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AHSAA Medical Advisory Committee Update 2020 James B. Robinson, M. D. Head Team Physician- University of Alabama Co-Chairman- AHSAA Medical Advisory Committee
Important Updates • • • Concussion Heat Illness EAP AEDs Telemedicine COVID-19
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
Concussion New Information • NCAA-DOD Care Consortium • • 46, 992 participants 4, 300 concussions • Average length of symptoms = 7. 3 days • Average time to return to play = 7. 8 days • Risk of second concussion = 72 days, none in first 14 days
Concussion New Information • Children may take up to 4 weeks to return to normal • Light exercise after the first 24 -48 hours speeds recovery • Individuals that delayed reporting symptoms took 3 days longer to recover
AHSAA Concussion Resources • Mandatory Training for ALL coaches • Links to NFHS on-line learning via website • Instructional presentations on web-site
Heat Related Deaths • Heat related deaths are declining • 2 deaths in 2018 (2 High School) • 3 rd most common cause of death in High School athletes • Usually occurs in first 4 days of practice (90%) • 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 STROKE Signs 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 • Mortality ~ 80%
EXERTIONAL HEAT STROKE Treatment • • • 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 • Ice chest with 6 towels, water, and ice • 911 - to Emergency Room only after cooled!
Cool First – Transport Second!! Alamama is the first state to enact a state-wide policy of “cool 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 ILLNESS Prevention • 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
AHSAA Acclimatization Rule Section 18 • • • The first day of Fall practice is Monday, August 3, 2020. The first three days of fall football practice must be in shorts. These three 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 9. 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 ILLNESS Prevention • • 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
Heat Illness Prevention • Heat Index Monitoring • • Newspaper Television Airport Phone Apps • Not the best indicator of heat stress, but best we got
Prevention • • • Adjust practice times Adjust practice intensity Adjust practice equipment Monitor your athletes Identify at-risk athletes especially those with sickle cell trait • Get an Athletic Trainer
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 2 hours • Use a urine color chart to determine hydration status • Be careful- 2 deaths in last two years from overhydrating NATA Position Statement: Fluid Replacement for Athletes; J Athl Train; 2000; 35(2): 212 -224
FLUIDS • Fluids should: Be cool- 50 -59 F⁰ Contain carbohydrate = <8% , no fructose Contain electrolytes- the more the better Palatable - increases intake by 15% • Avoid: Caffeine Energy Drinks Alcohol Carbonated beverages
EAP Emergency 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.
EAP Medical Time-out • Should be performed prior to each practice and games • Should include head coach, medical personnel (ATC, Team MD, EMT) • Identify emergency equipment- AED • Identify responsibilities: call 911, fetch AED, open access • Discuss foul weather plan
Sudden Cardiac Death • Responsible for 4 -5 deaths/year • Numbers are decreasing due to early response, AEDs, and EAPs!!! • Mandatory on-line course for coaches on the recognition of cardiac issues
AEDs • Sudden Cardiac death is the leading cause of death in athletes • For every minute after collapse, the survival rate decreases by 10% • Have an AED accessible within 1 minute of athletic events
AEDs • • Every school has one All AHSAA staff have one Most ATCs have one Make sure they are in an accessible location Make sure batteries are checked monthly Annual training for all users CPR and AED training for all coaches
Telemedicine • Wrestling coaches have the ability to videoconference with a physician to assess whether a skin condition needs to be seen by a physician • This allows for rapid treatment to ensure wrestlers are not removed from competition
Telemedicine • Network of physicians in each district willing to see athletes on a moments notice • Utilized only for Sub-State and State Championships last year • Will be available all year this year
Telemedicine for Wrestling Coaches • 2014 State Championships • 6 wrestlers with potentially disqualifying skin conditions • 3 wrestlers were disqualified at championship • 2015 State Championships • 0 wrestlers with skin conditions • 0 wrestlers disqualified • 2016 State Sub-Sectionals • 2 wrestlers disqualified • 2018 State Championships • 3 wrestlers disqualified!!!!! • 2019 State Championships • 3 wrestlers disqualified
Telemedicine • 205 -394 -1410
AHSAA MAC Best Practices • • • Education Screening Social Distancing Face Coverings Hygiene Weight room Guide lines
Education • It is the responsibility of the local school (system) to follow all guidelines provided by the ADPH, ALSDE and local county/city health departments. Before beginning any athletic activities, check your local government policy as their policies may be more restrictive. • Local school administration should provide coaches, student-athletes, and parents the supportive ALSDE, AHSAA and ADPH guidelines and educate all parties involved regarding the seriousness of COVID-19 and discuss all safety and cleanliness expectations.
