTP guidelines ▪ Risks  Training/ Education

Highlights of HB 2038  This bill applies to interscholastic athletic activity, including practice and competition, sponsored or sanctioned by a school district, a public school, including a charter school, or the University Interscholastic League (UIL).  does not apply to private schools that are members of TAPPS  Or Club sports

 Immediate Removal of student-athlete from athletics practice or competition if a head injury is suspected by:  a coach;  a physician;  a licensed health care professional; or  the student's parent or guardian or another person with legal authority to make medical decisions for the student.  Have the student-athlete evaluated by an appropriate health care professional as soon as practicable.  Call the student athlete over to the sideline so that the athlete may be evaluated- The act of calling a player over to the sideline does not by itself constitute a belief that the student athlete might have sustained a concussion.

 If it is determined that a concussion has occurred, the student-athlete shall: NOT be allowed to return to participation that day regardless of how quickly the signs or symptoms of the concussion resolve Be kept from activity until a physician indicates they are symptom free and gives clearance to return to activity. Must complete the District’s RTP Protocol A coach of an interscholastic athletics team may not authorize a student’s return to play.  Inform the student-athletes parent/guardian about the possible concussion and give them information on concussion. (PAPERWORK-Packet!)

 Concussion Oversight Team (COT)  Appointed & Approved by each school district or charter school  Headed by at least one physician with concussion management training.  To the greatest extent possible, COT must also include one or more: ▪ An athletic trainer; If the school district employs an athletic trainer they must be a member ▪ An advanced practice nurse; ▪ A neuropsychologist; or ▪ A physician assistant ▪ Administrators, coaches or other school officials can not serve on the COT  All COT need to show proof of Concussion Training ▪ Physicians are not required to take specific training or submit proof however they shall to the greatest extent practicable, periodically take an appropriate continuing education course in concussions  Establish a Return to Play Protocol  based on peer-reviewed scientific evidence

 In developing a RTP Protocol,  at a minimum- adopt the UIL Concussion Management Protocol ▪  If the local COT wishes to be more restrictive than the UIL Concussion Management Protocol, that is within their local discretion.  Each Athlete MUST complete the districts’ approved RTP protocol prior to being able to participate.  Examples:

DISD- also progresses in 24 hr/ increments & utilizes ImPact Testing ImPact Testing Friendswood ISD *The St. John Concussion Center puts together a binder of RTP for each sport* Must be symptom free for hours: Days 1 and 2 no more than 15 minutes of cardio work Days 2-4 no more than 25 minutes of cardio work Days 3-5 Continue Cardio but add in strength training or any non contact individual drills Days 4-6 Progress to non-contact drills Days 5-7 Progress to controlled contact Days 6-8 Full play

Lufkin ISD Klein ISD

 If the school district or charter school employs an athletic trainer, he/she is responsible for the compliance of the athlete with the return to play protocol.  A coach of an interscholastic athletics team may not authorize a student’s return to play.  AT not available:  a supervising adult approved by the school district with appropriate training in the recognition of the signs and symptoms of a concussion in athletes could serve in that capacity. ▪ This person is also then responsible for creating the appropriate documentation related to the injury event

 UIL approved continuing concussion education required for coaches, licensed health care professionals and recommended for physicians  Must be at least 2 hours, every 2 years.  Must be done by Sept, 1, 2012 ▪ This CME event qualifies  Concussion education  Parent  Student-Athlete  Teachers/ School Personnel ▪ In-service prior to school  And even to other Medical Professionals

 Prior to Athletic Participation  UIL Concussion information and acknowledgement form (April 15 th ) ▪ written information about concussions and relevant safety policies was received and read (signature required) ▪ Complete a new form each academic year.  Post Head Injury  the student athlete, parent/guardian, and other appropriate school employees must receive a written copy of the concussion oversight team’s RTP protocol.  Post concussion Instructions / Management Plan

 School/Academic Adjustments & Modification Following Concussion  Notify all school personnel regarding the student-athlete’s condition ▪ Advise teachers of post concussion symptoms & modifications ▪ Examples of modifications  Academic restrictions ▪ Difficulties ▪ Sandbagging and faking symptoms ▪ What to do? ▪ Teachers Reactions ▪ Compliance

 4 Basic Steps Involved are: (1) The student has been evaluated by Physician  using established medical protocols based on peer-reviewed scientific evidence  chosen by the student/parent/ guardian ▪ KISD- “a physician skilled in Concussion Management” ▪ ImPact/ Cognitive Testing

When Can I Play? (2) The student has successfully completed each requirement of the RTP protocol  Previous Examples  Varies per athlete  Pitfalls ▪ Many things cause headaches ▪ handle each student-athlete individually (see KISD Questionnaire)

 S/S Questionnaire  Completed by student  Reviewed/ Discussion by LAT  Compliance/ Supervision  Responsible party signature (LAT)  Fax to MD  MD clearance signature ▪ See also #3

When Can I Play? (3) The treating physician has provided a written statement indicating that, in the physician's professional judgment, it is safe for the student to return to play ▪ (Example- see KISD Questionnaire)

(4) the student and parent/guardian:  (A) Acknowledgement form stating they completed the requirements of the RTP protocol;  (B) provide the AT with the MD note (UIL Form):  (C) have signed a consent form indicating (UIL Form): ▪ informed about the RTP protocol; ▪ understands the risks of athletic participation ▪ will comply with any ongoing requirements of the RTP protocol; ▪ consents to the disclosure to appropriate persons (HIPAA/ FERPA) ▪ understands the immunity provisions

 Compliance  Club Sports  Social life ▪ Movies, texting, etc...  Isolation issues  Care of the whole athlete ▪ Practice time  Hiding or inflation of S/S  Education (everyone!)  Knowing your athletes

 “Doctor said that my MRI is clear so I don’t have a Concussion!”  CT or MRI- not diagnostic tool for a concussion  ImPact/ Cognitive Testing  Athlete evaluated on sidelines & has S/S of a concussion, they may not present with those same S/S when they see the MD several days later  Doesn’t mean they do not have a concussion  They still need to go through RTP  Athlete plays club sport, ER diagnosis with a Concussion- doesn’t let the AT or HS coach know.  We can only do the best we can with the info we have  UIL Yearly Acknowledgement form

 This is the law - not an option  Many are unaware of the new protocols  RTP Protocol  Can’t be circumvented regardless  Each District’s RTP will differ  An athlete must complete a school district’s RTP protocol even if the physician writes a clearance note  The athlete must then have a final written clearance note after they have completed the RTP protocol clearing them for a full release back to practice and game  UIL Form with parent signature for full release  We need to be proactive  Education & Good communication =  difficulties

 Thank you