King’s College

Department Of Sports Medicine

Student-Athlete Policies

Patient Bill of Rights

As a patient, you have the right to:

1. Considerate, compassionate, and respectful care regardless of race, color, sex, national

origin, diagnosis, disability, political affiliation, religion, gender, or age.

2. Seek consultation with the physician of your choice.

3. Obtain from your treating practitioners complete current information concerning your

diagnosis, treatment, and prognosis in terms that you can understand. When it is not

medically advisable to give such information to you, the information should be made

available to an appropriate person in your behalf.

4. Know by name the practitioners responsible for coordinating your care.

5. Request a copy of your medical records.

6. Receive information about any proposed treatment or procedure in order to make an

informed decision whether to consent to or refuse a course of treatment. Except in

emergencies, this information shall include the purpose and description of the procedure,

probable result, significant risks, and alternate courses of treatment.

7. Actively participate in decisions regarding your medical care, including refusing treatment to

the extent permitted by the law, and to be informed of the medical consequences of your

action.

8. You have the right to every consideration of your privacy concerning your own medical care

program. Case discussion, consultation, examination, and treatment are confidential and

should be conducted discreetly. Those not directly involved in your care must have your

permission to be present.

Patient Responsibilities

As a patient, you have the responsibility to:

1. Cooperate with members of the King’s College Department of Sports Medicine in order to

provide the necessary personal and medical history required for treatment. The patient should

notify the Athletic Trainers or Team Physician of any changes in his/her health.

2. Be considerate of the privacy and needs of other patients.

3. Ask questions when he/she does not understand information, medical words, or instructions.

4. Tell the physician or other member of the healthcare team whether or not he/she is willing

and able to follow the recommended treatment plan.

5. Participate actively in follow up care when the current level of care is no longer appropriate.

6. Provide information necessary to obtain insurance payments. The patient will work with the

entity, when needed, to arrange for payment.

7. Recognize that he/she makes decisions daily that impact on personal health.

Patient Guidelines

1. For your own safety:

a. Please enter the Sports Medicine facilities only when an Athletic Trainer is present.

b. Let us serve you; don’t perform self-treatment (including taping).

c. Please keep cleats and other athletic equipment outside the Sports Medicine facilities.

d. Please keep large personal items (backpacks, coats, etc.) in the locker room.

e. Be kind to each other; roughhousing and profanity are prohibited.

2. To keep the Sports Medicine facilities clean and sanitary:

a. Please keep shoes off of the tables.

b. Please shower before treatment or evaluation unless it is an emergency.

c. Please eat food and drink and use tobacco outside of the Sports Medicine facilities.

3. For your privacy and the privacy of others:

a. Please dress appropriately (the facility is co-ed).

b. Please be friendly and social, but don’t use the Sports Medicine facilities as a gathering place.

c. Use cell phones and pagers outside the Sports Medicine facilities.

d. Please do not go behind treatment curtains.

4. Please sign in prior to any treatment, including taping and wrapping.

5. Protect your eligibility; the Sports Medicine facilities phones can only be used for medical purposes.

6. Please keep all scheduled appointments. If you can’t make an appointment, notify an Athletic Trainer

before the time of your appointment.

Sports Medicine Clinic phone: 208-5940; Athletic Training Room phone: 823-5783

Not following the Patient Guidelines may put the health, safety, or eligibility of you or others at risk. To

deter this, there are consequences:

1st Offense: Verbal warning and formal meeting with the Sports Medicine Clinic Coordinator or

Athletic Training Room Coordinator. Head coach will be notified and may determine

further consequences.

2nd

Offense: Formal meeting with the Head Athletic Trainer. Head coach will be notified and may

determine further consequences.

3rd

Offense: Loss of all Sports Medicine Clinic/Athletic Training Room treatment privileges for the

remainder of the academic year. Head coach will be notified and may determine further

consequences.

Physical Examinations/Insurance Forms

NCAA rules and policies require that the following forms must be completed and submitted before a

student-athlete can participate in intercollegiate athletics:

New student-athletes

Physical exam

Detailed Medical History

Health Insurance Information, including a copy

of the front and back of insurance card(s)

Returning student-athletes

Annual Health Questionnaire

Health Insurance Information, including a copy

of the front and back of insurance card(s)

In accordance with the NCAA, the final decision regarding the physical qualification or rejection of a

student-athlete is the responsibility of the King’s College Team Physician and Head Athletic Trainer.

Revised 08/08

Memorandum

To: Student-Athletes and Parents/Guardians

From: Gregory K. Janik, MS, AT – King’s College Head Athletic Trainer

Re: Medical Services / Insurance

I am excited to welcome you to King’s College and provide you with some information related to the medical

services and insurance available to all student-athletes while they are engaged in intercollegiate athletic

programs at King’s College.