Screening • All coaches, athletes and personnel may be screened each day for signs and symptoms of COVID-19 infection prior to participating in any workout or gathering. To assist schools with the screening process, sample questionnaires may be found on the AHSAA website at the following link https: //www. ahsaa. com/Schools/COVID-19 -Screening-Tools • Only school personnel, coaches, athletic trainers, and studentathletes should be present during activities. Non-essential personnel should not be present. • Individuals having or experiencing any COVID-19 symptoms should follow ALSDE/ADPH guidelines listed at www. ahsaa. com.
Physical Distancing • Establish and maintain static groups for the maximum duration of any summer activity. • Space large enough to accommodate 36 square feet per participant, including adults • Supervision of one adult per 12 students • Maintain distance of six feet between person whenever possible • If activity requires closer than six feet, wear facial coverings • Wear facial coverings when entering common areas and to the greatest extent possible
Physical Distancing • Maintain the physical distancing (6 FEET) standards set forth by the ADPH and ALSDE. • Avoid groups at the end of workouts or practice sessions unless all group members are 6’ apart or wearing protective facial cloth covering. • While on the field of play or court, all athletes and coaches should maintain physical distancing of 6 feet. Based on the activity or drill, if physical distancing cannot be maintained, students and coaches should wear a protective facial cloth covering. • During group or position meetings, physical distancing should be maintained. • Students should remain in static (same) groups– do not interchange group members. • Assigned seating
Physical Distancing • When possible, have one specific entry and a separate exit point when arriving and departing the facility (gym, field house, weight room, etc. ). • Keep different teams separated. (Ex: Do not allow the volleyball team to cross paths with the basketball team. ) • Multi – sport athletes may attend more than 1 workout per day provided the athletes change clothes before attending the second, or third, workout and follow all ADPH hygiene guidelines concerning hand washing and cleanliness.
Face Coverings • When physical distancing cannot be maintained, cloth face coverings should be worn by all individuals (including all coaches and staff). Medical grade surgical masks or N-95 masks are not necessary. • Plastic face shields should not be used – including those attached to a helmet – in lieu of a cloth facial covering. All plastic shields must comply with NFHS rules.
Hygiene • Upon arrival, students should wash hands and before starting any workout/practice session. In accordance with ALSDE/ADPH guidelines, if a sink with soap and water is not available, provide hand sanitizer with at least 60 percent alcohol and supervise its use. • Avoid “shared” personal items – towels, cups, water bottles, gloves, etc. • ALL equipment including balls, bats, helmets, gloves, etc. should be wiped down and cleaned after each group activity, workout, skill development session, etc. Avoid sharing equipment whenever possible. • As soon as the workouts are complete, all student-athletes should leave the facility immediately. Students are encouraged to shower and wash all clothing that was worn during activities as soon as possible after returning home.
Weight Room Guidelines • All surfaces including, but not limited to, door handles, sinks, faucets, knobs, toilets, tables, soap dispensers, locker handles etc. , should be cleaned and sanitized thoroughly before groups arrive and once groups have left the area. • Maintain recommended spacing based on ADPH and ALSDE guidelines. (When possible, mark off or outline areas for the correct spacing. ) • Spotters should wear a cloth facial covering.
Weight Room Guidelines • When athletes end a set, all equipment should be wiped down before the next athlete begins. (Ex: Once Player A finishes a set of bench press, the bar, bench, and any weights that were changed out should be adequately sanitized before allowing another student/group to use. ) • After one group leaves the weight room and before the next group enters, the room should be completely cleaned and sanitized.
Other Information • Isolation: • Used to denote an active infection • To be maintained for at least 10 days from onset of symptoms or test • End of Isolation • At least 14 days from onset of symptoms or test • and. At and least 3 days (72 hours) of improvement in respiratory symptoms • and no fever without the use of fever reducing medication
Other Information • Quarantine: • Denotes exposure to someone with COVID -19 infection • Should last 14 days from last exposure as long as no symptoms develop regardless of results of testing
Other Information • Close Contact • Denotes being within 6 feet or less of a COVID positive individual for at least 15 minutes without the use of face coverings or had frequent bodily contact with a COVID positive individual • No guidelines on if masks were used by one or both parties but we know risk is reduced
Close Contact Exposure • If someone is identified as a close contact, then they should immediately go into quarantine for 14 days • If testing is to be performed, then should wait at least 3 -5 days from exposure due to incubation period and false sense of security of a negative test too soon.
Other Information • Contact Tracing: • Identifies any individual that would be considered a close contact beginning 48 hours prior to onset of symptoms or positive test • Duty of the ADPH, not the responsibility of the school or coaches
Thank You QUESTIONS?