PIONEER CENTRAL SCHOOL DISTRICT
12125 County Line Road
PO Box 579
Yorkshire, NY 14173
Phone: 716-492-9300
Fax: 716-9360
ATHLETIC TRAINING
STANDING OPERATING PROCEDURES
Approved By: ___________________________
Gordon F. Comstock MD, Chief Medical Officer
Approved By: ___________________________
Robert DeJohn Jr, ATC
TABLE OF CONTENTS
Education Law article 162 overview………………………………………………………………………3
Universal Precautions……………………………………………………………………………………….4
Concussion Management Protocol..………………………………………………………………….......5
Head Injury Report…………………………………………………………………………………………...8
SCAT 3…………………………………………………………………………………………….…………...9
Head Injury Instructions…………………………………………………………………………………...14
Suspected Spinal Injury Protocol………………………………………………………………………..17
Catastrophic Injury Plan…………………………………………………………………………………...20
Emergency Action Plan Template………………………………………………………………………..21
Orthopedic Injury Protocol………………………………………………………………………………...22
Asthma (MDI) Policies and Procedures…………………………………………………………………25
Epi-Pen Policies and Procedures………………………………………………………………………...27
Abdominal Trauma……………………………………………………………………………………….....29
Wound / Skin Infections…..………………………………………………………………………………..30
OTC Preparations…………………………………………………………………………………………...31
AED Polices and Procedures……………………………………………………………………………..32
NATA Recommendations for Lightning Safety………………………………………………………..34
Heat Illness…………………………………………………………………………………………………...36
NATA Fluid Replacement………………………………………………………………………………….38
Heat Index Procedures…………………………………………………………………………………….40
Wind Chill Procedures….………………………………………………………………………………….41
PIONEER CENTRAL SCHOOL DISTRICT
ATHLETIC TRAINING
STANDING OPERATING PROCEDURES
Every individual serving as a certified athletic trainer in the School District shall possess a valid license as a Certified Athletic Trainer from the State of New York issued pursuant to Article 162 of the Education Law. In addition, candidates must have successfully completed training in the operation and use of an automated external defibrillator (AED) pursuant to Public Health Law Section 3000-b(3)(a).
The practice of the profession of athletic training shall be as defined in, and consistent with, Education Law section 8352. The services provided by an athletic trainer shall include, but not be limited to, the following:
A. Prevention of athletic injuries, including assessment of an athlete’s physical readiness to participate;
B. Reconditioning to minimize the risk of re-injury and to return the athlete to activity as soon and safely as possible, excluding the reconditioning of neurological injuries, conditions or disease;
C. Health care administration, including medical record keeping, documentation and reporting of injuries, writing policies and procedures, budgeting and referral of injured athletes to appropriate authorized health care professionals when indicated;
D. Education and counseling of coaches, parents, student athletic trainers and athletes;
E. Risk management and injury prevention as enumerated in Commissioner’s Regulations;
F. Management of athletic injuries as enumerated in Commissioner’s Regulations;
G. Immediate care of athletic injury and physical conditions as enumerated in Commissioner’s Regulations;
H. Treatment and reconditioning of athletic injuries as enumerated in Commissioner’s Regulations;
I. Organization and administration as enumerated in Commissioner’s Regulations;
J. Other professional development and responsibilities, as enumerated in Commissioner’s Regulations.
Education Law Article 162
Public Health Law Section 3000-b(3)(a)
8 New York Code of Rules and Regulations
(NYCRR) Section 135.4(c)(7)(i)(d)
UNIVERSAL PRECAUTIONS
A. Occupational Safety manual of procedures and policies for compliance with OSHA Blood Borne Pathogens Standard 1910, 1030 is in the nurse’s office at all times.
B. Pioneer Central School District healthcare employees participate in a blood borne pathogens standard training program upon employment and annually.
C. Accurate medical and training record keeping by OSHA regulations is kept on each person in a confidential manner at administration.
D. Hepatitis B Vaccine and vaccination series are available but not mandatory to all certified athletic trainers employed at Pioneer Central School District.
E. All certified athletic trainers routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids. Gloves are worn for touching blood and body fluids, mucous membranes, or non-intact of all patients, for handling items or surfaces soiled with blood or body fluids. Gloves are changed after contact with each patient. Masks and protective eye wear or face shields are worn during procedures that are likely to generate droplets of blood or body fluids to prevent exposure of mucous membranes of the mouth, nose, and eyes. Gowns are worn during procedures that are likely to generate splashes of blood or other body fluids.
