MCLA ATHLETIC DEPARTMENTSPORTS MEDICINE

POLICIES AND PROCEDURES MANUAL

Table of Contents

Coverage and Personnel 3Clearance for Varsity Sport Participation 3Medical Care 5Sports Medicine Room 6Equipment 6Appendices 9

This document was created by the Sports Medicine staff to ensure the continued and growing success of the Athletic Training and Sports Medicine staff associated with Massachusetts College of Liberal Arts varsity Athletics. Furthermore, this document will outline, and define the policies and procedures required for appropriate use of the Athletic Training and Sports Medicine staff, facilities and associated functions.

1. Coverage and Personnela. All practice coverage is based on the availability of the Sports Medicine staffb. A member of the Sports Medicine staff will travel to all post-season competitionsc. A member of the Sports Medicine staff may travel with each team for scheduled

spring break/winter/preseason competitions d. It is the responsibility of the coaching staff to notify the Sports Medicine staff of

practice changes. e. Practice changes must be outside of 24 hours prior to an event for coverage to be

provided.f. The Sports Medicine staff reserves the right to discontinue outdoor practice and

competition in the event of inclement weather (including, but not limited to extreme temperatures, and lightning) See Appendix D, Appendix F, MCLA EAP

g. The Sports Medicine staff is comprised of the Head Athletic Trainer, Assistant Athletic Trainer, and Team Physician (College Physician)

h. The Sports Medicine staff works in conjunction with MCLA Student Health Services, Counseling Services, and the Strength and Conditioning coach.

i. The Sports Medicine staff is only responsible for the coverage and treatment of Athletic Department sponsored events and team participants.

j. The Sports Medicine staff utilizes SportsWare for injury surveillance and documentation purposes.

k. It is at the discretion of the Director of Athletics whether practices will be covered on days where the university is closed for weather related events.

i. The ability to cover practice will be determined by the safety of commuting to campus.

ii. In the event of a non-coverage practice, the head coach of that sport will be notified by the Sports Medicine staff or Director of Athletics.

l. Coverage will be provided for the traditional season. Unless otherwise notified, Non-traditional practices may not be covered.

2. Clearance for Athletic Team Participationa. Physicals

i. All first-year student-athletes must have a valid physical up to no more than six (6) months prior to the confirmed start date of their sport as per NCAA bylaw 17.1.5.

ii. It is the responsibility of the coaching staff to inform all participating individuals of the requirement for a physical exam.

iii. The Sports Medicine staff does not provide Physical Exams.iv. The Sports Medicine staff reserves the right to withhold a student-athlete from

participation due to negligence of obtaining a physical.v. Dates for qualifying Physicals are as follows:

1. Soccer, Women’s Tennis, Cross country, Golf, and Volleyball: February of the same calendar year.

2. Baseball, Softball, Men’s Tennis, and Lacrosse: March of the same calendar year.

3. Basketball: 15 April of the same calendar year.b. Each member of all varsity sports must obtain clearance through the Sports Medicine

department before they are cleared to participate in any team events. i. All required paperwork is located on the Sports Medicine section of the

MCLA Athletic website. The aforementioned paperwork is available on SportsWare online.

ii. Required paperwork must be completed and submitted before a student-athlete is able to be cleared.

iii. Proof of valid Health Insurance is required for clearance.iv. Team events include but are not limited to: team workouts, pre-season

practices, traditional season practices, non-traditional season practices. Team events are all activities qualifying as NCAA athletically related activities.

c. All participants (excludes: cross country, tennis and golf) must complete the online ImPACT baseline testing before they are cleared to participate.

d. Official start dates will be communicated to the Sports Medicine staff by the Associate Athletic Director or Director of Athletics

e. All student-athletes must be present at the predetermined time and date to be cleared by Sports Medicine staff.

i. If a student-athlete is unavailable due to extenuating circumstances (class, work etc.), they must make alternative plans with the Sports Medicine staff either in person, or by use of school email (@mcla.edu)

ii. The Sports Medicine staff reserves the right to delay clearance (in favor of those receiving routine treatment etc.) for student-athletes who do not contact the Sports Medicine staff prior to arriving at the Sports Medicine Room.

f. Student-athletes are required to comply with all NCAA rules regarding banned substances.

g. Student-athletes will be subject to random drug testing as outlined in the MCLA Department of Athletics Drug Testing Policy. All student-athletes found in violation will be subject by the rules outlined in the same document.

h. Insurancei. All student-athletes must have current insurance coverage

ii. All changes to insurance policies should be brought to the attention of the Sports Medicine staff.

iii. MCLA will provide ‘gap’ insurance, which will provide coverage after personal insurance from $25,000 to $90,000.

i. All changes to prescription, and daily medications should be brought to the attention of the Sports Medicine staff.