The King’s College Team Physician, Dr. William Charlton, MD is an orthopedic surgeon with extensive

experience in dealing with athletic injuries at the collegiate level. There are seven Certified Athletic Trainers to

assist in the daily management, treatment, and rehabilitation of injuries to King’s College student-athletes. In

addition, student-athletes have access to the King's College Student Health Center, which is staffed by registered

nurses, physician assistants, and a physician.

While ALL student athletes are required to have their own personal insurance in order to participate in

intercollegiate athletics, King’s College has supplementary secondary insurance to help defer the cost medical

bills that may be incurred. Below you will find important information to help you understand the insurance

process at King’s College and also provide you with information to best assure expeditious health care services

and reimbursement should an intercollegiate injury be sustained while at King’s College. Included you will find

the steps of the Pre-Certification / Prior Authorization Procedures with a provided checklist for student-athletes.

Additionally, insurance information regarding the coverage available and the procedures for processing claims

are explained.

Pre-Certification / Prior Authorization Procedures

To help assure student-athletes get the necessary health care services and procedures, certain services and

procedures must be first approved by the student-athlete’s insurance provider before a student-athlete will

receive reimbursable care. This process is called precertification / prior authorization and may included, but not

limited to, doctor visits, inpatient hospital services, rehabilitation, diagnostic tests, and surgeries.

Since the medical services and procedures provided through primary insurance providers are different and are

continually reviewed and subject to change by the insurance provider, it is necessary that all student-athletes /

policy holders contact their insurance company prior to attending King’s College and determine how they are

required to handle injuries should they occur while at King’s College. Additionally, if the student-athlete is from

outside the immediate Wilkes-Barre area, the insurance provider will need to be informed that the student-

athlete is attending college in an “out-of-network” area and the student-athlete will be participating in an

intercollegiate sport. The student-athlete / policy holder may also need to provide the insurance company with

the dates that the student-athlete will be attending the college (i.e. August until May).

In summary, in order to best assure medical services and procedures are carried out and reimbursed in an

expeditious fashion, the student-athlete / policy holder should contact and confirm with their insurance provider

as to the procedures for pre-certification / prior authorization prior to attendance at King’s College. While this

process cannot guarantee total reimbursement, by doing these necessary steps the student-athlete can best assure

speedy care and benefits from potential non-participant providers.

Checklist for Student-Athletes

Contact your health insurance provider customer service department and determine coverage

regulations. The phone number is usually printed on the back of the insurance card.

Notify your health insurance carrier that you are an intercollegiate athlete at King's College in Wilkes-

Barre, PA

Provide the health insurance carrier with the dates of college attendance (August to May).

Find out if your insurance carrier requires Pre-Certification / Prior Authorization and/or an out-of-

network referral in order for you to receive treatment outside the coverage area.

Student-athletes are responsible for knowing if Pre-Certification / Prior Authorization are required for

doctor consults, lab tests, diagnostic tests, surgeries, rehabilitation, and/or other services/procedures and

for obtaining that authorization.

The King’s College Student Health Center and the Athletic Training Department staff do not bill

insurances and are NOT responsible for obtaining pre-authorization.

The King’s College Student Health Center and the Athletic Training Department do not bill prescription

plans.

Student-athletes should know which local pharmacies will accept their prescription plan and the co-pay costs.

Student-athletes should carry a copy of their medical insurance card. King’s College must receive any

changes to a health insurance policy as soon as they occur. If proper notification is not received, King’s

College will not be responsible for any delays in payment, collections notices, credit reports, etc. that

may occur.

King’s College

Student-Athlete Supplemental Secondary Insurance Policy

In the event that a King’s College Student-Athlete is injured during an official team practice or game,

King’s College has supplementary secondary insurance through First Agency to help defer the cost medical

bills that may be incurred. This coverage is only for injuries /accidents resulting from the direct

participation in the intercollegiate athletics program during the dates of the primary competitive season and

designated off-seasons as approved by the Director of Athletics according to NCAA regulations. Once this

amount has been exceeded, the bills should be submitted to the student-athlete’s primary insurance. Each

individual’s personal primary insurance covers different percentages depending on the nature of the injury

and charges incurred. Once the student-athlete’s personal primary insurance has paid their maximum

amount, the remaining bills, if any, can be re-submitted to the King’s College affiliated insurance company.