F. Hands and other skin surfaces are washed immediately and thoroughly if contaminated with blood or other body fluids. Hands are washed immediately after gloves are removed.
G. All Athletic trainers should take precautions to prevent injuries caused by sharp instruments when handling during procedures and cleaning instruments after procedures.
H. A biohazard waste container will be located in each training room or nurses office.
I. Personal protective clothing and equipment are stocked in the athletic training room. This includes gloves, goggles, masks, shields and pocket masks.
J. Certified athletic trainers adhere to universal precautions when handling all laundry. Contaminated laundry will be placed in red biohazard bags and laundry department notified.
K. All athletic training rooms will be equipped with OSHA regulated biohazard pales and labels.
Concussion Management Protocol
The following policy will be followed by all schools, leagues, tournaments and events contracted to provide athletic training services. This policy follows guidelines and procedures outlined in consensus statement from 3rd International Conference on Concussion in Sport held in Zurich 2008 and procedures for Impact Concussion testing.
A concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury:
(1) Concussion may be caused by either 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 a 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 a structural injury.
(4) Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course; however, it is important to note that, in a small percentage of cases, post-concussive symptoms may be prolonged.
(5) No abnormality on standard structural neuroimaging studies is seen in concussion.
Any athlete that shows any signs or symptoms of concussion will be removed from play and assessed by healthcare professional. According to the consensus statement of the 2008 Zurich Conference, the suspected diagnosis of a concussion can include one or more of the following clinical domains:
(1) Symptoms: somatic (e.g. headache), cognitive (e.g. feeling like in a fog) and/or emotional symptoms (e.g. lability)
(2) Physical Signs (e.g. loss of consciousness, amnesia)
(3) Behavioral changes (e.g. irritability)
(4) Cognitive impairment (e.g. slowed reaction times)
(5) Sleep disturbance (e.g. drowsiness)
If any one or more of these components is present, a concussion should be suspected and the appropriate management strategy instituted.
Once first aid issues are addressed, an assessment of the concussive injury should be made using the Head Injury Report (Appendix A) or SCAT 2 (Appendix B). The post-injury results will be compared to the baseline SCAT 2, if available. Athletes with a suspected concussion will not be able to return to play that same day. These athletes should not be left alone and will be monitored after 15 and 30 minutes and every 30 minutes thereafter until the end of the event or until EMS are determined to be necessary. EMS should be activated for those athletes who suffer loss of consciousness, have a suspected neck injury or for those athletes whose symptoms worsen over a 15 or 30 minute time frame.
For those athletes not needing immediate referral parent/guardian must be contacted and head injury sheet given. (Appendix C). An athlete with a suspected concussion should not drive home. For those athletes that do not seek treatment at emergency room must be seen by a physician and present documentation to the school nurse.
Concussions will be managed symptomatically and through medical assessment. During the time that an athlete is symptomatic and recovering from injury, it is important to emphasize both physical and cognitive rest as outlined in Appendix C. Activities that require concentration and attention (e.g. scholastic work, video games, text messaging, etc) may exacerbate symptoms and possibly delay recovery. If necessary, accommodations should be made for student-athletes whose symptoms worsen while in school or become so severe that an athlete is unable to complete studies.
Return to Play Protocol
Once an athlete is asymptomatic for 24 hours and has medical clearance from a physician the athlete may begin Phase 1. The athletic trainer with communication of the Chief School Medical Officer will see the athlete and as authorized by the school policy, the following return to play protocol will be followed. As recommended by the New York State Public High School Athletic Association (NYSPHAA), this progression should be completed over 5-10 days and the athlete must have completed all five phases of the protocol in order to return to normal game play. The athlete must remain asymptomatic to progress to the next level. In the event that symptoms return, the athlete must stop activity. They may return to the previous phase of the protocol when asymptomatic for 24 hours. The athlete should be asymptomatic without the use of pharmacological agents/medications that may affect or modify their symptoms.
Phase 1 - Low impact, non-strenuous, light aerobic activity such as walking or riding a stationary bike. If tolerated without return of symptoms over a 24 hour period proceed to;
Phase 2 - Higher impact, higher exertion, and moderate aerobic activity such as running or jumping rope. No resistance training. If tolerated without return of symptoms over a 24 hour period proceed to;
Phase 3 - Sport specific non-contact activity. Low resistance weight training with a spotter. If tolerated without return of symptoms over a 24 hour period proceed to;
Phase 4 - Sport specific activity, non-contact drills. Higher resistance weight training with a spotter. If tolerated without return of symptoms over a 24 hour period proceed to;
Phase 5 - Full contact training drills and intense aerobic activity. If tolerated without return of symptoms over a 24 hour period proceed to;
Phase 6 - Return to full activities without restrictions.
