9/23/2016 Disclosures No financial conflicts of interest. - PDF document

9/23/2016 Disclosures • No financial conflicts of interest. Sport-Related Concussion • Research Funding from: – Under Armour Guidelines – What is the Current Standard of Care? – NCAA/DOD Grand Alliance Care Consortium – State of DE Economic Development Office Thomas W. Kaminski, PhD, ATC, FNATA, FACSM, RFSA Professor/Director of Athletic Training Education – AVEX/Footbeat Medical Advisory Board University of Delaware – Tekscan, Inc. Bayhealth Trauma Lecture Series Fall 2016 Kent General Hospital Dover, DE • Have performed R&D work for Triax, Inc. but have received no financial compensation as a result. • Isokinetic International website support. Athletic Training Research Laboratory Athletic Training Research Laboratory Concussion Concussions Can Happen Anywhere! • 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 CDC’s Concussion Video Athletic Training Research Laboratory Athletic Training Research Laboratory 4 1

9/23/2016 Medical Personnel and Coaches have historically mis-assessed concussions School coaches often ill-equipped to spot, manage concussions • There is much variation in the knowledge of health care providers managing concussed athletes. Need to make sure the person clearing for return to sport is current with http://medicalxpress.com/news/2015-06-school-ill-equipped- knowledge! concussions.html – Physicians (MD/DO) – Physician assistants – Nurse practitioners Youth and middle school coaches were significantly less able to spot – Chiropractors concussions, and the researchers said educational programs are – Athletic trainers needed for coaches at this younger level. – School nurses • New and emerging research and technologies will lead to a continuing evolution of care Athletic Training Research Laboratory Athletic Training Research Laboratory Sports-Related Concussion Extent of the Problem in the United States Professional athletes get a • great deal of attention- but CDC now estimates that 1.6 to 3.8 million sports-related just tip of iceberg! mTBIs occur each year – 1600 NFL players • Much more common in US (Langlois, et al., J Head Trauma Rehab. 2006, (5)375-378) high school than any other level- due to large number of participants – In Delaware, teens and young adults (ages 15-24) accounted for – HS Sports Participants 17% of all hospitalizations as a result of traumatic brain injuries • Football- 1.14 million (including SRC) during the reporting period of 2003-2007. • Boys Soccer- 384,000 – Only 8% to 19% of sports-related injuries result in LOC.* • Girls Soccer- 345,000 * Guskiewicz KM, et al. Am J Sports Med. 2000; 28(5)643-650 • Boys Basketball - 545,000 Schultz MR, et al. Am J Epidemiol. 2004;160:937-944. • Girls Basketball - 444,000 Collins MW, et al. Clin J Sport Med. 2003;13;222-229. Athletic Training Research Laboratory Athletic Training Research Laboratory Not Just a Football Extent of the Problem (or a “guy”) Problem Injury rate per 100,000 player games in high school athletes • 19.3% of all FB injuries in • Football 47 2009!!! • Girls soccer 36 • Over 100,000 • Boys soccer 22 concussions nationally • Girls basketball 21 in HS athletes yearly • Wrestling 18 based on CDC estimates, • Boys basketball 7 • Over 1,000 concussions • Softball 7 in HS athletes in Delaware each year • Data from HS RIO » JAT, 2007 Athletic Training Research Laboratory Athletic Training Research Laboratory 2

9/23/2016 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 DE News Journal Media Coverage Horizon? Athletic Training Research Laboratory Athletic Training Research Laboratory Recent Editorials in ATSHC Even the Kids are Involved Too! http://www.kidsconcussion.com/index.html Athletic Training Research Laboratory Athletic Training Research Laboratory 3

9/23/2016 So What’s The Big Deal for Health-Care Professionals? Part I – The Legal Stuff – Terminology: Lower Liability Standard for Coaches • Liability – legal responsibility! During Competition http://www.parksandrecreation.org/2015/M – Check your job description and duties as either a physical ay/Lower-Liability-Standard-for-Coaches- educator or coach (or both) During-Competition/ • 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 http://www.claimsjournal.com/magazines/special-report/2014/02/17/244535.htm circumstances The Rising Score of Youth Sports Head Injury Claims Athletic Training Research Laboratory Athletic Training Research Laboratory 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 No Need to Worry I’m Well -Versed in Legal Attacks Typically Involve: Treating Sport-Related Concussion! • 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 • Coaches and physical educators have become a target of lawsuits alleging failures to meet the “standard of care”. • In cases of unfortunate events the actions (or inactions) of the coach and/or physical educator are likely to be second guessed or blamed. Athletic Training Research Laboratory Athletic Training Research Laboratory 4

9/23/2016 Let’s Take a Look at HR829 - SAFE PLAY Act Federal Concussion Legislation Athletic Training Research Laboratory Athletic Training Research Laboratory State Legislators Want a State Concussion Legislation Piece of the Action Too! • Most State Legislation follows these main components: – Improve education on concussion and increase awareness – Immediate removal of any athlete suspected of sustaining a concussion (coach, athletic trainer or other medical personnel) – Can not return to activity until properly cleared (individuals capable of clearing athletes differ from state to state) Athletic Training Research Laboratory Athletic Training Research Laboratory Is Your State Impacted? Will This Legislation Change Things? • Check out - http://www.ncsl.org/research/health/trau • Policy Evaluation of State Youth Sports matic-brain-injury-legislation.aspx Concussion/Return to Play Legislation – Cloudburst has been awarded a contract with the Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention • Sample of State of Delaware legislation: and Control (NCIPC) to conduct a policy evaluation of the implementation of state youth sports concussion/return to play laws, to – Vol. 78 Del. Laws, Chap. 192 (2011 SB 111) report on and develop materials to disseminate key findings. Cloudburst Requires the Delaware interscholastic athletic association will assess the implementation of youth sports concussion/return to to adopt regulations to address the appropriate play legislation from two states with existing legislation. Following recognition and management of student athletes completion of the evaluation, a report shall be created and a exhibiting signs and symptoms consistent with a presentation shall be made to NCIPC that clearly demonstrates findings, concussion during practices, scrimmages and promising practices, and unintended consequences of the state interscholastic contests. This law also requires the signing legislation implementation efforts. of an informational sheet by students and their parents or guardians. HB404 recently signed to protect ALL youth athletes http://www.cloudburstgroup.com/ in State of DE Athletic Training Research Laboratory Athletic Training Research Laboratory 5