In the event that a student-athlete should receive a bill / statement for an injury that occurred as a direct

result of participation in intercollegiate athletics at King’s College, the student-athlete must inform a King’s

College certified athletic trainer in a timely manner. This second submission of bills / statements to King’s

College affiliated insurance company is the responsibility of the student-athlete and their parents. However,

the King’s College Athletic Training Staff will explain, give the necessary information, and assist the

student-athlete in the process. It is the policyholder’s responsibility to forward ITEMIZED bills/statements

AND Explanation of Benefits (EOB) Statements from the primary insurance company to the following

address in order to ensure timely payment:

First Agency, Inc

Attn: Diane Paige

5071 West H Avenue

Kalamazoo, WI 49009-8501

Fax (269) 381-3055

The King’s College Athletic Training Department and the King’s College Department of Athletics

WILL NOT be responsible for any delays in payment, collections notices, credit reports, etc. that occur due

to bills not being submitted in a timely manner. Any unpaid balances are the responsibility of the student-

athlete and/or the student-athlete’s parent(s)/guardian(s). In addition, if a student-athlete decides to see

a physician / medical consultant, and/or undergo a diagnostic test WITHOUT prior authorization /

referral from a member of the King’s College Athletic Training Department, payment of excess balances

cannot guaranteed and the student-athlete and/or the student athlete’s parent(s) / guardian(s) may be

financially responsible for any and all medical bills incurred.

This process can only be carried out if the student-athletes insurance company covers out-of-network

providers, if the student-athlete is away from their home territory. The King’s College Athletic Training

Staff strongly encourages student-athletes and their parents to contact their personal primary insurances to

explain that the student-athlete is attending college in an out-of-network area and participating in an

intercollegiate sport. The student-athletes are strongly encouraged to find out how they should handle any

injuries and if any exceptions can be made secondary to the student-athlete’s situation. The student-athlete

and their parents are strongly encouraged to contact their personal primary insurance before ALL physician

appointments and/or diagnostic testing (x-ray, MRI, etc). The King’s College Athletic Training Staff will

make every effort to assist the student-athlete to ensure coverage is approved, but ultimately it is the

responsibility of the student-athlete and their family.

If injuries/ accidents occur on campus, not a resulting from the direct participation in the intercollegiate

athletics program during the dates of the primary competitive season and designated off-seasons as

approved by the Director of Athletics according to NCAA regulations, the incident will fall under the King’s

College accident insurance policy.

King’s College

Student-Athlete Secondary Insurance Policy Schematic Example

BILLS SUBMITTED TO THE STUDENT-ATHLETE’S PERSONAL PRIMARY INSURANCE

Charges are billed to the student-athlete’s personal primary insurance by physician’s office or diagnostic center

Athletic Injury claim form is submitted to First Agency by the King’s College Athletic Training Department

If there are any remaining bills, they will most likely be sent to the student-athlete’s home address

These remaining itemized bills and the explanation of benefits (EOB) from the primary insurance can be

resubmitted by the student-athlete or their family and reviewed by First Agency

First Agency will review and evaluate payment of remaining balances

REMINDER: If the student-athlete is out of network and needs authorization, it is the student-athlete’s

responsible to obtain authorization or failure to do so may nullify the secondary policy.

King’s College Athletic Training

Sports Concussion and Closed Head Injury Policy and Protocol for Student-Athletes

If a member of the King’s College Department of Sports Medicine has a concern that a student-athlete may have sustained a sports concussion or closed head injury due to their participation in athletics, or if one or more individuals express concern to a member of the Department of Sports Medicine that a student-athlete may have suffered a sports concussion or closed head injury, this Policy and Protocol will be followed. The health and welfare of the student-athlete will be the primary consideration throughout the process. Definition of Sports Concussion: “Sports concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces”. (Concussion in Sports Group, Zurich 2008, Clin J Sports Med, 19:185-200, 2009)

1. Concussion may be caused by a direct blow to the head, face, neck, or elsewhere on the body with an “impulsive” force transmitted to the head.

2. Concussion typically results in the rapid onset of short lived impairment of neurological function that resolves spontaneously.

3. Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury.

4. Concussion results in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course; however, it is important to note that, in a small percentage of cases, post-concussive symptoms may be prolonged.

5. No abnormality on standard structural neuroimaging studies is seen in concussion. Definition of Closed Head Injury: Any injury to the head can cause damage to the brain stem and other vital centers of the brain. This can include but is not limited to traumatic brain injury, cerebral contusion, epidural hematoma, and subdural hematoma. (NATA Position Statement: Management of Sport-Related Concussion, 2004) Signs and Symptoms of Sports Concussion and/or Closed Head Injury: A sports concussion and/or closed head injury will be suspected if any King’s College student-athlete presents with one of the following signs, symptoms, or problems, in excess of his/her baseline score, after sustaining direct or indirect contact to the head. If no baseline test is available, a student-athlete must be symptom free according to the Certified Athletic Trainer’s assessment. These can include clinical symptoms, physical signs, cognitive impairment, and/or loss of consciousness. Any student-athlete with signs, symptoms, or problems will be removed from play that day, monitored and will not return to play on the day of injury.

