AHSAA Middle/Junior High School Conference Sept 24, 2014

AHSAAAHSAAMiddle/Junior High School Middle/Junior High School

ConferenceConferenceSept 24, 2014Sept 24, 2014

Marshall Smith Med, ATC, LATMarshall Smith Med, ATC, LATSports Medicine DirectorSports Medicine Director

Southern Bone & Joint SpecialistSouthern Bone & Joint SpecialistDothan AlDothan Al

Athletic Health Related IssuesAthletic Health Related Issues

Emergency Action PlansEmergency Action Plans

Heat IllnessHeat Illness

ConcussionsConcussions

HyponatremiaHyponatremia


When an Emergency occurs it affects When an Emergency occurs it affects more than just the people on the field or in more than just the people on the field or in the school.the school.


Required by the State of Alabama.Required by the State of Alabama.

Required by AHSAARequired by AHSAA


Review AnnuallyReview Annually

New Building AdditionsNew Building Additions

New BuildingsNew Buildings

Office Relocations/Staff/ClassroomsOffice Relocations/Staff/Classrooms

Redesigned Fields/StadiumsRedesigned Fields/Stadiums

Gate LocationsGate Locations


AED’sAED’s

Know LocationsKnow Locations

Boxes? Locked/ Alarms off-onBoxes? Locked/ Alarms off-on

Batteries - need to be checked frequentlyBatteries - need to be checked frequently

Pads- Check dates and proper sizesPads- Check dates and proper sizes


Practice, Practice, Practice!!!Practice, Practice, Practice!!!

Who should be involvedWho should be involved CoachesCoaches ATC’sATC’s Student Athletic TrainersStudent Athletic Trainers EMSEMS School AdministratorsSchool Administrators


Scenarios for PracticeScenarios for Practice

Injured athlete on Game fieldInjured athlete on Game field

Injured athlete on Practice fieldInjured athlete on Practice field

Injured athlete in Gym/ BasementInjured athlete in Gym/ Basement

Injured Student in school/ classroomInjured Student in school/ classroom

Every scenario will have different issuesEvery scenario will have different issues

to overcome.to overcome.

Emergency Action plansEmergency Action plans

Encourage your staff to introduce Encourage your staff to introduce themselves to the EMS staff at your themselves to the EMS staff at your games.games.

New staff on EMS units New staff on EMS units

May never have worked an athletic event!May never have worked an athletic event!

Athletic events are different than MVA’sAthletic events are different than MVA’s


DehydrationDehydration

Heat CrampsHeat Cramps

Heat ExhaustionHeat Exhaustion

Heat strokeHeat stroke

Dangerous ConditionsDangerous Conditions

Heat Index – Know Temperature and Heat Index – Know Temperature and Humidity LevelHumidity LevelTest Air with WBGT Heat Index MonitorTest Air with WBGT Heat Index Monitor

65-7365-73 Moderate Risk Moderate Risk73-82 High Risk73-82 High Risk82+82+ Very High Risk Very High Risk

Weather Bug App- Very GoodWeather Bug App- Very Good

NOAA’s National Weather Service NOAA’s National Weather Service Heat IndexHeat Index

Courtesy of NOAA’s National Weather Service www.nws.noaa.gov

Signs of DehydrationSigns of Dehydration

Dry mouthDry mouth

ThirstThirst

Irritable or crankyIrritable or cranky

HeadacheHeadache

Bored or disinterestedBored or disinterested

DizzinessDizziness

CrampsCramps

Excessive fatigueExcessive fatigue

Not able to keep upNot able to keep up

Dark yellow urineDark yellow urine

Other factors for Illness from Other factors for Illness from HeatHeat

Low fitness levelsLow fitness levels

High body fatHigh body fat

SicknessSickness

Previous dehydration or heat illnessesPrevious dehydration or heat illnesses

Inadequate heat acclimatizationInadequate heat acclimatization

Salt deficiencySalt deficiency

Medications/Dietary supplementsMedications/Dietary supplements

Serious Health RisksSerious Health Risks

Dehydration Can Result In:Dehydration Can Result In:

1.1. Heat CrampsHeat Cramps

2.2. Heat ExhaustionHeat Exhaustion

3.3. Heat StrokeHeat Stroke Recognize Warning Signs of Heat Recognize Warning Signs of Heat

IllnessIllness


Are a mild heat illness that can be treated Are a mild heat illness that can be treated easily.easily.