**The final determination of when an athlete may return to full contact activity (Phase 5) rests with the School Chief Medical Officer.
The consensus panel agreed that a range of “modifying” factors may influence assessment and management of concussions restricting child longer. These factors are:
1. Symptoms – number, duration (> 10 days) and severity of symptoms
2. Signs – prolonged LOC (> 1min), amnesia
3. Concussive convulsions
4. Temporal – frequency (repeated concussions over time), timing (injuries close together over time) and “recency” of previous concussion
5. Threshold – repeated concussions occurring with progressively less impact force or slower recovery time
6. Age – child and adolescent ( < 18 years old)
7. Medication – psychoactive drugs, anticoagulants
8. Behavior – dangerous style of play
9. Sport – high-risk activity, contact and collision sport, high sporting level
10. Gender – no unanimous agreement that female gender be modifier although gender may be a risk factor for injury and/or influence injury severity
The ImPACT Program
The ImPACT Program is a baseline web-based assessment tool that will be implemented to assist in the Return to Play Protocol. This assessment tool can be used in conjunction or in place of the SCAT 2 assessment tool. Student-athletes will be baseline tested prior to the start of their sport season and then retested every two years. The concussion will be managed symptomatically and clinically with consideration of the ImPACT test. The return to play protocol will be initiated and followed as described above. An athlete will be tested on ImPACT once they are asymptomatic for 24 hours and have completed PHASE 4 of the return to play protocol. The ImPACT results will be given to the Chief School Medical Officer as part of their final medical clearance.
ImPact Protocol
Upon implementation of Impact all student-athletes will be baseline tested prior to the start of sport season and then retested every two years. Follow up testing will be completed if an injury occurs. Concussion will be managed symptomatically and utilizing Impact test. An athlete who suffers a concussion will be tested on Impact 24-72 hrs post-injury. Once scores return to where MD and ATC feel the athlete has recovered from concussion s/he may begin functional return to play.
The above policy will be followed by the healthcare professionals that deal with the decision to allow an athlete to return to play and will be followed despite the athlete presenting a prescription note to return to play sooner from their primary care physician or Emergency room. If an athlete presents a prescription from their primary care physician for the appropriate time frame in regards to return to play, then the functional return steps will be followed by the athletic trainer. However, the final determination of when an athlete may return to play rests with the School Chief Medical Officer.
APPENDIX A
ATHLETIC TRAINER’S HEAD INJURY REPORT
Name____________________________ Sport ________________School______________ Day/Date________
Time ___________ Location ________________________ Equipment Worn ________________________
History_________________________________________________________________
_______________________________________________________________________
Previous History Y N _____________________________________________
LOC Y N How Long? _______________________________
Retrograde Amnesia Y N Memory Word Groups:
Anterograde Amnesia Y N Truck Dictionary Kitten ________
PEARL Y N Orange Coffee Velvet ________
Neck Pain Y N Pen Stereo Computer ________
Confused/Disoriented Y N After 5 min Y/N 10 min Y/N 15 min Y/N
Headache Y N Serial 5’s Good Fair Poor NT
Dizziness Y N Eye Tracking Good Fair Poor NT
Lightheaded Y N Dermatomes Good Fair Poor NT
Blurry Vision Y N Myotomes Good Fair Poor NT
Double Vision Y N Reflexes Good Fair Poor NT
Nausea Y N Cranial Nerves Good Fair Poor NT
Vomiting Y N Finger-to-nose Good Fair Poor NT
Tinnitus Y N Rhomberg + - NT
Tired Y N Pulse ______________________ NT
Thirsty Y N Blood Pressure ______________ NT
Agitated/Hostile Y N Respirations ________________ NT
Comments/Notes: _________________________________________________________ ________________________________________________________________________
Assessment: Uneventful Trauma Simple Complex
Restrictions: No Restrictions Modified Participation No Participation
Parents Notified: Y or N ___________________________________________________
Instructions: _____________________________________________________________
________________________________________________________________________
CALL YOUR CERTIFIED ATHLETIC TRAINER OR YOUR FAMILY PHYSICIAN IF SYMPTOMS PERSIST OR WORSEN
ATC __________________________________
APPENDIX B
SCAT3