3. Medical Carea. All student-athletes (in or out of season) have access to the Team Physician, and

office hours of the Sports Medicine Staff regarding all medical concerns.b. The Sports Medicine staff will evaluate, treat, and educate student-athletes regarding

all medical concerns and injuries.c. At any point, a student-athlete may choose to obtain a second opinion regarding a

medical concern.i. The Sports Medicine staff is not responsible for, and cannot act against the

diagnosis or opinion of a secondary physician.ii. Student-athletes must refer to their secondary physician for clearance

following suspension of participation, and may not be cleared to participate by the Sports Medicine staff.

iii. Following suspension of activity for a medical reason by a secondary physician, a student-athlete may be subject to additional clearance by the Team Physician

d. See “MCLA Concussion Guidelines” for return to play protocol following concussive head injuries.

i. See also “National Athletic Trainers’ Association Position Statement: Management of Sport Concussion” and “NCAA Concussion Fact Sheet for Student-Athletes”

ii. Further information regarding concussions and their care can be acquired from the Sports Medicine Staff

iii. Return to Learne. The Sport Medicine staff reserves the right to withhold a student-athlete from

participation if allowing them to compete would result in direct harm.f. Preferential coverage and treatment may be given to teams that are in season over

teams that are in their non-traditional season.g. Preferential coverage will be given to competition over practices.h. All coaches and staff are required to have an operational knowledge of the

Emergency Action Plan (Appendix G) as it applies to the practice/competition venues.

i. In the event of a College related incident, refer to the “MCLA Student Affairs Division Critical Incident Response Management Guide” and follow instructions set forth by the CIRT team, and Campus Police

j. Prior to competition, the Sports Medicine staff will provide pre-game medical care for both the home and away teams

k. Once a student-athlete is notified of a rehab protocol, and timeline, it is their responsibility to arrange and be present for rehabilitation.

l. Medical Devices

i. Student-athletes requiring an Epi-Pen (for allergies or other) are required to have that Epi-Pen on their person for all competitions and practices, home and away. Student-athletes not in possession of a prescribed Epi-Pen are subject to removal from activity for their own safety.

ii. The Sports Medicine Staff should be made aware of the requirement or necessity of all medical device for any reason.

m. The Sports Medicine staff does not dispense over the counter medications.4. Sports Medicine Room

a. See ‘Appendix A’ for general Sports Medicine Room rulesb. The Sports Medicine Room will be open August – May. c. The Sports Medicine Room will be closed June and July.d. Hours of operation for the Sports Medicine Room are determined by practice and

game schedules.i. Morning hours are reserved for injury treatment, evaluation and rehabilitation.

(Approximately 10 a.m. to 2 p.m.)ii. Pre-practice hours are reserved for pre-practice modalities, and taping/bracing.

(approximately 2 p.m. through the remainder of the evening)iii. If a student-athlete is unable to complete treatment or rehab during the

designated time, it is their responsibility to make alternate plans with the Sports Medicine staff.

iv. Monthly schedules will be posted outside the Sports Medicine Room5. Equipment

a. Medical Kits (“Med Kits”)i. All teams will receive a Med Kit containing basic athletic training equipment.

1. While in their possession, each med kit will be the sole responsibility of that respective team.

2. All med kits will be returned to the Athletic Training Room at the conclusion of the competitive season.

ii. Each Head Coach will have remote access to SportsWare in the event that a student-athlete requires their insurance card off of campus.

iii. A supplementary med kit will be placed in the Athletic Complex turf field athletic training shed during the fall and spring seasons.

b. Automated External Defibrillators (AEDs) three [3] are housed in the Sports Medicine Room. One additional AED is located in the Achievement Lounge of the Campus Center. One AED will be placed in the garage at the Athletic complex. (August until the last practice or competition in November, and replaced before the first practice in March until the end of the last practice or competition in May)

c. Each team is responsible for getting water from the Sports Medicine Room for practices.

i. Indoor sports will utilize a water cartii. It is recommended that all outdoor sports will fill one water cooler with ice,

and fill the cooler with water at the Athletic complex.iii. It is the responsibility of each team to return all equipment to the Sports

Medicine Room at the end of each practice sessiond. It is the responsibility of each field-based team to fill one ice chest from the Sports

Medicine Room for practice at the Athletic complex.

e. Each team will be provided the appropriate amount of water bottles prior to the start of their competition season.