The following is a list of possible signs, symptoms, or problems of a sports concussion or closed head injury: This list is not an all-inclusive list, other signs, symptoms, or problems may occur that are not listed. (Sports Concussion Assessment Tool Card)

Headache

Nervous or Anxious

“Pressure in the head”

Trouble falling asleep

Neck Pain

Balance problems

Drowsiness

Nausea or vomiting

Fatigue or low energy

Blurred vision

More emotional than usual

Dizziness

Difficulty remembering

Irritability

Sadness

Confusion

Sensitivity to light

Felling slowed down

Sensitivity to noise

Feeling like “in a fog”

Convulsions or Seizures

“Don’t feel right”

Difficulty concentration

Balance problems

REFERRAL GUIDELINES: Once a student-athlete has presented with any of the above signs, symptoms, or problems; they will be monitored, including vital signs and level of consciousness, every several minutes after the onset of symptoms. Monitoring will continue until one of the following scenarios is determined: 1. Immediate Referral to Emergency Room:

a. Any student-athlete presenting with any of the following signs, symptoms, or problems will be referred to the emergency room immediately upon on-field assessment:

Deterioration of neurological function

Decreasing level of consciousness

Irregularity in respirations

Irregularity in pulse

Unequal, dilated, or unreactive pupils

Any signs or symptoms of associated injuries, e.g. spine or skull fracture, or bleeding

Mental status changes: lethargy, difficulty maintaining arousal, confusion, or agitation

Seizure activity

2. Referral to Physician on the Day of Injury:

a. Any student-athlete presenting with any of the following signs, symptoms, or problems when compared to the initial on-field assessment, will be referred to a physician on the day of injury:

Loss of consciousness

Amnesia lasting longer than 15 min

Increase in blood pressure

Cranial nerve deficits

Vomiting

Motor deficits subsequent to initial on-field assessment

Sensory deficits subsequent to initial on-field assessment

Balance deficits subsequent to initial on-field assessment

Cranial nerve deficits subsequent to initial on-field assessment

Postconcussion symptoms that worsen

Additional postconcussion symptoms as compared with those on the field

b. A student-athlete will also be referred to a physician on the day of injury if he/she has not shown improvement in their signs, symptoms or problems by the end of practice or competition.

3. Release of the Student-Athlete from the Supervision of a Certified Athletic Trainer with Take-Home Instructions:

a. If the student-athlete has shown an improvement in their signs, symptoms or problems by the end of the practice or competition, they will be given Take-Home-Instructions (See Appendix A) for care while they are at home and not under the supervision of a Certified Athletic Trainer. These instructions will be given and explained to a responsible individual as determined by the Certified Athletic Trainer. The student-athlete will be continually monitored for deterioration every few hours and days afterwards as problems could arise over the next 24-48 hours. The student-athlete will be monitored regularly until they are symptom free.

4. Delayed Referral (after the day of injury):

a. If a student-athlete that was released from the supervision of a Certified Athletic Trainer and given Take-Home Instructions presents with any of the following signs, symptoms, or problems after the day of injury, he/she will be referred to a physician as determined by the Certified Athletic Trainer.

Any of the findings in the “Referral on Physician on Day-of-Injury” category that have developed since the initial evaluation

Postconcussion symptoms worsen or do not improve over time

Increase in the number of postconsussion symptoms reported

Postconcussion symptoms begin to interfere with the athlete’s daily activities (i.e., sleep disturbances or cognitive difficulties.

b. Any Student-Athlete that has presented with signs, symptoms, or problems related to a sports concussion will be monitored regularly using the Post-Concussion Symptom Scale (See Appendix B).

RETURN-TO-PLAY ASSESSMENT Assessment Tools: The King’s College Department of Sports Medicine will utilize the SCAT2, Sport Concussion Assessment Tool 2 and ImPACT. The SCAT2 is a standardized method of evaluating people after concussion in sport and can also be used for patient education. This Tool has been produced as part of the Consensus Statement on Concussion in Sport 3rd International Conference on Concussion in Sport, Zurich 2008. ImPACT is a computer based program that measures multiple aspects of cognitive functioning in student-athletes including: attention span, working memory, sustained and selective attention time, response variability, non-verbal problem solving, and reaction time. Testing: The following student-athletes will undergo baseline SCAT2 testing and ImPACT testing for the academic year if they participate in one of the listed varsity intercollegiate teams below. These include:

Football

Women’s Soccer

Men’s Soccer

Field Hockey

Wrestling

Women’s Basketball

Men’s Basketball

Men’s Lacrosse

Women’s Lacrosse

Baseball

Softball

Men’s Tennis

Volleyball

These athletic teams were chosen because they were shown to be at an increased risk for suffering sports concussions and closed head injuries (Journal of Athletic Training, 2003 and 2007). All student-athletes participating in one of the above sports during the academic year must be baseline tested prior to each student-athlete’s first day of practice. Each subsequent year will only require freshmen and first-time student-athletes at King’s College to be baseline tested. RETURN-TO-PLAY GUIDELINES: Once a student-athlete has displayed any of the signs, symptoms, or problems stated above the student-athlete will be removed from practice or competition for the remainder of that day. The student-athlete will be evaluated and administered the Sport Concussion Assessment Tool 2 (SCAT2). When the student-athlete is symptom free for 24 hours, the student-athlete will be retested using the SCAT2. Once they have passed the SCAT2 the student athlete will be ImPACT tested. The student-athlete will not be physically tested until the SCAT2 and ImPACT results have returned to baseline or are in an appropriate relation to baseline tests.

Sport Concussion Assessment Tool 2(SCAT2) and ImPACT Testing/ Retesting: Criteria 1:

If a student-athlete is symptom free or has returned to baseline on the Post-Concussion Symptom Scale, within the first 24 hours after injury and has remained symptom free for 24 hours he/she will be SCAT2 and ImPACT retested. If the first attempt of the SCAT2 and ImPACT retest have returned to baseline, the student-athlete can begin the Physical Exertion Testing Protocol, steps 1-3, that day. The student-athlete must return to baseline on the SCAT2 test, ImPACT test, be symptom free throughout the Physical Exertion Testing Protocol, steps 1-3, and remain symptom free until the next day before he/she can continue to step 4 of the Physical Exertion Testing Protocol and return to play. If the student-athlete has a recurrence of signs, symptoms, or problems during the Physical Exertion Testing Protocol, steps 1-3, or by the next day, he/she must follow Criteria 2 for return to play. If the first attempt of the SCAT2 and/or ImPACT retest have NOT returned to baseline but the student-athlete continues to have no signs, symptoms, or problems, he/she must follow Criteria 3 for return to play.

Criteria 2: If the student-athlete is not symptom free within the first 24 hours after the injury he/she will

not be retested with the SCAT2 or ImPACT until he/she is symptom free for 24 hours. If the first attempt of the SCAT2 and ImPACT retest have returned to baseline, the student-athlete can begin only step 1 of the Physical Exertion Testing Protocol that day but will not be able to complete any steps of the Physical Exertion Testing on the same day.

If the first attempt of the SCAT2 or ImPACT retest have NOT returned to baseline but the

student-athlete continues to have no signs, symptoms, or problems, he/she must follow Criteria 3 for return to play.

Criteria 3: If the student-athlete is not symptom free within the first 24 hours after the injury he/she will

not be retested with SCAT2 and ImPACT until he/she is symptom free for 24 hours. If the first attempt of the SCAT2 and/or ImPACT retest have NOT returned to baseline, the student-athlete must wait 24 hours to take the SCAT2 and/or ImPACT retest each time it has not returned to baseline. Once the SCAT2 and ImPACT have returned to baseline the student-athlete can begin only step 1 of the Physical Exertion Testing Protocol that day but will not be able to complete any additional steps of the Physical Exertion Testing on the same day.

Student-Athletes Without SCAT2 and/or ImPACT Baseline Testing:

If a student-athlete without a SCAT2 and/or ImPACT baseline test is symptom free within the first 24 hours after injury and has remained symptom free for 24 hours he/she can begin the Physical Exertion Testing Protocol, steps 1-3, that day. The student-athlete must be symptom free throughout the Physical Exertion Testing Protocol, steps 1-3, and remain symptom free until the next day before he/she can continue to step 4 of the Physical Exertion Testing Protocol and return to play. If the student-athlete is not symptom free within the first 24 hours after the injury he/she will not be permitted to begin Physical Exertion Testing until he/she is symptom free for 24 hours. Once the student-athlete has been symptom free for 24 hours, the student-athlete can begin only step 1 of the Physical Exertion Testing Protocol that day but will not be able to complete any additional steps of the Physical Exertion Testing on the same day.