Intense muscle spasms can develop after Intense muscle spasms can develop after exercising and losing large amounts of exercising and losing large amounts of fluid and salt from sweating.fluid and salt from sweating.

Athletes who sweat a lot or have a high Athletes who sweat a lot or have a high concentration of salt may be more likely to concentration of salt may be more likely to get heat cramps.get heat cramps.


Signs/SymptomsSigns/Symptoms Intense painIntense pain Persistent muscle contractionsPersistent muscle contractions

TreatmentTreatment Hydration (sports drink and/or water)Hydration (sports drink and/or water) Possibly extra sodiumPossibly extra sodium Stretching, relaxation, massageStretching, relaxation, massage


When can the athlete play again?When can the athlete play again?

As soon as they are symptom free.As soon as they are symptom free.

Important to continue to monitor.Important to continue to monitor.

May need to change eating and drinking May need to change eating and drinking habits, become more fit, or get better habits, become more fit, or get better adjusted to the heat.adjusted to the heat.


Is a moderate Heat Illness that occurs Is a moderate Heat Illness that occurs when an athlete continues to be physically when an athlete continues to be physically active even after suffering from ill effects of active even after suffering from ill effects of the heat.the heat.

The body struggles to keep up with the The body struggles to keep up with the demands, leading to heat exhaustion.demands, leading to heat exhaustion.

Heat ExhaustionHeat Exhaustion Signs/SymptomsSigns/Symptoms

Loss of coordination, dizziness or faintingLoss of coordination, dizziness or fainting DehydrationDehydration Profuse sweating or pale skinProfuse sweating or pale skin Headache, nausea, vomiting or diarrheaHeadache, nausea, vomiting or diarrhea Stomach/Intestinal cramps or muscle crampsStomach/Intestinal cramps or muscle cramps

TreatmentTreatment Shade or air conditioned areaShade or air conditioned area Remove excess clothing and equipmentRemove excess clothing and equipment Lie comfortably with feet above heart levelLie comfortably with feet above heart level If not nauseous, rehydrate with water or sports drinkIf not nauseous, rehydrate with water or sports drink Monitor heart rate, blood pressure, CNS status and Monitor heart rate, blood pressure, CNS status and

core temperaturecore temperature


When can the athlete play again?When can the athlete play again?

Should not be allowed to return until all Should not be allowed to return until all symptoms are gone.symptoms are gone.

Avoid intense practice in heat for a few Avoid intense practice in heat for a few days.days.

If received medical treatment, not until If received medical treatment, not until doctor approves and gives specific return to doctor approves and gives specific return to play instructions.play instructions.

Heat StrokeHeat Stroke

Is a severe heat illness that occurs when Is a severe heat illness that occurs when an athlete’s body creates more heat than it an athlete’s body creates more heat than it can release, due to the strain of exercising can release, due to the strain of exercising in the heat.in the heat.

Results in rapid increase in core body Results in rapid increase in core body temperature.temperature.

Can lead to permanent disability or death.Can lead to permanent disability or death.

Heat StrokeHeat Stroke Signs/SymptomsSigns/Symptoms

Core body temperature 104°F+Core body temperature 104°F+ CNS dysfunctionCNS dysfunction Nausea, vomiting or diarrheaNausea, vomiting or diarrhea Headache, dizziness or weaknessHeadache, dizziness or weakness Hot & wet or dry skinHot & wet or dry skin Increased heart rate, decreased blood pressure or fast Increased heart rate, decreased blood pressure or fast

breathingbreathing DehydrationDehydration CombativenessCombativeness

TreatmentTreatment 911911 Aggressive whole-body cooling (cold water immersion)Aggressive whole-body cooling (cold water immersion) Fans/ice/cold towels over much of the body if immersion Fans/ice/cold towels over much of the body if immersion

is not available.is not available.

Heat StrokeHeat Stroke

When can an athlete play again?When can an athlete play again?

When the doctor approves and gives When the doctor approves and gives specific return to play instructions.specific return to play instructions.

Parents should work with doctors to rule out Parents should work with doctors to rule out or treat other conditions that may cause or treat other conditions that may cause continued problems.continued problems.

