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Lake Norman High SchoolSports MedicinePolicy and Procedures Manual148590056515186 doolie roadMooresville, NC 28117704-799-8555iss.domain/2732Mr. Keith gentle Mr. Jay KeenerPrincipalAthletic Directorcenterbottom LAKE NORMAN HIGH SCHOOL CAMPUS MAP FOR EMERGENCY ACCESS020000 LAKE NORMAN HIGH SCHOOL CAMPUS MAP FOR EMERGENCY ACCESS-2105025-2028825-4572005410200BUS ENTRANCE- ACCESS TO BACK OF SCHOOL ONLY. NO FIELD ACCESSMAIN ENTRANCE: RED ARROW 1- Front door to school access to office, commons, and main level.RED ARROW 2- 2nd door entrance to weight room and main gymnasium level.RED ARROW 3- Main field access via service road. Visitors side of field and Fieldhouse level.RED ARROW 4- Service road access to baseball, softball, and tennis. Also soccer practice field.RED ARROW 5- Access to band and lacrosse practice field, via student parking lot00BUS ENTRANCE- ACCESS TO BACK OF SCHOOL ONLY. NO FIELD ACCESSMAIN ENTRANCE: RED ARROW 1- Front door to school access to office, commons, and main level.RED ARROW 2- 2nd door entrance to weight room and main gymnasium level.RED ARROW 3- Main field access via service road. Visitors side of field and Fieldhouse level.RED ARROW 4- Service road access to baseball, softball, and tennis. Also soccer practice field.RED ARROW 5- Access to band and lacrosse practice field, via student parking lotTable of contentsContact Information1Role Descriptions—Members of the Sports Medicine Team2Athletic Training Room3RulesRehabilitation & Return to Play-pg 6Visiting Team Services7Emergency Action Plan8Emergency Phone Numbers-hospitals and ATC, and ortho Carolina urgent caresVenue Locations AED Plan……………………………………………………………..…………………………….13Gfeller-Waller Concussion Awareness Act………………………………………………………...15Concussion Protocol……………………………………………………………………………..…17Heat Illness………………………………………………………………………………………….21Severe Weather Safety……………………………………………………………………………...25Communicable Disease & Skin Infection Procedures…………………………………………...…26MRSA ProtocolAppendixNCHSAA Sport Pre-Participation Examination FormPost-Concussion Self-Reported Symptom ScaleHome Management Plan/Instructions Post-ConcussionGfeller-Waller Concussion Clearance FormNCHSAA Concussion Return to Play FormSkin Condition Physician Release FormPrescribed Appliance in Athletic Contest-required physician signature on form to participate w/ approved ? in foam.Contact InformationMeg Thompson,LAT, ATC,HeadAthletic TrainerOrtho Carolina Office: 704-323-2926Cell: 704.491.7708LNHS : 704.799.8555 Email:mthompson@iss.k12.nc.usmeg.thompson@Mckenzie Graham1st ResponderCell: 704.746.5341Email: mckenziegraham22@Jay Keener,Athletic DirectorLNHS:704.799.8555Cell: 704.902.2110Email: jkeener@iss.k12.nc.usKeith Gentle, PrincipalOffice: 704.799.8555Email: kgentle@iss.k12.nc.usBrian Delay, MD, Team Orthopedic PhysicianOrthoCarolinaOffice: 704.323.2800Matt Dobler, PA, Team Sports Medicine PAOrtho CarolinaOffice: 704.323.2800Certified Athletic Trainer (ATC)An allied health care professional educated and skilled especially in sports related healthcare. In collaboration with physicians and other allied health care personnel, they serve as the tip of the sword of the athletic health care team at Lake Norman High School. All Certified Athletic Trainers are required by the national certifying body, Board of Certification (BOC) and the State of North Carolina (NCBATE) to maintain our skill through Continuing Education Requirements in health care, while also maintaining current BLS for Healthcare Providers (CPR & AED) certification from the American Heart Association and qualifications in First Aid and Blood borne Pathogens.Athletic Trainers are certified by the National Athletic Trainer Association NATA) &Board of Certification (BOC), after completing a university course of study leading to a bachelors or masters degree in athletic training. This body requires that qualified individuals take extensive written and oral examinations testing their skills in the prevention of injuries/illnesses, the recognition, evaluation, and immediate care of injuries/illnesses, the rehabilitation and reconditioning of injuries/illnesses, administration of this health care plan, and professional development and responsibility.In addition, as of 1997, all individuals who practice athletic training in the State of North Carolina are required to hold a specific license to practice per General Statute (S.L 1997-387).Team PhysicianThe team physician must have an unrestricted medical license and be an MD who is responsible for treating and coordinating the medical care of athletic team members. The principal responsibility of the team physician is to provide for the well being of the individual student-athletes enabling each of them to realize his/her full potential. The team physician should possess special proficiency in the care of musculoskeletal injuries and medical conditions associated with sports. The team physician also must oversee the ATC protocols filed with the North Carolina Board of Athletic Training Examiners.First ResponderA person designated by the school to provide first aid services at athletic events. A first responder must complete and maintain certification or be in the process of completing courses in the following:Cardio-pulmonary resuscitation as certified by an organization such as the American Red Cross or the American Heart Association;First aid as certified by an organization such as the American Red Cross or the American Heart Association; andInjury prevention and management as certified by an organization such as the National Athletic Trainers’ Association, the North Carolina High School Athletic Association. In addition, each first responder must complete 20 hours in staff development each school year.Head CoachAll coaching personnel who may be associated with medical coverage for interscholastic sports participation shall be at least minimally qualified as stated in the NCHSA Guidelines.Athletic Training RoomLocationThe Athletic Training Roomfor fall sports is located in Fieldhouse by main athletic field, inside of JV locker room. For winter and spring sportsit is located gymnasium level in hallway with auxiliary gym.Hours of OperationThe Athletic Training Room (ATR) will be open Monday through Friday 4th block (2:00 pm) will remain open throughout the afternoon as indicated by the Athletic Trainer. On weekends and holidays, the ATR will be open one hour prior to practices/games, as needed.In case of inclement weather, the ATR will close ONLY if classes are canceled. If the school has a delayed opening, then the hours of operation would commence at the regular scheduled operating hours.If there is a conflict with scheduled games and the operation hours, coaches and players will be notified by means of a posted sign on the ATR door stating when the ATR is closing and where the Athletic Trainer will be located.RulesNO CLEATS OR SPIKES allowed in the athletic training room.NO shoes allowed on the taping/treatment tables.Sign into injury log notebook, and report to the athletic trainer before doing any treatment or rehab. NO SELF TREATMENTS.Supplies should only be used when the athletic trainer gives permission.All athletes must be clean and properly dressed (athletic shorts and t-shirt) before entering the athletic training room unless otherwise stated by the athletic trainer.Return all equipment issued to you (i.e. crutches, ace wraps, pads, etc.).Allow ample time for pre-practice treatments.Treatment times will be arranged according to the availability of the athletic trainer and the needs of the athletes.Report all injuries to your coach and athletic trainer as soon as possible.If an athlete goes to the doctor, they MUST bring a note from that doctor clearing them to return to sports (not just school). This includes the emergency room.In the event that a licensed physician, physician’s assistant or nurse practitioner states that the student-athlete CAN return to activity, the Lake Norman High School Athletic Training staff reserves the right to still hold the athlete if they feel it is in the best interest of the student-athlete.Rehabilitation is mandatory for all athletes that are receiving daily taping treatments.The athletic training room will be locked at all times when not in use for athletics events. These facilities are under the direct supervision of the athletic trainer; no one is allowed to use these facilities without the knowledge and approval of the athletic trainer. Coaches: Please respect this and understand the importance behind this rule. ATR rules and policies will be given to every coach and student-athlete. Copies of the operating hours will be posted in the ATR and outside the door. If these rules are broken or if an athlete does not adhere to the rules and policies, the Athletic Trainer has the right to refuse treatment, and it will be the responsibility of the coach to deal with the athlete.Rehabilitation& TreatmentAll student-athletes will report to rehabilitation (rehab) at 1:30-2:30pm. Or immediately at 3:15 bell if they don’t have PE as a 4th block. Practice participation for that day will be determined at this time. Athletes that do not show up for rehab will only be allowed to practice at the discretion of the athletic trainer and respective coach. Return to pLay CriteriaReturn to play criteria status is made by multiple individuals. In the event that a licensed physician, physician’s assistant or nurse practitioner