i. The Sports Medicine staff will house, and clean all bottles issued in racksii. Disposable cups will not be provided for practices.

iii. Each first-year student-athlete will be given one water bottle. A replacement water bottle may be purchased from the Sports Medicine staff for three dollars

f. Home competition set up and equipmenti. Soccer, Lacrosse: 2 ten gal. water coolers, 1 ice chest, ice bags, 1 set of

crutches, 1 med kit, access to AED, water bottles for home team, 30 cups for visitors, 1 walkie-talkie.

ii. Tennis: 1, 8 or 10 gal. water cooler, 1 ice chest, ice bags, 1 set of crutches, 1 med kit, access to AED, water bottles for home team, 20 cups for visitors, 1 walkie-talkie

iii. Volleyball, Basketball: 2 carts, 2 ten gal. water coolers, 1 ice chest, ice bags, 1 med kit, access to AED, water bottles for home team, 30 cups for visitors, 1 walkie-talkie, 2 towels

iv. Baseball, Softball: 2 ten gal. water coolers, 1 ice chest, ice bags, 1 set of crutches, 1 med kit, access to AED, water bottles for home team, 30 cups for visitors, 1 walkie-talkie

v. In the event of an off-site home competition, a walkie-talkie is no longer required equipment

vi. Sports Medicine will assist with all contest set-up

Appendix ASports Medicine Room Rules

Student-athletes must sign-in utilizing the computer upon entering All tobacco products (smokeless or otherwise) are strictly prohibited Profanity, loud disruptions, racial/sexist/religious or other derogatory language will not be

tolerated Headphones and personal music should not interrupt with treatments Personal bags should be kept in individual lockers, or on the storage rack outside Athletic attire should be worn to all treatment sessions Wet, muddy, or otherwise dirty footwear should be left outside Student-athletes must shower before using immersion whirlpools Shoes/cleats are not allowed on the treatment tables Modalities are to be used exclusively by Sports Medicine staff Horseplay and other raucous behavior will not be tolerated Towels are not personal towels Cell phone usage is not permitted during rehabilitation Student-athletes are seen on a first come first served basis, however exceptions to this rule

can be made by the Sports Medicine staff.Appendix B

Concussion Policy & Take Home Guidelines

1. DEFINITION OF A CONCUSSION

Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. a The National Athletic Trainers’ Association utilizes the following definition procured from The American Academy of Neurology. Practice parameter: the management of concussion in sports (summary statement) “trauma induced alteration in mental status that may or may not involve loss of consciousness”. b Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘‘impulsive’ force transmitted to the head. Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hours. Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies. b

2. SIGNS AND SYMPTOMS OF A CONCUSSOINThe SCAT3 tool is utilized by the MCLA Sports Medicine staff in order to identify a concussion. The following are the listed and graded symptoms found on the SCAT3:headache, “pressure in head”, neck pain, nausea or vomiting, dizziness, blurred vision, balance problems, sensitivity to light, sensitivity to noise, feeling slowed down, feeling “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. c The SCAT3 tool also includes: The Glasgow coma scale (GCS), the Maddocks Score, sideline assessment, background, Cognitive assessment [Standardized Assessment of Concussion (SAC)], Neck Examination, Balance examination, Coordination examination and SAC Delayed Recall.c The ATSM utilizes all of these tools to identify specific signs and symptoms of a concussion.

3. CONCUSSION MANAGEMENT AND HOME CARE Signs to watch for:

Have a headache that gets worse, are very drowsy or can’t be awakened, can’t recognize people or places, have repeated vomiting, behave unusually or seem confused; are very irritable, have seizures (arms and legs jerk uncontrollably), have weak or numb arms or legs, are unsteady on their feet, have slurred speech. c

After a concussion diagnosis, the patient should be instructed to avoid medications other than acetaminophen. a

After a concussion diagnosis, the patient should be instructed to avoid ingesting alcohol, illicit drugs, or other substances that might interfere with cognitive function and neurologic recovery. a

After the initial monitoring period, rest is currently the best practice for concussion recovery. As such, there is typically no need to wake the patient during the night unless instructed by a physician. a

In addition to exclusion from physical activity related to team activities, concussed student-athletes should be excused from any activity requiring physical exertion (eg, physical education classes) a

Patients are highly encouraged to avoid ‘screen time’ (including phone, television, and computer) as these interactions are likely to exacerbate concussion symptoms.

