3/7/2018 Contemporary Definition Understanding the Standard of Care - PDF document

3/7/2018 Contemporary Definition Understanding the Standard of Care of Sport-Related Concussion (SRC) for Managing Sport-Related Concussions - Including an Update • Concussion( commotio Condensed from the 2012 definition cerebri ) – a traumatic brain from the Berlin 2016 Conference that read “a physiological disruption injury induced by of brain function caused by an biomechanical forces. external force and manifests as an Thomas W. Kaminski, PhD, ATC, FNATA, FACSM, RFSA alteration of attention and mental state and is indicated clinically by a Professor/Director of Athletic Training Education new onset or worsening of a range University of Delaware of evolving signs and symptoms that are influenced by both intrinsic and Analogous to extrinsic factors. GLATA - 50 th Annual Meeting ice cubes in a glass of Chicago, IL March 17, 2018 water! Concussion Research Group @ UD The Susceptible Patient Sports-Related Concussion in the United States The perfect storm of multi- system dysfunction and co-morbidities ! Concussion Research Group @ UD Concussion Research Group @ UD Another Way of Looking at Brain Motion during Concussion • Shake an egg hard enough and the yolk will scramble despite the shell remaining intact! • The jello-like brain floating in the skull, surrounded by shock- absorbing membranes called meninges, is always late to catch up! • Linear forces ripple top to bottom – no big deal, take plate and twist jello mold like a steering wheel --- quite a mess on your hands Concussion Research Group @ UD Concussion Research Group 1

3/7/2018 Diverse Medical Community Involved with Extent of the Problem Sport-Related Concussion Management • Professional/collegiate athletes get a great deal of • There is much variation in the attention- but just tip of knowledge of health care providers managing concussed athletes. Need to iceberg! make sure the person clearing for – ≈1700 NFL players return-to-sport is current with knowledge! – ≈12,000 Collegiate players (NCAA D-I) – Physicians (MD/DO) – Physician Assistants • Much more common in US – Nurse Practitioners high school than any other – Chiropractors level- due to large number of – Athletic Trainers participants – School Nurses – HS Sports Participants – Physical Therapists • Football- 1.14 million – Neuropsychologists • Boys Soccer- 384,000 • New and emerging research and • Girls Soccer- 345,000 technologies will lead to a continuing • Boys Basketball - 545,000 evolution of care • Girls Basketball - 444,000 Concussion Research Group @ UD Concussion Research Group @ UD What has happened to Not Just a Football make this such a big deal? • THE MEDIA!! (or a “guy”) Problem • BETTER SCIENCE/RESEARCH! • High profile cases – Second-Impact Syndrome (SIS) • Death or devastating brain damage when having a second injury when not healed from the first – Long-term effects https://www.youtube.com/watch?v=9TrCZcsSyA8 • Possible long-term Zac Easter Story (Iowa) effects - dementia, depression, CTE Concussion Research Group @ UD Concussion Research Group @ UD Problems for Athletes- Post-Concussion Syndrome Part I – The Legal Stuff • 85-90% of concussed young athletes will – Terminology: recover within 1 to 2 • Liability – legal responsibility! weeks – Check your job description and duties as either a • The remainder may physical educator or coach (or both) have symptoms lasting from weeks to months • Standard of Care - the legal duty to provide health interfering with school care services consistent with what other health care and daily life practitioners of the same training, education, and credentialing would provide under the circumstances • Subtle deficits may persist a lifetime Concussion Research Group @ UD Concussion Research Group @ UD 2

3/7/2018 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 Concussion Research Group @ UD Concussion Research Group @ UD 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 • • The evaluation or testing of an athlete (or lack more educated about the problem (some high-profile athletes thereof) involved) • Documentation of the injury • Communication with the athlete or with a physician about an athlete • Education of the athlete • ATC’s (and others) have become a popular target of lawsuits alleging failures to meet the “standard of care”. • In cases of unfortunate events the actions (or inactions) of the ATC, coach, physical educator are likely to be second guessed or blamed. Concussion Research Group @ UD Concussion Research Group @ UD Federal Regulations State Legislators Want a on the Horizon? Piece of the Action Too! H.R.2062 - Protecting Student Athletes From Concussions Act of 2015 H.R.829 - SAFE PLAY Act H.R.4460 - Youth Sports Concussion Act http://www.ncsl.org/research/health/traumatic-brain-injury-legislation.aspx Concussion Research Group @ UD Concussion Research Group @ UD 3

3/7/2018 Will This Legislation Change Things? State Concussion Legislation • Policy Evaluation of State Youth Sports • Most state legislation follows these main Concussion/Return to Play Legislation components: – Cloudburst has been awarded a contract with the Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention – Improve education on concussion and increase and Control (NCIPC) to conduct a policy evaluation of the implementation of state youth sports concussion/return to play laws, to awareness report on and develop materials to disseminate key findings. Cloudburst – Immediate removal of any athlete suspected of will assess the implementation of youth sports concussion/return to sustaining a concussion (coach, athletic trainer or play legislation from two states with existing legislation. Following completion of the evaluation, a report shall be created and a other medical personnel) presentation shall be made to NCIPC that clearly demonstrates findings, – Cannot return-to-activity until properly cleared promising practices, and unintended consequences of the state legislation implementation efforts. (individuals capable of clearing athletes differ from state to state) http://www.cloudburstgroup.com/ Concussion Research Group @ UD Concussion Research Group @ UD What Exactly is So What’s The Big Deal for ME? the Standard of Care? Concussion Research Group @ UD Concussion Research Group @ UD What Does the BOC Have to Say About the “Standard of Care”? Concussion Research Group @ UD Concussion Research Group @ UD 4

3/7/2018 Berlin 2016 Consensus Statement NATA Position Statement Concussion Research Group @ UD Concussion Research Group @ UD NAIA Athletic Trainers Manual NCAA Sports Medicine Handbook Concussion Research Group @ UD Concussion Research Group @ UD What Should YOU be Doing National Federation of with Regard to SRC State High School Associations Assessment and Evaluation? http://www.nfhs.org/resources/ sports-medicine/ NFHS Learning Center: Concussion in Sports – What You Need to Know Concussion Research Group @ UD Concussion Research Group @ UD 5