states that the student-athlete CANNOT return to activity for a specified amount of time or prior to Lake Norman High’s Team Physician reviewing the specific situation, then that decision MUST be adhered to.In the event that a licensed physician, physician’s assistant or nurse practitioner states that the student-athlete CAN return to activity, the athlete must have a written note indicating so.If the athlete has not been referred to a medical professional and has no direct recommendations from a healthcare professional, the head athletic trainer or the assistant athletic trainer will then make the decision as to when the athlete can return to play. The decision will be made with consultation of the Team Physician as necessary.RETURN TO PLAY CRITERIA FOR AN ATHLETE THAT HAS SUSTAINED A HEAD INJURY IS SOLEY THE DECISION OF THE TEAM PHYSICIAN, OTHER PHYSICIAN IN CONSULATION WITH THE TEAM PHYSICIAN, OR HEAD ATHLETIC TRAINER. NO ATHLETE SHALL RETURN TO PLAY, EVEN WHEN CLEARED BY A PHYSICIAN, WITHOUT WRITTEN NOTICE BEING TURNED INTO THE ATHLETIC TRAINING STAFF, AND CLEARANCE BY THE ATHLETIC TRAINING STAFF. THE ATHLETIC TRAINING STAFF RESERVES THE RIGHT, EVEN UPON CLEARANCE BY A PHYSICIAN TO HOLD THE ATHLETE FROM COMPETITION IF IT IS FELT THAT IT IS IN THE BEST INTEREST OF THE ATHLETE. NO EXCEPTIONS WILL BE MADE.In all cases, where a licensed physician, physician’s assistant, nurse practitioner, or other healthcare provider sees an athlete, the athlete must submit a written note indicating permission to return to play to the athletic trainer prior to returning to play. Visiting team servicesThe following will be provided for all visiting teams:WaterInjury ice & bagsConference rules state: Visiting team must bring their own water bottles. If a team is traveling without at Athletic Trainer, written permission and directions for the use of modalities (tape, heat, stretch, etc) for each athlete requiring treatment should be provided. Please also provide your team’s Athletic Trainer’s telephone number if he/she needs to be contacted. No athlete from a visiting team will receive treatment without written consent.Emergency Action PlanThe following emergency action plan is a general outline for Lake Norman High School Sports Medicine Department. Specific emergency plans for each individual sport and/or athletic facility/venue detailing emergency phone numbers, entrances and access routes, emergency phone locations, etc. are available in both sports medicine facilities and can be found in the Appendix of this manual. With athletic association practice and competition, the first responder to an emergency situation is typically a member of the sports medicine staff, most commonly a certified athletic trainer. A team physician will not usually be present at practices or competition. The type and degree of sports medicine coverage for an athletic event may vary widely, based on such factors as the sport or activity, the setting, and the type of training or competition. It is expected that every full-time athletic staff member, volunteer coach, and student-athletic trainers make themselves 100% knowledgeable about all facets of the Emergency Action Plan.NOTE: In the event that a certified athletic trainer is not on site during an emergency due to coverage guidelines, it is the coach’s responsibility to initiate the Emergency Action Plan.**All members of the emergency response team must make sure a member of the Sports Medicine staff, the Principal, and the Athletic Director are notified of any/all student-athletes taken to the Emergency Room, regardless of the transportation method.Emergency Phone NumbersAmbulance/Police/Fire9-911 (on-campus phone)911 (off-campus/pay phone)Poison Control Center1-800-222-1222Sherriff Iredell County Department-(704)664-7500Shepherd Rescue Squad-(704)663-5159Presbyterian-Huntersville ER(704) 316-409010030 Gilead RdHuntersville NC 28078Lake Norman Regional Hospital704-660-4000171 Fairview Rd. Mooresville NC 28117Lakeside Urgent Care(704)-316-1635130 Plantation Ridge Dr.Mooresville NC 28117Meg Thompson,LAT, ATC,HeadAthletic TrainerOrtho Carolina Office: 704-323-2926Cell: 704.491.7708LNHS : 704.799.8555 Email: mthompson@iss.k12.nc.usmeg.thompson@ Mckenzie Graham 1st ResponderCell: 704.746.5341Email: mckenziegraham22@Jay Keener,Athletic DirectorLNHS: 704.799.8555Cell: 704.902.2110Email: jkeener@iss.k12.nc.usKeith Gentle, PrincipalOffice: 704.799.8555Email: kgentle@iss.k12.nc.us____________________________0-512445Brian Delay, MD, Team Orthopedic PhysicianOrthoCarolinaAddress: Physicians Plaza, 10030 Gilead Road, Suite 130, HuntersvillePhone: (704) 323-2819Matt Dobler, PA, Team Sports Medicine PAOrtho Carolina HuntersvilleOrtho Carolina Urgent Care for after hours informationOffice: 704.323.2800Mooresville, NC 281179848 North Tryon St, Charlotte, NC 28262704.323.2104HoursMonday – Friday5:30 p.m. - 9 p.m.Saturday & Sunday10 a.m. - 2 p.m.142875600075 LAKE NORMAN HIGH SCHOOL CAMPUS MAP FOR EMERGENCY ACCESS020000 LAKE NORMAN HIGH SCHOOL CAMPUS MAP FOR EMERGENCY ACCESS1333506648450BUS ENTRANCE- ACCESS TO BACK OF SCHOOL ONLY. NO FIELD ACCESSMAIN ENTRANCE: RED ARROW 1- Front door to school access to office, commons, and main level.RED ARROW 2- 2nd door entrance to weight room and main gymnasium level.RED ARROW 3- Main field access via service road. Visitors side of field and Fieldhouse level.RED ARROW 4- Service road access to baseball, softball, and tennis. Also soccer practice field.RED ARROW 5- Access to band and lacrosse practice field, via student parking lot00BUS ENTRANCE- ACCESS TO BACK OF SCHOOL ONLY. NO FIELD ACCESSMAIN ENTRANCE: RED ARROW 1- Front door to school access to office, commons, and main level.RED ARROW 2- 2nd door entrance to weight room and main gymnasium level.RED ARROW 3- Main field access via service road. Visitors side of field and Fieldhouse level.RED ARROW 4- Service road access to baseball, softball, and tennis. Also soccer practice field.RED ARROW 5- Access to band and lacrosse practice field, via student parking lot-2181225-1971675250444020554952002Off-Campus PracticeIn an emergency situation that takes place at an off-campus facility, the developed emergency plan for that specific facility will take affect and cooperation with the facility administration is required.On-Campus PracticesLake Norman High School Sports Medicine personnel and/or other appropriate personnel will go onto the field/court to evaluate the student-athlete, and if necessary, administer basic life support, and stabilize the student-athlete until EMS arrives.If the injury is a suspected football or lacrosse cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician while the facemask is removed as indicated using standard protocols.If the injury is a suspected non-football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician as per standard protocol.The student-athlete will be placed on a spine board using standard protocols once EMS arrives.If the injury is a suspected cardio-respiratory emergency, the certified athletic trainer and/or other appropriate personnel will retrieve, set-up, and use the automated external defibrillator as per State of North Carolina protocols.Lake Norman High School Sports Medicine personnel, a member of the coaching staff, and/or other personnel will immediately use the closest available device to call EMS (911 from a non-campus phone, 9-911 from a campus phone) and direct them to the appropriate location. A member of the athletic staff will proceed to pre-determined locations to wait for EMS, direct them to the proper location, and guide them onto the field/court PER THE ABOVE CAMPUS MAP EMERGENCY ACCESS PLAN. Remaining persons will assist with crowd control and securing an unobstructed and safe passageway for EMS personnel.A member of the Lake Norman High School Sports Medicine staff, a member of the coaching staff, and/or a member of the Lake Norman High School athletic department will accompany the injured student-athlete to the medical facility with the injured student-athlete’s emergency medical information.Once at the medical facility, the designated individual will call back to the certified athletic trainer’s cellular phone with any medical updates.The certified athletic trainer will also call Jay Keener, Athletic Director, and/or his designee to provide any medical updates.The certified athletic trainer, a member of the coaching staff, and/or a member of the Lake Norman High School Athletic Department staff will contact the parent/guardian of the respective student-athlete.Home GamesLake Norman High School Sports Medicine personnel and/or other appropriate personnel will go onto the field/court to evaluate the student-athlete, and if necessary, administer basic life support, and stabilize the student-athlete until EMS arrives.If the injury is a suspected football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician while the facemask is removed as indicated using standard protocols.If the injury is a suspected non-football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician as per standard protocol.The student-athlete will be placed on a spine board using standard protocols once EMS arrives.If the injury is a suspected cardio-respiratory emergency, the certified athletic trainer and/or other appropriate personnel will retrieve, set-up, and use the automated external defibrillator as per State of North Carolina protocols.Lake Norman High School Sports Medicine personnel, a