Should return very slowly under the Should return very slowly under the supervision of health care professional.supervision of health care professional.

PreventionPreventionMeet with prospective players and parents Meet with prospective players and parents to educate them.to educate them.Discuss pre-season conditioning programDiscuss pre-season conditioning programAvoid mid-day heatAvoid mid-day heatTake regular breaks in shadeTake regular breaks in shadeSlowly increase practice time and intensitySlowly increase practice time and intensityPre-participation physicalPre-participation physicalEmergency action planEmergency action planATC on site if possible.ATC on site if possible.

Activity GuidelinesActivity GuidelinesA.A. 5-10 minute rest & fluid break after 25-30 minutes of activity5-10 minute rest & fluid break after 25-30 minutes of activity

B.B. 5-10 minute rest & fluid break after 25-30 minutes of 5-10 minute rest & fluid break after 25-30 minutes of activity/should be in shorts & t-shirt with helmet & should pads.activity/should be in shorts & t-shirt with helmet & should pads.

C.C. 5-10 minute rest & fluid break after every 15-20 minutes of 5-10 minute rest & fluid break after every 15-20 minutes of activity/shorts & t-shirt only.activity/shorts & t-shirt only.

D.D. Cancel or postpone all outdoor practices. Practice in air Cancel or postpone all outdoor practices. Practice in air conditioned space.conditioned space.

Acclimation to HeatAcclimation to Heat

Promote conditioningPromote conditioning

Usually takes 10-14 daysUsually takes 10-14 days

Carefully observe athletesCarefully observe athletes

HydrationHydration

Encourage athletes to drink before, during and Encourage athletes to drink before, during and after exerciseafter exerciseTake regular drink breaks in shadeTake regular drink breaks in shadeHelpful Beverages: water and sports drinks with Helpful Beverages: water and sports drinks with adequate electrolytesadequate electrolytesHarmful Beverages: fruit juice, CHO gels, soda, Harmful Beverages: fruit juice, CHO gels, soda, sports drinks 8%+CHO, caffeinated drinkssports drinks 8%+CHO, caffeinated drinks

Monitor Weight LossMonitor Weight Loss

Athletes should weigh before and after Athletes should weigh before and after practicepracticeCheck weight chartsCheck weight chartsUp to 3 percent weight loss through Up to 3 percent weight loss through sweating is normalsweating is normal


PreventionPrevention Teach NutritionTeach Nutrition Teach HydrationTeach Hydration Instruction in Proper Pre-Game Meal Instruction in Proper Pre-Game Meal

Education and Support Education and Support Korey Stringer InstituteKorey Stringer Institute CDC CDC

What is a Concussion?What is a Concussion?

A traumatic injury that alters normal A traumatic injury that alters normal brain functionbrain functionIt is a problem with function, not It is a problem with function, not structure: can’t see it or x-ray itstructure: can’t see it or x-ray itAny force applied to the body that Any force applied to the body that causes the brain to shift or rotate, causes the brain to shift or rotate, causing damage to brain cells that causing damage to brain cells that results in chemical changes that results in chemical changes that renders the brain vulnerable to renders the brain vulnerable to subsequent injury and may take subsequent injury and may take weeks to healweeks to heal

What is a Concussion?What is a Concussion?

A common problem in A common problem in ALLALL sports sports

Potential for serious complications including Potential for serious complications including deathdeath

Can even occur with a mild jolt or hit; Do not Can even occur with a mild jolt or hit; Do not have to lose consciousness- <10%have to lose consciousness- <10%

Occurs at all levels of play, but risk of serious Occurs at all levels of play, but risk of serious injury is more significant in adolescentsinjury is more significant in adolescents

Trained medical personnel are not always Trained medical personnel are not always available to evaluate these injuriesavailable to evaluate these injuries

Definition of ConcussionDefinition of Concussion““Concussion is a brain Concussion is a brain injury defined as a injury defined as a complex pathological complex pathological process affecting the process affecting the brain…Featuring brain…Featuring pathologic and pathologic and biomechanical injury.”biomechanical injury.”