Physical Exertion Testing Protocol: The student-athlete must be symptom free each consecutive day (minimum of 12 hours between each day) before he/she can progress to the next step in the sequence, with the exception of Criteria 1 and Student-Athletes Without Baseline Testing whose symptoms resolve within 24 hours (above). The student-athlete will not be returned to full contact activity until he/she has remained symptom free, or for those with a p baseline returned to baseline on the SCAT2 and ImPACT , and he/she has been able to accomplish all of the Physical Exertion Testing Protocol steps without experiencing any signs, symptoms or problems.

If a student-athlete experiences any signs, symptoms, or problems at any one step he/she will stop the physical exertion testing protocol and begin at the previous step the next symptom free day as long as he/she has been symptom free for a minimum of 12 hours.

Step 1. Aerobic exercise – short sprints, sit-ups, push-ups, etc. Step 2. Non-contact drilling/ Sport-specific exercise Step 3. Controlled contact drilling Step 4. Full-contact/ Competition

Disqualification: If the data shows that a student-athlete has suffered a sports concussion or closed head injury, a multidisciplinary approach will be taken to return the student-athlete to active status. The student-athlete will be spoken with regularly until symptom free. Because no two concussions are the same, disqualification for practice, competition, season or career will be determined by the certified athletic trainer, team physician, and any other involved medical specialists. References: National Athletic Trainers’ Association Position Statement: management of Sports-Related Concussion, Journal of Athletic Training, 2004; 39(3): 280-297 Summary and agreement statement of the first International Conference on Concussion in Sport, Vienna 2001, British Journal of Sports Medicine, 2002;36: 6-7 Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Praque 2004, British Journal of Sports Medicine, 2005;39: 196-204 Sex Differences and the Incidence of Concussions Among Collegiate Athletes, Journal of Athletic Training, 2003; 38(3); 238-244 NCAA Special Issue, Journal of Athletic Training, April-June 2007; 42(2): 173-319 Consensus Statement on Concussion in Sport 3rd International Conference on Concussion in Sport, Zurich 2008, Clinical Journal of Sports Medicine, 2009;19: 185-200

Athlete has not returned to baseline on Post Concussion

Symptom Scale within 24 hrs of initial injury

Step 1. Aerobic exercise

Athlete issymptom free or has returned to baseline on Post

Concussion Symptom Scale for 24 hrs before taking the SCAT2

&ImPACT

Step 3. Controlled contact drilling

Step 2. Non-contact drilling/

Sport-specific exercise

Take SCAT2 &ImPACT

IISCSCAT@SCAT2test

Pass SCAT2 &ImPACT Fail SCAT2 &/orImPACT

Begin Physical Exertion

Testing that day

Fail, wait next day*

between each

Pass, begin Physical

Exertion Testing

Step 4. Full contact drilling/competition

Wait next day*

Wait next day*

Wait next day*

Wait next day*

Symptom free

Symptom free

Symptom free

Symptoms occur

Symptoms occur

Symptoms occur

Wait next day*

Wait next day*

Wait next day*

CRITERIA 2

CRITERIA 3

Athlete has no baseline SCAT2 &ImPACT

Symptom free

within 24 hrs

Not symptom free

within 24 hrs

Symptom free

for 24 hrs

Athlete is symptom free or has returned to baseline on

Post Concussion Symptom Scale within 24 hrs of

initial injury and has remained that way for 24 hrs

Take SCAT2 &ImPACT

Pass SCAT2&ImPACT

Begin Physical Exertion

testing that day

Step 1. Aerobic exercise

Step 2. Non-contact drilling/

Sport-specific exercise

Step 3. Controlled contact drilling

* all steps completed on the same day

Step 4. Full contact

drilling/competition

Symptoms occur at

any stage: STOP

Symptom free

Symptom

free until

next day

CRITERIA 1

Follow

CRITERIA 3

Follow

Physical Exertion

Testing under

CRITERIA 2

Fail either test

/IiiiiiiiiiiiiimpII

Wait next day*

* Minimum of 12 hours

Appendix A: Take-Home-Instructions:

Any student-athlete who experiences any of the signs, symptoms, or problems of a Sports Concussion and is not being referred to a physician or emergency room the day of injury will be given these Take-Home-Instructions and the front page of the SCAT card (see Appendix B). The student-athlete must be monitored for possible deterioration as problems could arise over the first 24-48 hours. You should not be left alone and must go to the hospital at once if you experience any of the following:

Have a headache that gets worse

Are very drowsy or can’t be awakened (woken up)

Can’t recognize people or places

Have repeated vomiting

Behave unusual or seem confused; are very irritable

Have seizures (arms and legs jerk uncontrollably)

Have weakness or numbness in arms, legs, or face

Are unsteady on your feet (dizziness)

Have slurred speech

Experiences changes in breathing/pulse rate

Experiences any memory deficits

Experiences any vision difficulties

Experiences anything out of theordinary

Experiences any increases in symptoms (see front page of SCAT card)

***Remember, it is better to be safe.***

I believe that sustained a concussion on . To make sure he/she recovers, please follow the following important recommendations:

1. Please remind to report to the Scandlon Sports Medicine Clinic / Betlzer Athletic Training room tomorrow at for a follow-up evaluation.