member of the coaching staff, and/or other personnel will immediately use the closest available device to call EMS (911 from a non-campus phone, 9-911 from a campus phone) and direct them to the appropriate location PER THE ABOVE CAMPUS MAP EMERGENCY ACCESS PLAN. After activating EMS, game management personnel should notify all applicable personnel to discontinue all cheerleading and band activities, promotions, commercial announcements, etc.Game management personnel and/or other personnel will proceed to pre-determined locations to wait for EMS, direct them to the proper location, and guide them onto the field/court.Game management personnel and/or other personnel will assist with crowd control and securing an unobstructed and safe passageway for EMS personnel.A member of the Lake Norman High School Sports Medicine staff, a member of the coaching staff, and/or a member of the Lake Norman High School athletic department will accompany the injured student-athlete to the medical facility with the injured student-athlete’s emergency medical information.Once at the medical facility, the designated individual will call back to the certified athletic trainer’s cellular phone with any medical updates.The certified athletic trainer will also call Jay Keener, Athletic Director, and/or his designee to provide any medical updates.The certified athletic trainer, a member of the coaching staff, and/or a member of the Lake Norman High School Athletic Department staff will contact the parent/guardian of the respective student-athlete.Venue Directions: Football / Soccer / Track & Field/ LacrosseField stadium is located on Doolie Road, directly behind the school. From Doolie Road, turn right into main entrance of school at the guard shack. Enter stadium at RED ARROW #3 LOWER FIELD SIDE PER ABOVE CAMPUS MAP.Lake Norman High School Sports Medicine personnel and/or other appropriate personnel will go onto the field/court to evaluate the student-athlete, and if necessary, administer basic life support, and stabilize the student-athlete until EMS arrives.If the injury is a suspected football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician while the facemask is removed as indicated using standard protocols, and while assessment is initiated.If the injury is a suspected non-football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician as per standard protocol. Assessment will be initiated at this time. The 2015 NATA Statement on helmet and shoulder pad removal with suspected spinal injury. Simply states that helmet and shoulder pad removal on the field prior to transport, IF there are 3 or more trained personal to implement the procedure. Removal is to be determined on a case by case situation by the certified athletic trainer or team physician. Otherwise, athlete is stabilized with helmet and pad on, facemask removed prior to transport. The student-athlete will be placed on a spine board using standard protocols once EMS arrives.If the injury is a suspected cardio-respiratory emergency, the certified athletic trainer and/or other appropriate personnel will retrieve, set-up, and use the automated external defibrillator as per State of North Carolina protocols.Lake Norman High School Sports Medicine personnel, a member of the coaching staff, and/or other personnel will immediately use the closest available device to call EMS (911 from a non-campus phone, 9-911 from a campus phone) and direct them to the appropriate location. A member of the athletic staff will proceed to pre-determined locations to wait for EMS, direct them to the proper location, and guide them onto the field/court.Remaining persons will assist with crowd control and securing an unobstructed and safe passageway for EMS personnel.A member of the Lake Norman High School Sports Medicine staff, a member of the coaching staff, and/or a member of the Lake Norman High School athletic department will accompany the injured student-athlete to the medical facility with the injured student-athlete’s emergency medical information.Once at the medical facility, the designated individual will call back to the certified athletic trainer’s cellular phone with any medical updates.The certified athletic trainer will also call Jay Keener, Athletic Director, and/or his designee to provide any medical updates.The certified athletic trainer, a member of the coaching staff, and/or a member of the Lake Norman High School Athletic Department staff will contact the parent/guardian of the respective student-athlete.Venue Directions: Baseball / SoftballThe baseball and softball stadiums are located Hwy 150to 186 Doolie Road, 2nd entrance to school property, follow school buildings and black fencing along outside of stadium, continue onto sidewalk small blue shack and gait to reach baseball/softball fields and tennis courts. RED ARROW #4 DOWN SIDEWALK TO FIELDS PER ABOVE CAMPUS MAP.Lake Norman High School Sports Medicine personnel and/or other appropriate personnel will go onto the field/court to evaluate the student-athlete, and if necessary, administer basic life support, and stabilize the student-athlete until EMS arrives.If the injury is a suspected football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician while the facemask is removed as indicated using standard protocols, and while assessment is initiated.If the injury is a suspected non-football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician as per standard protocol. Assessment will be initiated at this time. The 2015 NATA Statement on helmet and shoulder pad removal with suspected spinal injury. If there is a suspected spinal cord injury with a head on collision in baseball/softball. Spine must be immediately stabilized by coach, while appropriate athletic personal are contacted by someone else. 911called 1st, ATC called 2nd. Meg Thompson 704-491-7708The student-athlete will be placed on a spine board using standard protocols once EMS arrives.If the injury is a suspected cardio-respiratory emergency, the certified athletic trainer and/or other appropriate personnel will retrieve, set-up, and use the automated external defibrillator as per State of North Carolina protocols.Lake Norman High School Sports Medicine personnel, a member of the coaching staff, and/or other personnel will immediately use the closest available device to call EMS (911 from a non-campus phone, 9-911 from a campus phone) and direct them to the appropriate location. A member of the athletic staff will proceed to pre-determined locations to wait for EMS, direct them to the proper location, and guide them onto the field/court.Remaining persons will assist with crowd control and securing an unobstructed and safe passageway for EMS personnel.A member of the Lake Norman High School Sports Medicine staff, a member of the coaching staff, and/or a member of the Lake Norman High School athletic department will accompany the injured student-athlete to the medical facility with the injured student-athlete’s emergency medical information.Once at the medical facility, the designated individual will call back to the certified athletic trainer’s cellular phone with any medical updates.The certified athletic trainer will also call Jay Keener, Athletic Director, and/or his designee to provide any medical updates.The certified athletic trainer, a member of the coaching staff, and/or a member of the Lake Norman High School Athletic Department staff will contact the parent/guardian of the respective student-athlete.Venue Directions: Gymnasium / Weight RoomLake NormanHigh School gymnasium is located Hwy 150 to 186 Doolie Road, 2nd entrance to school property, follow school buildings. To entergymnasium at court level, RED ARROW #2 THROUGH DOUBLE GLASS DOORS. Weight room to right. Main gymnasium straight ahead on right black doors. Lake Norman High School Sports Medicine personnel and/or other appropriate personnel will go onto the field/court to evaluate the student-athlete, and if necessary, administer basic life support, and stabilize the student-athlete until EMS arrives.If the injury is a suspected football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician while the facemask is removed as indicated using standard protocols, and while assessment is initiated.If the injury is a suspected non-football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician as per standard protocol. Assessment will be initiated at this time. The 2015 NATA Statement on helmet and shoulder pad removal with suspected spinal injury. Not applicable for weight room. The student-athlete will be placed on a spine board using standard protocols once EMS arrives.If the injury is a suspected cardio-respiratory emergency, the certified athletic trainer and/or other appropriate personnel will retrieve, set-up, and use the automated external defibrillator as per State of North Carolina protocols.Lake Norman High School Sports Medicine personnel, a member of the coaching staff, and/or other personnel will immediately use the closest available device to call EMS (911 from a non-campus phone, 9-911 from a campus phone) and direct them to the appropriate location. A member of the athletic staff will proceed to pre-determined locations to wait for EMS, direct them to the proper location, and guide them onto the field/court.Remaining persons will assist with crowd control and securing an unobstructed and safe passageway for EMS personnel.A member of the Lake Norman High School Sports Medicine staff, a member