April 21, 2015 TO: Chief School Administrators

Charter School Lead Persons Administrators of Nonpublic Schools FROM: Susan Martz, Assistant Commissioner Division of Student Services and Career Readiness SUBJECT: Scholastic Student-Athlete Safety Act Required Materials: Revised from April 29, 2014 The purpose of this memorandum is to provide information on the new Preparticipation Physical Evaluation (PPE) form, Health History Update Questionnaire, Sudden Cardiac Death in Young Athletes pamphlet and sign-off sheet to parents, guardians and student athletes, and to provide guidance on the implementation of the requirements authorized by P.L. 2013, c.71, the Scholastic Student-Athlete Safety Act (SS-ASA) to each public school district and nonpublic school with any of grades six through 12. The New Jersey Department of Education (NJDOE) broadcast dated September 10, 2013, informed all school districts, nonpublic schools and charter schools of the intent and requirements of the SS-ASA, and announced that the new forms authorized by the law would be provided when developed, approved and available for implementation. Please review the following guidance and direction for use of the new material as required by the SS-ASA prior to implementation at the local level. PPE Form The new PPE form developed jointly by the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine, must be used for all student physical examinations prior to a student’s participation in school-sponsored interscholastic and intramural athletic team or squad from this point forward. The new PPE form includes a History Form to be completed by the parent or guardian; a Supplemental History Form for Students with Special Needs; a Physical Examination Form; and a Clearance Form to be completed by the examining physician, advanced practice nurse (APN) or physician assistant (PA). Please remove the former PPE form from any school or district website and replace it with the new PPE form, which is available at: http://www.state.nj.us/education/students/safety/health/records/athleticphysicalsform.pdf.

TIME SENSITIVE Please share with school nurse(s)

and school physician immediately.

According to N.J.A.C. 6A:16-2.2(h)1ii(4), an incomplete form shall be returned to the student’s medical home for completion unless the school nurse can provide documentation to the school physician that the missing information is available from screenings completed by the school nurse or physician within the prior 365 days. In addition, according to N.J.A.C. 6A:16-2.2(h)1iv and N.J.A.C. 6A:16-2.3(a)3iv, each district shall provide to the parent written notification signed by the school physician stating approval of the student’s participation in athletics based upon the PPE or the reasons for the school physician’s disapproval of the student’s participation. Further, in accordance with N.J.A.C. 6A:16-2.3(a)3iii, the school physician may conduct student physical examinations in the physician’s office or other comparably equipped facility for students who do not have a medical home or whose parent has identified the school physician as the medical home for the purpose of the sports physical examination. The Student-Athlete Cardiac Assessment Professional Development Module (PD module) The NJDOE, in collaboration with the New Jersey Department of Health (NJDOH), and in consultation with the New Jersey Chapter AAP, the New Jersey Chapter AAFP, the American Heart Association (AHA) and the New Jersey Chapter American College of Cardiology (ACC), developed the PD module to increase the assessment skills of those health care providers who perform student-athlete physical examinations and screenings. A physician, APN or PA, who performs a student’s annual physical examination prior to the student’s participation in a school-sponsored interscholastic or intramural athletic team or squad, is required to first access and complete the PD module. The New Jersey State Board of Medical Examiners, New Jersey State Board of Nursing, New Jersey Chapter AAP, New Jersey Chapter AHA, New Jersey Chapter ACC, New Jersey Chapter AAFP, Athletic Trainer’s Society of New Jersey, New Jersey State Society of Physician Assistants, NJDOH and the NJDOE have a link to the PD module on their websites. Upon completion of the PD module, the physician, APN or PA, will be able to download and print a Certificate of Completion. The physician, APN or PA, should retain the Certificate of Completion for his/her files, but is not required to submit a copy of his/her Certificate of Completion to any public school district or nonpublic school. In addition, upon performing a student athlete’s annual physical examination, the physician, APN or PA, shall sign the certification statement on page four (Clearance Form) of the PPE form attesting to the completion of the PD module. In accordance with the requirements of the law, the board of education of a public school district and the governing board or chief school administrator of a nonpublic school shall retain the original signed statement on the PPE form to attest to the qualification of the physician, APN or PA, to perform the physical examination. Health History Update Questionnaire The parent or guardian of each student-athlete must complete and sign a Health History Update Questionnaire if the preparticipation physical examination was conducted 90 or more days prior to the first practice session of the athletic season. In the past, the update was required for medical examinations conducted 60 or more days prior to the start of the athletic season. The New Jersey Administrative Code will be revised to include this change required by the law. The Health History Update Questionnaire addresses the specific questions recommended by the American Heart Association. The questionnaire must be completed and signed by the student’s parent or guardian and .