2. Please review the items outlined above. If any of these problems develop prior to his/her visit, please go to the hospital immediately. Otherwise, you can follow the instructions outlined below.

It is OK to: To wake up every several

hours to monitor symptoms

Use ice pack on head and neck as needed for comfort

Eat a light diet Return to school Rest (no strenuous activity

or sports)

There is NO need to: Check eyes with flashlight Test reflexes

Stay in bed

Do NOT: Drink alcohol Do drugs

Drive

Take medications for symptoms

Exert yourself (physically or mentally), includes no texting, video games, or computer use as these may increase symptoms

Train (cardio or strength)

King’s College Athletic Training Concussion and Academic Recommendations

To ensure proper recovery from your concussion please follow these important academic recommendations:

1. It is YOUR (i.e. the student-athlete’s) responsibility to contact all of your instructors and inform them of your concussion. While it is OK to return to school you will need rest both mentally and physically. This means no strenuous activity or sports. If you believe that the concussion will impact your performance in class we strongly suggest you talk with your instructors in advance.

2. College policy states that only the instructor can excuse a student from class, a test or other

assignment. Therefore the athletic trainers can NOT excuse a student from a class, test or other assignment. The athletic trainers can provide instructors the confirmation of the concussion and/or to answer any questions in regards to sports-related concussions. The contact information is as follows:

Greg Janik 570-208-5900 X 5684 gregoryjanik@kings.edu

Amy Brzoska 570-208-5900 X 5650 amybrzoska@kings.edu

Melissa Ciocco 570-208-5900 X 5459 melissaciocco@kings.edu

Aaron Hand 570-208-5900 X 5391 aaronhand@kings.edu

Timothy Kulpa 570-208-5900 X 5236 timothykulpa@kings.edu Dave Marchetti 570-208-5900 X 5494 davidmarchetti@kings.edu Ryanne Ziobro 570-208-5900 X 5447 ryanneziobro@kings.edu

3. If you are going to miss more than two consecutive days of the same class due to the concussion you

will need to contact your athletic trainer, the Athletic Director Cheryl Ish at CherylIsh@kings.edu and

Robert McGonigle, Associate Vice President for Student Affairs and Dean of Students. The Student Affairs Office will only notify instructors of the absence, if there are two or more consecutive absences for the same class and they only notify instructors and CANNOT excuse the student from class. Only the instructor can excuse a student from class and decide how any missed tests, assignments or other

work is made up or handled. Please contact Student Affairs at: studentaffairs@kings.edu

4. Further, missed classes or missed work may prevent a student from completing a class. If classes are missed the student should consult with their academic advisor or Academic Advisement as soon as possible to explore options for potential withdrawal from class depending on the time in the semester.

5. If academic accommodations are necessary for testing, note taking, presentations, etc. in a class the student must arrange these through Sheri Yech in the Academic Skills Center at

sheriyech@kings.edu

The majority of students, other than those with the most extreme and long-lasting symptoms, are able to continue in their studies with some temporary accommodations. The goal is to support the recovering student in keeping up with academic demands in a way that does not overstress the cognitive functions and result in worsening symptoms. A careful balancing of rest with academic work and an individualized plan that prioritizes academic work and uses appropriate, temporary, evolving accommodations allows the student to progress as symptoms improve.1

1. McGrath, N. Supporting the student-athlete’s return to the classroom after a sport-related concussion. Journal of Athletic Training. 2010;45(5): 492-498.

Appendix B: Post Concussion Symptom Scale

Instructions: The Post Concussion Symptom Scale should not only be used for the initial evaluation, but for each subsequent follow-up assessment until all symptoms have cleared at rest and during physical exertion. In lieu of simply checking each symptom present, the ATC can ask the student-athlete to grade or score the severity of the symptom on a scale of 0-6, where 0 = none, 1-2 = mild, 3-4 = moderate, and 5-6 = most severe. Student-Athlete:

Symptom Date: Time:

Date: Time:

Date: Time:

Date: Time:

Date: Time:

Headache

“Pressure in Head”

Neck Pain

Nausea or Vomiting

Dizziness

Blurred Vision

Balance Problems

Sensitivity to Light

Sensitivity to Noise

Feeling Slowed Down

Feeling like “in a Fog”

“Don’t Feel Right”