of the coaching staff, and/or a member of the Lake Norman High School athletic department will accompany the injured student-athlete to the medical facility with the injured student-athlete’s emergency medical information.Once at the medical facility, the designated individual will call back to the certified athletic trainer’s cellular phone with any medical updates.The certified athletic trainer will also call Jay Keener, Athletic Director, and/or his designee to provide any medical updates.The certified athletic trainer, a member of the coaching staff, and/or a member of the Lake Norman High School Athletic Department staff will contact the parent/guardian of the respective student-athlete.Venue Directions: Tennis CourtsTennis courts are located on Doolie Road, opposite side of main parking lot. From Doolie Road, turn right into main entrance of school at the guard shack. Enter tennis courts at RED ARROW #4 traveling down sidewalk along baseball field, PER ABOVE CAMPUS MAPLake Norman High School Sports Medicine personnel and/or other appropriate personnel will go onto the field/court to evaluate the student-athlete, and if necessary, administer basic life support, and stabilize the student-athlete until EMS arrives.If the injury is a suspected football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician while the facemask is removed as indicated using standard protocols.If the injury is a suspected non-football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician as per standard protocol.The student-athlete will be placed on a spine board using standard protocols once EMS arrives.If the injury is a suspected cardio-respiratory emergency, the certified athletic trainer and/or other appropriate personnel will retrieve, set-up, and use the automated external defibrillator as per State of North Carolina protocols.Lake Norman High School Sports Medicine personnel, a member of the coaching staff, and/or other personnel will immediately use the closest available device to call EMS (911 from a non-campus phone, 9-911 from a campus phone) and direct them to the appropriate location. A member of the athletic staff will proceed to pre-determined locations to wait for EMS, direct them to the proper location, and guide them onto the field/court.Remaining persons will assist with crowd control and securing an unobstructed and safe passageway for EMS personnel.A member of the Lake Norman High School Sports Medicine staff, a member of the coaching staff, and/or a member of the Lake Norman High School athletic department will accompany the injured student-athlete to the medical facility with the injured student-athlete’s emergency medical information.Once at the medical facility, the designated individual will call back to the certified athletic trainer’s cellular phone with any medical updates.The certified athletic trainer will also call MasonoriToguchi, Athletic Director, and/or his designee to provide any medical updates.The certified athletic trainer, a member of the coaching staff, and/or a member of the Lake Norman High School Athletic Department staff will contact the parent/guardian of the respective student-athlete.Venue Directions: Practice Lacrosse Field and Marching Band practice. Soccer Practice FieldField stadium is located on Doolie Road, opposite side of main parking lot. From Doolie Road, turn right into main entrance of school at the guard shack. Enter band and lacrosse practice field via RED ARROW #5 lower parking lot, PER ABOVE CAMPUS MAP.Lake Norman High School Sports Medicine personnel and/or other appropriate personnel will go onto the field/court to evaluate the student-athlete, and if necessary, administer basic life support, and stabilize the student-athlete until EMS arrives.If the injury is a suspected football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician while the facemask is removed as indicated using standard protocols, and while assessment is initiated.If the injury is a suspected non-football cervical spine injury, in-line head and shoulder stabilization will be maintained by the certified athletic trainer or the team physician as per standard protocol. Assessment will be initiated at this time. The 2015 NATA Statement on helmet and shoulder pad removal with suspected spinal injury. Simply states that helmet and shoulder pad removal on the field prior to transport, IF there are 3 or more trained personal to implement the procedure. Removal is to be determined on a case by case situation by the certified athletic trainer or team physician. Otherwise, athlete is stabilized with helmet and pad on, facemask removed.The student-athlete will be placed on a spine board using standard protocols once EMS arrives.If the injury is a suspected cardio-respiratory emergency, the certified athletic trainer and/or other appropriate personnel will retrieve, set-up, and use the automated external defibrillator as per State of North Carolina protocols.Lake Norman High School Sports Medicine personnel, a member of the coaching staff, and/or other personnel will immediately use the closest available device to call EMS (911 from a non-campus phone, 9-911 from a campus phone) and direct them to the appropriate location. A member of the athletic staff will proceed to pre-determined locations to wait for EMS, direct them to the proper location, and guide them onto the field/court.Remaining persons will assist with crowd control and securing an unobstructed and safe passageway for EMS personnel.A member of the Lake Norman High School Sports Medicine staff, a member of the coaching staff, and/or a member of the Lake Norman High School athletic department will accompany the injured student-athlete to the medical facility with the injured student-athlete’s emergency medical information.Once at the medical facility, the designated individual will call back to the certified athletic trainer’s cellular phone with any medical updates.The certified athletic trainer will also call Jay Keener, Athletic Director, and/or his designee to provide any medical updates.The certified athletic trainer, a member of the coaching staff, and/or a member of the Lake Norman High School Athletic Department staff will contact the parent/guardian of the respective student-athlete.Automated External Defibrillator (AED)Policies and ProceduresMedical Necessity for Use of AEDDefibrillation is a recognized means of termination of certain potentially fatal arrhythmias during a cardiac arrest. Automated external defibrillators, or AEDs, accurately analyze cardiac rhythms and, if appropriate, advise/deliver an electric counter-shock. AEDs are currently widely used by trained emergency personnel and have become an essential link in the “chain of survival” as defined by the American Heart Association. Early accessEarly CPR by first responders or bystandersEarly defibrillationEarly advanced life supportIt is recognized that successful resuscitation is related to the length of time between the onset of a heart rhythm that does not circulate blood (ventricular fibrillation or VF, pulseless ventricular tachycardia) and defibrillation. The AHA states that with every minute it takes to respond, the chance for successful defibrillation decreases 7-10%. The provision of timely emergency attention saves lives. Athletic events (both practice and competition) present a high risk for cardiopulmonary emergencies. Therefore, by training certified athletic trainers and team physicians in the use of AEDs, the emergency response time is shortened.Explanation of the Use of AEDAutomated external defibrillator, or AED, means a defibrillator which:is capable of cardiac rhythm analysiswill charge and deliver a counter-shock after electrically detecting the presence of cardiac dysrhythmiais capable of continuous recording of the cardiac dysrhythmia at the sceneis capable of producing a hard copy of the electrocardiogramWritten Medical Protocol Regarding Use of AEDUse of the AED will follow the American Heart Association AED treatment algorithm. The AED is to be used only on patients in cardiopulmonary arrest. Before the device is utilized to analyze the patient’s ECG rhythm, the patient must be:unconsciouspulseless, andnot breathing The device is, however, not intended for children less than eight years of age and/or victims weighing less than 90 pounds. Lake Norman High School sports medicine staff will shock until “no shock indicated” message is received. VF is not longer present, the patient converts to a perfusing rhythm, or an advanced life support team arrives on scene and assumes control.Provisions to Coordinate with Local EMSIn the event of a cardiopulmonary emergency, the 911 emergency system should be activated as quickly as possible. The ATC or first responders should provide initial care as appropriate to the situation and coordinate with other emergency medical service providers upon their arrival in the provision of CPR, defibrillation, basic life support, and advanced life support.Operator ConsiderationsThe AED is intended for use by personnel (coaches, certified athletic trainers, and team physicians) who are authorized by a physician/medical director and have, at a minimum, the following skills and training:CPR training certificationAED training certificationTraining in the use of the AEDs located on siteLocation of and Maintenance Required for AEDsLake Norman High School has two (2) AED units. They are housed in the following locations:Main OfficeFall sports located in fieldhouse training room (JV locker room entrance). Winter and spring sports located Main Athletic Training Room in auxiliary gym hallway.During all football outdoor practices, competitions, and scrimmages an AED will be located on the Sports Medicine Golf cart or with ATC/1st responder medical supplies. AED travels with ATC/1st responder for all home events winter and spring seasons.GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2011 SESSION LAW 2011-147 HOUSE BILL 792AN ACT TO ENACT THE GFELLER-WALLER CONCUSSION AWARENESS ACT. The General Assembly of North Carolina enacts: TITLE OF ACT SECTION 1. This act may be known and cited as the Gfeller-Waller Concussion Awareness Act. DEVELOPMENT OF AN ATHLETIC CONCUSSION SAFETY TRAINING PROGRAM SECTION 2.