AHSAA Medical Advisory CommitteeUpdate 2015

James B. Robinson, M. D.Head Team Physician- University of Alabama

Co-Chairman- AHSAA Medical Advisory Committee

Important Updates

• Concussion• Contact Rules• Heat Illness• EAP

Concussion

• AHSAA concussion rule- 2010• AHSAA mandatory training- 2010• Alabama State Law- Act 2011-541

June 2011, Revised May 2012• Federal Law in the making

HB-308Section 22-11E-2 of the Code of Alabama

1975

• (a) Each local school system and governing body of each sport or recreation organization shall develop guidelines and other pertinent information and forms to inform and educate youth athletes and their parents or guardians in their program of the nature and risk of concussion and brain injury including continuing to play after suspected concussion or brain injury. On a yearly basis, a concussion and head injury information sheet shall be signed and returned by the youth athlete and the athlete’s parent or guardian prior to the youth athlete’s initiating practice or competition

HB-308Section 22-11E-2 of the Code of Alabama

1975

• (b) Each local school system and sports or recreational organization governing body shall ensure that coaches receive annual training to learn how to recognize the symptoms of a concussion and hoe to seek proper medical treatment for a person suspected of having a concussion.

HB-308Section 22-11E-2 of the Code of Alabama 1975

• (c) Each local school system and sports or recreational organization shall establish by rule the requirements of the training which shall be provided by using designated resources to the extent practicable and timeless to ensure that, to the extent practicable, every coach receives the training before the beginning of practice for the school athletic team.

HB-308Section 22-11E-2 of the Code of Alabama

1975

• (d) A youth athlete who is suspected of sustaining a concussion or brain injury in practice or a game shall be immediately removed from participation and may not return to play the day of the injury and until he or she is evaluated by a licensed physician and receives written clearance to return to play from a licensed physician.

AHSAA Concussion Resources

• Mandatory Training for ALL coaches

• Links to NFHS on-line learning via web-site

• Instructional presentations on web-site

Concussion

• Make sure all of your coaches have taken the on-line training course

• Know the signs and symptoms of a concussion

• Never let an athlete return to practice or game on the same day as injury occurred

“When in doubt, sit them out”• Only a licensed MD or DO can clear an

athlete for return to play

Football Contact Rules

• New for 2015• Limits the amount of full contact

practice time in an effort to reduce the number of exposures to concussion

• Some feel that repetitive sub-concussive blows to the head may be detrimental to the youth athlete and lead to future problems

Football Contact RulesWeek 1

• The first two days of fall practice must be in shorts: Practice time limited to 90 minutes

• The 3rd day of fall practice may include shoulder pads: Practice time limited to 90 minutes

• The 4th day of fall practice may also include shoulder pads: Practice time limited to 120 minutes.

Football Contact RulesWeek 1

• Full football gear/pads can be worn on day 5 (August 7, 2015): Practice time limited to 90 minutes of full-speed contact.

• Only one practice/day in full pads• Two-a-day practices cannot occur on

consecutive days• There must be at least a 4 hour break

between practices on days designated two-a-days

Football Contact RulesWeek 2

• May alternate days of full-speed contact practice not to exceed 120 minutes of full speed contact per week.

• One intra-squad scrimmage is allowed

Football Contact RulesWeek 3

• Alternating days of full-speed contact practice, not to exceed 120 minutes of full contact per week is allowed

• One intra-squad scrimmage is allowed

Football Contact RulesWeek 4 - End of Season• A total of 90 minutes of full-speed

contact per week is allowed.

Football Contact Rules

• Full pads may be continued during practice, only full-speed contact is limited.

• When in shells, no live action, full-speed contact should occur.

• May participate in : “air”, “bags”, ”wrap”, and “thud” at anytime.

Football Contact RulesDefinitions

• Full Contact: Any simulations in which live action occurs.             

• Live Action: Contact at game speed in which players execute full blocking and tackling at a competitive pace, taking players to the ground.Air: Players run unopposed without bags or opposition

Football Contact RulesDefinitions

• Bags: Activity is executed against a bag or pad to allow soft-contact

• Wrap: Drills run at full-speed until contact above the waist and players remain on their feet

• Thud: Any live action or full-speed contact with no pre-determined winner or without taking a player to the ground.