Zurich,2012 Zurich,2012

ConcussionsConcussions

International Conferences on Concussions International Conferences on Concussions in Sport:in Sport:

Vienna 2001Vienna 2001Prague 2004Prague 2004Zurich 2008Zurich 2008Zurich 2012Zurich 2012

State FocusState Focus

AHSAA – Point of emphasis rule for 2010 for all AHSAA – Point of emphasis rule for 2010 for all sports sports ““Any player who shows signs, symptoms or Any player who shows signs, symptoms or behaviors of a concussion must be removed behaviors of a concussion must be removed from the game and shall not return to play until from the game and shall not return to play until cleared by an appropriate health care cleared by an appropriate health care professional (a medical doctor under AHSAA professional (a medical doctor under AHSAA rules)” rules)” Previous rule stated athlete had to be Previous rule stated athlete had to be unconscious or apparently unconsciousunconscious or apparently unconscious

State Focus Continued:State Focus Continued:2011 2011

Alabama Concussion Law Alabama Concussion Law

Any athlete who receives a concussion must Any athlete who receives a concussion must immediately be removed from play and not be immediately be removed from play and not be allowed to return until a doctor says its safe and allowed to return until a doctor says its safe and gives written permissiongives written permission

All youth sports programs and recreational All youth sports programs and recreational organizations must distribute information sheets organizations must distribute information sheets detailing the symptoms and risks of concussion detailing the symptoms and risks of concussion and other forms of traumatic brain injury and other forms of traumatic brain injury

State Focus Continued: State Focus Continued: 2011 2011

Alabama Concussion LawAlabama Concussion Law Athletes and their parents or guardians Athletes and their parents or guardians must sign the information sheets must sign the information sheets acknowledging they have read and acknowledging they have read and understand the material understand the material

Coaches must also receive annual training Coaches must also receive annual training on how to recognize concussion on how to recognize concussion symptoms and how to treat an athlete with symptoms and how to treat an athlete with a concussiona concussion

Why Such a Concern in High Why Such a Concern in High SchoolsSchools

Adolescents are more vulnerable to Adolescents are more vulnerable to sustaining concussions and their brain sustaining concussions and their brain takes longer to heal after sustaining an takes longer to heal after sustaining an injuryinjuryMost high schools in Alabama do not have Most high schools in Alabama do not have a licensed certified athletic trainer or a licensed certified athletic trainer or physician available at all practices or physician available at all practices or games so coaches are responsible for the games so coaches are responsible for the health and safety of their teamhealth and safety of their team

Common Signs and SymptomsCommon Signs and Symptoms

CognitiveCognitive Feeling mentally Feeling mentally

foggyfoggy Feeling slowed downFeeling slowed down Difficulty Difficulty

rememberingremembering Difficulty Difficulty

concentratingconcentrating

PhysicalPhysical HeadacheHeadache Nausea/VomitingNausea/Vomiting DizzinessDizziness Balance ProblemsBalance Problems Visual ProblemsVisual Problems Fatigue/Feeling TiredFatigue/Feeling Tired Light & Noise Light & Noise

SensitivitySensitivity Numbness/TinglingNumbness/Tingling

Common Signs and SymptomsCommon Signs and Symptoms

SleepSleep DrowsinessDrowsiness Sleeping less than Sleeping less than

usualusual Sleeping more than Sleeping more than

usualusual Trouble falling asleepTrouble falling asleep

EmotionalEmotional IrritabilityIrritability SadnessSadness More emotionalMore emotional NervousnessNervousness

Using Concussion Clinical Trajectories Using Concussion Clinical Trajectories to to

Inform Targeted Treatment PathwaysInform Targeted Treatment Pathways

Previous Concussions

Sex

Treatment and RehabPathways

Concussion ClinicalTrajectories

Risk Factors

Migraine

LD/ADHD

Concussion

Age

Motion sensitivity,Ocular Hx?