submitted to the school nurse. Schools may choose to use their own form provided it includes these same questions. According to P.L. 2013, c.71, the school nurse must review the completed and signed

Health History Update Questionnaire and, if applicable, the athletic trainer shall review it as well. As with all health records, pursuant to N.J.A.C. 6A:32-7, these forms must be maintained in the school health office. The Health History Update Questionnaire may be found at: http://www.state.nj.us/education/students/safety/health/records/HealthHistoryUpdate.pdf Sudden Cardiac Death In Young Athletes Pamphlet Pursuant to N.J.S.A. 18A:40-41(d), school districts must distribute the Sudden Cardiac Death In Young Athletes pamphlet to each student-athlete and to the parents or guardians of the student-athletes, as part of the student’s preparticipation physical examination and completion of the athletic permission forms. A student-athlete and the parent or guardian of the student-athlete shall certify in writing that they received and reviewed the pamphlet. The pamphlet can be found at: http://www.state.nj.us/education/students/safety/health/services/cardiac.pdf and the student-athlete and parent or guardian certification and sign-off sheet can be found at: http://www.state.nj.us/education/students/safety/health/services/SuddenCardiacDeathPamphletSignOffSheet.pdf. School Physician In addition to the student’s medical home physician, APN or PA, the school physician must also complete the PD module. Further, the SS-ASA mandates inclusion of this requirement in the school physician’s annual contract with the school district. A live webinar was presented on Friday, May 9, 2014, from 10:30 a.m. to 12 noon to review the required actions and activities related to the SS-ASA and answer questions on the materials described in this memo. The webinar was recorded and posted on the NJDOE website at: http://www.state.nj.us/education/students/safety/health/services/athlete. SM/NCN:\SHSS Unit\School Health\Sudden Cardiac Death\Broadcast Scholastic Student-Athlete Safety Act Required Materials April 29 - REVD 4-10-15 CDP-KAW.docx c: Members, State Board of Education

David C. Hespe, Commissioner Senior Staff Diane Shoener Nancy Curry Jessani Gordon Christene DeWitt-Parker

Greg Kocher Executive County Business Officials

Executive County Superintendents Executive Directors for Regional Achievement Centers Garden State Coalition of Schools NJ LEE Group

1161 Route 130, P.O. Box 487, Robbinsville, NJ 08691 609-259-2776 609-259-3047-Fax

NJSIAA STEROID TESTING POLICY

CONSENT TO RANDOM TESTING

In Executive Order 72, issued December 20, 2005, Governor Richard Codey directed the New Jersey Department of Education to work in conjunction with the New Jersey State Interscholastic Athletic Association (NJSIAA) to develop and implement a program of random testing for steroids, of teams and individuals qualifying for championship games. Beginning in the Fall, 2006 sports season, any student-athlete who possesses, distributes, ingests or otherwise uses any of the banned substances on the attached page, without written prescription by a fully-licensed physician, as recognized by the American Medical Association, to treat a medical condition, violates the NJSIAA’s sportsmanship rule, and is subject to NJSIAA penalties, including ineligibility from competition. The NJSIAA will test certain randomly selected individuals and teams that qualify for a state championship tournament or state championship competition for banned substances. The results of all tests shall be considered confidential and shall only be disclosed to the student, his or her parents and his or her school. No student may participate in NJSIAA competition unless the student and the student’s parent/guardian consent to random testing. By signing below, we consent to random testing in accordance with the NJSIAA steroid testing policy. We understand that, if the student or the student’s team qualifies for a state championship tournament or state championship competition, the student may be subject to testing for banned substances. ___________________________ Signature of Student-Athlete Print Student-Athlete’s Name Date

___________________________ Signature of Parent/Guardian Print Parent/Guardian’s Name Date May 1, 2010

2016-17 NJSIAA Banned Drugs IT IS YOUR RESPONSIBILITY TO CHECK WITH THE APPROPRIATE OR DESIGNATED ATHLETICS STAFF BEFORE USING ANY SUBSTANCE

The NJSIAA bans the following classes of drugs:

Stimulants Anabolic Agents Alcohol and Beta Blockers Diuretics and Other Masking Agents Street Drugs Peptide Hormones and Analogues Anti-estrogens Beta-2 Agonists

Note: Any substance chemically related to these classes is also banned.