4. RETURN TO PLAY PROTOCOL AND PROGRESSIONGradual Return to Play Protocol b

Rehabilitation Stage Level of Functional Exercise Object of Stage1. No activity Symptom limited physical and cognitive rest recovery2. Light aerobic exercise Walking, swimming, or stationary cycling;

intensity <70% maximum heart rateIncrease heart rate

3. Sport-specific exercise

Running, intensive swimming, No head impact activities

Add movement

4. Non-contact drills Progression to more complex training drills; e.g. passing, kicking. Start progressive resistance training

Exercise, coordination, cognitive load

5. Full-contact practice Following medical clearance, participate in normal training activities

Restore confidence, assess functional skills6. Return to play Full go return to all activities

5. MCLA SPORTS MEDICINE BEST PRACTICES DISCLOSURE6. All concussions will be documented. All updates, and paperwork regarding student-athlete

concussions will be retained with that student-athletes file.7. Before returning to play, all student-athletes who have sustained a concussion will re-take

their ImPACT test8. It is the responsibility of the athlete to self-report all symptoms honestly to the SM staff9. In regards to coursework, the SM will: 1. Encourage students to discuss limitations with

specific professors. If a professor is unable or unwilling to work with a student, the SM will encourage that student to 2. Work with CSSE to create an appropriate course of action for that specific student.

10. All student athletes are requested to refrain from excessive ‘screen time’, as it will directly impact their concussion symptoms

11. If concussive symptoms persist, the SM staff will first refer that student-athlete to the Team Physician. If further medical care is required, the SM staff will work with that student-athlete to seek medical care from a neurologist (or other)

a. It is not the policy of the MCLA SM staff to procure diagnostic imaging for all concussive episodes. This is not medically advised. a,b

b. All athletes at high risk of concussion undergo baseline examination before the competitive season. a Baseline testing is repeated every two years

c. All concussive episodes are taken on a case by case basis. There is no specific timeline available within medical best-practices, and scientific research.

d. MCLA SM utilize current EBP standards for concussion management. This document, as well as standard of care for this injury are constantly changing.

e. MCLA SM staff will ImPACT test concussed individuals between steps 3 and 4 of the return to play protocol. Full return to play will be contingent upon interpretation of ImPACT results.

12. REFERENCES

a. National Athletic Trainers’ Association Position Statement: Management of Sport Concussion

b. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012

c. Sport Concussion Assessment Tool – 3rd edition

Take Home Concussion Guidelines

You (or someone monitoring you) are receiving this paper because you have recently been diagnosed with a concussion. Included in this hand-out is information regarding what to do next, as well as some common questions and answers.Q: What is happening?A: You have incurred a contact, or non-contact episode during physical activity that has altered your mental status. This means it affects how you think, and how your brain interacts with the world.Q: Do I need to go get a CT scan, MRI etc.?A: The ATSM staff in conjunction with the Team Physician will decide whether diagnostic imaging is necessary. You do not need to go to the emergency room as soon as you go home.Q: How long will my symptoms lastA: It is currently unknown how long concussion symptoms last. The ATSM staff treats each individual on a case by case basis. Q: What about school work?A: If you are having trouble with school work, or concentrating in class, let the ATSM staff know, and we will work along with CSSE to come up with an adequate solution.Q: Can I use my phone?A: It is *Highly discouraged* to text, or use your phone (computer, TV etc.) for extended periods. Staring at brightly lit screens, especially at night, will often make concussion symptoms worse.

You do not need to wake up a concussed individual every two hours throughout the night. Rest is the best thing for them.

Avoid all medications except for acetaminophen. If you do not know if this is what you have, ask the ATSM staff, we will provide you with the appropriate medication.

Avoid alcohol, and other drugs or substances that might interfere with how your brain works. Do not participate in your physical activity classes. If this is an issue, please talk with the

ATSM staff. Please come in daily so that we can appropriately monitor your symptoms!

Appendix CNOAA Weather Guidelines

These are signs you should look out for:Headache that gets worseAre very drowsy or can’t be awakened,Can’t recognize people or placesRepeated vomitingBehave unusually or seem confused

Are very irritableHave seizuresHave weak or numb arms or legsAre unsteady on their feetHave slurred speech

Appendix DNATA Environmental Cold Injuries Position Statement

http://natajournals.org/doi/pdf/10.4085/1062-6050-43.6.640?code=nata-site

Appendix ENATA Lightning Position Statement

http://lightningsafety.com/nlsi_pls/NATA_2013.pdf

Appendix FMCLA Sports Medicine Emergency Action Plan (EAP)

Located on the MCLA Sports Medicine Website and within the Athletic Department Standard Operating Procedures Manual

Appendix GNCAA Coaches’ Concussion Fact Sheet

https://www.ncaa.org/sites/default/files/2017SSI_ConcussionFactSheet_Coaches_20170721.pdf