New Advances in Concussion New Advances in Concussion TreatmentTreatment

Vestibular and Ocular Motor AssessmentVestibular and Ocular Motor Assessment

Balance AssessmentBalance Assessment

Recognize Balance Problems Recognize Balance Problems BESS TestBESS Test

(Balance Error Scoring (Balance Error Scoring System)System)

University of North Carolina Sports Medicine ResearchUniversity of North Carolina Sports Medicine ResearchLaboratory Chapel Hill, NC 27599-8700Laboratory Chapel Hill, NC 27599-8700

Vestibular and Ocular Motor Vestibular and Ocular Motor AssessmentAssessment

Smooth Pursuits- H testSmooth Pursuits- H testSaccades- Horizontal (eyes only)Saccades- Horizontal (eyes only)Saccades – Vertical ( eyes only)Saccades – Vertical ( eyes only)Convergence (near point) less than 8cmConvergence (near point) less than 8cmVOR- Horizontal ( head with eyes)VOR- Horizontal ( head with eyes)VOR- Vertical ( head with eyes)VOR- Vertical ( head with eyes)VMR- Horizontal ( body, head and eyes)VMR- Horizontal ( body, head and eyes)Headache, dizziness, nausea, fogginessHeadache, dizziness, nausea, fogginess

Comprehensive Assessment and Comprehensive Assessment and treatment Approach treatment Approach

Vestibular

Ocular-Motor

Symptoms

Physical Exertion

Neuro-Cognitive

Concussion


Commonly referred to as a low level of Commonly referred to as a low level of sodium in the blood.sodium in the blood.

Water Intoxication-without Na replacement Water Intoxication-without Na replacement during strenuous exercise.during strenuous exercise.

Can result from excess fluid in the body Can result from excess fluid in the body relative to the normal amount of sodium, relative to the normal amount of sodium, or it may be due to a loss of sodium and or it may be due to a loss of sodium and body fluid.body fluid.


Symptoms may consist of:Symptoms may consist of: Mental Changes- ConfusionMental Changes- Confusion HeadacheHeadache NauseaNausea TirednessTiredness Muscle SpasmsMuscle Spasms SeizuresSeizures VomitingVomiting


Mechanics of HyponatremiaMechanics of Hyponatremia

When the sodium levels in the blood are When the sodium levels in the blood are low, water tends to enter cells causing low, water tends to enter cells causing them to swell.them to swell.

When this occurs in the brain it causes When this occurs in the brain it causes Cerebral Edema. (Swelling in the Brain)Cerebral Edema. (Swelling in the Brain)

Causes increased pressure in the brain.Causes increased pressure in the brain.

Only occurs in Severe casesOnly occurs in Severe cases

HyponatremiaHyponatremiaTreatment and PreventionTreatment and Prevention

Treated with IV fluids and Electrolyte Treated with IV fluids and Electrolyte replacements.replacements.

Gradual replacement of fluids during Gradual replacement of fluids during exercise and following exercise.exercise and following exercise.

Monitor diet and lifestyleMonitor diet and lifestyle

Gradual Hydration and Food intake prior to Gradual Hydration and Food intake prior to athletic event and exercise to increase athletic event and exercise to increase sodium levels.sodium levels.

Thank YouThank You

Marshall Smith Med, ATC,LATMarshall Smith Med, ATC,LAT

Southern Bone & Joint SpecialistSouthern Bone & Joint Specialist

Dothan AlDothan Al

[email protected]@southernbone.com

Heat Stress and Athletic Participation. National Federation of State High School Associations.16 July 2008. http:www.nfhs.org/web/2005/03/sports_medicine_heat_stress_and_athletic_participation.asp

How to Recognize, Prevent & Treat Exertional Heat Illnesses. National Athletic Trainers’ Association. 16 July 2008 http://www.nata.org/newsrelease/archives/000056.htm

Kendrick Fincher Memorial Foundation. 16 July 2008. http://www.kendrickfincher.org/index.htm

National Oceanic and Atmospheric Administration’s National Weather Service Heat Index. United States Department of Commerce. Chart. 23 July 2008. http://www.weather.gov/os/heat/index.shtml

Parents’and Coaches’ Guide to Dehydration and Other Heat Illnessess in Children. National Athletic Trainers’ Association. June 2003.

http://www.nata.org/industryresources/heatillnessconcensusstatement.pdf.

Preseason Heat-Acclimatization Guidelines for Secondary School Athletics. Journal of Athletic Training Volume 44 Number 3 June 2009. National Athletic Trainers Association

http://www.nata.org/jat

Recommendations for Hydration to Prevent Heat Illness. National Federation of State High School Associations. 16 July 2008. http://www.nfhs.org/core/contentmanager/uploads/heatstressflyers.pdf

Heat Illness: Prevention and Treatment. Lynn Carr. August 2008.

Documents

AHSAA Middle/Junior High School Conference Sept 24, 2014