(a) The Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center at UNC-Chapel Hill in consultation with the North Carolina Medical Society, the North Carolina Athletic Trainers Association, the Brain Injury Association of North Carolina, the North Carolina Neuropsychological Society, the North Carolina High School Athletic Association, Inc., and the Department of Public Instruction shall develop an athletic concussion safety training program. The program shall be developed for the use of coaches, school nurses, school athletic directors, volunteers, students who participate in interscholastic athletic activities in the public schools, and the parents of these students. SECTION 2.(b) The program shall include, but not be limited to, the following: (1) Written information detailing the recognition of the signs and symptoms of concussions and other head injuries. (2) A description of the physiology and the potential short-term and long-term effects of concussions and other head injuries. (3) The medical return-to-play protocol for postconcussion participation in interscholastic athletic activities. CONCUSSION SAFETY REQUIREMENTS FOR INTERSCHOLASTIC ATHLETIC COMPETITION SECTION 3. G.S. 115C-12(23) reads as rewritten: "(23) Power to Adopt Eligibility Rules for Interscholastic Athletic Competition. – The State Board of Education may shall adopt rules governing interscholastic athletic activities conducted by local boards of education, including eligibility for student participation. With regard to middle schools and high schools, the rules shall provide for the following:a.All coaches, school nurses, athletic directors, first responders, volunteers, students who participate in interscholastic athletic activities, and the parents of those students shall receive, on an annual basis, a concussion and head injury information sheet. School employees, first responders, volunteers, and students must sign the sheet and return it to the coach before they can participate in interscholastic athletic activities, including tryouts, practices, or competition. Parents must sign the sheet and return it to the coach before their children can participate in any such interscholastic athletic activities. The signed sheets shall be maintained in accordance with sub-subdivision d. of this subdivision. For the purpose of this subdivision, a concussion is a traumatic brain injury caused by a direct or indirect impact to the head that Page 2 Session Law 2011-147 SL2011-0147 results in disruption of normal brain function, which may or may not result in loss of consciousness. b.If a student participating in an interscholastic athletic activity exhibits signs or symptoms consistent with concussion, the student shall be removed from the activity at that time and shall not be allowed to return to play or practice that day. The student shall not return to play or practice on a subsequent day until the student is evaluated by and receives written clearance for such participation from (i) a physician licensed under Article 1 of Chapter 90 of the General Statutes with training in concussion management, (ii) a neuropsychologist licensed under Article 18A of Chapter 90 of the General Statutes with training in concussion management and working in consultation with a physician licensed under Article 1 of Chapter 90 of the General Statutes, (iii) an athletic trainer licensed under Article 34 of Chapter 90 of the General Statutes, (iv) a physician assistant, consistent with the limitations of G.S. 90-18.1, or (v) a nurse practitioner, consistent with the limitations of G.S. 90-18.2. c.Each school shall develop a venue specific emergency action plan to deal with serious injuries and acute medical conditions in which the condition of the patient may deteriorate rapidly. The plan shall include a delineation of roles, methods of communication, available emergency equipment, and access to and plan for emergency transport. This plan must be (i) in writing, (ii) reviewed by an athletic trainer licensed in North Carolina, (iii) approved by the principal of the school, (iv) distributed to all appropriate personnel, (v) posted conspicuously at all venues, and (vi) reviewed and rehearsed annually by all licensed athletic trainers, first responders, coaches, school nurses, athletic directors, and volunteers for interscholastic athletic activities.d.Each school shall maintain complete and accurate records of its compliance with the requirements of this subdivision pertaining to head injuries.The State Board of Education may authorize a designated organization to apply and enforce the Board's rules governing participation in interscholastic athletic activities at the high school level." EFFECTIVE DATE SECTION 4. This act is effective when it becomes law and applies beginning with the 2011-2012 school year. In the General Assembly read three times and ratified this the 13th day of June, 2011. s/ Walter H. Dalton President of the Senate s/ Dale R. FolwellSpeaker Pro Tempore of the House of Representatives s/ Beverly E. Perdue Governor Approved 11:55 a.m. this 16th day of June, 2011LAKE NORMAN High schoolConcussion ProtocolThe following policy outlines the procedures to be followed in the management of mild traumatic brain injury (mTBI), or concussion. This policy describes baseline neurocognitive testing, initial management, serial monitoring, and return to play guidelines developed in order to provide for the safety and well being of those student-athletes participating Lake Norman High School Athletics.A concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. This includes a direct blow to the head, face, neck or elsewhere on the body, which creates an impulsive force transmitted to the head, resolves spontaneously and follows a sequential course altLake Norman some post concussive symptoms may be prolonged.Signs and SymptomsSYMPTOMSPhysicalHeadacheDizzinessNauseaBalance DifficultiesLight SensitivityDouble VisionFatigueFeeling dazed, stunned, dingedRinging in the earsCognitiveConfusionAmnesiaDisorientationPoor ConcentrationMemory DisturbanceReasoning DifficultiesEmotionalIrritabilitySadnessNervousnessDepressionMoodinessSleep DisturbancesPHYSICAL SIGNSLoss of/Impaired ConsciousnessPoor Coordination or BalanceInappropriate EmotionsVacant Stare/Glassy EyedInappropriate BehaviorPoor Coordination or BalanceSlow to Answer QuestionsVomitingSlurred speechConcussive Convulsion/Impact SeizureSlow to Follow DirectionsEasily Distracted, Poor ConcentrationPersonality ChangesSignificantly Decreased PerformanceBaseline AssessmentAll incoming freshmen or those first entering Lake Norman High School who are participating in those sports which have been identified as a high-risk contact or collision sport and/or those who have had a previous history of concussion or mTBI as identified by their health history will have a baseline neurocognitive test (ImPACT) performed as part of their athletic medical screening. The sports which currently undergo ImPACT testing are football, soccer, wrestling, basketball, lacrosse, diving, and pole vaulting. Time of InjuryIf concussion is suspected, a cervical spine injury should be excluded. Vital signs such as blood pressure and heart rate should be monitored.If symptoms have cleared within 15 minutes, then the student-athlete will complete a set of sports-specific drills withexertion to stimulate a return of symptoms. If symptoms do not return, then the athlete can be considered for return to play. According to state policy, any athlete that is suspected of having sustained a possible concussion cannot return to play that day and cannot return without a doctor’s note.An athlete who has lost consciousness or has amnesia lasting longer than 15 minutes will be referred to a physician on the same day.If the student-athlete is suffering from the following symptoms, he/she will be immediately transported to the hospital for imaging:Prolonged loss of consciousness (>1 minute) and/orFocal neurologic deficit and/orSignificant alteration or deterioration in mental statusIncrease in symptoms or concern that there might be a bleedWritten instructions will be given to the athlete and to another responsible adult who will observe and supervise the athlete during the acute stages of a concussion.A checklist will be administered by the Athletic Trainer to determine the number of symptoms after the event; the student-athlete will complete the Self-Reported Symptom Scale every 24 hours until symptom free and after each graded exertion test completed by the student-athlete thereafter. This information will be shared with the referring physician during each post-concussive evaluation.RecommendationsStudent-athletes should cease