Heat Illness

Heat Related Deaths

• 29 deaths in High School sports from 2000-2009

• 18 deaths in last 5 years- a record• 3rd most common cause of death

in High School athletes• Usually occurs in first 4 days of

practice• Death from Exertional Heat

Stroke is completely preventable!

EXERTIONAL HEAT STROKE

• Elevated core temperature ( >104 degrees) associated with signs of organ system failure due to hyperthermia.

• Total body collapse due to thermoregulatory failure

• Life threatening!• Mortality rates are directly related to

time before cooling and length of time core temperature elevated.

EXERTIONAL HEAT STROKESigns and Symptoms

• Temperature >104 rectal

• Fast heart rate• Low blood pressure• Sweating• Rapid breathing• Altered mental

status• Vomiting• Diarrhea• Seizures

• Coma ~ 70%• Acute renal failure• Rhabdomyolysis• Bleeding (DIC)• Pancreatitis/ GI

bleed• Mortality ~ 80%

EXERTIONAL HEAT STROKETreatment

• Measure rectal temperature• Lower temperature as rapidly as

possible!!• Place in a tub of ice water, remove

when temp <102°F (0 fatalities if cooled within 10 minutes)• If no ice tubs, place iced towels over

entire body and replace every 2-3 minutes

• 911- to Emergency Room only after cooled!

Treat First – Transport Second!!

“…no one should die if proper, prompt, and aggressive care begins within 10 minutes of collapse.”

Survival Time

100% survival rate when cooling initiated within 10 minutes

HEAT ILLNESSPrevention

• Emergency Plan Nearest Emergency facility, transportation, communications, cool tub, rectal thermometer• Pre-participation physical exam -

identify previous heat related problems• Adequate acclimatization = 10-14 days• Educate - athletes, coaches, parents• Well balanced diet, adequate sleep,

avoiding drugs and alcohol

ACCLIMATIZATION

• Physiologic process by which an individual becomes able to tolerate work in a hot environment.

• Becoming “Thermal efficient”• Usually takes 10-14 days - maximum

acclimatization takes 3 months.• Fluid and salt increase heat

acclimatization.• Exposure to hot environment for 60-90

minutes/day

AHSAA Acclimatization Rule Section 18

• The first day of Fall practice is Monday, August 3, 2015. The first two days of fall football practice must be in shorts. Shoulder pads may be worn on day 3 and day 4. These four days are designed for coaches to determine if the students are conditioned physically for football practice. During the first three days of practice, teams are allowed to use hand-held blocking pads. Helmets may be worn from the first day of practice, full pads from the fifth practice day. The earliest date full pads may be worn is August 7.

• No matter when a student begins fall football practice, that student must practice for three days in shorts before practicing in pads.

• During two-a-day practices, only one practice per day may be in full pads. The other practice that day can be only in helmets and shoulder pads.

• No consecutive days of two-a-days practices• 4 Hour break between two-a-days practices

HEAT ILLNESSPrevention

• Weigh athletes before and after practice.• “a pint’s a pound…”• Replace fluid lost during activity.• Monitor urine color and volume.• Have ice bags available• Adequate cold fluids available.• Rest periods- adjust for temperature and

place in shade if possible. “Cool Zone”• Remove clothing at rest periods, change

shirts

FLUIDS• Pre-hydration extremely important, if begin

dehydrated, will finish worse. • Pre-activity weight should be about the • same day to day.• Monitor urine color and volume.• Consume 17-20 oz 2-3 hours prior to activity• Consume 7-10 oz 10-20 minutes prior to activity• Consume 7-10 oz every 10-20 minutes of activity• Post-activity hydration in 2hours• Use a urine color chart to determine hydration

status

NATA Position Statement: Fluid Replacement for Athletes; J Athl Train; 2000;35(2):212-224

FLUIDS• Fluids should: Be cool- 50-59 F Contain carbohydrate = <8% , no fructose Contain electrolytes- the more the better Palatable - increases intake by 15%• Avoid: Caffeine Energy Drinks Alcohol Carbonated beverages

EAPEmergency Action Plan

• Each school is responsible for having an EAP that is venue specific

• EAP must be signed off by principal, athletic director, and medical director if available

• EAP should be practiced and updated yearly

• Each coach should have a copy available and located at each venue.

Thank You