12/28/2012 Learning Understanding the Standard “All of life should be a learning experience, not of Care for Managing Sport- just for the trivial Related Concussions reasons but because by continuing the learning process, we are Thomas W. Kaminski, PhD, ATC, FNATA, FACSM, RC Fellow Professor/Director of Athletic Training Education challenging our brain University of Delaware and therefore building brain circuitry” Lecture #2 Saturday 1/5/13 65 th Annual EATA Meeting & Clinical Symposium Arnold Scheibel (Professor of Buffalo, NY Neurobiology and Psychiatry and former Director of the Brain Research Institute, UCLA Medical Center) Athletic Training Research Laboratory Athletic Training Research Laboratory Concussion Anquan Bolden Concussion Fall 2008 • Definition - a clinical syndrome characterized by immediate and transient post- traumatic impairment of neural functions, such as alteration of consciousness, disturbance of vision, Analogous to equilibrium, etc... due ice cubes in a to brain stem(connects glass of cerebral hemispheres water! with the spinal cord) involvement Athletic Training Research Laboratory Athletic Training Research Laboratory Typical Sport-Related Concussion in Soccer Watch Here! Athletic Training Research Laboratory Athletic Training Research Laboratory 5 1
12/28/2012 Medical Personnel and Coaches have Sports-Related Concussion historically mis-assessed concussions in the United States • There is much variation in the CDC now estimates that 1.6 to 3.8 million sports-related knowledge of health care providers managing concussed mTBIs occur each year athletes. Need to make sure the person clearing for return (Langlois, et al., J Head Trauma Rehab. 2006, (5)375-378) to sport is current with knowledge! – In Delaware, teens and young adults (ages 15-24) accounted for – Physicians (MD/DO) 17% of all hospitalizations as a result of traumatic brain injuries – Physician assistants – Nurse practitioners (including SRC) during the reporting period of 2003-2007. – Chiropractors – Only 8% to 19% of sports-related injuries result in LOC.* – Athletic trainers * Guskiewicz KM, et al. Am J Sports Med. 2000; 28(5)643-650 – School nurses Schultz MR, et al. Am J Epidemiol. 2004;160:937-944. Collins MW, et al. Clin J Sport Med. 2003;13;222-229. • New and emerging research and technologies will lead to a continuing evolution of care Athletic Training Research Laboratory Athletic Training Research Laboratory Extent of the Problem Extent of the Problem Professional athletes get a • great deal of attention- but just tip of iceberg! – 1600 NFL players • 19.3% of all FB injuries in • Much more common in US 2009!!! high school than any other level- due to large number of participants • Over 100,000 – HS Sports Participants concussions nationally • Football- 1.14 million in HS athletes yearly • Boys Soccer- 384,000 based on CDC estimates, • Girls Soccer- 345,000 • Over 1,000 concussions • Boys Basketball - 545,000 in HS athletes in • Girls Basketball - 444,000 Delaware each year Athletic Training Research Laboratory Athletic Training Research Laboratory Not Just a Football What has happened to (or a “guy”) Problem make this such a big deal? Injury rate per 100,000 player games in high school athletes • Increasing awareness and incidence • Football 47 • Girls soccer 36 – Number of high profile • Boys soccer 22 athletes over the past 10 • Girls basketball 21 years • Wrestling 18 • Boys basketball 7 – Bigger and faster kids, • Softball 7 increased opportunities – Increased litigation from • Data from HS RIO misdiagnosis, treatment, » JAT, 2007 and removal from sport Athletic Training Research Laboratory Athletic Training Research Laboratory 2
12/28/2012 What has happened to make this Problems for Athletes- such a big deal? Post-Concussion Syndrome • High profile cases • 85-90% of concussed – Second Impact young athletes will Syndrome recover within 1 to 2 • Death or devastating weeks brain damage when • The remainder may having a second have symptoms lasting injury when not from weeks to months healed from the first interfering with school – Long-term effects and daily life • Possible long-term effects - dementia, • Subtle deficits may depression, CTE persist a lifetime Athletic Training Research Laboratory Athletic Training Research Laboratory Federal Regulations on the News Journal Media Coverage Horizon? December 25 Concussion diagnosis, management put to the test Student athletes