THE INSTITUTION AND THE STUDENT-ATHLETE SHALL BE HELD ACCOUNTABLE FOR ALL DRUGS WITHIN THE BANNED DRUG CLASS REGARDLESS OF WHETHER THEY HAVE BEEN SPECIFICALLY IDENTIFIED. Drugs and Procedures Subject to Restrictions

Blood Doping Gene Doping Local Anesthetics (under some conditions) Manipulation of Urine Samples Beta-2 Agonists permitted only by prescription and inhalation

NJSIAA Nutritional/Dietary Supplements Warning

Before consuming any nutritional/dietary supplement product, review the product with the appropriate or designated athletics department staff!

Dietary supplements, including vitamins and minerals, are not well regulated and may cause a positive drug test result.

Student-athletes have tested positive and lost their eligibility using dietary supplements. Many dietary supplements are contaminated with banned drugs not listed on the label. Any product containing a dietary supplement ingredient is taken at your own risk.

NOTE TO STUDENT-ATHLETES: THERE IS NO COMPLETE LIST OF BANNED SUBSTANCES. DO NOT RELY ON THIS LIST TO RULE OUT ANY SUPPLEMENT INGREDIENT. CHECK WITH YOUR ATHLETICS DEPARTMENT STAFF PRIOR TO USING A SUPPLEMENT. REMINDER: ANY DIETARY SUPPLEMENT INGREDIENT IS TAKEN AT THE STUDENT’S OWN RISK.

Some Examples of NJSIAA Banned Substances in Each Drug Class Do NOT RELY ON THIS LIST TO RULE OUT ANY LABEL INGREDIENT.

Stimulants Amphetamine (Adderall); caffeine (guarana); cocaine; ephedrine; fenfluramine (Fen); methamphetamine; methylphenidate (Ritalin); phentermine (Phen); synephrine (bitter orange); methylhexaneamine, “bath salts” (mephedrone); Octopamine; DMBA; etc. exceptions: phenylephrine and pseudoephedrine are not banned.

Anabolic Agents (sometimes listed as a chemical formula, such as 3,6,17-androstenetrione) Androstenedione; boldenone; clenbuterol; DHEA (7-Keto); epi-trenbolone; etiocholanolone; methasterone; methandienone; nandrolone; norandrostenedione; ostarine, stanozolol; stenbolone; testosterone; trenbolone; SARMS (ostarine); etc.

Alcohol and Beta Blockers Alcohol; atenolol; metoprolol; nadolo; pindolol; propranolol; timolol; etc.

Diuretics (water pills) and Other Masking Agents Bumetanide; chlorothiazide; furosemide; hydrochlorothiazide; probenecid; spironolactone (canrenone); triameterene; trichlormethiazide; etc.

Street Drugs Heroin; marijuana; tetrahydrocannabinol (THC); synthetic cannabinoids (eg. spice, K2, JWH-018, JWH-073)

Peptide Hormones and Analogues Growth hormone (hGH); human chorionic gonadotropin (hCG); erythropoietin (EPO); etc.

Anti-Estrogens Anastrozole; tamoxifen; formestane; ATD, clomiphene; SERMS (nolvadex); etc.

Beta-2 Agonists Bambuterol; formoterol; salbutamol; salmeterol; higenamine; norcuclaurine; etc.

ANY SUBSTANCE THAT IS CHEMICALLY RELATED TO THE CLASS, EVEN IF IT IS NOT LISTED AS AN EXAMPLE, IS ALSO BANNED! IT IS YOUR RESPONSIBILITY TO

CHECK WITH THE APPROPRIATE OR DESIGNATED ATHLETICS STAFF BEFORE USING ANY SUBSTANCE.

 

Some Examples of NJSIAA Banned Substances in Each Drug Class Do NOT RELY ON THIS LIST TO RULE OUT ANY LABEL INGREDIENT.

Stimulants Amphetamine (Adderall); caffeine (guarana); cocaine; ephedrine; fenfluramine (Fen); methamphetamine; methylphenidate (Ritalin); phentermine (Phen); synephrine (bitter orange); methylhexaneamine, “bath salts” (mephedrone); Octopamine; DMBA; etc. exceptions: phenylephrine and pseudoephedrine are not banned.

Anabolic Agents (sometimes listed as a chemical formula, such as 3,6,17-androstenetrione) Androstenedione; boldenone; clenbuterol; DHEA (7-Keto); epi-trenbolone; etiocholanolone; methasterone; methandienone; nandrolone; norandrostenedione; ostarine, stanozolol; stenbolone; testosterone; trenbolone; SARMS (ostarine); etc.

Alcohol and Beta Blockers Alcohol; atenolol; metoprolol; nadolo; pindolol; propranolol; timolol; etc.