doing any activity that causes the symptoms of a concussion to increase.If recommended by the Attending Physician, Tylenol or Acetaminophen may be used to help headache symptoms. NO IBUPROFEN.School modifications may be necessary, and should be initiated based on student-athlete’s symptoms.Student-athletes should not return to physical activity until they are symptom free and their ImPACT testing in within normal limits.Return to Play DecisionsIf symptoms have cleared within 15 minutes, then the student-athlete will complete a set of sports-specific exertion drills to stimulate a return of symptoms. If symptoms do not return, then the athlete can be considered for return to play.An athlete may not return to full participation in sports after a concussion fora minimum 5 days after asymptomatic assessment with physician clearance, neurocognitive testing (ImPACT) is within normal limits AND completion of the Functional Exertion Testing Protocol.Return to play should occur in gradual steps beginning with light aerobic exercise only to increase your heart rate (e.g. stationary cycle); moving to increasing your heart rate with movement (e.g. running); then adding controlled contact if appropriate; and finally return to sports competition.Pay careful attention to your symptoms and your thinking and concentration skills at each stage or activity. After completion of each step without recurrence of symptoms, you can move to the next level of activity the next day. Move to the next level of activity only if you do not experience anysymptoms at the present level. If your symptoms return, let your health care provider know, return to the first level and restart the program gradually.Day 1: Light aerobic exercise; no resistance trainingStationary bike: 10-20 minutesDay 2: Moderate aerobic exercise: no resistance trainingContinuous jogging: 10-20 minutes, target HR>140-170bpmDay 3: Weigh-training SessionWarm-up with light, aerobic exerciseDo not allow any 1-rep max or sub-maximal liftingMonitor breathing & technique throughout sessionDay 4: Sprinting (anaerobic exertion)Minimum of 5 sprints of 30 yardsDay 5: Non-contact agility drills, Non-contact practiceSport specific activitiesDay 6: Full contact practiceThis protocol should not be initiated until the student-athlete is asymptomatic and their neurocognitive testing (ImPACT) is within normal limits.If at any point during the progression post-concussive symptoms return, the student-athlete will revert back to the previous asymptomatic step after he/she returns to an asymptomatic state. If symptoms do not resolve, the Attending Physician should be consulted and appropriate medical attention should be provided.RETURN TO PLAY CRITERIA FOR AN ATHLETE THAT HAS SUSTAINED A HEAD INJURY IS SOLEY THE DECISION OF THE TEAM PHYSICIAN, OTHER PHYSICIAN IN CONSULATION WITH THE TEAM PHYSICIAN, OR HEAD ATHLETIC TRAINER. NO ATHLETE SHALL RETURN TO PLAY, EVEN WHEN CLEARED BY A PHYSICIAN, WITHOUT WRITTEN NOTICE BEING TURNED INTO THE ATHLETIC TRAINING STAFF, AND CLEARANCE BY THE ATHLETIC TRAINING STAFF. THE ATHLETIC TRAINING STAFF RESERVES THE RIGHT, EVEN UPON CLEARANCE BY A PHYSICIAN TO HOLD THE ATHLETE FROM COMPETITION IF IT IS FELT THAT IT IS IN THE BEST INTEREST OF THE ATHLETE. NO EXCEPTIONS WILL BE MADE.Multiple concussions Athletes who sustain a second concussion within the same competitive season or an adjacent season will be referred to a physician and will not be allowed to return to play without the physician’s clearance. These student-athletes should not begin the Functional Exertion Protocol for a minimum of 9 days following asymptomatic self-report and normalization of all testing measures, and cannot return to full contact participation until 15 days following normalization of all testing measures.Heat Illness Prevention and ManagementHeat illness is inherent in athletic participation and can produce many different types of medical problems. Heat illness primarily will affect those athletes involved in high-intensity or long-duration exercise. The incidence of heat illness increases as ambient temperature and relative humidity increase, but can occur in the absence of hot and humid conditions.Risk Factors for Heat IllnessDehydrationBarriers to evaporation (i.e. athletic equipment, rubber suits)Current or recent illnessHistory of heat illnessIncreased body mass indexWet bulb globe temperature previous night/dayPoor physical conditionExcessive or dark-colored clothing or equipmentOverzealous athletesLack of acclimatizationCertain medications & drugsElectrolyte imbalancePredisposing medical conditionsPoor dietHeavy/salty sweatersCertain supplements and/or ergogenic aidesLow percent body fatPrevention & RecommendationsThe National Athletic Trainers’ Association recommends educating student-athletes on the effects of dehydration and over-hydration on physical performance. Identify student-athletes susceptible to heat illness and dehydration prior to participation and developing a subsequent hydration protocol can optimize hydration status throughout participation. In addition, acclimatization to the weather or climate can help prevent heat loss. The process of acclimatization can take up to 12 or more days in adolescents and should begin prior to the start of the season.Recognition & ManagementExercise-Associated Muscle (Heat) CrampsSigns & SymptomsTreatmentDehydrationThirstSweatingTransient muscle crampsFatigueStop activity; move to shaded, cool areaProvide sodium-containing fluidMild stretching with massage of muscle spasmPlace student-athlete in recumbent positionGive athlete Heat Illness Warning sheetD/C participation that day; RTP next day if weight loss is <3% and athlete’s hydration status is WNLHeat SyncopeSigns & SymptomsTreatmentBrief episode of faintingDizzinessTunnel visionPale or sweaty skinDecreased pulseNormal body tempStop activity; move to shaded, cool areaProvide sodium-containing fluidMonitor vital signsElevate legs above headGive athlete Heat Illness Warning sheetD/C participation that day; RTP next day if weight loss is <3% and athlete’s hydration status is WNLHeat ExhaustionSigns & SymptomsTreatmentRaised body temperature (<104°F)Headache, dizziness, faintnessNormal blood pressureTachycardia (rapid heart rate)Weak pulseDehydrationCold, damp, ashen skinNausea and/or vomitingProfuse sweatingStop activity; move to shaded, cool areaRemove equipment/constrictive clothingMonitor vital signsElevate legs above head Provide sodium-containing fluidPlace ice towels on athletePlace ice bags on athlete’s neck, wrists, ankles, groin, behind knees, under armsGive athlete Heat Illness Warning sheetD/C participation that day; Consult with physician; RTP 48 hours if weight loss is <3% and athlete’s hydration status is WNLExertional Heat Stroke Signs & SymptomsTreatmentSudden onsetRaised body temperature (<104°F)Pulse rate > 160 bpmRapid respirations (20-30 rpm)Hot, dry, flushed skinNausea/vomitingLack of perspirationDry mouth and/or intense thirstHeadache, dizziness, confusion, lethargyStaggering body control, poor judgmentDecreasing consciousnessConvulsion/muscle spasmsLIFE-THREATENING EMERGENCY. SEEK IMMEDIATE MEDICAL ATTENTION.Stop activity; activate EMS immediatelyRemove from environmentRemove equipment/constrictive clothingMaintain ABCsMonitor vital signsUtilize ice tub/cold whirlpoolProvide sodium-containing fluidNo RTP until written clearance by MD 3-5 day progressive RTPExertionalHyponatremiaSigns & SymptomsTreatmentRaised body temperature (<104°F)Nausea/vomitingExtremity (hands/feet) swellingLow blood-sodium levelsProgressive headacheConfusionSignificant mental compromiseLethargyAltered consciousnessPulmonary edemaCerebral edemaSeizuresComaLIFE-THREATENING EMERGENCY. SEEK IMMEDIATE MEDICAL ATTENTION.Stop activity; activate EMS immediatelyRemove from environmentRemove equipment/constrictive clothingMaintain ABCsMonitor vital signsUtilize ice tub/cold whirlpoolDo NOT administer fluids without MD consentNo RTP until written clearance by MD 3-5 day progressive RTPSickle Cell TraitSigns & SymptomsTreatmentRBC can sickle during exertion in heat MIMICS CRAMPINGTriggered by heat stress, dehydration, and/or lactic acidosisCOLLAPSE EARLY IN EXERCISEHYPERVENTILATIONMEDICAL EMERGENCYLIFE-THREATENING EMERGENCY. SEEK IMMEDIATE MEDICAL ATTENTION.Stop activity; activate EMS immediatelyRemove from environmentRemove equipment/constrictive clothingMaintain ABCsMonitor vital signsProvide fluidsNo Day 1 fitness testsStop at first crampThe heat index is defined by the National Weather Service as the combination of air temperature (Fahrenheit degrees) and relative humidity (percent). This produces a reading of how the air feels to human skin. This “apparent temperature” or “heat index” for a particular day will dictate any cancellations or restricted game and practice conditions. The chart below converts temperature and humidity into heat index.National Weather Service Heat Index ChartThe weather will be monitored by the athletic training staff and any accommodations to games and practices will be determined from there. Accommodations may also need to be made due to air quality. Asthmatic athletes may also have a more difficult time due to air quality.Heat Index Reading….. Restrictions105 or greater…… Danger! Discontinue regular practice. All outside athletic events are to be canceled. Very short restricted practice is permitted. Practice indoors if possible.95-104…….Extreme Caution! Modify practice with frequent (required) water breaks. Games/events may continue with mandatory official time outs midway through quarters. Observe athletes carefully for signs of heat injuries. Make sure athletes drink water.84-93…….Warning. Provide plenty of water, and ensure that they are taking a break every half hour.Below 82…..No restrictions. Water is to be available at all times. Monitor the heat index for increases.SEVERE WEATHER SAFETY POLICYThe certified athletic trainer and/or the athletic director will determine whether or not a practice will continue due to severe weather. During games, these individuals will be in contact with the referees to coordinate efforts to suspend, delay or postpone a game.All coaches please understand that if any of these individuals recommends that the fields be cleared, please do so immediately. If the above individuals are not present, and lightening is spotted, please use common sense and clear the fields.HEAR IT CLEAR IT, SEE IT FLEE ITThe National Athletic T.rainers’ Association recommends the following guidelines for lightening, which we will be following:If severe weather is showing imminent signs, consider delaying the start of an event in order to allow the storm to pass.If lightening is present, use a flash to bang count to determine the distance of the storm. To use the flash to bang count, begin counting when the lightening flash is seen and stop counting when thunder is heard. By the time your flash to bang count is 30 or less, all individuals should be seeking shelter in a safe area.Once the storm has passed you must wait at least 30 minutes after the last sound of thunder or lightening flash before resuming activity. By not waiting the indicated time, you run the risk of a lightning strike by the back end of the storm.LIGHTENING SAFE LOCATIONS Any substantial frequently inhabited building. Buildings are grounded by their plumbing and electrical systems, so they are naturally safe. However, you should not be connected to these systems, i.e. being on the phone, taking a shower. DUG OUTS ARE NOT CONSIDERED ACCEPTABLE SHELTER. Also, the press box is not considered a safe zone. The concession stand is only considered one, if closed up.The secondary choice for a safer location is in an enclosed vehicle with a metal roof and closed windows. Convertible cars do not provide protection from lightening danger. It is important not to touch any part of the car’s metal frame while inside it during a lightning storm.SPECTATORS MUST ALSO CLEAR THE AREA DURING A LIGHTENING DELAY. THEY MAY NOT REMAIN IN THE STANDS.CARE FOR THE LIGHTENING STRUCK ATHLETE:If anyone is struck by lightning, EMS should be activated immediately. Next, the condition of the athlete should be evaluated and appropriate care provided. CPR should be administered if needed. Those still conscious should be treated for shock until EMS arrives.In event of a tornado, all fields must be cleared and athletes and spectators should report to the main building. Communicable Disease &Skin Infection ProceduresThe North Carolina High School Athletic Association (NCHSAA) has adopted the National FederationGuidelines (NFG) in an effort to minimize the possibility of transmission of any infectious disease during ahigh school athletic practice or contest. Each school is strongly encouraged to develop its own actionplan for the prevention of the transmission of infectious municable Disease and Skin Infection ProceduresWhile the risk for blood-borne infectious diseases, such as HIV/Hepatitis B,remains low in sports, proper precautions are needed to reduce the risk of spreadingdiseases. Along with these issues are skin infections that occur due to skin contactwith competitors and equipment.Universal Hygiene Protocol for All SportsShower immediately after all competition and practiceWash all workout clothing after practiceWash personal gear, such as knee pads, periodicallyDon’t share towels or personal hygiene products with othersRefrain from (full body) cosmetic shavingInfectious Skin DiseasesMeans of reducing the potential exposure to these agents include:Notify guardian, athletic trainer and coach of any lesion before competition orpractice. Athlete must have a health-care provider evaluate lesion beforereturning to competition.If an outbreak occurs on a team, especially in a contact sport, consider evaluating other team members for potential spread of the infectious agent.Follow NFHS or NCHSAA guidelines on “time until return to competition.”Allowance of participation with a covered lesion can occur if approved byhealth-care provider and in accordance with NFHS or NCHSAA guidelines.Blood-Borne Infectious DiseasesMeans of reducing the potential exposure to these agents include:Bleeding must be stopped immediately and all wounds covered. All blood-soakedclothing must be removed before continuing competition or practice.Contaminated clothing must be cleaned before using again.Athletic trainers or caregivers need to wear gloves and take other precautions toprevent blood-splash from contaminating themselves or others.Immediately wash contaminated skin or mucous membranes with soap andwater.Clean all contaminated surfaces and equipment with disinfectant before returning to competition. Be sure to use gloves with cleaning.Any blood exposure or bites to the skin that break the surface must be reportedand evaluated by a medical provider immediately.These procedures were obtained and revised by the NFHS (August 2005)All necessary forms: can be found on NC Coaches Association website under Health And Safety. Sport Pre-Participation Examination FormPost-Concussion Self-Reported Symptom ScaleHome Management Plan/Instructions Post-ConcussionGfeller-Waller Concussion Clearance FormNCHSAA Concussion Return to Play FormSkin Condition Physician Release FormPrescribed Appliance in Athletic Contest-required physician signature on form to participate w/ approved ? in foam.1457325-342900 2015 STATEMENTAppropriate Pre-hospital Management of the Spine-Injured AthleteUpdate (as of 8/5/15): NATA has received input from our membership and other organizations regarding the recent release of the Executive Summary from the Task Force on the Appropriate Prehospital Management of the Spine-Injured Athlete. The Task Force believes that the positions taken foster a “best practices” approach for our patients now and in the future. While we support the many locations that have already begun training initiatives for equipment removal, the Task Force does appreciate that the implementation of the positions nationally will take time and dedication. We believe that the input merits altering the wording to allow for greater flexibility. To that end, the Task Force core writing group has proposed revising Recommendation #4 from reading “...equipment should be removed prior to transport” to “when appropriate, protective equipment may be removed prior to transport.” The Task Force recognizes the variations in state emergency medical system protocols nationally, the availability of qualified EMS systems and hospital emergency departments locally, the differences in personnel and resources at various venues and levels of competition, and the uniqueness inherent in each situation and with each patient. These, along with medical-legal liability issues, lead us to conclude that it is prudent to state that health care providers make the decision regarding equipment removal on site based on the individual circumstances of the case. Once the "Appropriate Prehospital Management of the Spine-Injured Athlete” statement is completed, reviewed, and approved by the professional organizations represented at the task force meeting, educational materials will be developed by NATA and other groups to assist those health care providers whose education and professional training may not include various components of the recommendations outlined in the consensus statement. A list of frequently asked questions is currently in development. You may contact Katie Scott, MS, ATC, LAT, at katies@ with any additional questions. ***Executive Summary Background: In 1998 the National Athletic Trainers’ Association served as the host organization for an inter- association task force to develop guidelines for the care of the spine injured athlete. This 2015 document is an executive summary update of that 1998 document providing revised recommendations and key insights for the management of the cervical spine injured athlete. Recently, members of the original task force and additional spine trauma researchers discussed many changes in the current literature regarding pre-hospital treatment protocols for the cervical spine injured athlete-patient. These changes were the impetus for the development of the second inter-association task force. Key Points: Traumatic spinal cord injury (SCI) is a devastating condition that merits concerted focus due to its high rates of morbidity and mortality. Approximately 12,500 new cases of SCI are reported in the United States each year. Nine percent of these cases are due to participation in sports and recreational activities. The athlete-patient with a suspected SCI presents challenges for medical providers that are not common with the general population. The best example for this comes with athletes in equipment-intensive sports such as football, ice hockey and lacrosse where the equipment worn for protective purposes creates a treatment barrier for basic or advanced life support skills requiring access to the airway