return too soon after Concussion Liability Costs May Rise, Op-Ed Columnist ‘Train Wreck of a Play’ Collides With Why the NFL Sucks at Testing for A neurocognitive exam may enable concussions and Not Just for N.F.L. Should Kids Play Football? Consciences Concussions Maine schools to better determine when By KEN BELSON By Lisa Kocian By JOE NOCERA • By Sean Conboy By JUDY BATTISTA an injured athlete may resume | Globe Staff December 28, 2012 Published: December 10, 2012 Published: December 14, 2012 • 12.28.12 Published: December 15, 2012 competition. • 6:30 AM By Noel Gallagher ngallagher@pressherald.com@mainetoday .com Staff Writer http://www.nflevolution.com/medical-research Athletic Training Research Laboratory Athletic Training Research Laboratory Recent Editorials in ATSHC Even the Kids are Involved Too! http://www.kidsconcussion.com/index.html http://www.healio.com/jour nals/atshc Athletic Training Research Laboratory Athletic Training Research Laboratory 16 17 3
12/28/2012 Part I – The Legal Stuff So What’s The Big Deal for ME? • Terminology: – Liability – legal responsibility! • Clearly defined in the DE State Practice Act 4.0 Athletic Trainers (24 Del.C. § 2602) 4.1 Athletic injuries: 4.1.1 Athletic trainers may treat athletic injuries. Athletic injuries shall be considered musculoskeletal injuries to athletes that occur while currently participating in, or currently training for, scholastic, professional, or sanctioned amateur athletics, where such injury limits the athlete’s ability to participate or train for their sport. Athletic Trainers may also treat musculoskeletal injuries received by athletes that occur while currently participating in recreational activities, where such recreational activities are recognized by the Amateur Athletic Union (see website for list of activities within the AAU). All Athletic injuries must be documented by the Athletic Trainer as interfering with participation in or training for such athletic activities. Nothing prohibits the Athletic Trainer from treating minor sprains, strains, and contusions to athletes currently participating in professional, scholastic, recreational, or sanctioned amateur athletic activities. Athletic Training Research Laboratory Athletic Training Research Laboratory What Does the BOC Have to Say About the “Standard of Care”? Part I – The Legal Stuff – Terminology: • Standard of Care - the legal duty to provide health care services consistent with what other health care practitioners of the same training, education, and credentialing would provide under the circumstances Athletic Training Research Laboratory Athletic Training Research Laboratory 21 Strategies for Avoiding Strategies for Avoiding Legal Liability Legal Liability Establish policies • • Build relationships • Document activities • Insist on a written contract • Maintain confidentiality • Obtain informed consent • Provide proper instruction • Provide physical exams • Supervise your staff • Know the profession and its • Participate in CE standards • Recognize your qualifications • Document hazards • Maintain insurance coverage Athletic Training Research Laboratory Athletic Training Research Laboratory 4
12/28/2012 No Need to Worry I’m Well -Versed in Treating Sport-Related Concussion! Legal Attacks Typically Involve: • With more attention in the media on SRC’s the public has become more educated about the problem (some high-profile athletes • The evaluation or testing of an athlete (or lack involved) thereof) • Documentation of the injury • Communication with the athlete or with a physician about an athlete • ATC’s (and others) have become a popular target of lawsuits alleging failures to meet the “standard of care”. • Education of the athlete • In cases of unfortunate events the actions (or inactions) of the ATC, coach, physical educator are likely to be second guessed or blamed. Athletic Training Research Laboratory Athletic Training Research Laboratory AMSSM Position Part II - What Exactly is Statement 2012 the Standard of Care? http://www.amssm.org/Content/pdf%20files/2012_ConcussionPositionStmt.pdf Athletic Training Research Laboratory Athletic Training Research Laboratory 27 NATA Position Statement NFL Health and Safety A newer updated position statement is forthcoming! http://www.nflevolution.com/home Athletic Training Research Laboratory Athletic Training Research Laboratory 29 5
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