Diuretics (water pills) and Other Masking Agents Bumetanide; chlorothiazide; furosemide; hydrochlorothiazide; probenecid; spironolactone (canrenone); triameterene; trichlormethiazide; etc.

Street Drugs Heroin; marijuana; tetrahydrocannabinol (THC); synthetic cannabinoids (eg. spice, K2, JWH-018, JWH-073)

Peptide Hormones and Analogues Growth hormone (hGH); human chorionic gonadotropin (hCG); erythropoietin (EPO); etc.

Anti-Estrogens Anastrozole; tamoxifen; formestane; ATD, clomiphene; SERMS (nolvadex); etc.

Beta-2 Agonists Bambuterol; formoterol; salbutamol; salmeterol; higenamine; norcuclaurine; etc.

ANY SUBSTANCE THAT IS CHEMICALLY RELATED TO THE CLASS, EVEN IF IT IS NOT LISTED AS AN EXAMPLE, IS ALSO BANNED! IT IS YOUR RESPONSIBILITY TO

CHECK WITH THE APPROPRIATE OR DESIGNATED ATHLETICS STAFF BEFORE USING ANY SUBSTANCE.

 

Approximately 90% of sports-related eye injuries can be prevented with simpleprecautions, such as using protective eyewear.2 Each sport has a certain type ofrecommended protective eyewear, as determined by the American Society forTesting and Materials (ASTM). Protective eyewear should sit comfortably on theface. Poorly fitted equipment may be uncomfortable, and may not offer the besteye protection. Protective eyewear for sports includes, among other things, safetygoggles and eye guards, and it should be made of polycarbonate lenses, a strong,shatterproof plastic. Polycarbonate lenses are much stronger than regular lenses.3

Health care providers (HCP), including family physicians, ophthalmologists, optometrists,and others, play a critical role in advising students, parents and guardians about the proper use

of protective eyewear. To find out what kind of eye protection is recommended, and permitted for your child’ssport, visit the National Eye Institute at http://www.nei.nih.gov/sports/findingprotection.asp. Prevent BlindnessAmerica also offers tips for choosing and buying protective eyewear at http://www.preventblindness.org/tips-buying-sports-eye-protectors,and http://www.preventblindness.org/ recommended-sports-eye-protectors.It is recommended that all children participating in school sports or recreational sports wear protectiveeyewear. Parents and coaches need to make sure young athletes protect their eyes, and properly gear up forthe game. Protective eyewear should be part of any uniform to help reduce the occurrence of sports-relatedeye injuries. Since many youth teams do not require eye protection, parents may need to ensure that theirchildren wear safety glasses or goggles whenever they play sports. Parents can set a good example by wearingprotective eyewear when they play sports.

Participating in sports and recreational activities is an important part of a healthy, physically active lifestyle forchildren. Unfortunately, injuries can, and do, occur. Children are at particular risk for sustaining a sports-relatedeye injury and most of these injuries can be prevented. Every year, more than 30,000 children sustain serioussports-related eye injuries. Every 13 minutes, an emergency room in the United States treats a sports-relatedeye injury.1 According to the National Eye Institute, the sports with the highest rate of eye injuries are:baseball/softball, ice hockey, racquet sports, and basketball, followed by fencing, lacrosse, paintball and boxing.

Thankfully, there are steps that parents can take to ensure their children’s safety on the field, the court, or whereverthey play or participate in sports and recreational activities.

Prevention ofSports-RelatedEye Injuries

1 National Eye Institute, National Eye Health Education Program, Sports-Related Eye Injuries: What You Need to Know and Tips for Prevention,www.nei.nih.gov/sports/pdf/sportsrelatedeyeInjuries.pdf, December 26, 2013.

2 Rodriguez, Jorge O., D.O., and Lavina, Adrian M., M.D., Prevention and Treatment of Common Eye Injuries in Sports,http://www.aafp.org/afp/2003/0401/p1481.html, September 4, 2014; National Eye Health Education Program, Sports-Related Eye Injuries: What You Needto Know and Tips for Prevention, www.nei.nih.gov/sports/pdf/sportsrelatedeyeInjuries.pdf, December 26, 2013.

3 Bedinghaus, Troy, O.D., Sports Eye Injuries, http://vision.about.com/od/emergencyeyecare/a/Sports_Injuries.htm, December 27, 2013.

The most common types of eye injuries that can result from sports injuries areblunt injuries, corneal abrasions and penetrating injuries.

� Blunt injuries:Blunt injuries occur when the eye is suddenly compressedby impact from an object. Blunt injuries, often caused by tennis balls,racquets, fists or elbows, sometimes cause a black eye or hyphema(bleeding in front of the eye). More serious blunt injuries often breakbones near the eye, and may sometimes seriously damage importanteye structures and/or lead to vision loss.

� Corneal abrasions: Corneal abrasions are painful scrapes on the outsideof the eye, or the cornea. Most corneal abrasions eventually heal on their

own, but a doctor can best assess the extent of the abrasion, and may prescribe medication to help control thepain. The most common cause of a sports-related corneal abrasion is being poked in the eye by a finger.� Penetrating injuries: Penetrating injuries are caused by a foreign object piercing the eye. Penetrating injuries

are very serious, and often result in severe damage to the eye. These injuries often occur when eyeglasses breakwhile they are being worn. Penetrating injuries must be treated quickly in order to preserve vision.4

� Pain when looking up and/or down, or difficulty seeing;

� Tenderness;� Sunken eye;� Double vision;� Severe eyelid and facial swelling;� Difficulty tracking;

If a child sustains an eye injury, it is recommended that he/she receiveimmediate treatment from a licensed HCP (e.g., eye doctor) toreduce the risk of serious damage, including blindness. It is alsorecommended that the child, along with his/her parent or guardian,seek guidance from the HCP regarding the appropriate amount oftime to wait before returning to sports competition or practice aftersustaining an eye injury. The school nurse and the child’s teachersshould also be notified when a child sustains an eye injury. A parent

or guardian should also provide the school nurse with a physician’s notedetailing the nature of the eye injury, any diagnosis, medical orders for

the return to school, as well as any prescription(s) and/or treatment(s) necessary to promotehealing, and the safe resumption of normal activities, including sports and recreational activities.

According to the American Family Physician Journal, there are several guidelines thatshould be followed when students return to play after sustaining an eye injury. For

example, students who have sustained significant ocularinjury should receive a full examination and clearanceby an ophthalmologist or optometrist. In addition,students should not return to play until the period oftime recommended by their HCP has elapsed. For more

minor eye injuries, the athletic trainer may determine thatit is safe for a student to resume play based on the nature of the injury, and how the

student feels. No matter what degree of eye injury is sustained, it is recommended thatstudents wear protective eyewear when returning to play and immediately report any concerns with their visionto their coach and/or the athletic trainer.

Additional information on eye safety can be found at http://isee.nei.nih.gov andhttp://www.nei.nih.gov/sports.

4Bedinghaus, Troy, O.D., Sports Eye Injuries, http://vision.about.com/od/emergencyeyecare/a/Sports_Injuries.htm, December 27, 2013.

Most CommonTypes of EyeInjuries

� The eye has an unusual pupil sizeor shape;

� Blood in the clear part of the eye;� Numbness of the upper cheekand gum; and/or

� Severe redness around the whitepart of the eye.

What to do if aSports-RelatedEye InjuryOccurs

Signs orSymptoms of an Eye Injury

Return to Playand Sports

May 12, 2015

TO: Chief School Administrators Charter School Lead Persons

Administrators of Nonpublic Schools FROM: Susan Martz, Assistant Commissioner Division of Student Services and Career Readiness SUBJECT: Fact Sheet for Parents on Sports-Related Eye Injuries in Youth The purpose of this memorandum is to announce the availability of Sports-Related Eye Injuries: An Educational Fact Sheet for Parents. Eye injuries are the leading cause of preventable blindness and visual impairment in children, and most injuries occurring in school-aged children are sports-related. The fact sheet, developed by the New Jersey Department of Education, includes critical information to promote the prevention of eye injuries as well as recommendations for the appropriate management of eye injuries that may occur. Each school district and nonpublic school is required to distribute the educational fact sheet annually to parents or guardians of the students, pursuant to N.J.S.A. 18A:40-41.9(b), in order to reduce the needless loss of sight that can occur during sports activities. The attached fact sheet may also be accessed at: http://www.state.nj.us/education/students/safety/health/SportsRelatedEyeInjury.pdf. Questions may be directed to schoolhealthservices@doe.state.nj.us. NC/CDP:N:\SHSS Unit\School Health\Broadcast memos CDP\May 12 15 broadcast eye fact sheet(1).docx

Attachment c: Members, State Board of Education

David C. Hespe, Commissioner Senior Staff

Nancy Curry Diane Shoener

Peter Carfagno Christene DeWitt-Parker Jessani Gordon Greg Kocher Executive County Business Officials Executive County School Superintendents Executive Directors for Regional Achievement Centers Garden State Coalition of Schools NJ LEE Group