Eagle C.A.R.E. — A Sport Club Concussion Management Program: Part 2

March 22, 2012

Bob Liebau
Associate Director of Campus Recreation
University of Mary Washington

Editor’s Note: This article is part two in a series documenting the Eagle C.A.R.E Concussion Management Program. Part 1 focused on the ‘Education and Baseline Testing’ part of the program. The current article deals with’ Concussion Management & Assessment’ and the ‘Post Concussion Treatment Plan’.

Concussion Management and Assessment
The summary items for this component are:

1. Student-athlete is immediately removed from play
2. Sport Club first responder or coach will provide sideline assessment following Pocket SCAT2 guidelines (http://www.irbplayerwelfare.com/pdfs/Pocket_SCAT2_EN.pdf). This pocket assessment tool provides a step-by-step process for identifying a concussion. It is endorsed by FIFA, IIHF, IOC, and the IRB.
3. A student-athlete that looses consciousness or whose condition worsens will immediately be transported to Mary Washington Hospital by ambulance/rescue squad
4. A student-athlete who is conscious but has exhibited signs and/or symptoms of a concussion is to be referred to Mary Washington Hospital for evaluation
5. Student-athlete will notify physician upon arrival of ImPACT data availability

Detailed points for concussion management and assessment include the following:

• A student-athlete suspected of sustaining a concussion will immediately be removed from play. The sport club’s first responder or coach will provide sideline assessment following the Pocket SCAT2 guidelines.

• A student-athlete suspected of having a concussion is not permitted to return-to-play on the day of the injury.

• The following situations indicate a medical emergency and require immediate activation of the campus Emergency Medical System. Any student-athlete requiring transportation to the hospital will be accompanied by a designated team representative along with the injured student-athletes baseline ImPACT test data; a sport club officer or team first responder:

o Any student-athlete with a witnessed loss of consciousness of any duration
o Any student-athlete who has symptoms of a concussion, and who is not stable ( i.e. condition is worsening)
o An student-athlete who exhibits any of the following symptoms:
o Deterioration of neurological function: headaches that worsen, seizures, focal neurologic signs, looks very drowsy or can’t be awakened, repeated vomiting, slurred speech, can’t recognize people or places, increasing confusion or irritability, weakness or numbness in arms or legs, neck pain, unusual behavior change, significant irritability, any loss of consciousness greater than 30 seconds or longer
o Decreasing level of consciousness
o Decrease or irregular respirations
o Any signs or symptoms of associated injuries, spine or skull fracture, or bleeding
o Mental status changes: lethargy, difficulty maintaining arousal, confusion or agitation
o Seizure activity

• A student-athlete who is conscious but has exhibited signs and/or symptoms of a concussion is to be referred to Mary Washington Hospital immediately for evaluation.

• The injured student-athlete, team representative, or emergency medical personnel will notify the physician upon arrival at the hospital that ImPACT testing data is available.

• All sport club presidents are responsible for making certain that visiting sport clubs receive a copy of our concussion policy prior to travel and for providing the same concussion care for visiting student-athletes.

• Any sport club student-athlete who sustains a suspected concussion at practice or competition away from UMW will be treated according to the emergency protocol on-site.

Post Concussion Treatment Plan
The summary items for this component are:

1. Return to play is a medical decision that must be made by a physician
2. Student-athlete MAY NOT return to practice or competition without the written consent of a concussion specialist or other physician
3. The Sport Club President must ensure that the student-athlete does not return to play until the date specified by the physician
4. A follow-up ImPACT test will be given post-concussion

Detailed points for the post concussion treatment plan include the following:

• Return to play is a medical decision that must be made by a concussion specialist.

• A student-athlete may not return to practice or competition without the written consent of a concussion specialist or other physician.

• Once the physician has cleared the student-athlete to return to play, it is strongly recommended that the athlete is progressed back to full activity following the step-wise process detailed below. Progression is individualized, and will be determined on a case by case basis. Factors that may affect the rate of progression include: previous history of concussion, duration and type of symptoms, age of the athlete, and sport in which the athlete participates. An athlete with a prior history of concussion, one who has had an extended duration of symptoms, or one who is participating in a collision or contact sport may be progressed more slowly.

o Complete cognitive rest. Activities requiring concentration and attention may worsen symptoms and delay recovery.
o Light exercise. This step should not begin until the athlete is no longer having concussion symptoms and is cleared by a physician for further activity. At this point the athlete may begin walking or riding an exercise bike. No weight-lifting.
o Running without gear or equipment.
o Non-contact training drills in full equipment. Weight-training can begin.
o Full contact practice or training.
o Return to competition.

• The Sport Club President must ensure that the student-athlete does not return to play until the date specified by the physician.

• A follow-up ImPACT test will be given post-concussion 24 to 48 hours after the injury.

• If post-concussion symptoms occur at any stage, the student-athlete should stop the activity and the treating physician should be contacted for additional evaluation.

Return-To-Play Options for the Physician

1. Cleared to return to play without restriction
2. Follow-up ImPACT test required
3. Cleared to return to play with restrictions
4. Cleared to return to play without restriction on a specific date
5. Return appointment with physician required

Due to FERPA (http://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html) and HIPAA (http://www.hhs.gov/ocr/privacy/) guidelines, the Department of Campus Recreation professional staff does not have the consent to view a medical diagnosis without the expressed written consent of the student-athlete. The physician consulting with the Department of Campus Recreation is required to limit any return-to-play notes with this understanding.

The Department of Campus Recreation at the University of Mary Washington has put this program into place to help safeguard the well-being of student-athletes participating in the sport club program and has the full support of the sport club student council. The program was designed to be used without the presence of a certified athletic trainer on staff. While this program is specific to UMW, the program model can be used by any college or university that does not employ dedicated athletic trainers for their recreational sports programs as well as those programs which currently employ athletic trainers. Understanding the medical implications of concussions as a result of sport club participation is extremely important for all schools regardless of their ability to develop a sustainable concussion management program. Thirty nine states currently have legislation to safeguard secondary school student-athletes from concussions. Student-athletes and their parents will expect universities to have minimal protocols in place when making decisions concerning sport club participation.

Providing training and certifying student participants and coaches as first responders and using a no cost sideline assessment tool like the Pocket SCAT2 , should be the first step in the recognition of a concussion and should be the basic protocol of a sport club risk management program regardless of the utilization of an athletic trainer or other medical professional.
Utilizing a baseline testing program, like ImPACT, allows onsite or offsite medical personnel to accurately gauge the severity of a head injury. And while there is a cost associated with implementing any baseline testing program, most are not priced so high as to create a financial burden in these times of cost cutting and continued budget reductions. The decision for any school to use a baseline assessment tool should be based, first and foremost, upon institutional philosophy and not associated costs.

If you would like more information about the UMW program, you may contact Associate Director Bob Liebau at rliebau@umw.edu or Director Mark Mermelstein at mmermels@umw.edu.