and chest. The sports medicine team must work together as an efficient unit in order to accomplish its goals. In an emergency situation, the team concept becomes even more critical, because miscommunication may lead to errors with potentially catastrophic repercussions. Recommendation 1: It is essential that each athletic program have an Emergency Action Plan (EAP) developed in conjunction with local EMS. Preparation is essential and should include education and training, maintenance of emergency equipment and supplies, appropriate use of personnel and formation and implementation of an EAP. Ideally, an athletic trainer should be on site during all sporting events. If medical personnel are not present, sports administrators should develop procedures for implementing the EAP and ensuring that all coaches are trained as first responders to ensure appropriate care prior to the arrival of trained medical personnel. Recommendation 2: It is essential that sports medicine teams conduct a “Time Out” before athletic events to ensure EAPs are reviewed and to plan the options with the personnel and equipment available for that event. Recommendation 3: Proper assessment and management of the spine injured athlete-patient will result in activation of the EAP in accordance with the level or severity of the injury. Recommendation 4: Protective athletic equipment should be removed prior to transport to an emergency facility for an athlete-patient with suspected cervical spine instability. Recommendation 5: Equipment removal should be performed by at least three rescuers trained and experienced with equipment removal at the earliest possible time. If fewer than three people are present, the equipment should be removed at the earliest possible time after enough trained individuals arrive on the scene. Rationale for Equipment Removal Recent changes in some emergency medical services (EMS) protocols have impacted management of spine injuries in the field and during preparation for and transportation to hospital emergency departments. In the past, it was recommended that protective equipment (e.g., helmets and shoulder pads in football, hockey and lacrosse) be left in place for transport and removed upon arrival in the hospital Emergency Department. It is essential and now recommended that, when appropriate, in an emergency situation with equipment- intensive sports (e.g., helmets and shoulder pads in football, hockey and lacrosse), the protective equipment be removed prior to transport to the hospital. Rescuers should be able to recognize when is it NOT appropriate to remove equipment on field of play and have a plan to best manage the patient. The rationale for consideration of equipment removal on the field is rooted in, but not limited to, the following concepts: Advances in equipment technology Equipment removal should be performed by those with the highest level of training. In most cases, athletic trainers have been exposed to more equipment removal training than many other members of the medical team. As a result, individuals on the field may have a greater knowledge of equipment removal procedures than the hospital emergency department staff. Expedited access to the athlete-patient for enhanced provider care Chest access is prioritized Recommendation 6: Athletic protective equipment varies by sport and activity; and styles of equipment differ within a sport or activity. Therefore, it is essential that the sports medical team be familiar with the types of protective equipment specific to the sport and associated techniques for removal of the equipment. ?A wide variety of facemasks, helmets and shoulder pads exist in the various sports. Members of the medical team should be skilled in facemask, helmet and shoulder pad removal. In an emergency situation, it is important to have access to the airway and chest. As the chest is not accessible when wearing shoulder pads, it is recommended that the medical team remove the shoulder pads on the field of play. Recommendation 7: A rigid cervical stabilization device should be applied to spine injured athlete-patients prior to transport. A rigid cervical collar should be applied at the earliest and most appropriate time possible during pre- hospital procedures. With practice, cervical collars can be placed and removed with manual in-line stabilization and potentially minimal risk. The medical team needs to continue manual in-line stabilization even after the rigid cervical collar is applied. Several research studies have demonstrated that rigid cervical collars are not effective in controlling cervical spine motion in all planes of movement. Manual in-line stabilization must be maintained until the athlete-patient has been stabilized on a full body immobilization device and a head immobilization device has been applied. Recommendation 8: Spine injured athlete-patients should be transported using a rigid immobilization device. The transport of the spine injured athlete-patient requires special considerations which may include, but are not limited to the mechanism of injury, size of the athlete-patient, equipment worn by the athlete- patient, and the number and skill level of the sports medical team members. Throughout the years different terminology has been used by pre-hospital medical care teams to describe procedures used to prevent iatrogenic spinal cord injuries. Initially spinal traction was used and was followed by spinal immobilization. Sports medical care teams must now recognize the concepts of spinal motion restriction (SMR) as compared to spinal immobilization. SMR implies that true spinal immobilization cannot be obtained even with the patient securely strapped to a spine board. Like spinal immobilization, the premise of SMR is to prevent further harm to a spinal cord or column injury. Criteria for the use of SMR guidelines and immobilization devices should include: Blunt trauma with altered level of consciousnessSpinal pain or tendernessNeurologic complaint (e.g., numbness or motor weakness) Anatomic deformity of the spineHigh-energy mechanism of injury and any of the following: Drug or alcohol intoxication Inability to communicate Distracting injury Recent publications have expressed concern related to the use of the long spine board due to potential harmful effects to the patient if the patient remains on the long spine board for an extended period of time. However, in the case of a potentially spine injured athlete it is recommended that a long spine board or other immobilization device be used for transport. The ED medical team is encouraged to assess the athlete-patient on arrival to the ED. Following the assessment, the athlete-patient should be transferred off the spine board to the appropriate hospital bed for further care to decrease chances of pressure sore development and other potential detrimental side effects related to a prolonged length of time on the board. Recommendation 9: Techniques employed to move the spine injured athlete-patient from the field to the transportation vehicle should minimize spinal motion. The spine injured athlete-patient should be transferred to the long spine board or vacuum mattress using a technique that limits spinal motion. In the case of a supine positioned athlete, the medical team should use the 8-person lift (previously described as the six-plus lift) to move the athlete-patient to the long spine board. The scoop stretcher may be employed to lift the supine athlete-patient from the field. In the case of a prone positioned athlete, the medical team should position the spine board and use a log roll push technique to place the athlete-patient on to the long spine board. Recommendation 10: It is essential that a transportation plan be developed prior to the start of any athletic practice or competition. Recommendation 11: Spine injured athlete-patients should be transported to a hospital that can deliver immediate, definitive care for these types of injuries. The choice of the most appropriate hospital should be determined and written in the EAP. If definitive care is not readily available, spine injured athlete-patients should be transported to the nearest hospital for stabilization and possible air medical evacuation to the nearest trauma center. Attempts should be made to avoid this extra delay in definitive care as the patient in this scenario might have improved outcomes with expeditious definitive management. Emergency medical teams should keep in mind that every time the spine injured athlete-patient is moved, the chance for additional neurological compromise increases. For this reason, transfer of the athlete- patient in the pre-hospital setting and within the ED should be kept to a minimum and appropriate transfer devices should be used. ED staff must avail themselves of training modules in the event an athlete arrives with equipment in place. Recommendation 12: It is essential that prevention of spine injuries in athletics be a priority and requires collaboration between the medical team, coaching staff and athletes. Recommendation 13: The medical team must have a strong working knowledge of current research, as well as national and local regulations to ensure up-to-date care is provided to the spine injured athlete-patient. Recommendation 14: It is essential that future research continue to investigate the efficacy of devices used to provide spinal motion restriction. ................
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