Difficulty Concentrating

Difficulty Remembering

Fatigue or Low Energy

Confusion

Drowsiness

Trouble Falling Asleep

More Emotional

Irritability

Sadness

Nervous or Anxious

Other:

King’s College Athletic Training Concussion Information Sheet

A concussion is a brain injury and all brain injuries are serious. Concussions are often caused by an impact to the head, or to another part of the body, with the force transmitted to the head. Concussions disrupt the way the brain normally works, and vary greatly in severity. Even though most concussions are mild, all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. You can’t see a concussion, and most sports concussions occur without loss of consciousness. Signs and symptoms may show up right away, or can take hours or days to fully appear. Seek medical attention immediately if you suspect a concussion has occurred. Signs observed by teammates, parents, or coaches may include that the student-athlete:

Appears dazed or confused Has a vacant facial expression (“blank stare”)

Is unsure of events of game, score, opponent

Confused about assignment

Moves clumsily/appears uncoordinated Can’t recall events from before the injury

Has slurred speech Answers questions slowly or can’t answer Can’t recall events from after the injury

Loses Consciousness Has seizures or convulsions Shows behavior or personality changes

Symptoms may include one or more of the following:

Headaches “Pressure in head” Nausea/vomiting Neck pain Balance problems or dizziness

Blurred vision Sensitive to light or noise Drowsiness Amnesia Feels slowed down

Feeling fogy or groggy Changes in sleep patterns Fatigue/no energy Sadness Mood/emotional changes

Nervousness or anxiety Concentration problems Memory problems Confusion Repeats same question/comments

What happens if someone keeps playing with a concussion or returns too soon?

Student-athletes with signs/symptoms of a concussion should be removed from play immediately. Continuing to play while experiencing signs or symptoms of a concussion leaves the student-athlete especially vulnerable to greater injury. There is increased risk of significant brain damage from a concussion for a period of time after that concussion occurs, particularly if the student-athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (“second impact syndrome”) with devastating and even fatal consequences. It is well known that student-athletes will often underreport symptoms of injuries – concussions are no different.

If you think you might have suffered a concussion

If you notice signs or symptoms of a concussion, seek immediate medical attention right away from a licensed healthcare provider trained in the evaluation and management of concussions, or your hospital’s Emergency Department. Any athlete suspected of suffering a concussion must be removed from the game or practice immediately, and may not return until the athlete is evaluated (and cleared in writing) by a healthcare provider trained in the evaluation and management of concussions. This includes Physicians (MD or DO), Athletic Trainers (AT), Nurse Practitioners (ARNP) and Physician Assistants (PA-C). Please keep a copy of this sheet for your reference at home

King’s College Sports Medicine Concussion Return to Play Protocol

Student-Athlete’s Name:________________________________ Date of Concussion:_______________________

SCAT 2: Date:________ Pass / Fail Date:________ Pass / Fail Date:________ Pass / Fail Date:_________ Pass / Fail Clinician:_____________ Clinician:_____________ Clinician:_____________ Clinician:_____________ IMPACT: Date:________ Pass / Fail Date:________ Pass / Fail Date:________ Pass / Fail Date:_________ Pass / Fail Clinician:_____________ Clinician:_____________ Clinician:_____________ Clinician:_____________

**The Student-Athlete should stop IMMEDIATELY if he/she experiences any symptom(s) during any part of this test** Step 1. Aerobic exercise – short sprints, sit-ups, push-ups, etc. Age: ________ Max Heart Rate (220-age):________ 70% of Max Heart Rate:________ **Patient should wear heart rate watch monitor if available** Timed Run (Total time = 15 minutes): After 5 minutes: HR:________ S/Sx’s: YES or NO After 10 minutes: HR:________ S/Sx’s: YES or NO After 15 minutes: HR:________ S/Sx’s: YES or NO Repeated Sprints x 4 (30-60 second break between): Repeated Sprints #1 (Followed by 30 sec. of push-ups) HR:________ S/Sx’s: YES or NO Repeated Sprints #2 (Followed by 30 sec. of up-downs) HR:________ S/Sx’s: YES or NO Repeated Sprints #3 (Followed by 30 sec. of jumping jacks) HR:________ S/Sx’s: YES or NO Repeated Sprints #4 (Followed by 30 sec. of mountain climbers) HR:________ S/Sx’s: YES or NO Comments: Clinician: Date:

King’s College Sports Medicine Concussion Return to Play Protocol – CONTINUED

Student-Athlete’s Name:________________________________ Date of Concussion:_______________________

Step 2. Non-contact drilling/ Sport-specific exercise: Clinician: Date: Step 3. Controlled contact drilling: Clinician: Date: Step 4. Full-contact/ Competition: Clinician: Date: