GEORGE MASON UNIVERSITY Center for Sports Performance

GEORGE MASON UNIVERSITY Center for Sports Performance

SPORTS MEDICINE SPORTS SCIENCE SPORTS NUTRITION SPORTS PSYCHOLOGY STRENGTH & CONDITIONING

POLICIES AND PROCEDURES 2017-2018 George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

The following sports Medicine Policies and Procedures Manual outlines of the standard operating procedures for the George Mason University Sports Medicine Department. This manual was developed by the Athletics Health Care Administrator and staff athletic trainers in conjunction with the team physicians. The Medical Director has had careful oversight, has reviewed, and has approved the manual in its entirety. The signatures below represent approval for the institution of these policies and procedures and are maintained by the Athletics Health Care Administrator and Athletic Department.

Approved by ______Medical Director (Team Physician) Date

Approved by ______Athletics Health Care Administrator Date

Approved by ______Athletic Director Date

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George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

TABLE OF CONTENTS TABLE OF CONTENTS ...... 2

SPORTS MEDICINE ...... 6 SCOPE OF PRACTICE ...... 7 VIRGINIA ATHLETIC TRAINERS LICENSURE ACT ...... 8 NATA CODE OF ETHICS ...... 8 SPORTS MEDICINE DEPARTMENT PERSONNEL ...... 8 SPORTS MEDICINE ADMINISTRATIVE CHAIN OF COMMAND ...... 10 SPORTS MEDICINE SERVICES AND OPERATIONS ...... 10 SPORTS MEDICINE STAFF RELATIONS ...... 11 SPORTS MEDICINE HOURS OF OPERATION ...... 12 ATHLETIC TRAINING ROOM RULES ...... 12 SPORTS MEDICINE FACILITY GENERAL POLICIES AND PROCEDURES ...... 14 SPORTS MEDICINE OPENING AND CLOSING PROCEDURES ...... 16 GENERAL MEDICAL ELIGIBILITY GUIDELINES ...... 18 RETURNING STUDENT-ATHLETES MEDICAL FORMS ...... 22 ON-CAMPUS EVALUATIONS FOR MEN’S BASKETBALL ...... 22 SICKLE CELL ASSESSMENT AND MANAGEMENT PROTOCOL ...... 25 MEDICAL HARDSHIP / DISQUALIFICATION ...... 27 MEDICAL SERVICES ...... 29 FINANCIAL COVERAGE OF MEDICAL CARE ...... 29 MEDICAL REFERRAL POLICIES ...... 29 PRE-SEASON CAMP EDUCATIONAL PROCEDURES ...... 30 MEDICAL KITS AND EQUIPMENT ...... 30 EQUIPMENT AT PRACTICE ...... 31 ORTHOTICS ...... 31 DURABLE MEDICAL EQUIPMENT (BRACES) ...... 31 GEORGE MASON UNIVERSITY DRUG AND ALCOHOL POLICY ...... 33 ADMINISTERING MEDICATIONS ...... 43 MEDICAL REFERRAL ...... 50 GEORGE MASON UNIVERSITY STUDENT HEALTH ...... 50 MASON IMMUNIZATION POLICY ...... 51

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INSURANCE POLICY AND PROCEDURES ...... 54 DENTAL CARE ...... 65 JEWELRY/BODY PIERCING ...... 65 EYE CARE ...... 65 PHARMACY ...... 65 NUTRITIONAL SUPPLEMENTS AND ERGOGENIC AGENTS ...... 66 NCAA BANNED DRUG LIST ...... 67 TOBACCO PRODUCTS ...... 70 "AFTER-HOURS" EMERGENCIES ...... 70 RETURN TO PLAY POLICY ...... 71 TRANSPORTATION OF STUDENT-ATHLETES POLICY ...... 72 MEDICAL RECORDS AND CONFIDENTIALITY/HIPAA/FERPA ...... 73 ELECTRONIC MEDICAL RECORD (NEXTT) ...... 74 POLICY & PROCEDURE ON THE DISCLOSURE OF HEALTH INFORMATION ...... 76 POLICY ON PERMITTED DISCLOSURES OF HEALTH INFORMATION ...... 77 POLICY ON STUDENT-ATHLETES’ RIGHT TO INSPECT AND COPY ATHLETIC HEALTH RECORDS ...... 79 POLICY ON STUDENT-ATHLETES’ RIGHT TO AMEND ATHLETIC HEALTH RECORDS ...... 80 POLICY ON MAINTENANCE OF AN ACCOUNTING OF DISCLOSURES OF ATHLETIC ...... 82 HEALTH RECORDS ...... 82 POLICY ON STUDENT-ATHLETES RIGHT TO REQUEST RESTRICTIONS AND CONFIDENTIAL COMMUNICATIONS CONCERNING ATHLETIC HEALTH RECORDS ...... 83 POLICY ON FACSIMILE OF STUDENT-ATHLETE’S ATHLETIC HEALTH RECORDS...... 83 POLICY ON RELEASE OF STUDENT-ATHLETE’S INJURY INFORMATION TO THE MEDIA ...... 84 POLICY ON RELEASE OF STUDENT-ATHLETE’S MEDICAL INFORMATION TO PROFESSIONAL SCOUTS AND ORGANIZATIONS ...... 85 PARENT/GUARDIAN COMMUNICATION POLICY ...... 85 ATHLETIC TRAINING STAFF / COACHING STAFF RELATIONSHIP...... 86 SPORT COVERAGE POLICY ...... 88 VISITING TEAM PROCEDURES ...... 91 EQUIPMENT SIGN-OUT PROCEDURE ...... 91 USE OF SUPPLIES BY COACHES ...... 91 CPR AND FIRST AID FOR COACHES ...... 92 GEORGE MASON UNIVERSITY EXPOSURE CONTROL PROGRAM ...... 93

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BIOHAZARDOUS WASTE DISPOSAL ...... 95 COMMUNICABLE DISEASE POLICY ...... 97 MODALITY CALIBRATION ...... 98 VEHICLE USE – ELECTRONIC CART POLICY ...... 98 BUDGET AND INVENTORY – PROCURMENT POLICIES ...... 100 EMERGENCY ACTION PLAN ...... 101 MASON ATHLETICS EMERGENCY ACTION PLANS ...... 102 EMERGENCY TRANSPORTATION ...... 106 VENUE SPECIFIC EMERGENCY PLANS & GPS ADDRESSES ...... 108 CATASTROPHIC INCIDENT RESPONSE PLAN ...... 135 AUTOMATED EXTERNAL DEFIBRILLATOR (AED) POLICY ...... 146 OXYGEN ADMINISTRATION POLICY ...... 150 LIGHTNING AND THREATENING WEATHER POLICY ...... 153 COLD STRESS AND EXPOSURE ...... 159 HEAT ILLNESS POLICY AND PROCEDURES: ...... 161 REHYDRATION ...... 176 DISORDERED EATING ...... 179 CONTRACT FOR MEDICAL CARE ...... 182 SKIN DISORDERS ...... 183 CONCUSSION MANAGEMENT – NCAA PROTOCOL ...... 185 ADHD ...... 197 CERVICAL SPINE INJURIES ...... 199 SUDDEN CARDIAC DEATH ...... 204 SICKLE CELL TRAIT ...... 206 CONDITIONS OF IMPAIRMENT ...... 208 PREGNANCY AND PARENTING POLICY ...... 209 TYPE 1 DIABETES ...... 212 ASTHMA POLICY ...... 216 HYPERTENSION ...... 222 TRANSGENDER POLICY ...... 224

MENTAL HEALTH/ SPORTS PSYCHOLOGY ...... 228

SPORTS NUTRITION ...... 239 4 2/16/2018

George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

BODY COMPOSITION ASSESSMENT AND WEIGHT MANAGEMENT ...... 239

STRENGTH & CONDITIONING/WEIGHT ROOM ...... 244

SPORTS SCIENCE/ RESEARCH- PATRIOT PERFORMANCE LAB ...... 252 STUDENT-ATHLETE FORMS ...... 256

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SPORTS MEDICINE

MISSION / VISION Introduction George Mason University Sports Medicine is charged with providing optimal athletic health care and aiding in the athletic performance of George Mason University student-athletes. As an integral part of the George Mason University Department of Athletics, George Mason Sports Medicine works under the guidelines of the National Collegiate Athletic Association (NCAA), the Atlantic-10 (A-10) Conference, George Mason University, and the Department of Athletics.

Mission Statement: George Mason University Sports Medicine is composed of Certified Athletic Trainers, Team Physicians, and other performance and allied health care professionals who provide a variety of experience, clinical techniques and philosophies in sports medicine. It is the mission of the Mason Sports Medicine Program to provide the student-athletes of George Mason University with the highest quality healthcare available. Members of the Mason Sports Medicine program make it a priority to stay up to date with the leading knowledge and standards of medical care in order to provide the most comprehensive and appropriate health care to meet each individual student-athletes’ needs. Each member of the Mason Sports Medicine Program strives to ensure the safe participation of every George Mason University student-athlete.

Vision Statement: The Mason Sports Medicine Program serves each individual George Mason University student-athlete to help them succeed on and off the playing field/court. The Mason Sports Medicine Program delivers sports medicine services to all George Mason University student-athletes. The services provided to each student-athlete are:

1. Injury/Illness Prevention and Wellness Protection 2. Clinical Evaluation and Diagnosis 3. Immediate and Emergency Care 4. Treatment and Rehabilitation

The Mason Sports Medicine Program strives to utilize the most up to date evidence based practices and technologies to continue to deliver high quality health care to each student-athlete. The goal of the Mason Sports Medicine Program is to be proactive in its approach to reduce the risks of injury that occur with athletic participation, while also providing accessible health care to all student-athletes that is cognizant of their individual needs to ensure their safe return to participation in a timely fashion.

Philosophy George Mason University Sports Medicine provides optimal medical services for the student- athlete through a systematic screening and management of each individual. George Mason

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Sports Medicine is grounded in the philosophy that injury prevention along with progressive training principles leads to optimal athletic performance. This philosophy is the result of the combined efforts of Certified Athletic Trainers, Physical Therapists, Chiropractors, Team Physicians, and other performance and allied health care professionals.

Furthermore, the George Mason University Sports Medicine Department strives to provide the intercollegiate student-athletes with the highest standard in health care. In doing so, the Sports Medicine staff is devoted to facilitating exemplary care, prevention, treatment, and rehabilitation of injuries and illnesses in conjunction with maximizing athletic performance. The Sports Medicine Department is dedicated to providing student-athletes with the latest in sports medicine research and technology; and in creating an environment that promotes the total wellness of the student, the athlete, and the person.

George Mason Sports Medicine maintains a close relationship with the George Mason School of Education and Human Development and in particular, the George Mason Athletic Training Education Program (ATEP), to provide clinical training and experience to athletic training students. George Mason staff ATs serve as preceptors to athletic training students in the ATEP and provide classroom and laboratory instruction as a supplement to the ATEP professors. Staff ATs also participate in the University’s mission of service to the university community and surrounding community through various guest lectures and community service projects.

The Department of Intercollegiate Athletics has three Athletic Training Rooms on campus.

Field House - Room 129 (Main Athletic Training Room) Phone: 703-993-3279 General Athletic Training Room Hours: 10:00 a.m. to 7:00 p.m. Weekends: Only for specific practices and events

Recreation and Athletic Complex- Room 1204 Phone: 703-993-3278 Hours - Only for specific practices and events

Eagle Bank Arena – Room 1059 Phone: 703-993-3063 Hours - Only for specific practices and events

SCOPE OF PRACTICE Athletic Training is an allied health profession that includes the practice of preventing, recognizing, assessing, managing, treating, and rehabilitating athletic related injury under the direction of a physician licensed in the Commonwealth of Virginia who is authorized to refer for health care services within the scope of the Virginia Athletic Trainers Licensure Act.

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VIRGINIA ATHLETIC TRAINERS LICENSURE ACT Under § 54.1-2400 and Chapter 29 of Title 54.1 of the Code of Virginia, effective July 1, 2004, all individuals wishing to practice athletic training in the state shall be licensed by the Virginia Board of Medicine. Licensure is a two-stage process, requiring successful completion of the National Athletic Trainers Association Board of Certification National Medical Exam, and the completion of the Virginia Licensure Application. The necessary forms, designated fees and formal description of the licensing and renewal process can be found on the Virginia Board of Medicine web page at https://www.dhp.virginia.gov/medicine/medicine_forms.htm#AthleticTrainer All athletic trainers employed at George Mason University must have all licensure documentation on-file within the Sports Medicine Department.

NATA CODE OF ETHICS Preamble The Code of Ethics of the National Athletic Trainers' Association has been written to make the membership aware of the principles of ethical behavior that should be followed in the practice of Sports medicine. The primary goal of the Code is the assurance of high quality health care. The Code presents aspirational standards of behavior that all members should strive to achieve. The principles cannot be expected to cover all specific situations that may be encountered by the practicing athletic trainer, but should be considered representative of the spirit with which athletic trainers should make decisions. The principles are written generally and the circumstances of a situation will determine the interpretation and application of a given principle and of the Code as a whole. Whenever there is a conflict between the Code and legality, the laws prevail. The guidelines set forth in this Code are subject to continual review and revision as the Sports medicine profession develops and changes.

The full NATA Code of Ethics can be found at: Http://www.nata.org/membership/about- membership/member-resources/code-of-ethics

Documentation to report ethical violations to the NATA can be found at: http://ww.nata.org/ethics-complaint-form

The Board of Certification for the Athletic Trainer maintains the standards of practice for the profession. These standards of professional practice can be found at: http://bocatc.org/public- protection#standards-discipline

SPORTS MEDICINE DEPARTMENT PERSONNEL The Athletic Training Staff consists of a Senior Associate Athletic Director, a Sports Medicine Coordinator, a Head Athletic Trainer, two Associate Athletic Trainers, four Certified Athletic Trainers and two Athletic Training Residents. All athletic training staff members are certified by the National Athletic Trainers’ Association and licensed by the Commonwealth of Virginia.

Certified Athletic Trainer Coverage Responsibilities: 8 2/16/2018

George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

Sports medicine Staff Position/Sports Phone number

Debi Corbatto, MS, ATC Sr. Associate AD/Performance 703-625-1721 (cell) Well-Being, Risk Management 703-993-9536 (office) [email protected] Linda Pullen, MEd, ATC Sports Medicine Coordinator 703-402-0969 (cell) Softball, Rowing, M/W Tennis 703-993-3280 (office) [email protected] Ray Yamrus, MS, ATC Head Athletic Trainer 703-362-6564 (cell) Men’s Soccer, Lacrosse 703-993-3280 (office) [email protected] Rebekah Schmidt, MS, ATC Associate Athletic Trainer 860-303-8666 (cell) Men’s Basketball, Spirit Groups 703-993-3277 (office) [email protected] Emily Deck, MS, ATC Associate Athletic Trainer 863-207-5075 (cell) Women’s Basketball, Spirit Groups 703-993-3277 (office) Justin Fegley, MS, ATC Certified Athletic Trainer 570-691-5884 (cell) Women’s Soccer, Wrestling 703-993-3277 (office) Brian Wright, MS, ATC Certified Athletic Trainer 757-418-2095 (cell) Track & Field, Swimming 703-993-3277 (office) Robert Viles, MS, ATC Certified Athletic Trainer 302-463-9445 (cell) Women’s Volleyball/Baseball 703-993-3277 (office) Danielle Saltarelli , MS, ATC Athletic Trainer Resident 703-389-1112 (cell) Non-Traditional Sports, Men’s Volleyball 703-993-3278 (office) Tracey Opoku-Anarfi, MS, ATC Athletic Training Resident 703-505-0172 (cell) Non-Traditional Sports, Track & Field 703-993-3278 (office) Linda Cooper Administrative Assistant 240-355-8010 (cell) 703-993-3279 (office)

Physician Staff Dr. Frank Pettrone Head Team Physician/Medical Director/Orthopedics Dr. John McConnell Orthopedic Surgeon Dr. Francis O’Connor Primary Care Sports Medicine Supervisor Dr. Caleb Dickison Primary Care Sports Medicine Dr. Zachary Devilbliss Primary Care Sports Medicine Dr. Angela Gordon Orthopedic & Sport Physical Therapy Dr. Steven Bernabeu Chiropractor 9 2/16/2018

George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

Dr. Richard Resnick Podiatrist

SPORTS MEDICINE ADMINISTRATIVE CHAIN OF COMMAND

Frank Pettrone, MD Head Team Physican

Debi Corbatto, MS, ATC Linda Pullen, MEd, ATC Athletics Health Care Concussion Point Person- Administrator Medical Sr. Assoc. AD- Performance, Sports Medicine Coordinator Well-Being,Risk Management

Various components of Team Physicians Certified Athletic Trainers Academic Support (Vary based on date/sporting (Vary based on date/sporting Office of Disability Services event) event) Other student services as required.

George Mason University Medical Line of Authority – 2017/2018

SPORTS MEDICINE SERVICES AND OPERATIONS In accordance with the Board of Certification (BOC) Standards of Practice, Certified Athletic Trainers (ATCs) perform their professional services under the direction of the Team Physician who is licensed to practice medicine in the Commonwealth of Virginia. The Sports medicine Staff, under the direct supervision and standing orders of the Team Physician, provides the management of injuries and illness incurred by the patient while participating in intercollegiate

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George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

athletics at George Mason University. The services provided by the Sports Medicine Staff are divided into six domains established by the National Athletic Trainers' Association. The domains are: Prevention Recognition, evaluation, and assessment Immediate care Treatment, rehabilitation, and reconditioning Organization and administration Professional development and responsibility

SPORTS MEDICINE STAFF RELATIONS Physicians and Medical Advisors The Sports Medicine Department utilizes a primary care sports medicine model that includes fellowship-trained primary care and orthopedic trained physicians. Furthermore, the department employs a registered dietician as part of the medical staff. The Team Physicians guide and direct the care given to George Mason University students. The Sports Medicine Coordinator ensures coordination of care within the Sports Medicine Staff and associated service providers.

Visiting Athletic Trainers Members of the Athletic Training Staff will conduct themselves according to the manner outlined in the NATA Code of Ethics. Athletic Trainers of visiting teams are to be extended every courtesy during their visit to George Mason University.

Patient Relations The goal of initial care and rehabilitation of athletic injuries and illnesses is restoration of the patient to a medically safe and functional level of intercollegiate athletic participation. Treatment and rehabilitation is initiated early on and stresses active patient involvement in healing, along with developing an awareness of the patient’s responsibility for a successful outcome. The successful treatment plan requires subsequent visits to the Sports Medicine facility with consistent participation (3-5 days / week) by the patient to effectively attain a pre- injury level and subsequent re-entry into athletic participation. The final decision for return to full activity rests with the Team Physician(s) in concert with the Certified Athletic Trainer supervising the patient’s care.

ATHLETIC TRAINING ROOM POLICIES

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George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

Field House Sports Medicine Facility The Field House Sports Medicine Facility services the Men’s & Women’s Soccer, Wrestling, Baseball, Softball, Golf, Women’s Lacrosse, Rowing, Men’s & Women’s Tennis, Cross Country, and Track and Field teams. The RAC Sports Medicine Facility The George Mason Center Sports Medicine Facility services the Men’s & Women’s Basketball teams, Men’s and Women’s Volleyball, Competition day Wrestling. Eagle Bank Arena Sports Medicine facility The Eagle Bank Arena Sports Medicine facility services Men’s and Women’s Basketball.

SPORTS MEDICINE HOURS OF OPERATION Normal operating hours of the Field House athletic training facility are 10:00am-7:00pm. At times, the athletic training facility may close early due to teams traveling or all practices and games being completed. The Sports Medicine Staff are expected to keep hours in conjunction with team practices and schedule treatment and rehabilitation times for their respected teams. All treatment and rehabilitation is scheduled by appointment outside of normal practice times. The Sports Medicine facility is open 1 hour before practice and 1 ½ hours before games for walk in services. The Sports Medicine facility will remain open 30 minutes after games and practices. Athletes can schedule individual appointments with a Certified Athletic Trainer as needed.

ATHLETIC TRAINING ROOM RULES

 The Athletic Training Room is a medical facility and appropriate behavior and dress is required at all times. Shirts are required unless removal is necessary for evaluation or treatment.

 No treatments are to be self-administered.

 No athletic equipment or personal belongings are allowed in the Athletic Training Room. The Athletic Training Room Staff is not responsible for the loss/damage of equipment or personal belongings.

 No cleats are allowed in the Athletic Training Room.

 Athletes must shower and change practice/competition clothing after practices/games prior to treatment and use of the whirlpools.

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 Any malfunction of the equipment should be reported to the staff member in charge.

 Food is not allowed in the Athletic Training Room.

 Tobacco products are not allowed in the Athletic Training Room.

 Medical supplies or equipment should not be removed without the permission of an athletic trainer. Any item on loan from the Athletic Training Room must be checked-out and returned immediately upon recovery from the injury necessitating the item. Athletic teams will be charged for any item not returned.

 The athletic trainer's decisions about treatment, taping, and/or administration of this facility are final.

 Under no circumstances shall a student-athlete be present in an athletic training room when an athletic trainer is not in attendance.

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George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

SPORTS MEDICINE FACILITY GENERAL POLICIES AND PROCEDURES In order to ensure proper and precise medical care and treatment, the following guidelines must be followed at all times.

 All student-athletes must be cleared to participate by the Team Physician through a pre- participation physical exam.  All student-athletes should have proof of insurance on file with the Sports Medicine Staff prior to participation (insurance form and copy of front and back of insurance card).  All student-athletes must report injuries within 24 hours after occurrence.  Do not seek medical attention without reporting to the Sports Medicine facility first (with emergency illnesses/injuries as the exception).  All referrals will be made through the Sports Medicine Staff.  Use of the Sports Medicine facility is strictly for student-athletes involved in the George Mason University intercollegiate athletics program.  Student-athletes are not permitted in the Sports Medicine facility without proper supervision.  Student-athletes must seek the guidance of a Certified Athletic Trainer every time they enter the Sports Medicine facility.  Student-athletes must report to the Sports Medicine facility for taping, treatment, and rehabilitation in proper attire (i.e. shorts, sweats, t-shirts, sports bras, etc.).  Unnecessary clothing and equipment (i.e. cleats, helmets, shoulder pads, gloves, balls, etc.) are not to be brought into the Sports Medicine facility. These items are to be left in the hall or in their locker rooms.  The use of tobacco products will not be tolerated in the Sports Medicine facility.  Food and drinks are not permitted in the treatment areas of the Sports Medicine facility.  Abusive and/or foul language, horseplay, and/or loitering are not allowed in the Sports Medicine facility.  All student-athletes must shower before receiving any form of treatment – including use of hydrotherapy and whirlpools.  Shoes are not allowed on the treatment tables.  No supplies are to be taken from the Sports Medicine facility without the permission of a Certified Athletic Trainer.  All equipment is to be signed-out before being removed.  Student-athletes are not to operate equipment and/or perform “self-treatments.”  Student-athletes are not permitted to use Sports Medicine facility phones, fax machines, copy machines, and/or computers under any circumstances.  Multimedia devices are not permitted to be used during rehabilitation.  There is a mandate to report any ethics or professional violation issues of any nature to Sr. Associate AD for Performance, Well-Being, and Risk Management within 24 hours.  Mandatory report to Sr. Assoc. AD for Performance, Well-Being, Risk Management, of any concern on the part of a student-athlete regarding any healthcare provider. The athletics administration will follow-up and report findings to the Athletic Director. 14 2/16/2018

George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

 All treatments/examinations are held in public areas when possible. Each student-athlete, regardless of gender, will be offered trained medical chaperones for all treatments/examinations/EKG’s/physicals behind closed doors. The student-athlete may decline this offer and if they do so, their choice will be dictated into the medical record for that visit.  Chaperones’ principal responsibilities are to protect student-athletes by observing examination and being prepared to raise any concerns about a provider’s behavior or actions, reassure or comfort student-athletes, participate in medical recordkeeping, and be sensitive and respect the student-athlete’s dignity and confidentiality.  No internal obstetrical, gynecological, breast or digital rectal examinations/treatments conducted at the training room. All invasive medical examinations are to be referred to outside specialist/provider. This does not preclude obtaining a rectal temperature in order to diagnose/treat heat stroke, or hernia exams during PPE or clinic. Should the need arise for one of those procedures, it will be conducted with a medical chaperone.

All student-athletes are expected to strictly adhere to the rules and regulations at all times. Failure to comply with the rules and regulations may result in disciplinary sanctions.

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George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

SPORTS MEDICINE OPENING AND CLOSING PROCEDURES Taping and Counter Area Opening Procedure o The taping area is to be checked to ensure it is ready to go for taping in the afternoon. Closing Procedure o Daily, the taping drawers are to be re-stocked and arranged neatly. o Weekly the instrument tray is to be emptied and cleaned with disinfectant. o Daily, the sundry jars are to be stocked with the appropriate items. o Gloves are to be restocked as needed. o Taping tables are to be wiped with tape remover and cleaned with disinfectant. o The counter tops are to be cleaned and disinfected. o The sinks are to be cleaned. o The cabinet drawers and doors are to be wiped down with disinfectant.

Modality and Treatment Area Opening procedures o Clean towels and hydrocollator covers are to be placed on the appropriate shelves (near hydrocollator/in closet). o Clean ace wraps are to be rolled and placed in the ace wrap drawer.

Regular Maintenance o The treatment tables are to be cleaned with disinfectant after each use. o Weekly, the treatment table shelves and contents are to be cleaned with disinfectant. o Weekly, the modality equipment (electrical stimulation and ultrasound) is to be wiped down. o All modality attachments are to be placed on the cart after use. o Electric stimulation pads are not to be left out in the open. If adhesive pads are being used, the athlete’s skin must be cleaned with alcohol swab prior to treatment. Adhesive pads must be placed on plastic card and returned to sealed bag to extend pad usage. o The ultrasound transducer head is to be cleaned with a dry towel after each use. o The hydrocollator unit is to be drained and cleaned at the end of each school year. Also, the outside of the unit is to be cleaned with stainless steel cleaner as needed. o The whirlpools are to be drained and cleaned with disinfectant daily. o The outside and tops of the whirlpools are to be cleaned and disinfected weekly or more often if necessary.

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George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

o The hydrotherapy equipment (HydroWorx, Cold Plunge, etc.) water must have pH and Chlorine levels checked daily, while Total Alkalinity and Calcium Hardness must be checked weekly. Levels should be recorded in the appropriate file with changes made to alter the chemical balance done as needed. o The HydroWorx must be emptied and cleaned twice annually, at which time the filters should be removed and cleaned. o The Cold Plunge must be emptied and cleaned once a month, at which time the filters should be removed and cleaned. Closing Procedures o The treatment tables are to be cleaned with disinfectant. o The dirty towels and ace wraps are to be collected and placed in the dirty laundry bin. They are to be taken to laundry room, washed and dried each evening. At the end of each day, the hydrocollator covers are to be laundered. o The hydrocollator’s water level is to be checked and filled to the appropriate level. o Weekly, ice cups are to be made to fill the freezer. o The Game Readys are to be emptied, dried out, and left open. o Game Ready sleeves are to be removed from the heat exchanger, left unzipped and hung to dry with the blue side facing out. o Ultrasound gel bottles are to be refilled. o The paraffin bath is to be emptied and cleaned at the end of each school year, or more frequently dependent on the cleanliness of the unit. Rehabilitation Equipment Maintenance o Daily the rehab area is kept neat and clean. o Weekly, the rehab equipment is to be wiped down with disinfectant. o Daily the rehab equipment vinyl is to be wiped down after use.

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George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

GENERAL MEDICAL ELIGIBILITY GUIDELINES Every George Mason University student-athlete should have an initial physical performed by the George Mason University Team Physicians and Sports Medicine Staff in their first year at the university. This physical must be cleared by a team physician prior to participation in any athletically related activity. Student-athletes that miss the assigned physical dates will have to re-schedule their physical with the Sports Medicine Staff and the Team Physician and may not be eligible for practice at the first team sessions. Physicals completed by any other physician will not be accepted. No student-athlete may participate without completing the physical examination and being cleared by the George Mason University designated Team Physician. Failure to receive medical authorization to participate in Intercollegiate Athletics shall immediately disqualify any athlete from all competition until medical clearance has been obtained. Each year after the first year at Mason, every returning student-athlete must complete an updated medical history form and turn in updated insurance information as a part of an interim medical evaluation. This updated information will be processed through the Vivature Student-Athlete Portal. Student-athletes will be re-evaluated by our Athletic Trainers and/or our Team Physician on an annual basis. This process includes the assessment of their past injuries/illnesses, blood pressure, pulse, height, weight. Should the Sports Medicine team find any issue of concern during the interim screening process, they may be referred for more extensive evaluation by the team physician. The team physician will review all interim medical evaluation forms and will make final medical clearance for participation. Failure to receive medical authorization to participate in Intercollegiate Athletics shall immediately disqualify any athlete from all competition until medical clearance has been obtained. Evaluations will be performed using the Student-Athlete Medical and Physical History Form, pre-approved by our team physicians. All incoming freshmen and transfers will receive notice of a mandatory medical screening time prior to the start date of their individual sport. Student-athletes must complete the following requirements in the Vivature portal prior to participation in any athletic activity: 1. Student-Athlete Medical History and Physical Form 2. Medical Disclosure Agreement and Insurance Form 3. Personal/Family Insurance Information Form 4. Disclosure of Medical Information Form 5. Assumption of Risk Form 4. Personal/Family Insurance Card (provide copy of FRONT and BACK of card) 5. Sickle Cell Trait Screening Results (incoming freshmen, transfers, and try- outs only) 18 2/16/2018

George Mason University – Department of Athletics Frank Pettrone Center for Sports Performance Policy & Procedure Manual

6. Cognitive Baseline Concussion Testing Required

All student athletes must complete a sickle cell test and provide an official status result as part of the medical clearance process. The NCAA requires that all incoming freshmen and transfer student-athletes show proof of sickle cell trait testing (blood test) prior to participation in intercollegiate athletics. Those student-athletes who participate in cheerleading and dance are exempt. Incoming freshmen may obtain this test from their family physician. Please discuss the cost of this test with your physician and/or Health Insurance Company. Mason cannot cover the cost of your private screening. Mason Athletics will provide the screening on campus and cover the charges for any student-athlete. Incoming freshmen and transfers will not be allowed to participate without sickle cell trait test results cleared by a Mason team physician. Please open the websites and review the educational information provided by the NCAA on sickle cell: http://web1.ncaa.org/web_files/health_safety/SickleCellTraitforSA.pdf http://web1.ncaa.org/web_video/health_and_safety/sickle_cell/sickleCell.html

In addition to the forms pertaining to physicals and re-certification the student-athletes must provide the Sports Medicine Staff with a completed Insurance Information Form and copies of the front and back of their insurance cards prior to participation on an annual basis. All George Mason University student-athletes should have primary health insurance that covers athletic related injuries upon arrival at the University. If the student-athlete does not have health insurance, they can call 703-993-9536 to discuss health insurance options. The NCAA requires that all student-athletes sign a Medical Disclosure Agreement prior to participation in intercollegiate athletics. This agreement pertains to the importance of communicating all injuries including concussions and illnesses to the athletic training staff prior to further participation. Student-athletes and parents are asked to thoroughly read this agreement and the information pertaining to personal health insurance and the Mason athletic training room billing and the secondary insurance policy. Injuries/ illness that are not disclosed in a timely manner from the date of injury or onset of symptoms will not be considered for coverage under MASON’s secondary policy. Open the website to review the educational information provided by the NCAA on concussions: http://web1.ncaa.org/web_files/health_safety/ConFactSheetsa.pdf Each head coach is required to submit their roster of scholarship and non-scholarship student- athletes to the sports medicine coordinator by July 1 of each year. The Sports Medicine Department will make the necessary arrangements for the pre-participation physical examinations for the student-athletes. The coach will be informed of the date and time that pre-participation physical exams have been scheduled. It is the head coach’s responsibility to see that his/her student-athletes attend their scheduled pre-participation physical exam. If a student-athlete fails to attend his/her pre-

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participation physical examination, the student-athlete will remain ineligible until the pre- participation physical examination is completed. In conjunction with the pre-participation physical examination, the student-athlete will also disclose his/her previous injury or illness record, past medical history, and family history. Failure to disclose any injury or illness, past or present, relieves the Athletics Department of all liability in the event the athlete sustains a subsequent injury or re-injury to the affected part. Should any coach allow participation of a student-athlete who has not completed and been cleared through a university pre-participation physical examination, they personally assume all liability for this action. Students who are not officially on the team's NCAA roster but who wish to "try out" or "walk on" to a team must first complete a physical that will be approved by our team physician, provide evidence of sickle cell status and complete the indemnity agreement. Any injuries sustained before the athlete is officially added to the NCAA roster will be the responsibility of that student- athlete and/or his/her parent(s)/guardian(s). Incoming Freshman and Transfer Student-Athletes Medical Forms  Participation Prerequisite All athletic health care forms and insurance information must be submitted to the athletic department prior to the student-athlete coming to campus. Forms can be completed via the Vivature Student-athlete Portal. All incoming freshman and transfer student-athletes must submit the following health forms: Medical History Questionnaire Student-athletes must complete a medical history questionnaire through our online portal in the two weeks prior to the pre-participation exams (PPE) and prior to participation each year. Failure to complete the form in its entirety and accurately will disqualify the student-athlete from participation until it is completed. Please note: Student-athletes that willfully withhold information pertaining to their health status will relieve George Mason University of all responsibilities should a subsequent injury, re-injury, or illness occurs. Sickle Cell Solubility Test Results of this test must be on file in our sports medicine department prior to beginning athletic activity at George Mason University. Receipt of Insurance Procedures The George Mason University Athletics Department has specific guidelines for insurance coverage of student-athlete injuries prior to participation. All student- athlete’s or their parent(s)/guardian(s) for those under 18 years old must read this information and sign this form acknowledging that they have read and accept the procedures established by George Mason University Athletics.

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Insurance Form/ Copy of insurance cards Student-athletes must complete and return the health insurance form and a front and back copy of the up to date insurance card to the Sports Medicine Staff prior to participation. Student-athletes must have one of the following primary insurance coverage plans: personal insurance, covered under parents/guardians policy, or through George Mason University student primary health insurance. If a student- athlete does not have the means to secure an insurance policy, George Mason University will make arrangements on a person by person basis. It is a requirement for participation that all student-athletes carry primary insurance that covers athletic injuries PRIOR to participation in any George Mason athletic event. Consent to Disclose protected health information Consent to treat, and Acknowledgement of Risk Due to the concern over medical record confidentiality, it is necessary for the Sports Medicine Staff at George Mason University to obtain your authorization to gather and release your medical information. By electronically submitting this form, you release the Sports medicine Staff at George Mason University of any and all legal responsibility or liability that may arise from this authorization. Student-athletes must understand there is an apparent risk of injury in intercollegiate athletics. Prior to participation student-athletes must complete and return this form in order for the Sports Medicine Staff to provide medical aide and treatment.

This form must be electronically completed in the Vivature portal prior to participation, and by completing and submitting this form; the student-athlete acknowledges and agrees with its contents.

Supplement Disclosure George Mason University and the NCAA strongly discourage the use of supplements due to lack of FDA regulations and the potential of such containing banned substances. Any student-athlete who is using supplements must notify that the Sports Medicine Staff. All Supplementation must be disclosed upon filing of the medical packet. Students who disclose the use of supplementation will be counseled by the Sports Medicine staff, and all supplements will be evaluated. Students who disclose the use of supplements assume all risk with associated practices. Drug-testing Consent George Mason University along with the NCAA Division I regulations, reserve the right to randomly test any student-athlete for any and all substances banned by the NCAA. This form must be signed and returned to the Sports Medicine Staff prior to participation.

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Student-athlete Concussion Statement George Mason University student athletes are required to complete concussion education. Each student is made aware of concussion signs and symptoms as well as the concussion policies upon entry to the Athletics Department. The student-athlete must show compliance with the George Mason University concussion management policies.

RETURNING STUDENT-ATHLETES MEDICAL FORMS Participation Prerequisite In addition to the yearly physical (assessment of blood pressure, pulse, height, weight, lungs, and heart), all returning student athletes must complete the following forms before they are eligible to participate in any training sessions (practice, strength and conditioning, competition) Updated Medical History Questionnaire Student-athletes must complete and return to the Sports Medicine Staff an updated medical history questionnaire prior to participation each year. Please note: Student- athletes that willfully withhold information pertaining to their health status will relieve George Mason University of all responsibilities should a subsequent injury, re-injury, or illness occur. Receipt of Insurance Procedures Student-athletes at George Mason University must update their understanding of insurance procedures yearly. It is highly recommended that student-athletes share this information with their parents.

Insurance Form/Copy of Insurance Cards Per George Mason University policy and NCAA Division I regulations, all returning varsity student-athletes must submit a new insurance form. In addition, a photocopy of the front and back of a current insurance card must be sent along with your form for our records.

Student-athlete Concussion Statement George Mason University student athletes are required to complete concussion education. Each student is made aware of concussion signs and symptoms as well as the concussion policies upon entry to the Athletics Department. The student-athlete must show compliance with the George Mason University concussion management policies.

ON-CAMPUS EVALUATIONS FOR MEN’S BASKETBALL The NCAA passed legislation on March 14, 2012 allowing coaches to conduct on-campus evaluations on prospective student-athletes, both from high school and junior college at the conclusion of their respective playing seasons. These on-campus evaluations can only be performed if the student-athlete has exhausted their high school, prep school, or junior college 22 2/16/2018

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eligibility and only during the athlete’s unofficial or official campus visit.

The NCAA has recommended that prior to this on-campus evaluation each prospective student- athlete must undergo a medical examination by a licensed medical practitioner. Each medical examination shall include a sickle cell solubility test unless documented results of a prior test are provided to the university. The examination must be administered within the prior six months of the athlete’s initial participation in practice, competition or out of season conditioning activities during their prior season.

It is the position of George Mason University Sports Medicine Department that each prospective student-athlete MUST complete and pass a physical examination prior to participation in any tryout activity at George Mason. The George Mason minimum requirements on the physical examination are as follows:

Sickle Cell Solubility Test Medical Examination by licensed practitioner Completion of the indemnity agreement

The prospective student-athlete may undergo this physical examination at home if they choose, but it must be within six months of their on-campus evaluation. It must include ALL items as required by the George Mason University Athletic Department and the prospective student- athlete must bring the written results with them before they are permitted to participate in their on-campus evaluation. The physical exam paperwork MUST be signed by a licensed medical practitioner. The prospective student-athlete must also show proof of billable health insurance in order to perform in an on-campus try-out.

Coaches are encouraged to inform all prospective on-campus student-athletes of this policy and to make arrangements accordingly. Coaches are also strongly encouraged to communicate with the Sports Medicine Staff prior to bringing prospective student-athletes for an on-campus evaluation.

END OF YEAR INJURY REVIEW This process is done at the end of the student-athletes’ competitive season to evaluate the need for subsequent treatment of unresolved injuries from that current year, and to make sure no new or unreported injuries have occurred to the student-athlete while participating. Beginning in 2018 all student-athletes must meet with the George Mason Sports Medicine Department staff to complete the End of Year Injury Summary form and to address follow up care.

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EXIT INTERVIEW This process is done at the end of the student-athletes’ eligibility to evaluate the need for subsequent treatment of unresolved injuries during the eligibility period, and to make sure no new or unreported injuries have occurred to the student-athlete while playing a sport at George Mason University. All student-athletes must meet with the George Mason Sports Medicine Department staff to address any additional needs. Furthermore, if a student-athlete is removed or quits the team, they are required to schedule an appointment with the George Mason Sports Medicine department to be cleared medically. Failure to do so must be documented by the Sports Medicine Staff in the student-athlete’s medical file and could lead to forfeit of further medical care and insurance benefits pertaining to sports participation.

FURTHER EVALUATION As part of the exit interview process, the student-athlete or athletic trainer may request an examination by a team physician to determine the status of a previous or current injury. If surgery or further treatment of an athletic-related injury is required, it must be performed as soon as possible, once team eligibility has expired. No procedure will be paid for unless coordinated through the George Mason University Sports Medicine Staff. The George Mason University Athletic Department will not be responsible for any injury or condition that is not documented in the athlete’s permanent medical file.

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SICKLE CELL ASSESSMENT AND MANAGEMENT PROTOCOL Initial Assessment . The NCAA has mandated that all incoming student-athletes be tested for sickle cell trait or show proof of a test prior to participation in a NCAA sanctioned sport. The student-athletes, beginning their initial season of eligibility or trying out for an NCAA athletic team, will be subject to this requirement. Cheerleading and dance are exempt from this pre-participation policy. Sickle cell screening is accomplished using a simple blood test. 1. Incoming student-athletes and try-outs may obtain sickle cell screening from their family physician. 2. All 50 states screen for sickle cell at birth and this information may be available from the family physician or pediatrician. 3. If birth screening results are unavailable, incoming student-athletes are required to obtain private screening results. 4. The financial cost of this private screening will be the sole responsibility of the student-athlete and/or parents. 5. The cost should be discussed with the family physician and/or the athlete’s health insurance company. . Incoming scholarship and recruited student-athletes may obtain sickle cell screening through the athletic training department if no results are available at the time of the MASON medical screening sessions. The cost of this screening will be covered by the athletic department. Incoming athletes will not be allowed to participate until the results are obtained which will take a minimum of 24 hours after blood draw. . Students trying out for ICA teams may obtain sickle cell screening through the athletic department but will be responsible for the cost of the screening. Students trying out will not be allowed to participate until the results are obtained which may take a minimum of 24 hours after blood draw. II. Sickle Cell Education . All student-athletes will be emailed the websites with the NCAA Fact Sheet for Sickle Cell Trait and the NCAA Sickle Cell Trait Video with their pre- participation medical forms and instructions. . All athletic coaches will be emailed the websites with the NCAA Fact Sheet for Sickle Cell Trait for Coaches and the NCAA Sickle Cell Trait Video with the pre- participation information for their student-athletes. III. Sickle Cell Positive Management . No positive sickle cell trait student-athlete will be disqualified from participation solely based on the test results. . Student-athletes with documentation of a positive sickle cell trait will be counseled by a team physician on the implication of sickle cell trait on health, athletics, and family planning.

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. The team physician will review the NCAA fact sheet and precautions with the student-athlete prior to participation. This counseling will be documented with the student-athlete’s and team physician’s signature in the athlete’s medical record. . Precautions and treatment guidelines will be reviewed with the student-athlete’s athletic trainer and head coach prior to participation. This counseling will be documented with the athletic trainer’s and head coach’s signature in the athlete’s medical record.

 WEBSITES

http://web1.ncaa.org/web_files/health_safety/SickleCellTraitforSA.pdf

http://web1.ncaa.org/web_video/health_and_safety/sickle_cell/sickleCell.html

http://www.nata.org/sites/default/files/SickleCellTraitAndTheAthlete.pdf

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MEDICAL HARDSHIP / DISQUALIFICATION POLICY Risk is inherent to intercollegiate athletics. Whether due to injury, illness or pregnancy, participation may be limited or even terminated depending on the risks of the medical condition. The NCAA has set forth specific rules dealing with these medical cases and George Mason University will follow the rules of the NCAA. The Certified Athletic Trainers and Team Physicians providing care for student-athletes must be well versed in the bylaws that govern participation in intercollegiate athletics. Medical hardships, medical extensions and a medical disqualification, also known as a medical non-counter, are types of these waivers that the Compliance Office may have to file for a student-athlete. All of these waivers will have to be submitted to the Atlantic-10 Conference (A-10) for review and approval or denial. The Compliance office is the authority on this subject and all questions should be addressed to that office.

Medical Hardships May be submitted to the A-10 by the compliance office if the following criteria are met: The injury/illness occurred during the senior year of HS or during one of the 4 seasons of intercollegiate competition The injury/illness occurred during the first half of the playing season The injury/illness occurred and limited participation in 30% of the scheduled contests (whichever is greater)

Medical Extensions May also be submitted to the A-10 by the Compliance office if the following criteria are met: All of the criteria of a “Medical Hardship” apply This seeks to extend the student-athlete’s career from 5 to 6 years 2 out of the 5 years must have been lost due to circumstances beyond the student-athlete’s control Documentation Contemporaneous medical documentation will be provided to George Mason University Athletic Compliance office for their submittal to the A-10 and/or NCAA. Documentation is to include but not limited to: Diagnosis or description of student-athlete’s condition by team physician Any and all lab work pertaining to the illness/injury Diagnostic test reports (X-rays, US, MRI, CT-scans, bone scans, etc.) 27 2/16/2018

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Any documentation that shows the debilitating effects of the illness/injury (treatment logs, rehabilitation logs, etc.)

Medical Disqualification Medical disqualification follows the recommendation of the medical community that a student- athlete is unable to continue intercollegiate participation due to the extent or limitations of a medical condition. If medical disqualification is recommended, the career of the student-athlete involved will be terminated at this level of intercollegiate athletics, and he/she will no longer participate at George Mason University

The staff athletic trainer and the Team Physicians will work together to make sure that every avenue has been explored and that a proper diagnosis has been reached prior to any decision of disqualification. The George Mason University Medical Director may consult with other team physicians who have experience with the medical condition(s) involved. Outside medical opinions will be reviewed by the George Mason University Athletics Medical Director, but the ultimate decision on medical disqualification is that of the George Mason University Medical Director. The medical disqualification decision will be forwarded to the George Mason University Compliance Office and kept in the student-athlete’s file.

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MEDICAL SERVICES General services provided by the George Mason University Sports Medicine Staff Pre-participation physical examinations Coverage of all in-season athletic practices (exceptions: cross country, tennis, golf, rowing), and out of season practices as possible. Coverage of all in-season home athletic competitions Coverage of all in-season away athletic competitions (exceptions: cross country, tennis, golf, rowing) On-site injury evaluation and emergency care Clinical injury and illness evaluation Posture and functional movement screening Therapeutic treatment and rehabilitation Preventative strength and conditioning programs Referral to sports medicine orthopedic physicians and other medical specialists Custom ordering and fitting of orthopedic braces (ankle, knee, shoulder, etc.) Taping, bracing, and custom orthopedic splinting Education and counseling of athletic injury and illness

Injuries must be anticipated in any type of athletic activity. Every sport assumes some degree of risk. Therefore, when an injury does occur to a student-athlete participating in the intercollegiate athletics program, the following care, supervision, payment and medical services are available:

FINANCIAL COVERAGE OF MEDICAL CARE It is extremely important that Department of Athletics policies and procedures related to insurance and financial responsibility be understood by and communicated to all athletes as well as their respective parent(s) and/or guardian(s). There is a mutual responsibility shared by all parties to adhere to these policies and procedures to ensure the proper processing and prompt payment of expenses related to the care and treatment of illness and injury. The following section outlines the rights and responsibilities of student-athletes regarding athletic health care. It is imperative that the athlete read and understand this information so that they know what to expect and what is expected of them in the event they suffer an injury or illness. This information will be shared with athletes at the beginning of each year.

MEDICAL REFERRAL POLICIES Except in emergencies, a staff athletic trainer MUST screen all conditions prior to referral to a team physician or other consultant. This policy assures proper and immediate care, close follow- 29 2/16/2018

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up treatment and smooth injury management for the student-athlete and the George Mason University Department of Athletics Sports Medicine Staff. The Sports Medicine Staff will make all referral appointments. Transportation to medical facilities/offices located off-campus will be provided by the Sports Medicine Staff ONLY if the student-athlete is unable to arrange personal transportation. Medical care and treatment of all student-athletes will be done through the team physicians, consultants and healthcare resources associated with George Mason University Sports Medicine team as approved by the Sports Medicine Coordinator. If a student-athlete desires a second opinion, the student-athlete is required to request such through their respective staff athletic trainer for approval by the Athletics Health Care Administrator., the Sports Medicine Coordinator before the physician’s visit or procedure is allowed. Expenses related to care or treatment without following this policy will not be the responsibility of George Mason University Department of Athletics. The student-athlete and/or parent(s) and/or guardian(s) must provide for a release of information from the healthcare provider to the George Mason Sports Medicine Staff. A consultation between the parent(s) and/or guardian(s) of any student-athlete and the George Mason University Department of Athletics Sports Medicine Staff will be arranged whenever requested. All decisions regarding medical approval or disqualification in the intercollegiate athletics program will be made solely by the George Mason University Department of Athletics Team Physician and/or associated consultants. The George Mason University Department of Athletics Sports Medicine Staff reserves the right to require referral to an outside medical agency for the evaluation, treatment and/or rehabilitation of any problem not related to athletics.

PRE-SEASON CAMP EDUCATIONAL PROCEDURES The Sports Medicine Staff will be expected to take part in yearly training and updates along with the Athletic Training Students prior to pre-season camp each August. Topics to be discussed are emergency procedures, CPR, OSHA, and others at the discretion of the Athletics Health Care Administrator., the Sports Medicine Coordinator and Director of the Athletic Training Education Program.

MEDICAL KITS AND EQUIPMENT Medical kits and equipment are to be stocked daily at the end of each practice or game session. It is imperative that when supplies are used that they are replaced. Prior to practice or a game the medical kits and equipment must be checked to make sure all pertinent supplies are present. When traveling, the Certified Athletic Trainer must carry a sports medicine kit and team insurance/emergency contact information.

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EQUIPMENT AT PRACTICE The following equipment is to be present at covered George Mason University athletic events and practices when available. Medical Kit Splint bag Ice Water Biohazard trash bags Emergency Medical Crash Bag (Oxygen, rectal thermometer, bag valve mask) AED Spine board (Soccer, Lacrosse)

ORTHOTICS The George Mason University Sports Medicine Staff has the ability to refer student athletes for visit with podiatrist for orthotics. In the event that an athlete would need a set of corrective orthotics, the following procedures will be used.

The student-athlete is informed of the Certified Athletic Trainer’s intention to use custom orthotics as a treatment method. The student-athlete will have an appointment with the team podiatrist for custom fitting. Orthotics may take up to 3 weeks to arrive.

DURABLE MEDICAL EQUIPMENT (BRACES) The Mason Sports Medicine Department maintains a stock and bill program for many DME’s. In the event that DME is needed for an athletic injury, the Student-athlete’s insurance will be billed for any DME product that is used. If the student-athlete’s insurance will not cover DME, Mason Athletics will become the primary payer and the brace will be paid for via purchase card. All orthopedic bracing is kept in the storage room (Field House). In the event that an athlete is injured and needs orthopedic bracing the following procedures will be followed: The student-athlete is evaluated and a complete injury report is filed in Electronic Medical Record (NEXTT). The Athletic Trainer will communicate with the team physician that a DME item is being used. The student-athlete is informed that an orthopedic brace is needed as a treatment intervention. The Certified Athletic Trainer sign out the brace in the folder in Sports Medicine Coordinator office. George Mason University does keep a small stock of braces on the shelf for use if there is no other option, or if the injury is not severe enough to warrant a specific orthopedic brace. All 31 2/16/2018

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braces issued to student-athletes must be documented in the equipment sign-out section of the folder in the Sports Medicine Coordinators office and returned at the end of its use.

Should a DME be required that is not in stock, the Certified Athletic Trainer will order the appropriate equipment with the assistance of the Sports Medicine Coordinator.

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GEORGE MASON UNIVERSITY DRUG AND ALCOHOL POLICY George Mason University, recognizing that drug and alcohol abuse presents a serious threat to individual health and community safety, strives to maintain a campus free from the illegal use and abuse of alcohol, and the use, possession or distribution of illegal drugs. Students are expected to comply with all federal, state and local laws, and university policies. Students who use, possess and/or sell illegal drugs, including the illegal use of alcohol, are considered in violation of George Mason University’s Code of Student Conduct and shall be subject to university discipline independent of any criminal or civil prosecution that may result from violations of state or federal laws. In addition to the university policy on substance abuse, all employees, including student employees, are subject to the Virginia Governor’s Executive Order 01.01.1991.16 on the Drug-and-Alcohol-Free Workplace. The university reserves the right to conduct drug testing consistent with applicable federal and state laws. Students are strongly encouraged to help create a campus community free from the negative effects of substance use and alcohol abuse. ATHLETICS DRUG INTERVENTION PROGRAM Program Philosophy. o George Mason University seeks to maintain an environment that supports and encourages the pursuit of knowledge without interference from the effects of drug and alcohol abuse. The improper use of drugs has become a matter of deep concern within our society; many lives are damaged, and in some cases destroyed, by drug abuse. George Mason is determined to help all students and employees avoid the hazards associated with drug abuse through its established policies on drug abuse that apply to all members of the academic community; however, this program is specifically designed for the members of our intercollegiate athletics teams. It is based on the premise that drug abuse is not conducive to the welfare of our student- athletes. o Many drugs, when used in connection with athletic activities can pose serious risks to the health of the student-athlete and may endanger others in contact with the drug user. Symptoms of illness, temporary or permanent injury, and even death can be caused by such drug abuse. Use of certain drugs may temporarily improve some types of athletic performance and thereby create an unfair competitive advantage for the person using them. Such use of drugs violates the basic principles of sportsmanship. o Student-athletes often become highly publicized role models and their abuse of drugs can negatively influence young people, as well as damage the reputation of the institution. Therefore, George Mason does not condone the abuse of drugs while participating in intercollegiate athletics. To become and remain a participant, a person must comply with the terms of this program on drug abuse education, screening, and counseling. Furthermore, this policy is not to be construed as a contract between the institution and the student-athletes at George Mason University, however, signed consent and notification forms shall be considered affirmation of the student athletes’ agreement to the terms and conditioning contained in this policy. At 33 2/16/2018

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any time, George Mason University has the right to amend this policy that is separate and distinct from the NCAA Drug-Testing Program. Athletic Department Staff Responsibility o All athletics staff members must be aware of and committed to the drug education and drug testing program. No athletics staff member shall encourage or advise any student-athlete to take performance-enhancing or non-therapeutic drugs. Additionally, they shall not issue or assist student-athletes in obtaining any performance-enhancing or non-therapeutic drugs. Staff members should communicate that student-athletes should not abuse alcohol, tobacco or other drugs and should bring known issues of alcohol, tobacco, and/or drug abuse to the attention of the Athletics Health Care Administrator., the Sports Medicine Coordinator and/or the teams athletics trainer, for advice and education against these types of substances and shall report the use, or suspected use, of performance-enhancing and/or non-therapeutic drugs by a student- athlete to the Sports Medicine Coordinator, Sr. Associate Athletic Director for Compliance, Assistant Athletic Director for Compliance or the administrative sports oversight. All athletics staff members shall direct student-athletes who desire to use dietary supplements to the teams’ athletic trainer. Program Purpose o The Department of Intercollegiate Athletics at George Mason University (Mason) is concerned with the health, safety, and welfare of the student-athletes who participate in its programs and represent the University in competitive athletics. The use or abuse of alcohol, illegal drugs, prescription drugs, and dietary supplements is not in the best interest of student-athletes and is detrimental to the mission of Mason’s athletic program. o Mason recognizes its responsibility to provide educational programming that will support positive decision-making processes. Mason will encourage and support programming that educates student-athletes on the physiological and psychological dangers inherent in the misuse of drugs and alcohol, inform student-athletes about the local, state, and federal laws concerning the use and possession of alcohol and drugs, and reinforce alternative activities supporting a drug or alcohol-free lifestyle. A drug and alcohol program which embraces an educational, screening, and (if necessary) rehabilitation component, will facilitate a positive decision-making process for our student-athletes.

Program Consent o CONDITIONS OF ELIGIBILITY o Mason student-athletes are required to sign the NCAA Drug Testing Consent Form annually, in which the student-athlete consents to be tested by the NCAA for the use of drugs prohibited by NCAA legislation.

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i. This form is a NCAA requirement for all Division I student-athletes in order to practice or compete in intercollegiate athletics. o In addition to NCAA requirements, Mason student-athletes must sign the Mason Drug Testing Consent Form to allow a limited release of test results, as set forth in these procedures. Failure to consent to institutional drug testing will result in the student-athlete’s ineligibility for participation in athletics. o All Mason student-athletes listed on the institutional squad list and who have signed the institutional consent form shall be subject to drug testing under the terms of this policy. This includes, but is not limited to, student-athletes who are “red shirting,” academically ineligible, injured, and/or fifth year student-athletes who are receiving athletically related financial aid and/or using other athletically related services. All student-athletes shall be subject to drug testing under the terms of this policy throughout the calendar year, including summer.

Program Education Component o EDUCATION PROGRAM o Educational programs will be offered to increase awareness, prevent problems, and promote the general well-being of student-athletes. . In order to meet the health, safety, and welfare needs of our student-athletes, Mason student-athletes will be provided a minimum of one alcohol/drug awareness presentation and at least one additional wellness presentation each academic year. . Mason student-athletes are required to attend all educational programs offered by the Department. Prohibited Drugs o During the period of their eligibility to participate in athletics, a student-athlete may not use the drugs specified on the NCAA Banned-Drug Classes List. . The NCAA banned drug classes are as follows: stimulants, anabolic agents, diuretics, street drugs, peptide hormones and their related compounds. . Student-athletes are expected to review the most current NCAA Banned Drug Classes List annually at http://www.ncaa.org/2016-17-ncaa-banned- drugs-list o Mason explicitly reserves the right to test for substances not listed on the NCAA Banned Drug Classes List and to test at detection levels that vary from those of the NCAA. Mason’s Intercollegiate Athletics Drug Education and Testing Program is separate and distinct from the NCAA’s drug testing program, including, but not limited to, banned substances, sanctions imposed and levels of detection.

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Dietary Supplements o Student-athletes are advised not to take dietary supplements, as many contain banned substances and can lead to a positive drug test result in addition to serious side effects such as cramping, dizziness, nausea, kidney damage and even death. o If a student-athlete intends on taking dietary supplements, they are required to review the product with an athletic trainer, Team Physician and/or Mason’s Sports Dietician. The student-athlete is required to have the supplement disclosure form on file with a list of the product’s ingredients on file with the Sports Medicine department; failure to do so could result in sanctions outlined in this policy. Program Description o The basic test to be used for drug screening is a urinalysis. However, other types of tests may be utilized to determine the presence of drugs listed in the NCAA Banned-Drug Classes List. The testing based on urinalysis will be implemented as follows: o Mandatory Screening: Student-athletes will be selected for testing by random selection. This test can occur during the traditional and/or nontraditional season for the respective sport. o Individualized Reasonable Suspicion Screening: Any student-athlete suspected of drug use and identified by the Deputy AD, the Sports Administrator, the Athletics Health Care Administrator. or the Sports Medicine Coordinator may be subject to testing at any time during the academic year. o Positive Test Follow-up Screening: Any student-athlete who has tested positive on a previous date may be subject to required testing at any time as deemed appropriate by the Sports Medicine Coordinator.

Testing Procedures

o The Department of Athletics will conduct substance abuse testing in accordance with the accepted procedures identified in this document. o Selection for testing will be based on random selection, a prior positive test as outlined in this policy or cause as outlined in Section VIII. o The student-athlete will provide a urine sample that will be tested for the presence of illegal drugs, non-prescribed drugs, the abuse of prescribed drugs, use of narcotics and/or steroids, and nutritional supplements not approved by the NCAA, at such times and places as determined by the Director of Athletics or his/her designee. . Collection and analysis is performed by a contracted third-party professional collection and laboratory service. . All urine samples for testing by Mason will follow the same specimen collection procedures as used by the NCAA. . The use of substances and methods that alter the integrity or validity of urine samples provided during drug testing is strictly prohibited.

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 Examples of banned methods include catheterization, urine substitution, and/or tampering with or modification of renal excretion by the use of the diuretics or related compounds.  Any urine sample tested for the presence of banned substances may also be tested for the presence of substances used to alter the integrity or validity of urine samples. o A positive finding for these substances or other methods of tampering will be considered a positive drug test. o Any attempt to tamper with a urine sample during the collection process will be treated as a positive drug test. o Testing may occur at any time of the day during the calendar year, even during vacation periods. o Notice will be provided in writing by the Athletics Director or his/her designee to the Head Coach and the student-athlete at least 12 hours prior to the prescribed testing time. o The refusal or inability to provide a sample will be considered a positive test. o All test results accumulate during the entire time that an individual is a student- athlete at Mason. o A positive NCAA drug test will be treated as a positive Mason drug test.

Reporting Results

o When the laboratory notifies the Director of Athletics or his/her designee of a student athlete’s positive test, Mason will immediately request a test of the student-athlete’s B sample to confirm the finding. Specimen B findings will be final. o A positive result will be reviewed by the Team Physician to determine if there is an acceptable medical exemption. . Student-athletes are required to provide a complete list of all his/her medications and/or dietary supplements to the Team Physician at their annual physical. It is the responsibility of the student-athlete to update this list as changes occur throughout the academic year. Failure to properly report prescription drugs to the Sports Medicine department could potentially negate any possible medical exemption. o The Director of Athletics or his/her designee will notify the student-athlete verbally and in writing of the positive finding. The Director of Athletics or his/her designee also will notify the parents/guardian in writing of the positive test result. o Records and other information shall remain in the possession of the Director of Athletics or his/her designee and may be released only as stated on the consent form and as set forth in these procedures. o Appropriate action will take place following a positive test result according to the sanctions outlined in this policy.

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Sanctions After Positive Results o FIRST POSITIVE TEST RESULT . A confidential meeting between the student-athlete, Director of Athletics or his/her designee and Head Coach will be held as soon as possible to evaluate the nature and extent of drug involvement. . Notification of parents. Mason recognizes the increased involvement of parents of student-athletes and may, therefore, notify parents of the impermissible drug use. . Counseling and rehabilitation. The student-athlete will be required to have an evaluation/assessment at the GMU Counseling Center. The student-athlete must make an appointment for the evaluation within a week of being notified of the positive result. The Counseling Center will notify the Director of Athletics or his/her designee of the student athlete’s attendance, completion of the program or subsequent referral. The student-athlete must comply with the treatment recommendations as a condition of these sanctions; failure to do so could result in removal from athletic participation. The evaluation and recommended treatment must be completed within a reasonable period of time (as determined by the individual conducting the evaluation) following the positive test result. Any expenses incurred as the result of the assessment and all treatment and rehabilitation will be paid for by the student-athlete. . Informed Consent – The student athlete will agree to sign an informed consent waiver with the substance abuse counselor in order for the counselor to communicate with members of the athletic department. . Future Testing – The student athlete will be subject to future testing without notification for up to one calendar year. . Appeal – The student athlete has the right to appeal his/her case, which is outlined in Section VII of this policy. . The Director of Athletics has the right to impose additional sanctions at his/her discretion in regards to participation and/or reduction or cancellation of athletic aid. o SECOND POSITIVE TEST RESULT . A confidential meeting between the student-athlete, Director of Athletics or his/her designee, and Head Coach and Sport Administrator will be held as soon as possible to evaluate the nature and extent of drug involvement. . Notification of parents. Mason recognizes the increased involvement of parents of student-athletes and may, therefore, notify parents of the impermissible drug use for the second time.

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. Counseling and rehabilitation. The student-athlete will be required to have an evaluation/assessment at the GMU Counseling Center. The student-athlete must make an appointment for the evaluation within a week of being notified of the positive result. The Counseling Center will notify the Director of Athletics or his/her designee of the student athlete’s attendance, completion of the program or subsequent referral. The student-athlete must comply with the treatment recommendations as a condition of these sanctions; failure to do so could result in removal from athletic participation. The evaluation and recommended treatment must be completed within a reasonable period of time (as determined by the individual conducting the evaluation) following the positive test result. Any expenses incurred as the result of the assessment and all treatment and rehabilitation will be paid for by the student-athlete. . Informed Consent – The student athlete will agree to sign an informed consent waiver with the substance abuse counselor in order for the counselor to communicate with members of the athletic department. . Suspension from Athletic Participation. Student-athlete will be suspended from 20 percent of the scheduled during the competitive season; scrimmages, exhibitions and non-championship season competition do not satisfy the withholding requirement. Partial numbers in the calculation of 20 percent shall be rounded to the nearest whole number. Withholding requirement must be fulfilled at the next earliest opportunity, and will continue into the following season if required. Furthermore, the head coach may impose a longer suspension from competition based upon team policies and procedures. . Future Testing – The student athlete will be subject to future testing without notification for up to one academic year. . Appeal – The student athlete has the right to appeal his/her case, which is outlined in Section VII of this policy. . The Director of Athletics has the right to impose additional sanctions at his/her discretion in regards to participation and/or reduction or cancellation of athletic aid. o THIRD POSITIVE TEST RESULT . A confidential meeting between the student-athlete, Head Coach and Athletic Director will be held as soon as possible. . Notification of parents. Mason recognizes the increased involvement of parents of student-athletes and may, therefore, notify parents of the impermissible drug and possible immediate cancellation of athletically related aid.

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. Permanent Suspension from Athletic Participation. The student athlete will be permanently removed from athletic participation and all athletics aid may be immediately cancelled without the eligibility of reinstatement. . Appeal – The student athlete has the right to appeal his/her case, which is outlined in Section VII of this policy. o APPEAL PROCESS o Student-athletes who test positive under the terms of the Drug and Alcohol Education and Testing Program will be entitled to a hearing prior to imposition of any sanction. Appeals will be heard by a three-person Appeals Committee comprised of the Team Physician, the George Mason University NCAA Faculty Athletic Representative (Chair), and an additional member determined at time of appeal. o Requests for a hearing must be made within forty-eight (48) hours of notification of a positive test result. If the forty-eight hours would end on a weekend or University holiday, the request must be made by noon on the next business day. o Requests must be in writing and received by the Director of Athletics or his/her designee. o The student-athlete may have an advisor present at the appeal if the student- athlete so desires; however, such advisor shall neither represent the student- athlete before the Appeals Committee nor speak for the student-athlete at the appeal. Only the student-athlete may present his or her own case. o The Appeals Committee will schedule the hearing to take place no more than seventy-two (72) hours after the written request is received, but may, in its sole discretion, extend such schedule for its own convenience. Either the student- athlete or other parties involved may request an extension of this time from the Director of Athletics or his/her designee, who will consider whether to grant the extension upon a showing of good cause. o These proceedings shall include an opportunity for the student-athlete to present evidence, as well as to review the results of the drug test. The proceedings shall not be open to any other attendees, and the contents of the hearing shall be held confidential o After hearing all such evidence, as it deems relevant, the committee shall deliberate in private for the purpose of making findings of fact. The findings and conclusions shall be based exclusively on information supplied at the hearing. o Within three days after it concludes its inquiry, the committee shall report its conclusions concerning the facts, as well as any advice concerning the severity of the sanctions proposed, to the faculty athletics representative who shall decide what sanctions, if any, shall be imposed. The decision of the Faculty Athletics Representative is final.

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Testing for Cause o Nothing in this policy shall prevent or limit the University’s right to require a student-athlete to submit to testing when there is cause to do so. o For purposes of this section, cause shall be defined as behavior, conduct or performance by the student-athlete which leads the university to conclude that there is the likelihood that the student-athlete is taking or is under the influence of illegal drugs or banned substances (as defined above). . Among the indicators that may be used in evaluating a student-athlete’s behavior, conduct or performance are: class attendance, significant GPA changes, athletic practice attendance, increased injury rate or illness, changes in physical appearance, academic/athletic motivational level, emotional condition, mood changes, and legal involvement. o Cause may be based on information received that a student-athlete is using illegal drugs or alcohol. In such case, the determination that cause exists to require a student-athlete to submit to testing will be made only after consultation between the Team Physician, the Head Athletics Trainer, and the Head Coach of the sport. All must agree that the observations, behavior, conduct or performance of the student-athlete are such that testing for cause is required to protect the health of the student-athlete, the health of others and/or to protect the integrity of the sport. o Before any testing for cause is performed by committee decision, it will be reviewed by University Counsel.

Safe Harbor Program o A student-athlete who has engaged in drug use is encouraged to seek assistance from the Athletics Department by voluntarily disclosing his/her use to the Director of Sports Medicine or any other athletics department staff member prior to be being identified as having violated the drug policy. In the event that a student athlete declares safe harbor to an athletics staff member, he/she shall notify the Director of Sports Medicine as soon as possible. o A student-athlete is not eligible to enter the Safe Harbor Program: . More than one (1) time; . After he/she has been informed of an impending drug test; . After documentation of a positive drug test; or . Thirty (30) days prior to NCAA or Conference postseason competition o Mason will work with the student to prepare a Safe Harbor treatment plan in conjunction with substance abuse counselors on campus. The student-athlete will be required to sign a waiver in order for the counselor to contact members of the athletic department. This provision allows a student-athlete to self-report a substance abuse problem without repercussions of a positive test, thereby exempting him/her from drug testing while in the Safe Harbor Program. 41 2/16/2018

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. These individuals will still be required to undergo an evaluation by a substance abuse counselor. The counselor will determine the appropriate form(s) of intervention and rehabilitation needed by the student-athlete based on the circumstances of the case. The counselor will report back to the Director of Sports Medicine that the individual has undergone the required sessions. Upon completion of the required sessions, the student- athlete will subsequently be drug tested to demonstrate compliance with the Mason Drug Testing and Education Program. o Upon entry into the Safe Harbor Program, the student-athlete will be evaluated by the team physician who my remove the student from play or practice if medically indicated. o A student-athlete will be permitted to remain in the Safe Harbor Program for a reasonable period of time, not to exceed thirty (60) days, as determined by the treatment plan. o If a student-athlete is determined to have used new banned substances after the initial Safe Harbor Program test (as determined by follow up testing), or fails to comply with the Safe Harbor Program treatment plan, the student-athlete will be removed from the Safe Harbor Program and be subject to appropriate disciplinary actions as detailed in the Mason Drug Testing and Education Program policies and procedures. o Entering the Safe Harbor Program will be treated as one of the disciplinary action phase and any positive test indicating new banned substance use after the initial Safe Harbor Program test will be treated as the next subsequent positive. o While in compliance with the Safe Harbor Program treatment plan, the student- athlete will not be included in the list of students eligible for random drug testing by Mason. Students in the Safe Harbor Program may be selected for drug testing by the NCAA. o The Director of Athletics, Team Physician, Director of Sports Medicine, and the student-athlete’s head coach by be informed of the student-athletes participation in the Safe Harbor Program. The athletic trainer assigned to the student-athletes sport may also be notified if medically appropriate. Other university employees may be informed only the extent necessary for the implementation of this policy.

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ADMINISTERING MEDICATIONS The George Mason University Certified Athletic Trainer has the permission, as an agent of record, from the Team Physician to administer oral and topical over the counter (OTC), metered dose inhalers, emergency injectables, and finger stick blood glucose tests with the following provisions: General Guidelines:  The medical staff person is a Certified Athletic Trainer through the (BOC) and holds a current licensure to practice Athletic Training in the Commonweatlh of Virginia.  The administering of medications will be done in accordance within the Virginia State and Federal law.  The Certified Athletic Trainer shall keep all medications in a locked room/cabinet for storage.  Storage shall be kept in the original container that is clearly labeled with the type of medication, and directions for administration.  Storage shall be kept free of food or any unauthorized access.  The Certified Athletic Trainer will place all documentation from the Team Physician with the student-athlete’s medical record to be kept on file.  The Certified Athletic Trainer shall be the only person to have access to the locked room/cabinet and will be the only person to administer medications other than the Team Physician.  The Certified Athletic Trainer will document all medications that are administered.  The documentation will include the student-athlete’s name, date of administration, type of medication, and time of administration. Prescription Medications All prescription medications are to be stored in the George Mason University Sports Medicine clinic physician’s office under lock and key. The physician shall be the only person who may dispense prescription medication. Full disclosure about the medication (i.e. side effects/ contraindications) will be given the student- athlete at the time it is administered. The Certified Athletic Trainer may assist a student-athlete taking prescription medications that have been dispensed by the Team Physician. All prescription medications that are dispensed or administered will be logged in the patient’s medical file. Prescription medications will be inventoried annually and all expired medications will be properly discarded. (Refer to medication disposal) Certified Athletic Trainers may administer medications in the absence of the Team Physician only after verbal order has been given over the phone and all proper documentation has taken place. In no instance shall a Certified Athletic Trainer administer any prescription medication to a student-athlete without a direct order from the Team Physician.

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Non-Prescription Medication All medications will be ordered and administered in prepackaged units. The Certified Athletic Trainer has the authority to administer over the counter medications per the physician’s discretion. Prior to administration of medication by a Certified Athletic Trainer, the Team Physician must agree to the following guidelines to administer oral, topical, emergency injectable, finger stick blood glucose tests, and inhalant medications. The Certified Athletic Trainer will understand the types and use of common oral and topical over the counter medications, as well as emergency injectable, inhalants, and finger stick blood glucose tests. The Certified Athletic Trainer will understand the basic principles in administering oral, topical, emergency injectable, finger stick blood glucose tests, and inhalant medications. The Certified Athletic Trainer will demonstrate the application and installation of oral, topical, emergency injectable, finger stick blood glucose tests, and inhalant medications. The Certified Athletic Trainer will be able to recognize common side effects of oral, topical, emergency injectable, finger stick blood glucose tests, and inhalant medications. The Certified Athletic Trainer will learn the proper follow up procedures in case of adverse reaction to any medication. The Certified Athletic Trainer will demonstrate and understand the importance of documentation when handling and administering medications. Also, the Certified Athletic Trainer will learn to avoid and document medication administration errors. The Certified Athletic Trainer will be able to appropriately interpret orders given by the Team Physician. The Certified Athletic Trainer will understand medical abbreviation commonly used for medications. The Certified Athletic Trainer will understand the required documentation from the Team Physician when administering medications. The Certified Athletic Trainer will understand and demonstrate the proper handling, disposal, and storage of all medications. Types of Administration: Oral medications All prescription and non-prescription medications Topical medication Topical ointments such as anti-fungal cream, hydrocortisone, calamine lotion, hydrogen peroxide, triple antibiotic, Lamisil, and topical anti-inflammatory medications. 44 2/16/2018

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Finger stick blood glucose test Emergency injectables Emergency epinephrine (Epipen) Inhalant medications Asthma inhalers Description of Administration of Medications Wash hands; encourage student-athlete to do the same.(optimal conditions) Verify the authorization with the label. Gather necessary items. Identify the student-athlete. Check the label for name, time, medication, dose and route when picking up the container. Prepare the medication without touching the medication. Check the label for name, time, medication, dose and route. Check the label for name, time, medication, dose and route when returning the container to the locked safe place. Observe the student-athlete for any unusual behaviors or conditions. Explain the procedure to the student-athlete. Position the student-athlete properly for the medication administration. Administer the medication to the correct student-athlete. Administer the correct medication. Administer at the correct time. Administer the correct dose. Administer by the correct route. Verify the student-athlete received the medication. Record medication administration. Report unusual reactions immediately. Clean, return and/or dispose of equipment, as necessary. Wash hands. (optimal conditions) Assisting a Student-athlete with Oral Medication Administration (Tablets or Capsules) Remove bottle cap and hold cap in one hand and container in other hand. Pour the medication into the cap, or medicine cup and administer to student-athlete. Verify the student-athlete swallowed the medication.

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Recap the bottle and return it to the proper place. Oral Medication Administration (Liquid or Powder) Shake container per label instructions. Pour liquid from side of the bottle opposite the label (hold label in palm of hand). Pour into graduated medicine cup. Carefully pour and measure medication at eye level and directly in front of eyes. After replacing the lid, wipe off any medication on the outside of the container. Topical Medication Administration (Skin Medications) Gather necessary equipment. Cleanse the skin; apply medication in a thin layer, or as ordered. Cover skin, if directed. Eye Drops Gather necessary equipment. If drainage is present, wipe with a clean cotton ball wiping once from the inside to the outside. Use new clean cotton ball for each eye. Position student-athlete with head tilted back and eyes looking up. Open the eye to expose the conjunctival sac. Approach the eye outside the field of vision. Avoid touching the dropper tip to anything. Drop the medication into the sac, not on the eyeball, with the drop not falling more than 1” to the eye. Gently close the eye. Ask the student-athlete to keep the eye closed for a few minutes. Blot excess medication with a clean cotton ball or tissue for each eye treated. Eye Ointment Gather necessary equipment. If drainage is present, wipe with a clean cotton ball, wiping once from the inside to the outside. Use a clean cotton ball for each eye. Position student-athlete with head tilted back and eyes looking upward. Open the eye to expose the conjunctival sac. Approach the eye outside the field of vision. Avoid touching the tip to anything. Apply ointment in a thin layer along inside lower lid. Hold the lid open a few seconds. Gently close the eye. Ask the student-athlete to keep the eye closed for a few minutes. Blot excess medication with a new clean cotton ball or tissue, for each eye treated.

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Ear Drops Gather necessary equipment. Position the student-athlete. o If lying flat on a treatment table, turn face to the opposite side. o If sitting in a chair, tilt head sideways until the ear is horizontal. Cleanse entry to ear canal with a clean cotton ball, as necessary. Straighten the ear canal. Pull outer ear gently down and back (ages 3 and under), or up and back (older children). Drop the medication on the side of the canal. Avoid the dropper touching anything. Instruct the student-athlete to maintain the position for 1 minute. Loosely place a cotton ball in the ear, if ordered.

Inhaler: Monitoring Student-athlete Self-Administration Observations when monitoring student-athlete self-administration of medication may include: Stand up, feet slightly apart. Shake inhaler for approximately two seconds. Position inhaler with canister upside down. Holding mouthpiece 1-2 inches from lips (or as instructed), open mouth wide. When using a spacer, place mouthpiece in mouth. Breathe out naturally. Open mouth wide (or as instructed) and begin to inhale deep breath, slowly. If using a spacer, seal mouth around mouthpiece and inhale a deep breath. After the beginning of deep breath, squeeze canister down on mouthpiece and breathe slowly, as deeply as possible. Hold breath as long as possible – up to 10 seconds – to allow medication to settle as deeply as possible into and onto air passages. Wait approximately 1-2 minutes and repeat process. This technique will allow delivery of medicine into air passages opened by first puff. Team Physician approves this standing order for athletic trainer to administer inhaler for student- athlete who may need assistance. Epi-pen Medication (In Allergic Emergencies, follow individualized administration instructions that may include): Pull off safety cap. Place tip on thigh. May be injected through clothing. Restrain knee before injecting. Press auto-injector against thigh until mechanism activates, and hold in place for 10 seconds. 47 2/16/2018

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Follow emergency instructions. Call 911 and notify parents Team Physician approves this standing order for athletic trainer to administer epi-pen for student-athlete who may need assistance.

Finger-stick Blood Glucose Tests: Wash Hands. Apply Gloves. Clean area with alcohol and dry completely. Use the spring lances device to puncture skin. Hold hand down and milk the finger from the palm towards the tip. Turn palm down so that the blood hangs. Catch the drop of blood on the special test strips pad. Follow the instruction on the glucose monitoring machine. Record your test result. Clean puncture wound. Cover with Band-Aid. Dispose of test strip and gloves in biohazard container. Team Physician approves this standing order for athletic trainer to assist student-athlete with finger stick glucose test, if needed.

Missing/Stolen Medication If medication is missing or stolen, the following steps are to be taken: Notify Sports Medicine Coordinator. Notify campus security if needed. Notify the Team Physician to replenish the medication supply. Completely document the occurrence. Medication Disposal The following steps are to be taken for medication return or disposal: At the conclusion of each year all over the counter medications will be inventoried for expiration date. Any medication found to be out of date will be disposed of appropriately. Medication Management Procedures The Sports Medicine Coordinator will ensure that all medications purchased are properly labeled. 48 2/16/2018

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The Sports Medicine Coordinator will ensure that each facility at George Mason University is properly stocked with OTC medications. The Sports Medicine Coordinator will ensure that each facility has medication logs that are labeled for each month. Each facility will have a certified athletic trainer who is responsible for ensuring that medication logs are correctly completed on a daily basis. At the end of the month, the same individual will be responsible for turning in all logs to the Sports Medicine Coordinator. Certified athletic trainers are responsible for tracking all medication administered while traveling with athletic teams. Travel logs are to be turned in to the Sports Medicine Coordinator at the end of each month. All logs are to be turned into the facility coordinator who is responsible for submitting month logs to the Sports Medicine Coordinator on the 31st of each month. The Sports Medicine Coordinator will maintain and keep accurate records of the location and expiration date for emergency medications (albuterol, epi-pens, and glucagon). The Sports Medicine Coordinator will complete a year-end audit of all OTC and prescription medications used.

Documentation of Medication Administration George Mason University uses written reports to document all oral, topical, finger stick blood glucose, emergency injectable and inhalant medications that are administered to the student athlete.

The documentation guidelines are as follows: Complete the following information: o student-athletes’ full name o name of medication as written on container o RX number on lot of medication (if from a large lot, not individual doses) o amount of medication (number of pills) o Injury/illness o Side of body Document in the patients record the name, dose, and prescription, and pill count for any medications other than OTC. Clearly state exact amount of medication to be administered in each dose in the notes section in EMR system, Use medical abbreviations when necessary, such as: BID, TID. Record side effects and contraindications if appropriate. Document significant observations in comment section and inform the Team Physician and parents/guardian if necessary.

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Always maintain confidentiality regarding the student-athlete, their medication and their disease or illness at all times. Any notes regarding reactions to medications, etc. will be place in the student-athletes electronic medical record.

MEDICAL REFERRAL A student-athlete who has sustained an injury/illness is to report it to a Certified Athletic Trainer (ATC) within 24 hours of the incident. If referral is necessary, the Certified Athletic Trainer will schedule an appointment with the Team Physician in the clinic at George Mason University. Any appointments scheduled independent of the Sports Medicine Staff’s referral will not be covered by the athletic department’s secondary insurance. If emergency care is warranted, the Certified Athletic Trainer will activate the emergency medical system.

GEORGE MASON UNIVERSITY STUDENT HEALTH The Mason University Student Health Service is an adjunct facility to the Sports Medicine Center. There may be instances where the student-athlete would be referred to the Student Health Center. It is important that the student-athlete comes to the Sports Medicine facility prior to any referral being made, or calls their athletic trainer for direction and assistance. Any student- athlete who is referred to the Health Service shall be sent with the Sports Medicine Referral form. The student-athlete should complete a HIPAA form at Student Health Services to allow the physician who evaluates the student-athlete to complete detailed notes and return them with the student-athlete to the Sports Medicine facility. All Mason Health Center referrals are to be run through the student-athlete’s primary insurance. Insurance and demographic information is to be sent with the student-athlete upon referral. As a reminder, services that are not directly related to a sports injury are the financial responsibility of the student-athlete.

Business Office Hours: Monday - Friday, 8 a.m. - 5 p.m. Clinic Hours: Monday - Friday, 8:30 a.m. - 5 p.m. Closed Saturday and Sunday, university holidays

Services offered: Allergy Shot Clinic Birth Control Services Common Illnesses Emergency Contraception Flu Shots Gynecological Exams, Problems and Infections Health Education Services HIV Testing Immunizations and TB Testing 50 2/16/2018

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Lab Services Physical Exams (well person) Prescriptions and Medications Referral Network of Specialists in George Mason Community Routine and Sports-Related Injuries Sexually Transmitted Diseases (STDs) Smoking Cessation MASON IMMUNIZATION POLICY

Student athletes are to comply with the George Mason University immunization policy. The Sports Medicine Department does not maintain immunization records. All records are to be on file with the health center when the student-athlete enters George Mason University as a freshman. The George Mason immunization policy is as follows:

Policy Statement: George Mason University enforces a mandatory pre-matriculation immunization requirement to reduce the incidence and risk of vaccine-preventable disease in the college community. Reason for Policy: This policy is consistent with the recommendations of the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention, the Virginia Department of Health, and the American College Health Association's Recommendations for Institutional Pre-matriculation Immunizations. Responsible Executive and Office: o Responsible Executive: Vice President for University Life o Responsible Office: Mason Immunization Office (http://shs.gmu.edu/immunizations/ ) Entities Affected by this Policy: All undergraduate and graduate degree and non-degree students, regardless of credit hours, taking courses on George Mason’s main campus or any of its satellite facilities are covered under this policy. Entities Exempted from this Policy: Students taking courses online, overseas, at their place of employment if employment is off-campus, or at any of the city/county schools, are exempt from this policy. Procedures: Immunization Requirements o Measles, Mumps, Rubella Immunity 51 2/16/2018

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o Two doses of MMR vaccine given at least 28 days apart and after 12 months of age. o Acceptable alternative proof of immunity: Positive antibody titer to measles, mumps, and rubella (must submit copy of titer results) OR birth date before 1957. In the event of an outbreak, those born before 1957 may be required to show titer proof of immunity and, if negative titer, receive one dose MMR. o Tetanus, Diphtheria, Pertussis Immunity. o Students must have completed the childhood series (≥4 doses of DTaP*) and provide proof of a single dose of adult Tdap vaccine (Adacel or Boostrix) given at or after 11 years of age, regardless of the date of any prior Tetanus or Td** booster. o A Td booster will be accepted in place of Tdap only if the pertussis component is medically contraindicated. o *DTaP is the vaccine given to children < 7 yrs of age to protect against Diphtheria, Tetanus and Pertussis. Tdap is the adult version of the same vaccine given to adolescents and adults 10 and over. The “a” in DTaP and Tdap stands for “acellular,” meaning that the pertussis component contains only a part of the pertussis organism. o **Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years. o Meningococcal Disease (Meningitis): Who must comply: In accordance with Virginia law, all students living in on-campus housing must be immunized against meningococcal disease or sign a waiver indicating they understand the risks of the disease and decline immunization. o Acceptable vaccine: Quadrivalent meningococcal vaccine (protects against 4 serogroups: A, C, Y, and W-135) given on/after age 16.* Conjugate vaccine (Menactra, Menveo) preferred; Polysaccharide vaccine (Menomune) acceptable alternative if conjugate not available. o *If initial dose was given before age 16, booster dose with conjugate vaccine is needed to protect student during college years. o Tuberculosis Screening: Who must comply: all international students on temporary visa status (regardless of prior BCG inoculation) and all students who have lived outside the U.S. or Canada for six months or longer. o Acceptable TB screening: PPD (Mantoux) intradermal skin test. Tine test is not acceptable. PPD must be completed at George Mason University or by a U.S. healthcare provider within one year of entry to the University. o If PPD is positive: a negative chest x-ray, performed in the U.S. after the date of the positive PPD, must be documented. A copy of the official report by a chest physician or radiologist is required as proof. o Polio: Who must comply: all international students from countries listed by the U.S. Centers for Disease Control and Prevention as endemic for wild poliovirus (currently Afghanistan, Angola, Egypt, Ethiopia, India, Niger, Nigeria, Pakistan, Somalia, and Sudan). o Acceptable proof of immunity: three doses IPV or OPV.

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o George Mason University Sports Medicine provides yearly flu vaccine clinics for student athletes. It is the medical stance of the George Mason University medical staff that vaccination for influenza is strongly recommended yearly. Documentation The George Mason Health History/Immunization Form, available on the University website (http://shs.Mason.edu/about/forms/) , must be completed and returned to the Health center prior to the student's first semester or summer session in attendance, along with any supportive documentation (chest x-ray report, titer results, etc.). Copies of school immunization records or medical records documenting immunizations are acceptable. Immunization records must be signed by a health care provider. Exemptions from Immunization Requirements o Medical exemptions are vaccine-specific and require verification by a healthcare provider of the medical contraindication to a specific vaccine(s).

o Religious exemptions require completion of a Request for Exemption on the basis of religious beliefs. Form is available at the Student Health Center and must be notarized.

o In the event of a disease outbreak, students exempted from immunization requirements may be requested by the University, at the direction of public health authorities, to show titer proof of immunity, become immunized, or remain off campus for the duration of the outbreak. Consequences of Non-compliance Students who fail to comply with the requirements in sections A. and B. above will be blocked from registration. If a temporary waiver is granted for one term, all requirements must be completed before early registration for the subsequent term or registration will be blocked.

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INSURANCE POLICY AND PROCEDURES The George Mason University Department of Athletics requests that student-athletes be covered by individual medical insurance prior to participating in any practice, game, and/or competition. The student-athlete’s medical insurance should cover intercollegiate athletics related injuries/illnesses. The student-athlete’s medical insurance will be considered the PRIMARY insurance coverage for all athletic related injuries/illnesses. The Health Insurance Information Form must be completed and a photocopy (front & back) of their medical/health insurance card, dental insurance card, prescription benefits card submitted on a yearly basis.

Medical Billing George Mason University Sports Medicine is pleased to be the healthcare provider for our student-athletes during their participation in the Mason University Intercollegiate Athletics program. In order for our staff to provide the best possible care to your student athlete, it is vital that you provide complete and accurate insurance information. If your insurance information changes for any reason, we would appreciate you updating the information as soon as possible. Please note: Insurance information must be on file with the George Mason University Department of Athletics and George Mason University Sports Medicine prior to being cleared by the team physician for participation in intercollegiate athletic practice and competition.

Every student-athlete should be covered under a personal or family insurance policy and is encouraged to obtain complete personal health insurance. This is the primary policy. Mandatory requirements accompany most primary plans. It is the responsibility of the student-athlete to know the requirements of their personal policy. If the personal policy guidelines are not followed, the secondary policy will not go into effect and the Department of Intercollegiate Athletics will not be responsible for the incurred expenses. Student-athletes with Tricare Military or any HMO insurance plan will be required to follow the requirements of their insurance plan. It is highly recommended that a primary care physician in the Tricare North Region, be selected in the Fairfax vicinity. By completing this process in advance, health care needs can be addressed in a timely manner for Tricare student-athletes. Please contact Linda Pullen at [email protected] for appropriate forms and further information concerning this procedure. 1. It is the responsibility of the student-athlete to have the following information on file in the Athletic Training Room at all times:  Medical Insurance Information Form  Insurance Card (copy of front and back)  Personal/Family Insurance Information Form 2. It is the responsibility of the student-athlete and/or the policyholder to keep insurance information current and notify the Athletic Training Room Staff immediately when changes occur. 3. It is the responsibility of the student-athlete to know and abide by the rules and regulations of the policy. 4. In the event a student-athlete is injured during official competition or practice, it is the responsibility of the student-athlete and/or policyholder to submit all claims in this order:  To their Personal/Family Insurance company for payment.

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 Provide the Athletic Training Room Staff with itemized bills and an “explanation of benefits” (EOB) from the primary insurance. Secondary policy will take effect after claims have been submitted to the student-athlete’s insurance company.

George Mason University’s Secondary Insurance Policy

The Department of Intercollegiate Athletics provides each student-athlete with a secondary sports accident insurance policy. This means that in the event there are outstanding bills after the student- athlete’s personal policy has addressed all claims; the Department of Intercollegiate Athletics secondary insurance policy becomes effective in accordance with its limitations and restrictions.

1. This policy pertains ONLY to athletically related trauma during official GMU competition or practice. Medical expenses acquired due to illness, pre-existing injuries, injuries outside of official practice or competition, self-inflicted injuries and injuries not reported in a timely manner are the sole financial responsibility of the parent, guardian or student-athlete. Student-athletes without primary medical insurance assume this risk.

2. The student-athlete must coordinate any treatment of an athletically related injury with the Athletic Training Room Staff. In the event the student-athlete chooses to independently acquire medical or therapy services without a written referral from a team physician or athletic trainer, the costs of such services shall be the sole responsibility of the student-athlete. If the student-athlete chooses to obtain medical services normally available through the University from an outside source, the cost of such services will be the sole responsibility of the student-athlete unless prior written approval has been obtained from the Athletic Training Room Staff. Health care providers are available to student- athletes free of charge through the Athletic Training Room (i.e., orthopedics, family practice, podiatrist, chiropractic).

3. The student-athlete must comply with the recommended treatment and rehab protocol as instructed by the team physician and/or athletic trainer. In the event, the student-athlete does not comply with the recommended treatment/rehab protocol, the cost of additional medical services for this injury, will be the sole responsibility of the student-athlete. A student-athlete must consistently report to the athletic training room for treatment and rehab a minimum of 3 days each week to be in compliance with this policy. Written documentation from an athletic trainer will be required for exception to this policy.

4. After a medical bill has been processed through the student-athlete’s primary policy, the outstanding balance of athletically related bills should be submitted to the Athletic Training staff for processing with the secondary policy. AN ITEMIZED BILL from the student- athlete’s doctor and/or hospital and an EXPLANATION OF BENEFITS paid by the primary insurance company are required to process the outstanding balance.

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6. The secondary insurance policy is only in effect for a period of 2 YEARS from the date of injury. Therefore, in order to successfully process your claim, timely submission of excess claims and all documentation to the Athletic Training staff is essential.

7. The secondary policy will not be in effect in instances where the student-athlete has not properly followed their primary policy’s rules and regulations and/or has been non- compliant with recommended treatment and rehab protocols as provided by team physicians and/or athletic trainers.

8. It is the responsibility of each student-athlete to know all policies and procedures related to the Athletic Training Room and Insurance policy (consult your Student-Athlete Handbook, the Sports Medicine Coordinator, or an administrator if you need further information).

George Mason University’s Athletic Department assumes no financial or legal responsibility for: . unreported injuries including concussions . unreported illness and medical conditions including pregnancy . charges by a healthcare provider to which a student-athlete was not referred by a member of the Athletic Training Room Staff or team physician . injuries or conditions not occurring during, or as a result of, participation in a scheduled, supervised practice and/or competition including self-inflicted injuries

All arrangements for the care of injuries are to be made and processed before the student- athlete withdraws, leaves or graduates from George Mason University.

Pre-existing Medical Conditions Medical conditions existing prior to athletic participation at George Mason University are the financial responsibility of the student-athlete and his or her family. Elimination from participation because of pre-existing conditions or injuries incurred while competing for George Mason University is the prerogative of the team physician. Failure to report medical conditions releases George Mason University from liability in the event of any injury caused by the unreported condition.

Medical Expenses All athletically related injuries must be reported to the team athletic trainer or team physician within a timely manner to enable the Athletic Department to help with any medical expense. All coverage provided by the Department is in compliance with guidelines issued by the NCAA, and therefore does not allow for payment for injuries that are not the result of supervised intercollegiate practice or competition. If injured in an intramural sports game, Departmental coverage is not applicable. If a student-athlete seeks medical care without pre-approval by the Athletic Department athletic training staff and/or team physicians, any and all charges incurred will be the responsibility of the student-athlete. 56 2/16/2018

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Dental Care Each student-athlete is responsible for his or her own dental care unless the need for the care is a result of an injury to sound teeth incurred during recognized athletic/team activity. Proper preventive measures (mouth guards, protective devices) must be taken during all practices, scrimmages, and games, etc. in accordance to NCAA rules that apply to each sport.

Eye Care Direct injury as the result of trauma is covered under the Athletic Department secondary policy. Eye care that is medically necessary for safe performance in a particular sport is also covered. Any appointments for exams, glasses or contacts require pre-approval by athletic administration.

When student athletes require medical care for an injury or illness, the charges are applied to the student-athlete’s family medical coverage. For injuries related to direct participation in George Mason University sanctioned practices and events, the copays, coinsurance, and deductibles will be covered by George Mason University Athletics. With increases in the costs of providing health care, we offset these rising costs, by billing primary insurance carriers for physician directed rehabilitation and treatment services rendered in the George Mason University Athletic Training Rooms. This should facilitate a continuation of improving health care services without putting the financial burden on you or your student- athlete. Any out of pocket costs that are to be paid by you, will be paid by George Mason University. Please note with the changes in the healthcare legislation, your premiums will not go up due to these types of claims, nor will your student-athlete be negatively impacted and labeled as uninsurable.

Please note the following important information about charges, health insurance and health insurance information:  We will not bill you or your son or daughter for these services - only the insurance company. We will pay any member responsibility.  You will receive an EOB (Explanation of Benefits) in the mail or online each time a charge is filed. THIS IS NOT A BILL. Please send us this EOB and we will take care of any amounts due. George Mason University Athletics provides a secondary medical and catastrophic insurance program for its student-athletes. THIS POLICY, HOWEVER, IS SECONDARY TO, OR IN EXCESS OF, PERSONAL MEDICAL INSURANCE COVERAGE, and covers only injuries / illnesses / accidents resulting from the direct participation in the 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.

104 Week Limitation on Secondary Insurance Coverage

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George Mason University’s medical and catastrophic insurance program will pay for the excess of the “Necessary” medical treatment up to the “Usual” and “Customary” charges for such expense incurred within 104 weeks (2 years) from the initial date of the injury / illness / accident. The first expense must be incurred within sixty calendar days of the date of the injury / accident. It is the responsibility of the George Mason University athletic trainer supervising the sport to keep track of the 104 the Sports Medicine Coordinator and/or his designee of any cases approaching the 104-week limitation. Compliance with Insurance Company Requests: It is the student-athletes and his/her parent(s) / guardian(s) responsibility to understand the conditions that apply to their policy and comply with any requests for information, etc. from the primary insurance company. Any delinquent bills resulting in bad credit due to non-compliance with insurance company requests may be the responsibility of the student-athlete and/or his/her parent(s) / guardian(s).

In the event that a student-athlete and/or his/her parent(s) / guardian(s) receives payment / reimbursement directly from their insurance company for athletic related injury / illness claims, the full account balance becomes the responsibility of the student-athlete and/or his/her parent(s) / guardian(s), until payment is turned over to the provider. HMOs: If a student-athlete’s primary insurance is an HMO, the George Mason University Sports Medicine staff strongly encourages the student-athlete and/or his/her parent(s) / guardian(s) to change the primary care physician (PCP) to a George Mason University Team Physician or local physician to obtain a “guesting privilege” in the George Mason area. This will allow the student- athlete to have a network of physicians in the George Mason area, as well as better access to care. A member of the George Mason University Sports Medicine staff can assist in this process. Insurance Policy Changes: George Mason University Sports Medicine must receive any changes to a health insurance policy as soon as they occur. If proper notification is not received, George Mason University Athletics may not be responsible for any delays in payment, collections notices, credit reports, etc. that occur. Medical Bills: In the event that a student-athlete receives a bill / statement for an injury / illness that occurred as a direct result of participation in athletics at George Mason University, the student-athlete must submit the bill / statement to a George Mason University certified athletic trainer in a timely manner. Bills not received in a timely manner may be the responsibility of the student-athlete and/or the student athlete’s parent(s)/ guardian(s). The George Mason University Department of Athletics and/or George Mason University Sports Medicine 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. Submit all correspondence to:

George Mason University Sports Medicine Attn: Insurance Coordinator 4400 University Drive, MS3A5 Fairfax, VA 22032 58 2/16/2018

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(703) 993-3280 Fax: (703) 993-3360

Exclusions and Limitations: George Mason University Athletics’ secondary medical insurance policy WILL NOT apply to the situations indicated below. This list is not all-inclusive.

Injuries / illnesses that are not the direct result of intercollegiate athletics participation during the dates of the primary competitive season and designated off-seasons as approved by the Director of Athletics according to NCAA regulations. Experimental procedures. Cosmetic surgery or procedures unless directly related to an athletics related injury. Hospital room and board charges in excess of the semi-private room rate unless hospitalized in an intensive care unit. Injuries / illnesses that are a result of intramural, club sports, and recreational activities (non- intercollegiate activities), as well as training / conditioning activities that occur outside of the primary competitive season and designated off-season periods. Injuries / illnesses that are recurrences of old injuries/ illnesses which were sustained before participation in the intercollegiate sports program. Expenses for athletic injuries incurred after completion of the student-athlete’s intercollegiate athletic eligibility. Medical expenses beyond the limitations and exclusions of, or not covered by, George Mason University Athletics' insurance policy.

Personal health insurance coverage is a requirement of the University and of George Mason Athletics. Medical bills resulting from the aforementioned activities will be submitted to the student-athlete’s primary medical insurance. Any unpaid balances are the responsibility of the student-athlete and/or the student-athlete’s parent(s)/guardian(s).

The Master Policy on file at the University contains all of the provisions, limitations, exclusions, and qualifications of the George Mason University Athletics’ insurance policy, some of which may not be included in this brochure. If any discrepancy exists between this brochure and the Policy, the Master Policy will govern and control the payment of benefits.

International Student-Athletes: In order to be enrolled in classes at any United States college or university, international students must prove that they have insurance that complies with standards set by the federal government. Insurance requirements will vary depending on if the student qualifies for F-1 status or J-1 status.

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o All F-1 students must carry health insurance that meets specifications outlined by the United States Department of State (DOS). Failure of an F-1 student to carry health insurance will result in termination of the student’s program and a report of the program termination to the United States Department of State. F-1 students must carry health insurance that provides for emergency medical evacuation and repatriation. J-1 Students o All J-1 students must carry health insurance for themselves and all J-2 dependents that meet specifications outlined by the United States Department of State (DOS). Failure of a J-1 student to carry health insurance will result in termination of the student’s program and a report of the program termination to the United States Department of State

If an international student-athlete is already covered by insurance that meets the requirements outlined above, he/she must provide written proof of coverage to the George Mason University Health Center. The information must be in English and should clearly specify the amount, period, and type of coverage, the deductible, the company rating, any co-payments, exclusions, and the policy concerning pre-existing conditions.

Anyone with questions regarding insurance requirements for international students should contact the George Mason University Student Health Center or the Athletics Compliance Director.

Proof of compliance with international student insurance requirements must be made at the George Mason University Health Center in order to avoid deportation, exclusion from classes, and/or exclusion from participation in George Mason Athletics.

The aforementioned guidelines may not be exact in every situation and for every student-athlete. International insurance regulations are continually amended and changed by the U.S. government. The George Mason University Sports Medicine staff will not be held responsible for changes that the University or government may make, and/or the student-athlete’s failure to check the specific guidelines for their country or insurance company. It is the student-athlete’s responsibility to make sure that they are in compliance with Federal, George Mason University, and George Mason University Athletics regulations at all times.

Practice Players: All practice players are required to provide proof of existing medical insurance in conjunction with having their initial or annual physical examination as well as meet the requirements for sickle cell testing. It is recommended that this policy provide benefits for athletic related injury. A front and back copy of the participant’s primary insurance card must be on file with the George Mason University Department of Athletics before the student-athlete will be allowed to participate in any practice or competition. In the event of an injury during practice the practice player will be triaged by the George Mason University Medical Staff and appropriate follow up will take place based upon the recommendations of the Team Physician and Certified Athletic 60 2/16/2018

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Trainer. All expenses occurred will be billed through primary insurance only and any remaining medical expenses will be the responsibility of the student.

Absence of Primary Insurance In the event that a student-athlete does not have primary medical insurance and is financially unable to purchase medical insurance, he/she may receive exemption of the policies previously stated. If you do not have primary medical insurance, you MUST contact the Sr. Associate AD for Performance, Well-Being & Risk Management at 703-993-9536 as soon as possible.

If financial need is established, the George Mason University Department of Athletics will assume primary accident insurance on the student-athlete for all injuries that occur as a result of participation in intercollegiate athletics at George Mason University. Costs associated with any injury that is not a direct result of intercollegiate athletics participation at George Mason University are assumed by the student-athlete.

***No student-athlete will be permitted to participate as a member of any GEORGE MASON UNIVERSITY intercollegiate athletics team without primary medical insurance or Exemption***

NCAA Catastrophic Insurance Program The NCAA sponsors a Catastrophic Injury Insurance Program, which covers the student-athlete who is catastrophically injured while participating in a covered intercollegiate athletic activity. The policy has a $100,000 deductible (which will be covered by the student-athlete’s primary health insurance policy AND George Mason University Athletic Insurance Basic Policy) and will and provide benefits in excess of any other valid and collectible insurance. For more information, refer to the NCAA web site at www.ncaa.org.

Special Circumstances Special circumstances, which may arise, that are not covered by these policies will be reviewed on a case-by-case basis and a final decision will be rendered by the Athletics Health Care Administrator. and the Sports Medicine Coordinator on any action and disposition.

Injury / Illness Reporting Procedures: Any student-athlete who has suffered an injury or illness is to communicate it to the Sports Medicine Staff.

Any student-athlete requiring medical attention or treatment for injuries or other related medical problems while participating in their Intercollegiate Athletic Program is to report this injury or problem to the athletic trainer assigned to his/her sport. The athletic trainer will then administer first aid and make arrangements for consultation, if needed.

If the Team Physician is on the site or is called for consultation and diagnosis, he/she will prescribe treatment. If the prescribed treatment is available in the athletic training room, the

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The Team Physician has created standing order prescriptions for the bulk of injuries seen in the training room and has authorize the Certified Athletic Trainers to perform evaluation, rehabilitation and therapy for these injuries according to the standing orders.

If the Team Physician believes the injury is of the nature or severity that requires the consultation of another medical specialist, referrals will be made as soon as possible by the Team Physician or a member of the Athletic Training Staff.

Medical records are maintained in the Athletic Training facility for all student-athletes participating in the Intercollegiate Athletic Program. The Athletic Training Staff and the Team Physician, when needed, are the final authority on when an injured or ill student-athlete may return to practice or competition. HIPAA guidelines are strictly enforced.

Any student-athlete who is injured / becomes ill must IMMEDIATELY report the injury / illness to a member of the George Mason University Sports Medicine Staff. Costs pertaining to an injury and/or illness not reported in a timely manner may be the responsibility of the student- athlete and/or his/her parent(s) / guardian(s).

All injured or ill student-athletes who cannot fully participate are listed on a weekly injury report that the staff athletic trainer gives to the Head Coach and Strength, & Conditioning staff as well as individual communication to those parties prior to each day’s athletic activity. Everyone on this list must report for treatment during the designated treatment times unless specifically advised otherwise by their staff athletic trainer and report as usual to practice or game attired in Athletic Department issued clothing.

Student-athletes who are sick must, at the discretion of the athletic training staff, by seen by the Team Primary Care Physician at a regularly scheduled primary care clinic carried out at the Athletics Field House. If a student-athlete desires to see the Team Physician, he/she must notify a staff athletic trainer as soon as possible. NOTICE: All primary care visits will be billed to the student athlete’s primary insurance. George Mason University’s secondary accident policy does not cover general medical illness.

If a student-athlete is injured during a practice session, workout session or contest, the Sports Medicine Staff will aid him/her as quickly as possible, evaluate the student-athlete and proceed with the appropriate, immediate care. The coach will be informed as quickly as possible regarding the student-athlete's injury and availability for that particular practice, workout or contest.

All therapeutic treatment, if necessary and available, will be administered by the Athletic Training Staff and will be billed to the student athlete’s primary insurance. See the information on medical billing for additional details.

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In the case of an emergency, the Athletic Training Staff will administer the necessary emergency care until EMS (Emergency Management Services) or a team physician arrives. Coaches are not to interfere with the Athletic Training Staff and their management of emergency situations.

Physician Referrals / Consultations: The George Mason University Department of Athletics has fostered positive relationships with many medical providers in the Fairfax area who have consistently provided high quality service to George Mason University student-athletes. Members of the George Mason University Sports Medicine Department will refer student-athletes to these providers, unless extenuating circumstances necessitate a different provider. Student-athletes with HMO policies are strongly encouraged to have a local primary care physician (PCP), so that timely care can be given.

All student-athletes must be seen and evaluated by a George Mason University Certified Athletic Trainer before a referral to a physician will be made. A member of the George Mason University Sports Medicine Department must authorize and properly refer all student-athletes to see a physician or medical consultant, and/or for diagnostic tests. 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 George Mason University Sports Medicine Department, the student-athlete and/or the student athlete’s parent(s) / guardian(s) will be financially responsible for any and all medical bills incurred.

All student-athletes have access to be seen by a Primary Care Sports Medicine Physician at various times each week in the Field House Athletic Training facility. Appointments are established by the Sports Medicine staff through the use of a scheduling matrix. However, urgent matters pertaining to in-season teams will be given priority if scheduling conflicts arise. Student-athletes who have schedules that conflict with clinic times may be referred to George Mason University Student Health Center, but must have a medical referral slip from the Sports Medicine Clinic in order for the visit to be covered by Athletics.

Referrals If a member of the George Mason University Medical Staff determines that a referral or consultation is necessary for a student-athlete, the appointment for such a visit will be arranged by the Team Physician or a Certified Athletic Trainer. If a student-athlete refers himself/herself without obtaining prior approval from the Sports Medicine Department, the student-athlete shall assume medical and financial responsibility for such visits and medical attention. Coaches do not have the authority to arrange medical referrals to any physician or medical service without consulting and receiving prior approval through the Sports Medicine Department.

Missed Doctor’s Appointment Policy: Student-athletes who are late and/or fail to show-up for scheduled appointments with the team physician, medical consultants, and/or diagnostic tests / procedures will be financially responsible for all charges resulting from the missed appointment. In addition, the student- athlete will be responsible for rescheduling the appointment and providing his / her own transportation. 63 2/16/2018

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“Off Campus” Physical Therapy and Rehabilitation Procedures: At times, it may be necessary for a student-athlete to utilize an “Off Campus” physical therapy facility. In such situations, permission must be granted by the Athletics Health Care Administrator., the Sports Medicine Coordinator and/or his designee. Such referrals must come from a member of the George Mason University Sports Medicine Department. If a student- athlete decides to utilize physical therapy / rehabilitation services without the authorization of a member of the George Mason University Sports Medicine Department, the student- athlete and/or the student athlete’s parent(s) / guardian(s) will be financially responsible for any and all medical bills incurred.

Orthopedic and/or Medical Second Opinions: If a student-athlete and/or his/her parent(s) / guardian(s) desire another physician’s opinion on an orthopedic and/or medical injury / illness, a George Mason University Certified Athletic Trainer will make arrangements for the second opinion with a qualified local physician. If a student- athlete decides to see an orthopedic and/or medical physician without the authorization of a member of the George Mason University Sports Medicine Department, the student-athlete and/or the student athlete’s parent(s) / guardian(s) will be financially responsible for any and all medical bills incurred.

Dental Care: The Department of Athletics will assume financial responsibility for the payment of dental injuries that are incurred while participating in an official team practice or contest. As with other injuries, this insurance is SECONDARY to, or in excess of, personal medical and dental insurance coverage. All dental injuries associated with athletic participation must be reported to a member of the Athletic Training Staff. The Team Dentist will perform all dental repairs whenever possible. The cost of any dental procedure that is not pre-approved by the Director or Sports Medicine will be incurred by the student-athlete.

Referral for standard dental care such as cavities, cleaning, gum infections, wisdom teeth extraction, or any other dental problems not related to an athletic injury will run through the student-athlete’s primary dental insurance. In the event that a student-athlete does not possess dental insurance, the expenses occurred will be the responsibility of the student-athlete. At times the Athletics Health Care Administrator. and/or the Sports Medicine Coordinator may authorize payment for dental care in special circumstances. In extenuating circumstances, some athletes with substantial unmet need may qualify to use the Student-athlete Assistance Fund for non- athletically related medical expenses. Each case will be reviewed on an individual basis.

Custom molded mouthpieces will be fitted for student-athletes participating in high-risk sports (e.g. basketball, lacrosse, etc.) and other student-athletes who express a desire for them and are approved by the Sports Medicine Coordinator.

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George Mason University – Department of Athletics Sports Medicine Policy and Procedure Manual athlete is not properly wearing his/her required mouthpiece at the time of injury. Medical bills associated with such injuries will be the sole responsibility of the student-athlete and/or his/her parent(s) / guardian(s).

DENTAL CARE Each student-athlete is responsible for his or her own dental care unless the need for the care is a result of an injury to sound teeth incurred during recognized athletic/team activity. Proper preventive measures (mouth guards, protective devices) must be taken during all practices, scrimmages, and games, etc. in accordance to NCAA rules that apply to each sport. JEWELRY/BODY PIERCING All jewelry should be removed prior to athletic activities. Earrings, necklaces, watches, bracelets, rings, toe rings, eyebrow rings, tongue studs, navel rings or other types of body piercing jewelry should not be worn in competitions or practices. Jewelry can be the direct cause of injury to oneself or other individuals and may cause the severity of an injury to worsen (i.e. tongue stud in an unconscious athlete). Jewelry should not be brought to competitions/practices where it cannot be safely stored. Medical expenses due to injury as a result of wearing jewelry during competitions/practices will be the financial responsibility of the student-athlete.

EYE CARE Direct injury as the result of trauma is covered under the Athletic Department secondary policy. Eye care that is medically necessary for safe performance in a particular sport is also covered. Any appointments for exams, glasses or contacts require pre-approval by athletic administration.

Corrective Lenses Student athletes who need corrective lenses will be referred for an eye examination by the Team Optometrist. Should it be determined that a student-athlete need vision correction, the cost of contact lenses will be incurred by the student-athlete. At times the Sports Medicine Department may incur the cost of vision correction contact lenses; however each case is reviewed on an individual basis. In order for the Sports Medicine Department to incur the cost associated with corrective lenses, the student-athlete must seek prior approval for such visual aid from the Sports Medicine Coordinator. The Athletics Health Care Administrator. the Sr. Associate for Compliance and the Sports Medicine Coordinator will determine Student Assistance Fund (SAF) eligibility. Those student-athletes who are Pell eligible and/or demonstrate financial need will receive priority in order to receive services paid for by the Special Assistance Fund. Each situation will be assessed on an individual basis and will follow in accordance with the policies and procedures set by the George Mason University Athletics Department.

Contact lenses which are lost or misplaced, other than in athletic participation, will be replaced by the student-athlete at his/her own expense. Corrective glasses are NOT the financial responsibility of the Sports Medicine Department.

PHARMACY

George Mason University has a relationship with Giant Pharmacy (10653 Braddock Rd. University Mall, Fairfax, VA 22032, 703-591-0020) as a local provider for prescription 65 2/16/2018

George Mason University – Department of Athletics Sports Medicine Policy and Procedure Manual medications. Prescriptions that are ordered by a George Mason physician can be taken to Giant Pharmacy to be filled if your insurance allows. If not, we will help you find a local pharmacy that accepts your health insurance. All payment for prescriptions for George Mason student athletes must be made by the student-athlete, and will be reimbursed by Mason Athletics ONLY if the prescription is authorized by a member of the Sports Medicine Staff, and is for a sport- related injury. Unauthorized prescriptions will not be reimbursed and will be the responsibility of the student-athlete. After filling the prescription, the student-athlete should take the prescription receipt and the bag with paperwork attached to their athletic trainer for processing. The prescription will be logged in and turned over to the athletic business office. Student- athletes can pick up their reimbursement from the business office. Prescription receipts from physicians outside of the athletic department will not be honored unless previous approval was given. Prescriptions for illness are not covered.

Payment of medications will fall under these scenarios: Prescriptions that are being filled for a general medical illness will be the sole responsibility of the student athlete. Prescriptions that are being filled as a result of injuries/illnesses that are a direct result of participation in athletics at George Mason will be filled through the student athlete’s primary insurance. All patient responsibility will be paid by the student-athlete and then receipts taken to their athletic trainer for reimbursement. If an athlete does not possess prescription benefits through the primary insurance, or the student-athlete is unable to pay for the prescription, they should contact their athletic trainer.

Medications Student-athletes should not take any medication (prescription and over-the-counter) or other oral substances from any individual other than a team physician or an athletic trainer under the direction and supervision of a team physician. It is against the law for athletic trainers, coaches or any individual to provide a prescription medication for a person other than who the physician prescribed it for. There is a danger of severe reaction to many medications. The NCAA requires documentation from a physician to be on file in the athletic training room for medications prescribed for Attention Deficient Hyperactivity Disorder (ADHD). This documentation must include information pertaining to the evaluation and diagnostic testing pertaining to the diagnosis of ADHD and the recommended treatment including prescription medication (http://www.ncaa.org/sites/default/files/ADHD%20reporting%20form.pdf). The NCAA and the GMU Drug Testing Policy requires that each student-athlete maintain a current record of all medications in the athletic training room. Misuse and abuse of any medication including over the counter medications can be harmful to your health.

NUTRITIONAL SUPPLEMENTS AND ERGOGENIC AGENTS Many supplements and agents are advertised as products that enhance athletic performance (e.g., ergogenic agents). The pressure to maximize performance and gain a competitive advantage at any cost has become prevalent. Consequently, there has been an explosion in the manufacturing 66 2/16/2018

George Mason University – Department of Athletics Sports Medicine Policy and Procedure Manual and advertising of these products. However, there are few products, which demonstrate scientifically, that enhance athletic performance. Many products are classified as “nutritional agents” or “herbal medicines.” These substances are not governed by agencies or regulations that control purity, efficacy, and safety, as are foods and pharmaceutical products. Consequently, there is tremendous variability in quality and purity of these products. The dangerous side effects and long-term risks involved in the use of many supplements and agents is also an area lacking scientific research. Accordingly, the policy of the Team Physicians, sports dietitian, and Athletic Training Room Staff is to only endorse the use of those products with proven scientific benefit and which are regulated by agencies that control the purity and safety of the product. The department will follow the guidance of the NCAA in strongly advising against the use of any nutritional supplement or ergogenic agent that without regulation could contain a substance that is on the NCAA banned drug list. An athlete assumes this risk when consuming this type of product during NCAA and GMU drug testing.

It is also the desire of the Sports Dietitian to provide educational information on a product the student-athlete may consider using. The Sports Dietitian will schedule appointments to discuss products and their usage. Educational resources are available for a student-athlete to review. It is our hope that each student-athlete will make intelligent and educated decisions in the use of any substance consumed with the desire to enhance athletic performance. Sound nutritional habits still remain the most effective and safe method. It is, therefore, the most intelligent first step to improve athletic performance.

NCAA BANNED DRUG LIST

The NCAA bans the following classes of drugs: a. Stimulants b. Anabolic Agents c. Alcohol and Beta Blockers (banned for rifle only) d. Diuretics and Other Masking Agents e. Street Drugs f. Peptide Hormones and Analogues g. Anti-estrogens h. Beta-2 Agonists

Note: Any substance chemically related to these classes is also banned.

The institution and the student-athlete shall be held accountable for all drugs within the banned drug class regardless of whether they have been specifically identified.

Drugs and Procedures Subject to Restrictions: a. Blood Doping. b. Local Anesthetics (under some conditions). c. Manipulation of Urine Samples.

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Some Examples of NCAA Banned Substances in Each Drug Class

NOTE: There is no complete list of banned drug examples. Check with your athletics department staff before you consume any medication or supplement.

Stimulants

 amphetamine (Adderall)  caffeine (guarana)  cocaine  ephedrine  fenfluramine (Fen)  methamphetamine  methylphenidate (Ritalin)  phentermine (Phen)  synephrine (bitter orange) exceptions: phenylephrine and pseudoephedrine are not banned.

Anabolic Agents – (sometimes listed as a chemical formula, such as 3,6,17-androstenetrione)

 boldenone  clenbuterol  DHEA  nandrolone  stanozolol  testosterone  methasterone  androstenedione  norandrostenedione  methandienone  etiocholanolone  trenbolone

Alcohol and Beta Blockers (banned for rifle only)

 alcohol  atenolol  metoprolol  nadolol  pindolol  propranolol 68 2/16/2018

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 timolol

Diuretics (water pills) and Other Masking Agents

 bumetanide  chlorothiazide  furosemide  hydrochlorothiazide  probenecid  spironolactone (canrenone)  triameterene  trichlormethiazide

Street Drugs

 heroin  marijuana  tetrahydrocannabinol (THC) no other substances are classified as NCAA street drugs.

Peptide Hormones and Analogues

 growth hormone(hGH)  human chorionic gonadotropin (hCG)  erythropoietin (EPO)

Anti-Estrogens

 anastrozole  tamoxifen  formestane  3,17-dioxo-etiochol-1,4,6-triene(ATD)

Beta-2 Agonists

 bambuterol  formoterol  salbutamol  salmeterol

Any substance that is chemically related to the class of banned drugs is also banned (unless otherwise noted).

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TOBACCO PRODUCTS The NCAA prohibits the use of tobacco products by the student-athlete during practice and competition. The student-athlete who is using tobacco during practice/competition shall be disqualified for the remainder of that practice/competition. The GMU athletic department prohibits the use of tobacco products in and on all athletic facilities.

"AFTER-HOURS" EMERGENCIES

In case of an "after-hours" emergency, student-athletes should proceed immediately the nearest urgent care center (Inova Emergency Care Center 4315 Chain Bridge Rd, Fairfax, VA 22030, or Inova Fairfax Hospital 3300 Gallows Road, Falls Church, VA 22042), The Student-athlete is to notify, and/or have someone else notify a member of the George Mason University Sports Medicine Staff as soon as possible. If the Certified Athletic Trainer cannot be reached the student-athlete is to notify the head coach. In the event that the Head Coach cannot be reached, the student-athlete is to call an assistant coach.

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RETURN TO PLAY POLICY A George Mason University Team Physician or his/her designee, in consultation with a George Mason University certified athletic trainer, has the final authority in deciding if and when an injured student-athlete may return to practice or competition. A student-athlete's private physician DOES NOT have any jurisdiction as to the participation status of the student-athlete. Any student-athlete seen by a physician other than the George Mason University Team Physician must return to the Sports Medicine clinic for follow-up and final clearance prior to active participation status. If a student-athlete is under the care of a private physician for an injury or illness and the physician's treatment precludes or alters activity in intercollegiate athletics, the student-athlete must secure, in writing, a release to reinstate the student-athlete to full participation. No student-athlete will be allowed to return to participation until the George Mason University Sports Medicine Staff has received a release from the treating physician AND is cleared by a George Mason University Team Physician or designee.

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TRANSPORTATION OF STUDENT-ATHLETES POLICY Although the George Mason University Sports medicine Staff will make every reasonable effort to arrange transportation for student-athletes to doctor’s appointments, diagnostic tests, surgeries, etc., this may not be possible in all situations. Therefore, the policy of the George Mason University Sports Medicine Staff with regards to the transportation of student-athletes to doctor’s appointments, diagnostic tests, surgeries, etc. will be: If the student-athlete has a viable means of transportation, he/she may be responsible for his/her own transportation to and from the appointment. If a student-athlete does not have a viable means of transportation and/or is not able to drive due to an injury / illness, a George Mason University Certified Athletic Trainer will make every effort to aid the student-athlete in finding a means of transportation in a timely manner. The following will be used as an order of priority for other means of transportation. o Teammate or friend o Member of the coaching staff The Certified Athletic Trainer will transport the student-athlete only as a last resort after all other means are exhausted.

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MEDICAL RECORDS AND CONFIDENTIALITY/HIPAA/FERPA Medical Records The Sports Medicine Department will keep a record of all pertinent medical records acquired in the care of each student athlete. All medical records are kept using an EMR system (NEXTT) which is password protected per HIPAA/FERPA regulations. Furthermore, the Sports Medicine Department keeps a protected shared drive location for all scanned copies of medical records. Access to the EMR drive or NEXTT software must be approved by the Sports Medicine Coordinator. Confidentiality All of the information gathered and kept private by the Sports Medicine Department is highly confidential and is protected by the Federal Right to Privacy Act (HIPPA/FERPA). It is the responsibility of all our personnel within the Sports Medicine Department to ensure that all patient information (personal, medical, or education related) remains confidential. Due to the number of staff personnel that may be involved with the management of injury/illness cases, it is essential that a policy of confidentiality be observed in order to maintain an atmosphere of mutual trust between the student-athlete and the Sports Medicine Staff. It is illegal for any unauthorized personnel to gain access to the student-athlete’s medical information, through any and all means. A student-athlete must sign a waiver for release of any information to any family member, media source, health-care professional or professional scout. All questions from the news media will be referred to the student athlete. Unless other arrangements are made, no information regarding the health status of any student-athlete will be released by the Sports Medicine Department.

All medical files must be kept for seven years within the EMR system. All student-athlete records that are removed from a team due to the student-athlete being cut, or voluntarily quitting the team are removed from the active database in NEXTT. All student athletes who are not active are considered “archived” in the NEXTT tracking system. Once a student athlete’s file has reached seven years past the date of graduation, the NEXTT administrator may “Purge” the medical record from the database.

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ELECTRONIC MEDICAL RECORD (NEXTT) Each member of the George Mason University Sports Medicine staff is required to maintain adequate and appropriate documentation on all George Mason student-athletes under his/her care. Therefore, all medical records are to contain required documentation, be addressed daily, be kept current, and filed properly in the injury management software.

Injuries are to be documented if the following occur: A student-athlete has been removed from practice or competition for an injury episode. A student-athlete has missed a practice or competition due to a medical reason. A student-athlete needs to be referred to a physician for any medical reason. A student-athlete is evaluated at any time by a Certified Athletic Trainer. Medical Problems are: A student-athlete who reports a medical issue where no time loss is documented. Problems are to be documented at the discretion of the Certified Athletic Trainer depending on the type of care needed to resolve the issue. When a student-athlete is receiving treatment for a medical issue but is not limited or modified in participation. All treatments/rehab received in the Sports medicine facility must be documented along with its given injury.

All athletic injuries, treatment/rehabs, limitations, and services are to be recorded in the Electronic Medical Record (NEXTT) Injury tracking software by the evaluating Certified Athletic Trainer. Once a student-athlete returns to play and has been discharged from all treatment and rehabilitation the injury is to be marked as resolved in the Electronic Medical Record (NEXTT).

Documentation is required for the following situations: Initial Injury Evaluation. Medical Referral to any allied health professional. Diagnostic imaging. Athlete treatment or rehabilitation. Progress notes or status reports. Re-evaluation or Progress notes. All communication with physicians and other allied health professionals regarding care of student-athletes. Athlete released from care / Discharge Summary. General documentation for all injury and rehabilitation documentation must include the Student- Athlete’s name and identifying demographics, subjective information concerning the injury / 74 2/16/2018

George Mason University – Department of Athletics Sports Medicine Policy and Procedure Manual chief complaint (CC), objective findings pertaining to the CC, treatments rendered, assessment of injury, plan of care addressing the CC, signature of responsible clinician and date.

For the purposes of providing quality health care, George Mason Athletic Trainers must write notes in a SOAP-type format and document the specific treatments and/or exercises performed in the NEXTT database. Documentation of the treatments and/or exercises must include the weight/resistance, reps, sets, and/or time spent on each.

All athlete medical records are considered confidential and must be handled as such. Any information related to a student-athlete’s medical condition, test results, treatment or care shall not be discussed with anyone except those directly involved with the medical care of that athlete.

Student-athlete medical records are considered student health records and are also subject to the protection provided by the Federal Education Record Protection Act (FERPA) in accordance with the George Mason University Athletics Policy & Procedure on the Disclosure of Health Information. As such, records are to be maintained in a secure location for seven years after the student-athlete has discontinued participation in George Mason University Athletics. Student- Athletes may gain access to their records freely; however, parents of non-minor student-athletes, outside institutions, or medical offices may only gain access to these records with written consent from the student-athlete.

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POLICY & PROCEDURE ON THE DISCLOSURE OF HEALTH INFORMATION Purpose The George Mason University Department of Athletics (Mason Athletics) creates a record of the health care and services that each student-athlete receives while a member of the University’s athletic teams in order to provide quality care and comply with certain legal requirements. Mason Athletics understands that student-athletes and qualified parents have certain rights regarding confidentiality of, access to, and correction of athletic health records maintained by Mason Athletics. The purpose of this policy is to implement those statutory rights in Mason Athletics.

Mason Athletics may contract with third parties to provide health care for student athletes. Those third parties are responsible for complying with the provision of the Health Insurance Portability and Accountability Act, and subject to Virginia law. These policies apply to any records maintained by Mason Athletics, but not to any records maintained by any third parties. Definitions For the purposes of this policy, Mason Athletics operationally defines the following:

1. A Student-Athlete is any person who is, or was, an official member of a varsity intercollegiate sports team at George Mason University.

2. A Qualified Parent is a parent or guardian of a student-athlete who has been given written consent by the student-athlete in a form approved by the University, to review the student-athlete’s athletic health record.

3. An Athletic Health Record is any record (written, printed, taped, filmed, electronic, etc.) made by a physician, athletic trainer, or other recognized health professional/paraprofessional and maintained by Mason Athletics.

Annual Notification Mason Student-Athletes will be notified of their rights annually through the following publications: Mason Student-Athlete Manual Mason Athletic Department Policies & Procedures Manual Policy Coverage This Policy describes the practices of Mason Athletics, including: Any Certified Athletic Trainer employed by Mason Athletics All departments and units of Mason Athletics, including the Mason Athletic Training Staff, Coaches, Sports Information Staff, Administrators, and all other employees of the Mason Athletics department. All students enrolled in the Athletic Training Education Program (ATEP) at Mason who are performing services for Mason Athletics. 76 2/16/2018

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Any third party Mason Athletics contracts with to provide health care services in the Sports Medicine Program. POLICY ON PERMITTED DISCLOSURES OF HEALTH INFORMATION The following categories describe different ways that George Mason Athletics may use and disclose medical information about its student-athletes. For each category of use or disclosure, explanation and example is provided. Not every possible use or disclosure in a category is listed; however, all of the permitted uses and disclosures will fall within one of these categories.

In addition, George Mason Athletics may always disclose information to the student-athlete himself/herself about his/her own medical information, treatment alternatives, health related benefits and services, etc.

Disclosures Permitted without Written Consent Treatment. Mason Athletics may use medical information about student-athletes to provide treatment and services for athletic injuries. Mason Athletics may disclose medical information about student-athletes to Certified Athletic Trainers, graduate and undergraduate athletic training students who are providing services to the student-athlete, and other athletic department personnel who are involved in the treatment of the student-athlete. For example, a certified athletic trainer treating a student-athlete for an athletic injury may need to communicate with an athletic training student who will assist in the student-athlete’s treatment. Mason Athletics may disclose information about student-athletes to people outside of the athletic department who may be involved in a student-athlete’s care such as physicians, physician assistants, and nurses.

Athletic Department Health Care Operations. Mason Athletics may use and disclose a student-athlete’s medical information as necessary for administrative functions in the athletic department and ensure that all of its student-athletes receive quality care. For example, Mason Athletics may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for student-athletes. Mason Athletics may also combine medical information about many student-athletes to decide what additional athletic training services may be offered, what services are not needed, and whether new treatments are effective. Mason Athletics may combine this information with information from other clinical programs to compare how we are doing and to see where we can make improvements in the care and services we offer. We will remove information that identifies student-athletes from this set of information so others may use it to study health care and health care delivery without identifying specific student-athletes.

Observation of Services. The Mason Sports Medicine facility and satellite athletic training rooms are a training ground for athletic training students. Mason Athletics may allow students to observe services. In addition, personnel from another agency involved with a student-athlete’s care may be allowed to observe services.

Classroom Disclosures. As a teaching facility, Mason Athletics may disclose certain medical information in classes taught at the university. Mason Athletics will remove information that

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identifies student-athletes from the set of medical information so students may use it to study health care and health care delivery without identifying specific student-athletes.

Research. Under certain circumstances, Mason Athletics may use and disclose de-identified medical information about student-athletes for research purposes. For example, a research project may involve comparing two treatment techniques. All research projects are subject to the university approval process, including any necessary approvals from the University’s IRB. This approval process evaluates a proposed research project and its use of medical information, and balances the research needs with the student-athlete’s need for privacy. Researchers will not have access to a student-athlete’s name, address, or any other information that reveals a student-athlete’s identity.

As Required by Law. Mason Athletics will disclose medical information about a student- athlete when required to do so by applicable law, or in response to judicial order or lawfully issued subpoena. This could include disclosure to law enforcement officials, to authorized federal officials for national security activities, disclosures for health oversight activities, to report public health risks, or to report suspected abuse, neglect or domestic or dating violence.

Health Care Emergency. Mason Athletics may use and disclose medical information about student-athletes as necessary to provide for the emergency health care needs of the student- athlete.

Lawsuits and Disputes. If a student-athlete is involved in a lawsuit or dispute with George Mason University, Mason Athletics may disclose medical information about the student- athlete which is relevant for the University to proceed with the legal action, or to defend itself, as appropriate.

Disclosures Permitted with Written Consent

Coaches. Mason Athletics may use and disclose a student-athlete’s medical information to athletic department coaches and administrators as provided in the annual consent requested from student-athletes. These uses and disclosures are necessary to run the athletic department. For example, Mason Athletics may need to disclose information about a student-athlete’s injury, playing status, treatment protocol, and time of disability to a coach in order to provide information to the coach for strategic planning of sport management.

Parents, Guardians and Other Individuals Involved in a Student-Athlete’s Care or Payment for Care. George Mason Athletics may use and disclose a student-athlete’s medical information to parents and guardians of the student-athlete, and/or to any other individuals involved in the student-athlete’s care or payment for care, as provided in the annual consent requested from student-athletes. For example, a parent may contact Mason Athletic Trainers or coaches to inquire about the insurance claims for treatment that a student-athlete is receiving for an athletic injury. Access to specific medical records regarding the injury or care related to the injury would need a release signed by the student-athlete

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Media. Mason Athletics may disclose a student-athlete’s injured body part and return status only- to media during a contest as provided in the annual consent requested from student- athletes.

Payment. Mason Athletics may use and disclose medical information about student-athletes as provided in the annual consent requested from student-athletes so that treatment and services they receive in the Sports Medicine facility may be billed and payment may be collected from student-athletes, an insurance company, or a third party. For example, Mason Athletics may need to disclose information about a strength test that a student-athlete received in the sports medicine center so that a health plan will reimburse the cost of that test. Mason Athletics also may tell a student-athlete’s health plan about a treatment that the student-athlete is going to receive to determine whether the plan will cover the cost of the treatment.

Research. Under certain circumstances, Mason Athletics may use and disclose medical information about student-athletes for research purposes as provided in a written consent from the student-athletes. For example, a research project may involve comparing two treatment techniques. All research projects are subject to the university approval process, including any necessary approvals from the University’s IRB. This approval process evaluates a proposed research project and its use of medical information, balancing the research needs with the student-athlete’s need for privacy of medical information. The research project must be approved before any medical information is disclosed, but we may disclose information about student-athletes to people preparing to conduct a research project.

Procedure for Permitted Disclosures Mason Athletics will request a Consent to Disclose Health Information on an annual basis from Student-Athletes as part of the medical clearance procedure of student-athletes. Mason Athletics will publish this policy in the Student-Athlete Manual on an annual basis. Student-Athletes will acknowledge receipt of the Student-Athlete Manual through their sport administrator and the receipt will be kept on file in the Compliance Office. All requests for athletic health records made through legal action (i.e. subpoena, court order, discovery request or summons), in connection with a legal action, or pursuant to applicable law shall be referred to the university’s legal counsel, who will then direct Mason Athletics as to permissible disclosure. POLICY ON STUDENT-ATHLETES’ RIGHT TO INSPECT AND COPY ATHLETIC HEALTH RECORDS Student-Athletes have the right to inspect and copy medical information contained in the Athletic Health Record.

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Procedure to Inspect Athletic Health Records Student-Athletes or Qualified Parents of minors wishing to review their Athletic Health Records should submit a written request to the Sports Medicine Coordinator. The Sports Medicine Coordinator will make the necessary access arrangements as promptly as possible and notify the student-athlete or qualified parent of the time and location where the records may be inspected. Access must be provided within 45 days or less from receipt of the request.

POLICY ON STUDENT-ATHLETES’ RIGHT TO AMEND ATHLETIC HEALTH RECORDS Student-Athletes have the right to have records corrected that they believe are inaccurate, misleading, incomplete, or in violation of their privacy rights. However, Student-Athletes do not have a right to request that any records be deleted. Student-Athletes have the right to request an amendment for as long as the information is kept by or for the Mason Athletic Department.

Mason Athletics may deny a student-athlete’s request for an amendment if it is not in writing and does not include a reason to support the request. In addition, Mason Athletics may deny a student-athlete’s request for reasons that include, but are not limited to information that: Was not created by Mason Athletics Is not a part of the information kept by the Mason Athletic Department; or Is accurate and complete. Procedure to Amend Athletic Health Record Student-Athlete must submit any request, in writing, to amend a specific Athletic Health Record to the Sports Medicine Coordinator. In so doing, the student-athlete should identify the part of the record the student-athlete wants changed and specify why the student-athlete believes it to be inaccurate, misleading, incomplete, or in violation of their privacy rights. The Athletics Health Care Administrator., or the Sports Medicine Coordinator may comply with the request or may decide not to comply. He/she must make the decision within a reasonable time after he/she receives the request. If the Athletics Health Care Administrator., or the Sports Medicine Coordinator decides not to comply, they will notify the student-athlete in writing of the decision, the reason for the decision, and advise the student-athlete of the right to a hearing to challenge the information believed to be inaccurate, misleading, incomplete, or in violation of their privacy rights. Upon request, the Athletics Health Care Administrator. or the Sports Medicine Coordinator will arrange for a hearing within a reasonable time after the request for a hearing and will notify the student-athlete reasonably in advance of the date, location, and time of the hearing. The hearing will be conducted by a hearing officer who is a disinterested party appointed by the Director of Athletics. The hearing officer may be an official of the University. The student- athlete shall be afforded a full and fair opportunity to present evidence relevant to the issues raised in the original request to amend the student-athlete’s athletic health record. One or more individuals may assist the student-athlete, including an attorney. 80 2/16/2018

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Within a reasonable time after the hearing, the hearing officer will prepare a written decision based solely on the evidence presented at the hearing. The decision will include a summary of the evidence presented and the reasons for the decision. If the hearing officer decides that the information is inaccurate, misleading, incomplete, or in violation of the student-athlete’s privacy rights, the Athletics Health Care Administrator. or the Sports Medicine Coordinator will amend the athletic health record and notify the student-athlete, in writing, that the record has been amended. If the hearing officer decides that the contested information is not inaccurate, misleading, incomplete, or in violation of the student-athlete’s privacy rights, the hearing officer will, in writing, give reasons for the decision and notify the student-athlete that the student-athlete has a right to place in the athletic health record a statement commenting on the contested information and/or a statement setting forth reasons for disagreeing with the decision. The statement will be maintained as part of the student-athlete’s athletic health record as long as the contested portion is maintained. If Mason Athletics discloses the contested portion of the record, it will also disclose the statement.

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POLICY ON MAINTENANCE OF AN ACCOUNTING OF DISCLOSURES OF ATHLETIC HEALTH RECORDS Student-Athletes have a right to request an “accounting of disclosures”. This is a list of the disclosures Mason Athletics made of medical information other than requests by or disclosures to the student-athlete; a party with written consent of the student-athlete; officials within George Mason University with a legitimate educational interest in the information; a party pursuant to a subpoena which orders that the existence or the contents of the subpoena, or the information furnished in response to the subpoena, not be disclosed; or in response to an ex parte court order obtained by the U.S. Attorney General concerning investigations or prosecutions of terrorism.

The record will indicate who requested or received information, and the legitimate interest the party had in requesting or obtaining the information. If the information was disclosed in connection with a health or safety emergency, the record will also include the threat that was the basis for the disclosure.

To ensure student-athletes can receive an accounting of disclosures of their protected health information, Mason Athletics will track disclosures through Consent forms maintained in the student-athlete’s athletic health record. Procedure to Obtain an Accounting of Disclosures of Athletic Health Records Mason Athletics will maintain an accounting of disclosures of Protected Health Information on each student-athlete for at least five years. Disclosures will be tracked by Consent forms maintained in student-athlete’s athletic health record. The student-athlete must submit a written request for an Accounting of Disclosures of Athletic Health Records to the Sports Medicine Coordinator, which may not be longer than five years.

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POLICY ON STUDENT-ATHLETES RIGHT TO REQUEST RESTRICTIONS AND CONFIDENTIAL COMMUNICATIONS CONCERNING ATHLETIC HEALTH RECORDS Mason Student-Athletes have the right to request a restriction or limitation on the medical information Mason Athletics uses or discloses about a student-athlete for treatment, payment, or health care operations.

Mason Athletics does not have to agree with the student-athlete’s request. If Mason Athletics does agree, Mason Athletics will comply with the request unless the information is needed to provide the student-athlete with emergency treatment.

Mason Student-Athletes have the right to request that Mason Athletics communicate with the student-athlete about medical matters in a certain way or at a certain location. For example, student-athletes can request that Mason Athletics contact them at work or by mail only. Procedure to Request Restrictions or Confidential Communications Concerning Athletic Health Records To request restrictions, Mason Student-Athletes must make the request in writing to the Sports Medicine Coordinator. The request must include (1) the information the student-athlete wants to limit, (2) whether the student-athlete wants to limit use, disclosure, or both; and (3) to whom the student-athlete wants the limit to apply. To request confidential communications, Mason Student-Athletes must make the request in writing to the Sports Medicine Coordinator. Mason Athletics will not ask the reason for the request. Mason Athletics will accommodate all reasonable requests. The student-athlete must specify how and where to contact the student-athlete. POLICY ON FACSIMILE OF STUDENT-ATHLETE’S ATHLETIC HEALTH RECORDS.

Mason Athletic Department personnel will follow the procedures below when transmitting health records via facsimile. Procedure to Facsimile Student-Athlete Health Records

The “Mason Sports Medicine Facsimile Cover Sheet,” including a confidentiality notice, is to be completed for all facsimiles containing health information. Reasonable efforts must be made to ensure facsimile transmissions to the correct destination by: (1) periodically checking speed dial numbers for accuracy and validity, and (2) reminding those who frequently receive confidential and privileged health information to notify Mason Sports Medicine if their facsimile number changes. A scan of the facsimile cover sheet and subsequent pages will be placed in the student-athlete’s athletic health record as provision of an accounting of disclosure.

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POLICY ON RELEASE OF STUDENT-ATHLETE’S INJURY INFORMATION TO THE MEDIA Mason Student-Athletes have the right to hold all injury information confidential and private. As a standard operating procedure, Coaches, Sports Communication Staff, and other athletic department personnel are to refrain from sharing injury information with the media; however, in certain occasions, injury information could be released after consent is obtained from the Student-Athlete.

In order to prevent unauthorized disclosure of injury information, all initial releases shall be coordinated through the Associate Athletic Director, Communications.

Procedure to Release Injury Information to the Media Requests to release injury information to the media are to be made to the Sports Information Staff Member who oversees specific sport coverage. The Sports Information Staff will request that the sports medicine staff obtain written consent from the student-athlete in a form approved by the University. Once the consent has been obtained, the sports medicine staff will notify the Sports Information Staff in accordance with the terms of the consent. The Sports Information Staff will notify the head coach that consent has been obtained. The head coach will then notify the Sports Information Staff of his/her desire to release injury information in accordance with the terms of the consent.

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POLICY ON RELEASE OF STUDENT-ATHLETE’S MEDICAL INFORMATION TO PROFESSIONAL SCOUTS AND ORGANIZATIONS Mason Student-Athletes have the right to hold all medical information confidential and private. Coaches, Athletic Trainers, Sports Information Staff, and other athletic department personnel are to refrain from sharing injury information with professional scouts. Student-Athletes shall maintain total control over information shared with professional scouts and organizations, and coaches cannot comment about medical information of student-athletes to professional scouts and organizations. Procedure to Release Medical Information to Professional Scouts and Organizations Requests to release injury information to professional scouts and organizations shall be referred directly to the student-athlete. The Student-athlete will then have three choices: (a) whether or not to release the requested information, and (b) what information to release, and (c) the mode of the release of the information. A student-athlete may obtain a copy of medical history in accordance with the Policy on Student- Athletes’ Right to Inspect and Copy Athletic Health Records. Student-athletes may then release the information directly to the professional scout, or work with the Athletics Health Care Administrator. or the Sports Medicine Coordinator to enter the information into collection services produced by professional sports leagues. The sports medicine staff will copy only the requested information and provide it directly to the student-athlete. The student-athlete may then decide to provide the record to the professional scout or organization. PARENT/GUARDIAN COMMUNICATION POLICY Parents/Guardians will only be contacted in case of an emergency, unless specifically requested by the student-athlete, or unless the student-athlete has consented in writing to disclose his/her health information to the parent/guardian. Otherwise, it is the responsibility of the student- athlete to communicate injury information to their parents. o An emergency being constituted as the need for care outside the scope of Sports medicine and/or the need for a specialized physician as determined by the Sports medicine Staff under the supervision of the Head Team Physician (i.e. emergency room care, neurologist, surgeon, etc.).

By direction of the National Athletic Trainer’s Association Bylaws and Virginia Athletic Trainer Statue 14-51-01 the Sports Medicine Staff may be bound by confidentiality. If a student-athlete requests specific information to be held in confidence and doing so does not compromise future care, the Sports Medicine Staff cannot disclose information to coaches, administrators, and/or parents/guardians without consent from that student-athlete. Once consent from the student-athlete is received and documented, the Sports Medicine Staff will be happy to discuss any information as permitted by the written consent.

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ATHLETIC TRAINING STAFF / COACHING STAFF RELATIONSHIP Injuries take variable amounts of time to heal properly. Understand that the Team Physician and the Athletic Training Staff will return a student-athlete to participation when the time is appropriate and safe for the student-athlete. Purchase or distribution of any nutritional supplements and/or ergogenic aids by coaches is strictly prohibited by the NCAA and George Mason University Athletic Department. If a student-athlete is taking supplements and/or ergogenic aids, they must disclose this information in the pre-participation physical exam. The Sports Medicine staff member will discourage the use of supplementation and inform the student-athlete of the associated risks of using non- regulated products. It is the expectation of the athletic training staff that coaches will not attempt to evaluate, treat, or rehabilitate athletic injuries/illnesses. If a coach is not satisfied with the care being rendered to his/her student-athletes by a Certified Athletic Trainer, he/she should direct his or her concerns to the Sports Medicine Coordinator, the Senior Associate Athletic Director for Performance, Well-Being & Risk Management, the Deputy Director of Athletics, then the Director of Athletics in that order. Athletic training students are under the direct supervision of a Certified Athletic Trainer. If a coach has concerns regarding an athletic training student he/she should notify the supervising certified athletic trainer. The Certified Athletic Trainer and the coaching staff will establish the method of communication most efficient on a sport-to-sport basis. If a method cannot be agreed upon by the two parties, the Athletics Health Care Administrator., the Sports Medicine Coordinator will decide how injury information will be communicated to the coaching staff. It is recommended that all athlete status be kept accurate in Electronic Medical Record (NEXTT) and a coach’s report be delivered to the coach on a minimum of a weekly basis; this may need to be daily for some sports. The coaching staff will be notified by already established means of communication of any student-athletes who have specific limitations or who are completely restricted from participation. The coaching staff will not be notified of each individual treatment provided to their student- athletes. If the coaching staff wishes to monitor whether or not a student-athlete has shown up for treatment/rehabilitation this information can be obtained from the ATC. Individual student-athlete’s files are privileged medical records and cannot be shared without written authorization from the student-athlete. Athletes should have ample time between practices/competitions and meetings/meals to receive treatment and care for injuries or illness. During evaluation and re-evaluation the athletic trainer will often give recommendations to the student-athlete for modifying their practice regimen in order to speed up the healing process or avoid re-injury. If the coach has specific questions regarding limitations of the student-athlete this information can be obtained from the team’s Certified Athletic Trainer.

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By direction of the National Athletic Trainer’s Association Bylaws and Virginia Athletic Trainer Statue 14-51-01 the Sports Medicine Staff may be bound by confidentiality for medical information. If a student-athlete requests specific information to be held in confidence and doing so does not compromise future care, the Sports Medicine Staff cannot disclose information to coaches, administrators, and/or parents/guardians without consent from that student-athlete. However, in the event that a student-athlete discloses information related to a crime that is committed on campus, it is the duty of the athletic trainer to report the incident to the department of campus safety as deemed necessary by the Cleary Act. George Mason University supports a positive student-athlete development model through respect and sportsmanship. Each student-athlete should be afforded a reasonably safe environment protected from personal endangerment such as abuse (physical, sexual, emotional), assault, hazing or harmful punishment. At no time shall a member of the coaching staff or sports medicine staff engage in such behaviors that would endanger the health and safety of a student athlete. George Mason University Sports Medicine Staff has the unchallengeable authority to cancel or modify a workout for health and safety reasons, as he or she deems appropriate. A member of George Mason Sports Medicine Staff is empowered and protected when reporting events thought to endanger a student-athlete or in conflict with maintaining a safe environments during athletic activity.

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SPORT COVERAGE POLICY Practice An attempt will be made to provide all traditional season teams with on-site coverage by a Certified Athletic Trainer with the exception of M/W golf and rowing and M/W tennis. If circumstances do not allow for a Certified Athletic Trainer to be present on-site during practice, communication by walkie-talkie or cellular phone will be in place. During all practice times there will be a Certified Athletic Trainer available to respond within four minutes of all on campus practice facilities. For off campus locations, the response time may be longer than 4 minutes, and the coach should feel comfortable in calling 9-1-1 and activating emergency response if they deem the situation warrants this level of action.

Selected Non-traditional season practices will be afforded the services of an ATC when regular season schedules permit. In all other circumstances non-traditional season practices will not be afforded on-site coverage by a Certified Athletic Trainer. Furthermore, if a certified athletic trainer is not present during a countable activity (some low risk sports and out of season activities) then George Mason University requires in conjunction with the NCAA that one person on site (coach) must be trained in CPR/First Aid/AED use.

In the event of an emergency when a Certified Athletic Trainer is not present on-site during a traditional or non-traditional season practice; the supervising coach should act in accordance with the George Mason University Sports Medicine Emergency Action Plan. It is recommended that all coaches employed by George Mason University hold current CPR/First Aid/AED certification.

For all High Risk Sports, a Certified Athletic Trainer is required to be in attendance or on the premise for in season and out of season practices. During non-competitive seasons a team coach or strength and conditioning coach who are certified in CPR, First Aid, and AED usage will be present during individual skill sessions and weight lifting.

High Risk Sports include: Men’s Soccer Women’s Soccer Women’s Lacrosse Pole Vault Wrestling Men’s Basketball Women’s Basketball

For Moderate Risk Sports a Certified Athletic Trainer is required to be on the premise during competition and practices. During non-competitive season a team coach or strength and

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Furthermore a certified athletic training staff member will travel with the following sports during their competitive season: Women’s Lacrosse Women’s Soccer Men’s Soccer Women’s Volleyball Men’s Volleyball Wrestling M/W Track & Field (as requested) Men's Basketball Women's Basketball Baseball Softball

The George Mason University Sports Medicine Department requires a Team Physician be present for home events for the following sports: Women’s Soccer Men’s Soccer Lacrosse Wrestling Men’s Basketball Women’s Basketball All away travel for athletic training students will be at the discretion of the respective sports Head Coach depending on budgetary restrictions. It is encouraged, when possible, for staff athletic trainers to make travel opportunities available for athletic training students.

In the event that an athletics team travels without a Certified Athletic Trainer prior arrangement will be made to ensure that the student-athletes will have appropriate medical care and supervision. Head coaches will also be given emergency information regarding insurance policies and payment of medical bills, should they be incurred by student-athletes while competing off campus. It is the responsibility of the head coach to contact a staff athletic trainer immediately if medical attention is required for a student-athlete.

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VISITING TEAM PROCEDURES INJURY TO THE VISITING TEAM Any visiting student-athlete who is injured while practicing or competing at George Mason University in Intercollegiate Athletics will be afforded the same care as a George Mason University student-athlete. If the visiting team has a team physician and/or a Certified Athletic Trainer traveling with them, they will be allowed to handle the injury according to their own policies. If the visiting team does not have a team physician and/or a Certified Athletic Trainer traveling with them, a member of the George Mason University Sports Medicine Staff will handle the case as if it were one of his/her own athletes. Any medical expenses incurred by visiting student-athletes are the responsibility of their athletic department. Payment arrangements will be made accordingly. USE OF THE ATHLETIC TRAINING ROOM FACILITIES The Athletic Training facilities are primarily for the student-athletes participating in the George Mason University athletics programs and for the evaluation, treatment, and rehabilitation of athletic injuries. These facilities are also available to visiting teams on a reciprocal, courtesy basis. Other athletics department staff and university personnel will be permitted to use the athletic training facilities with the authorization of the Sports Medicine Staff, subject to the priorities of the athletics program.

When the athletic training rooms are not in use for Intercollegiate Athletics, the facilities will be locked. These facilities are under the direct supervision of the Athletics Health Care Administrator. and the Sports Medicine Coordinator and his/her staff and are unavailable for use by outside staff members. All therapeutic modalities must be operated by the personnel of the Sports Medicine Staff. Athletic training facilities are not available for summer camp use.

Emergency Management Services (EMS) and the George Mason University Police Department (FSUPD) will be activated for any emergency situation not involving athletics department personnel or visiting athletic teams.

EQUIPMENT SIGN-OUT PROCEDURE All braces, splints, crutches, and other Sports Medicine Department equipment given to a student-athlete must be done so by a Certified Athletic Trainer only. Athletic training students may not distribute equipment. All braces, splints, crutches, and other Sports Medicine Department equipment given to a student-athlete must be signed out appropriately using Equipment Sign-Out log. Student-athletes must return all equipment assigned to them in a timely manner. Failure to return the equipment will result in the student-athlete being charged for the item. USE OF SUPPLIES BY COACHES Any coach who wants to borrow Sports Medicine supplies such as coolers, medical supplies, or strength and conditioning equipment must receive permission from the Sports Medicine Coordinator. Coaches can submit their request in writing via email or use the telephone to ask permission. The equipment that is borrowed is the full responsibility of the coach. Once the coach is finished with the equipment he/she is responsible for returning all equipment to the 91 2/16/2018

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Sports Medicine facility the way they received it (i.e. coolers are to be clean and dry and put away)

CPR AND FIRST AID FOR COACHES With athletic practice and competition, the first responder to an emergency situation is typically a member of the sports medicine Staff, most commonly a Certified Athletic Trainer. The type and degree of sports medicine coverage for an athletic event or practice may vary, based on the sport or activity, the setting, time of year, and the type of training or competition. The first responder in some instances may be a coach or other institutional personnel. The Athletic Department requires in conjunction with the recommendation of the NCAA that all athletics personnel associated with practices, competitions, skills instruction, and strength and conditioning receive certification in cardiopulmonary resuscitation (CPR), first aid, prevention of disease transmission, AED training, and emergency plan review. Furthermore, if a certified athletic trainer is not present during a countable activity (some low risk sports and out of season activities) then George Mason University requires in conjunction with the NCAA that one person on site must be trained in CPR/First Aid/AED use.

The Mason Athletics will pay for the training of personnel with emergency oversight responsibilities. The coach may review courses offered by Mason Recreation at: https://recreation.Mason.edu/aquatics/certification-courses/aquaticscertification-coursescpr-and- first-aid-training. Once they have identified a course in CPR/AED/First Aid that meets their schedule, they can contact the Department of Recreation Director of Risk Management, Camps and Aquatic Programs at 703-993-4986, identify themselves as a member of the Athletics staff, and register for the course. Once your course is complete and you have your verifications documents, please turn them in to the Sr. Assoc. AD for Performance, Well-Being & Risk Mgmt. to assure NCAA compliance. If a coach or other institutional personnel have not completed this certification, they are NOT authorized to act as the required first responder for the purposes of covering a practice or event

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GEORGE MASON UNIVERSITY EXPOSURE CONTROL PROGRAM (REVISED JUNE 2013) The following information has been adapted from the George Mason University Exposure Control Plan, which can be found on-line in full detail with appendices at: https://ehs.Mason.edu/wp- content/uploads/2015/03/BloodbornePathogensExposureControlProgram.pdf Athletics Health Care Responsibilities The following information was taken from the 2013-2014 NCAA Sports Medicine Handbook, June 2013, pages 78-80.

The following recommendations are designed to further minimize risk of transmission of blood- borne pathogens and other potentially infectious organisms in the context of athletics events and to provide treatment guidelines for caregivers. In the past, these guidelines were referred to as “Universal (blood and body fluid) Precautions.” Over time, the recognition of “Body Substance Isolation,” or that infectious diseases may also be transmitted from moist body substances, has led to a blending of terms now referred to as “Standard Precautions.” Standard precautions apply to blood, body fluids, secretions and excretions, except sweat, regardless of whether they contain visible blood. These guidelines, originally developed for health care, have additions or modifications relevant to athletics. They are divided into two sections — the care of the student- athlete, and cleaning and disinfection of environmental surfaces.

Care of the Athlete: All personnel involved in sports who care for injured or bleeding student-athletes should be properly trained in first aid and standard precautions. Assemble and maintain equipment and/or supplies for treating injured/bleeding athletes. Items may include personal protective equipment (PPE) (minimal protection includes gloves, goggles, mask, fluid-resistant gown if chance of splash or splatter); antiseptics; antimicrobial wipes; bandages or dressings; medical equipment needed for treatment; appropriately labeled “sharps” container for disposal of needles, syringes and scalpels; and waste receptacles appropriate for soiled equipment, uniforms, towels and other waste. Pre-event preparation includes proper care for wounds, abrasions or cuts that may serve as a source of bleeding or as a port of entry for blood-borne pathogens or other potentially infectious organisms. These wounds should be covered with an occlusive dressing that will withstand the demands of competition. Likewise, care providers with healing wounds or dermatitis should have these areas adequately covered to prevent transmission to or from a participant. Student-athletes may be advised to wear more protective equipment on high-risk areas, such as elbows and hands. The necessary equipment and/or supplies important for compliance with standard precautions should be available to caregivers. These supplies include appropriate gloves, disinfectant bleach, antiseptics, designated receptacles for soiled equipment and uniforms, bandages and/or dressings, and a container for appropriate disposal of needles, syringes or scalpels. When a student-athlete is bleeding, the bleeding must be stopped and the open wound covered with a dressing sturdy enough to withstand the demands of activity before the student-athlete may continue participation in practice or competition. Current NCAA policy mandates the 93 2/16/2018

George Mason University – Department of Athletics Sports Medicine Policy and Procedure Manual immediate, aggressive treatment of open wounds or skin lesions that are Medical Issues deemed potential risks for transmission of disease. Participants with active bleeding should be removed from the event as soon as is practical. Return to play is determined by appropriate medical staff personnel and/or sport officials. Any participant whose uniform is saturated with blood must change the uniform before return to participation. During an event, early recognition of uncontrolled bleeding is the responsibility of officials, student-athletes, coaches and medical personnel. In particular, student-athletes should be aware of their responsibility to report a bleeding wound to the proper medical personnel. Personnel managing an acute blood exposure must follow the guidelines for standard precaution and presume all blood is infectious. Gloves and other PPE, if necessary, should be worn for direct contact with blood or other body fluids. Gloves should be changed after treating each individual participant. After removing gloves, hands should be washed. If blood or body fluids are transferred from an injured or bleeding student-athlete to the intact skin of another athlete, the event must be stopped, the skin cleaned with antimicrobial wipes to remove gross contaminate, and the athlete instructed to wash with soap and water as soon as possible. NOTE: Chemical germicides intended for use on environmental surfaces should never be used on student-athletes. Any needles, syringes or scalpels should be carefully disposed of in an appropriately labeled “sharps” container. Medical equipment, bandages, dressings and other waste should be disposed of according to facility protocol. During events, uniforms or other contaminated linens should be disposed of in a designated container to prevent contamination of other items or personnel. At the end of competition, the linen should be laundered and dried according to facility protocol; hot water at temperatures of 71 degrees Celsius (160 degrees Fahrenheit) for 25-minute cycles may be used. Post-exposure evaluation and follow-up. Following the report of any incident in which an athlete has non-intact skin, eye, mouth, mucous membrane or parenteral (under the skin) contact with blood or other potentially infectious materials, the athlete should seek a confidential medical evaluation and follow-up. This evaluation must be conducted by a licensed health care professional.

Disinfecting of Environmental Surfaces All individuals responsible for cleaning and disinfection of blood spills or other potentially infectious materials (OPIM) should be properly trained on procedures and the use of standard precautions. Assemble and maintain supplies for cleaning and disinfection of hard surfaces contaminated by blood or OPIM. Items include personal protective equipment (PPE) (gloves, goggles, mask, fluid-resistant gown if chance of splash or splatter); supply of absorbent paper towels or disposable cloths; red plastic bag with the biohazard symbol on it or other waste receptacle according to facility protocol; and properly diluted tuberculocidal disinfectant or freshly prepared bleach solution diluted (1:100 bleach/water ratio). Put on disposable gloves.

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Remove visible organic material by covering with paper towels or disposable cloths. Place soiled towels or cloths in red bag or other waste receptacle according to facility protocol. (Use additional towels or cloths to remove as much organic material as possible from the surface and place in the waste receptacle.) Spray the surface with a properly diluted chemical germicide used according to manufacturer’s label recommendations for disinfection, and wipe clean. Place soiled towels in waste receptacle. Spray the surface with either a properly diluted tuberculocidal chemical germicide or a freshly prepared bleach solution diluted 1:100, and follow manufacturer’s label directions for disinfection; wipe clean. Place towels in waste receptacle. Remove gloves and wash hands. Dispose of waste according to facility protocol, the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC). Final Notes: All personnel responsible for caring for bleeding individuals should be encouraged to obtain a hepatitis B (HBV) vaccination. Latex allergies should be considered. Non-latex gloves may be used for treating student-athletes and the cleaning and disinfection of environmental surfaces. Occupational Safety and Health Administration (OSHA) standards for Blood borne Pathogens (Standard #29 CFR 1910.1030) and Hazard Communication (Standard #29 CFR 1910.1200) should be reviewed for further information. Member institutions should ensure that policies exist for orientation and education of all health care workers on the prevention and transmission of blood-borne pathogens. Additionally, in 1992, the Occupational Safety and Health Administration (OSHA) developed a standard directed to eliminating or minimizing occupational exposure to blood-borne pathogens. Many of the recommendations included in this guideline are part of the standard. Each member institution should determine the applicability of the OSHA standard to its personnel and facilities.

BIOHAZARDOUS WASTE DISPOSAL Procedure for handling/storing/disposing of hazardous waste in the Sports medicine facility and related athletic courts/fields in response to Environmental Health and Safety policies and procedures at George Mason University

Designation of Infectious Waste in the Sports medicine facility: This may include by is not limited to human blood, body fluids or secretions. Contaminated dressings and swabs. Used tongue blades. Used disposable rubber gloves. Contaminated sharps.

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Used needles and syringes Used razor blades Contaminated scalpels Segregation of Infectious Waste: Segregate waste contaminated with human blood, body fluids, or secretions at point of origin. Immediately after use, dispose of the contaminated dressings, swabs, tongue blades, and gloves by placing them in the container lined with red bag that is imprinted with the hazard symbol. Rubber gloves are to be used during all procedures involving infectious wastes. Place rubber gloves along with waste in the container lined with a red bag. When the red bag in the step-up container becomes full, it should be taped shut and placed in large red plastic bag inside the biohazard box. When on the field, place all contaminated materials in small red bag with the biohazard symbol, and transport to the clinic for storage. Immediately place used syringes with needles attached, used razor blades, and contaminated scalpels in the puncture resistant sharps container. Do not recap needles. Packaging and Storing of Infectious Waste: Select appropriate materials for each type of waste. Puncture resistant for sharps. Bags for solid/semi solid waste.

Packaging should maintain its integrity during storage and transport.

Cardboard boxes with hazardous waste symbol, and impervious tear resistant red plastic bags of at least 3-mil thickness will be supplied by the Hazardous Waste Disposal Company retained by George Mason University.

Treatment of Infectious Waste: We are presently using Environmental Management Services, Inc. (EMS). George Mason Sports Medicine is not a scheduled weekly pickup. Waste is picked up as requested. George Mason Sports Medicine must give the designee within Environmental Health & Safety at least 5 days advance written notice (email) to schedule a pickup at the Field House. All Athletics medical waste must be consolidated from satellite facilities to the Field House Athletic Training Room for pickup for disposal. A member of the George Mason University Athletic Training Staff must be physically present in the Field House Athletic Training Room to sign the medical waste shipping papers for the shipment. If there is no one present, the waste will not be shipped. All original copies of shipment paperwork that the driver leaves with the George Mason University Athletic Training Staff must be sent over to the designee with Environmental Health

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& Safety. Copies of the shipment paperwork must be kept on file. Shipment history can be provided by Environmental Health & Safety as needed. Environmental Health & Safety will provide the George Mason University Athletic Training Facilities with all your sharps containers. EMS will provide fiber shipping boxes and biohazard bag box liners. If more boxes & liners are needed, the driver can provide new boxes when he picks up the waste. All medical waste must be packed into the fiber boxes with a red biohazard bag liner that are provided by EMS. Limit box weight to <40lbs. There is a surcharge for heavy boxes. Closed full sharps containers go into the lined fiber boxes.

COMMUNICABLE DISEASE POLICY The Center for Disease Control (CDC) outlines specific policies for minimizing exposure of communicable diseases within health care facilities and between health care providers and patients. George Mason University Sports medicine Services provides health care to student- athletes and we choose to use the following provisions to manage communicable diseases that may arise in our on campus Sports medicine facility GUIDELINES: (CDC Personnel Health Guideline, 1998) A well-defined policy must be in place, concerning contact of personnel with patients when personnel have potentially transmissible conditions. The policy includes: o Personnel responsibility in using the health service and reporting illness o Work restrictions o Clearance for work after an illness that required work restriction. Identify the person with the authority to relieve personnel of duties. Develop work-exclusion policies that encourage personnel to report their illnesses or exposures and that do not penalize them with loss of wages, benefits, or job status. Educate and encourage personnel who have signs and symptoms of a transmissible infectious disease to report their condition promptly to their supervisor and occupational health. Provide appropriate education for personnel on the importance of good hygienic practices, especially hand washing and covering the nose and mouth when coughing and sneezing. POLICY: If a Certified Athletic Trainer becomes ill, he/she is to report to a medical provider for an evaluation. If the Certified Athletic Trainer is going to miss work to be evaluated, this must be communicated to the supervisor. Upon evaluation the medical practitioner will determine the appropriate intervention needed and the amount of time the employee shall remain out of contact with others to prevent transmission.

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If the Certified Athletic Trainer acquires a communicable disease, he/she will notify their immediate supervisor as soon as possible. The supervisor will then notify the Athletics Health Care Administrator. or the Sports Medicine Coordinator of the employee’s condition including the amount of time the employee will be absent from the work place.

The employee shall return to work after he/she has been re-evaluated by a medical practitioner.

The Center for Disease Control & Prevention (CDC) provides these preventative guidelines for the reporting of communicable disease with health care facilities. These regulations are designed to provide for the uniform awareness, prevention, and reporting of diseases in order that appropriate control measures may be instituted to interrupt the transmission of disease. Since Certified Athletic Trainers are providing direct health care to patients under the supervision of the Team Physician, the appropriate precautions must be utilized. Any person who acquires any of the listed communicable disease will be referred for further medical attention and be kept out of the Sports medicine facility until the person has been deemed non-contagious.

Communicable Diseases sited by the CDC: Bloodborne pathogens Conjunctivitis Parovirus Cytomegalovirus Pertussis Diphtheria Poliomyelitis Gastrointestinal infections, acute Rabies Hepatitis A Rubella Herpes simplex Scabies and pediculosis Measles Staphylococcus aureus infection and carriers Meningococcal disease Streptococcus infection Mumps Tuberculosis

MODALITY CALIBRATION All therapeutic modalities are required to have proper calibration each year by law. The Sports Medicine Coordinator’s is responsible for making sure all equipment in the Sports Medicine facility is operating in a safe and efficient manner. Each year during the summer, all therapeutic equipment will be checked and calibrated.

VEHICLE USE – ELECTRONIC CART POLICY The Sports Medicine department has an electronic cart which is used to assist with the sports medicine operation. This includes field set up, transportation of injured athletes, and various other daily duties. This vehicle is to be used and operated based on the manufacturer’s recommendations. In order to operate the vehicle, drivers should complete the Mason Golf Cart Use Training (http://risk.Mason.edu/training/golf-cart-use-training/).

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All equipment is to be secured in the bed of the vehicle for transport. Passengers are to sit in the front two seats only. No one is permitted to ride in the bed of the vehicle due to safety specifications.

Electronic vehicles are maintained on an as need bases and once a year they have annual service by the facilities department on campus.

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BUDGET AND INVENTORY – PROCURMENT POLICIES June 1st: Execute Bid- All supplies purchased for the Sports medicine Department must be done through competitive pricing. Submit bids to vendor o Medco Bid expected return is 1-2 weeks Vendor is required to follow these guidelines: o Bid on the specific item numbers for each product. If there is not a specific item number for a product, please do not bid on a substitute. o Supply only one price per product, per line. o If unable to bid on an item, please indicate by N/B (no bid). o Price items individually per unit, then as a total price based on quantity. o All medication bids must have a minimum shelf life of 2 years from our receipt. June 15th-July 1st: Prepare Order o Cover sheet, order with comparable pricing will be scanned and emailed to Sports Medicine Coordinator. o Each order must be reviewed and authorized by the Sports Medicine Coordinator prior to being placed

Receiving, Distribution, Counting: o All items will be shipped to the Fieldhouse Athletic Training room. . George Mason University- Field House Athletic Training Room 4400 University Drive, MS 3A5 Fairfax, VA 22030 o Upon arrival items will be counted and checked for accuracy via packing slip in comparison to original order that was placed. o Once items are check-in they may be kept in the Fieldhouse storage room or distributed as necessary to the RAC and/or Eagle Bank Arena facilities o All items will be inventoried annually in each facility o After the annual inventory, usage totals will be assessed to determine what items need to be replaced.

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EMERGENCY ACTION PLAN Introduction Emergency situations (emergency and/or life threatening conditions) may arise at any time during George Mason University athletic events. Action must be taken in a timely manner in order to provide the best possible care to the sport participant. The development and implementation of an emergency plan will help ensure that the best care is provided.

Since emergencies can occur at any time and during any activity, all individuals involved with the sports team must be prepared. This includes athletic training staffs, coaches, athletic training students, athletic administrators, and campus police. Athletic organizations have a duty by law to develop an emergency plan that may be implemented immediately when necessary and to provide appropriate standards of emergency care to all sports participants. The athletic training team must be prepared in the event that an injury occurs. This preparation involves formulation of an emergency plan, proper coverage of events, maintenance of appropriate emergency equipment and supplies, utilization of appropriate emergency medical personnel, and continuing education in the area of emergency medicine and planning. Through careful pre-participation physical screenings, adequate medical coverage, safe practice and training techniques, the potential emergencies may be averted. However, injuries are common with sports participation, and proper preparation on the part of the athletic training team should enable each emergency situation to be managed appropriately. Components of the Emergency Plan Emergency personnel Emergency communication Emergency equipment Roles of first responder Venue directions with map (all venue specific plans will be in appendices of this document)

Emergency Plan Personnel With athletic practice and competition, the first responder to an emergency situation is typically a member of the athletic training staff, most commonly a certified athletic trainer. The type and degree of athletic training coverage for an athletic event or practice may vary, based on the sport or activity, the setting, time of year, and the type of training or competition. The first responder in some instances may be a coach or other institutional personnel. The athletic training staff strongly recommends in conjunction with the recommendation of the NCAA that all athletics personnel associated with practices, competitions, skills instruction, and strength and conditioning receive certification in cardiopulmonary resuscitation (CPR), first aid, prevention of disease transmission, AED training, and emergency plan review.

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MASON ATHLETICS EMERGENCY ACTION PLANS

Important phone numbers:

Emergency Medical Systems 911 (campus phone connects to campus police)

Cell phone (connects to EMS dispatcher)

Campus Police 703- 993-2810 (from cell phone)

Athletic Training Rooms Field House 703-993-3279/3280/3277

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Recreation and Athletic Complex 703-993-3278 Patriot Center 703-993-3063

Building Staff Offices 703-993-3222/3458 Field House 703-993-5323 RAC 703-993-3000 Patriot Center Office 703-993-3939 Aquatic Center Office

Certified Athletic Trainers Brian Wright 703-993-3277 (o)/757-418-2095 (c) [email protected]

Emily Deck 703-993-3277 (o)/863-207-5075(c) [email protected]

Justin Fegley 703-993-3278 (o)/570-691-5884(c) [email protected]

Robert Viles 703-993-3277 (o)/302-463-9445(c) [email protected]

Tracey Opoku-Anarfi 703-993-3279 (o)/703-505-0172(c) [email protected]

Danielle Saltarelli 703-993-3279 (o)/703-389-1112(c) [email protected]

Linda Pullen 703-993-3280 (o) /703-402-0969 (c) [email protected]

Rebekah Schmidt 703-993-3277 (o) /860-303-8666 (c) [email protected]

Ray Yamrus 703-993-3280 (O)/571-437-9040 (C) [email protected]

Team Physician Dr. Frank Pettrone 703-525-6100 (W)

Team Dentist Dr. Dale Shewmaker 703-385-6960 (W)

Team Optometrist Dr. Court Thelen 703-941-4110 (W)

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Emergency Facilities INOVA Emergency Care 703-877-8200

Fairfax Hospital 703-776-1110

Fair Oaks Hospital 703-391-3600

Virginia Hospital Center 703-558-5000

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Activating EMS

If an accident or medical emergency occurs, the following Emergency Plan must be enacted:

Call 911 Dialing this number from a campus phone will connect you directly to campus police.

Dialing this number from a cell phone will connect you directly to an EMS dispatcher.

You will be asked… Victim’s age. Victim’s sex. Is the victim conscious? Is the victim breathing? Does the victim have a head or neck injury? Is there severe bleeding? Do you suspect a fracture? Where are you located?

Answer all of the questions the best that you can and do not hang up the phone until the person you called has hung up. They may have more questions or be able to provide verbal assistance.

If you placed the 911 call from a campus phone or a cell phone:

Call 3-3222 Field House Front Desk Call 3-5323 RAC Front Desk Call 3-3000 Patriot Center Front Office Call 3-3939 Aquatic Center Front Office

Ask to speak to the Building Manager. Explain the situation and tell the manager exactly where the victim is located so they can direct EMS personnel to your location. Building Managers will also contact Campus Police.

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Emergency Transportation

As a general rule these conditions may be transported to INOVA Access of Fairfax by athletic emergency plan personnel, if further medical attention is required. Individual circumstances will dictate the decision.

1. Suspected joint injuries with no apparent fracture. 2. Certain joint fractures/dislocations. 3. Non-severe bleeding.

These conditions may not be transported by athletic emergency plan personnel:

Call 911

1. Suspected cervical spine injury. 2. Respiratory or cardiac arrest. 3. Severe bleeding. 4. Heat exhaustion and heat stroke. 5. Hip or knee dislocation. 6. Obvious fracture of large bone. 7. Severe allergic reaction with anaphylactic shock. 8. Diabetic shock. 9. Head injury with loss of consciousness greater than 1 minute. 10. Repeated or prolonged seizure. 11. Significant impact that may cause internal injury.

EMS will transport, according to emergency situation, to the appropriate medical facility: - INOVA Emergency Care Center - Fairfax Hospital - Fair Oaks Hospital - Virginia Hospital (by request of Head Team Physician)

Planned Access to a Physician

Team physicians will be available on site for all home soccer and basketball games, wrestling matches, cross country meets and all A-10 Championship Events. Team physicians will also be scheduled at specific times during multiple day athletic competitions. Team physicians are available to see athletes in the field house athletic training room on Monday and Wednesday afternoons. Certified Athletic Trainers will communicate and/or coordinate emergency care with

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Access to Insurance Information and Medical Alerts

Athletic trainers and team coaches will travel with medical emergency information for each student athlete. Pertinent medical history, insurance information and emergency contacts are listed in this report.

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VENUE SPECIFIC EMERGENCY PLANS & GPS ADDRESSES

Facility GPS Addresses

GEORGE MASON UNIVERSITY FIELD HOUSE 4501 University Drive (703) 993 - 3222 OTHER [FIELD HOUSE] ADDRESSES LOCATION ADDRESS

MASON Stadium 4495 University Dr. Outdoor Track Baseball Stadium 4531 University Dr. Practice Field #1 10750 Campus Dr. Practice Field #2 10752 Campus Dr. ICA Field #1 4601 Rapidan River Rd. Field #2 4607 Rapidan River Rd. Softball Stadium Intramural Field #3 4609 Rapidan River Rd. Intramural Field #4 4611 Rapidan River Rd. Intramural Field #5 4613 Rapidan River Rd. ICA Maintenance Building (by 4603 Rapidan River Rd. Softball) Tennis Complex 10780 West Campus Way

OTHER [NEARBY] ADDRESSES LOCATION ADDRESS

Eagle Bank Arena 4500 Patriot Cir. RAC 4350 Banister Creek Ct. Aquatic & Fitness Center 4520 Patriot Cir. West Campus Pavilion 4605 Rapidan River Rd. West PE Module (Study Hall) 4540 Global Ln. Johnson Center 4477 Aquia Creek Ln. Center for the Arts 4373 Mason Pond Dr.

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Venue Specific Emergency Action Plans

Aquatic Center Natatorium

1. Emergency Personnel: A lifeguard and a certified athletic trainer will be on site for competitions. A lifeguard and coach with water safety and first responder training will be on site for all practices. Certified athletic trainers will be accessible from the field house athletic training room Monday – Friday from 10:00 to 7:00 pm.

2. Emergency Communication: Emergency call placed from the guard station adjacent to the pool.

3. Emergency Equipment: Emergency equipment (AED, Ambu-bag, collar and spine board) will be on site for all competitions and practices.

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene. Lifeguards will provide emergency care in the pool. Athletic trainers cover all meets and will provide emergency care pool side.

B. Emergency equipment retrieval by lifeguards.

C. Activation of emergency medical systems (EMS) by lifeguards.

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested).

2. Notify building manager (703-993-3939).

3. Notify campus police (703-993-2810).

D. Direction of EMS to scene will be managed by campus police and/or athletic and building staff. 1. Make roadway to emergency entrance accessible.

2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

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5. Venue Directions: Natatorium is located in the Aquatic Fitness Center on Patriot Circle. Natatorium is accessible through the side entrance located to the left of the Aquatic Fitness Center.

6. GPS Address: 4520 Patriot Circle, Fairfax, VA 22030

7. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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Baseball Stadium

1. Emergency Personnel: A certified athletic trainer will be on site for all competitions. A coach with first responder training will be on site for all practices and individual skill sessions. Certified athletic trainers may also be accessible from adjacent athletic fields or from the field house athletic training room.

2. Emergency Communication: Cell phone communication must be available at all competitions and practices.

Cell Phone Call 911 Call Athletic Trainers (703-993-3279) Call Campus Police (703-993-2810) Call Building Staff (703-993-3222)

3. Emergency Equipment: First aid supplies including pocket mask will be available at all competitions and practices. Additional emergency equipment (AED, Ambu-bag, collar, spine board, and splints) will be accessible from the field house athletic training room (703-993-3279).

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff from field house athletic training room in response to emergency call. First aid supplies and pocket mask in team medical kit on site.

C. Activation of emergency medical systems (EMS) by athletic training staff or coaching staff .

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested).

2. Notify campus police if call made from cell phone (703-993- 2810).

3. Notify building staff if call made from cell phone (703-993- 3222/3458).

D. Direction of EMS to scene will be managed by campus police and/or athletic and building staff .

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1. Open appropriate gates.

2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

5. Venue Directions: Baseball stadium is located on University Drive next to the Field House Recreation Sports Complex. Entrance to the field is available through the parking lot to the right of the field house. Gates will be opened for easy access.

6. GPS Address: 4531 University Drive, Fairfax, VA 22030

7. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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Boat House

1. Emergency Personnel: A certified athletic trainer or emergency medical personnel will be on site for all competitions. A coach with first responder training will be on site for all practices.

2. Emergency Communication: Emergency call placed at the boat house or via cell phone.

3. Emergency Equipment: First aid supplies including pocket mask will be on site for all competitions and practices. Additional emergency equipment provided by EMS.

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff or coaching staff during competitions and practices.

C. Activation of emergency medical systems (EMS) by athletic staff or event staff.

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested).

2. Notify Sandy Run Recreation Staff (703-690-4392).

3. Notify athletic training staff (703-993-3279).

D. Direction of EMS to scene will be managed by event staff or Parks and Recreation staff.

1. Make roadway to emergency accessible.

2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

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5. Venue Directions: Rte. 123 South (Ox Road) to Fountain Head Regional Park. Turn right on Hampton Road, left on Van Thompson Road to Sandy Run Regional Park. Park officials will provide escort to George Mason University Boat House.

6. GPS Address: 10450 Van Thompson Road Fairfax Station, VA 22039

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Field House

1. Emergency Personnel: Certified athletic trainer will be on site during scheduled hours of operation of the athletic training room and for all scheduled practices and competitions. A coach with first responder training will be on site for all scheduled strength and conditioning or individual skill sessions.

2. Emergency Communication: Emergency call placed at the closest phone by dialing 911. Direct link to campus police who will call EMS and respond to the emergency. Notify athletic trainers and building managers.

Cell Phone Call 911 Call Athletic Trainers (703-993-3279) Call Campus Police (703-993-2810) Call Building Staff (703-993-3222)

3. Emergency Equipment: First aid supplies including pocket mask will be available in the weight room and at the front desk. Additional emergency equipment (AED, Ambu-bag, collar, spine board, and splints) available from athletic training room during hours of operation.

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff during practices and competitions. First aid supplies and pocket mask made available by athletic personnel during other conditioning sessions. C. Activation of emergency medical systems (EMS) by athletic staff or building staff in field house. 1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested).

2. Notify campus police(703-993-2810).

3. Notify building staff (703-993-3222/3458).

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A. Direction of EMS to scene will be managed by campus police, event staff and building staff:

1. Open appropriate doors and make hallways accessible.

2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

5. Venue Directions: Field House is located at the intersection of Chain Bridge Road (Rt. 123) and University Drive.

6. GPS Address: 4501 University Drive, Fairfax, VA 22030

7. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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RAC Turf Field

1. Emergency Personnel: A certified athletic trainer will be on site for all practices and competitions. A team physician will be available at all competitions.

2. Emergency Communication: Cell phones must be available for all competitions and practices.

Cell Phone Call 911 Call Campus Police (703-993-2810) Call Building Staff (703-993-5323)

3. Emergency Equipment: First aid supplies, AED, ambu-bag, collar, spine board, and splints will available at the RAC turf field for competitions.

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff or coaching staff during competitions and practices.

C. Activation of emergency medical systems (EMS) by the athletic trainer .

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid given; specific directions; other information as requested).

2. Notify campus police (703-993-2810).

3. Notify RAC building staff(703-993-5323).

D. Direction of EMS to scene will be managed by campus police, event and athletic staff.

1. Make roadway in front of building accessible.

2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

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5. Venue Directions: RAC turf field is located to the right of the Recreation and Athletic Complex off Patriot Circle on Anna River Court.

6. GPS Address: 4350 Banister Creek Court, Fairfax, VA 22030

7. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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Eagle Bank Arena

1. Emergency Personnel: A certified athletic trainer will be on site for all practices and competitions. A physician will also be on site for all basketball competitions. A coach with first responder training will be on site for all conditioning and individual skill sessions. Additional athletic training staff accessible from field house Monday - Friday 10:00 to 7:00 pm.

2. Emergency Communication: Emergency call placed from closest office phone. Dialing 911 on campus phone provides direct link to campus police who will call EMS and respond to the emergency. Cell phones will connect directly to an EMS dispatcher.

Cell Phone Call 911 Call Athletic Trainers (703-993-3279) Call Campus Police (703-993-2810) Call Building Staff (703-993-3000)

3. Emergency Equipment: Emergency equipment (AED, Ambu-bag, collar, spine board, and splints) will be on site for all competitions and practices.

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff or coaching staff during competitions and practices.

C. Activation of emergency medical systems (EMS) by athletic training staff or coaching staff.

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid

treatment; specific directions; other information as requested).

2. Notify campus police (703-993-2810).

3. Notify building staff (703-993-3000).

D. Direction of EMS to scene will be managed by campus police, event staff and athletic staff.

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1. Make roadway to loading dock accessible.

2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

5. Venue Directions: Patriot Center is located on Patriot Circle. The gymnasium is accessible through the rear loading dock doors of the Patriot Center.

6. GPS Address: 4500 Patriot Circle, Fairfax, VA 22030

7. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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Practice Fields 1, 3, 4, 5

1. Emergency Personnel: A certified athletic trainer will be on site for all competitions. A coach with first responder training will be on site for all practices and individual skill sessions. Certified athletic trainers may also be accessible from adjacent athletic fields or from the field house athletic training room.

2. Emergency Communication: Cell phone communication must be available at all competitions and practices.

Cell Phone Call 911 Call Athletic Trainers (703-993-3279) Call Campus Police (703-993-2810) Call Building Staff (703-993-3222)

3. Emergency Equipment: First aid supplies including pocket mask will be available at all competitions and practices. Additional emergency equipment (AED, Ambu-bag, collar, spine board, and splints) will be accessible from the field house athletic training room. (703-993-3279).

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff from field house athletic training room in response to emergency call. First aid supplies and pocket mask made available by on-site coaching staff.

C. Activation of emergency medical systems (EMS) by athletic training staff or coaching staff .

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid given; specific directions; other information as requested).

2. Notify building staff (703-993-3222/3458).

3. Notify campus police (703-993-2810).

D. Direction of EMS to scene will be managed by campus police, event staff and building personnel:

1. Open appropriate gates.

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2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

5. Venue Directions: The Practice Fields are located off University Drive past the Field House Recreation Sports Complex. After the baseball stadium, turn left on Rapidan River Road and the practice fields begin immediately on the left with Field #1, Softball Field, Fields 3-5.

6. GPS Address: Field #1 4601 Rapidan River Road, Fairfax, VA Field #3 4609 Rapidan River Road, Fairfax, VA Field #4 4611 Rapidan River Road, Fairfax, VA Field #5 4613 Rapidan River Road, Fairfax, VA

6. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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Recreation and Athletic Complex Venue

1. Emergency Personnel: A certified athletic trainer will be on site for all practices. A coach with first responder training will be on site for individual skill sessions. Additional athletic trainers are accessible from the field house athletic training room Monday – Friday 10:00 – 7:00 pm.

2. Emergency Communication: Emergency call placed at the closest phone by dialing 911. Direct link to campus police who will call EMS and respond to the emergency. Notify athletic trainers and building managers.

Cell Phone Call 911 Call Athletic Trainers (703-993-3278/3279) Call Campus Police (703-993-2810) Call Building Staff (703-993-5323)

3. Emergency Equipment: Emergency equipment (first aid supplies and AED) will be on site for all practices and individual sessions. An AED is located at the front entrance and on the second floor by racquetball/squash courts. Additional emergency equipment (Ambu-bag, collar, spine board, and splints) will be accessible from the athletic training room.

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff or coaching staff .

C. Activation of emergency medical systems (EMS) by athletic training staff or coaching staff.

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested).

2. Notify Campus Police (703-993-2810).

3. Notify building manager (703-993-5323)

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D. Direction of EMS to scene will be managed by campus police and building staff:

1. Make roadway in front of building accessible.

2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

5. Venue Directions: Recreation and Athletic Complex is located in the off Patriot Circle on Banister Creek Court.

6. GPS Address: 4350 Banister Creek Court, Fairfax, VA 22030

1. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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Soccer Practice Fields

1. Emergency Personnel: A Certified Athletic Trainer will be on site for all traditional season practices. A coach with first responder training will be on site for all non-traditional practices and individual skill sessions. Certified athletic trainers may also be accessible from adjacent athletic fields or from the field house athletic training room.

2. Emergency Communication: Cell phone communication must be available at all practices.

Cell Phone Call 911 Call Athletic Trainers (703-993-3279) Call Campus Police (703-993-2810) Call Building Staff (703-993-3222)

3. Emergency Equipment: First aid supplies including pocket mask will be available in team medical kit on site. Additional emergency equipment (AED, Ambu-bag, collar, spine board, and splints) will be accessible from the field house athletic training room (703-993-3279).

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff from field house athletic training room in response to emergency call. First aid supplies and pocket mask in team medical kit on site.

C. Activation of emergency medical systems (EMS) by athletic training staff or coaching staff.

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested).

2. Notify campus police (703-993-2810).

3. Notify building staff (703-993-3222/3458).

D. Direction of EMS to scene will be managed by campus police, event staff and building personnel:

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1. Open appropriate gates.

2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

5. Venue Directions: Soccer practice fields are located on University Drive behind the Field House Recreation Sports Complex. Entrance to the fields is available between the field house and the stadium field. Gates will be opened for easy access.

6. GPS Address: 10750 Campus Drive, Fairfax, VA 22030

7. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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Stadium Field / Outdoor Track

1. Emergency Personnel: A certified athletic trainer and a physician will be on site for all soccer competitions. A certified athletic trainer will be on site for all lacrosse games and track meets. A coach with first responder training will be on site for all track practices. Certified athletic trainers may also be accessible from adjacent athletic fields or from the field house athletic training room.

2. Emergency Communication: Cell phone communication must be available at all practices and competitions.

Cell Phone Call 911 Call Athletic Trainers (703-993-3279) Call Campus Police (703-993-2810) Call Building Staff (703-993-3222)

3. Emergency Equipment: Emergency equipment (AED, Ambu-bag, collar, spine board, splints) will be on site for all competitions. First aid supplies and emergency equipment are accessible from the field house athletic training room for all practices.

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff from emergency equipment bag on site. First aid supplies and emergency equipment made available by athletic training staff from adjacent fields or field house athletic training room for track practices.

C. Activation of emergency medical systems (EMS) by athletic training staff or event personnel.

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested).

2. Notify campus police (703-993-2810).

3. Notify building staff (703-993-3222/3458).

D. Direction of EMS to scene will be managed by campus police, event staff and building personnel:

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1. Open appropriate gates.

2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

5. Venue Directions: Soccer stadium is located on University Drive to the right of the Field House Recreation Sports Complex. Gates will be opened for easy access.

6. GPS Address: 4495 University Drive, Fairfax, VA 22030

7. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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Softball Field

1. Emergency Personnel: A certified athletic trainer will be on site for all competitions. A coach with first responder training will be on site for all practices and skill sessions. Certified athletic trainers may also be accessible from adjacent athletic fields or from the field house athletic training room.

2. Emergency Communication: Cell phone communication must be available at all practices and competitions.

Cell Phone Call 911 Call Athletic Trainers (703-993-3279) Call Campus Police (703-993-2810) Call Building Staff (703-993-3222)

3. Emergency Equipment: First aid supplies including pocket mask will be available at all practices. An AED will be available at all competitions. Additional emergency equipment (AED, Ambu-bag, collar, spine board and splints) will be accessible from the field house athletic training room.

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff from field house athletic training room in response to emergency call. First aid supplies and pocket mask in team first aid kit on site.

C. Activation of emergency medical systems (EMS) by athletic training staff or coaching staff .

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid given; specific directions; other information as requested).

2. Notify campus police (703-993-2810).

3. Notify building staff (703-993-3222/3458).

D. Direction of EMS to scene will be managed by campus police, event staff and building personnel:

1. Open appropriate gates.

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2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

5. Venue Directions: Softball field is located off University Drive past the Field House Recreation Sports Complex and the Baseball Stadium. Turn left on Rapidan River Road and the softball field is the second field on the left.

6. GPS Address: 4607 Rapidan River Road, Fairfax, VA 22030

7. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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Tennis Complex

1. Emergency Personnel: A certified athletic trainer will be on site for all competitions. A coach with first responder training will be on site for all practices, conditioning, and individual skill sessions. Additional athletic training staff is accessible from the field house athletic training rooms from 10:00 – 7:00 pm.

2. Emergency Communication: Cell phones must be available for all competitions and practices.

Cell Phone Call 911 Call Athletic Trainers (703-993-3279) Call Campus Police (703-993-2810) Call Building Staff (703-993-3222)

3. Emergency Equipment: First aid supplies and pocket mask will be on site for all practices. An AED will be on-site for competitions and available for practices from the field house athletic training room. Additional medical equipment (Ambu-bag, collar, spine board, and splints) are available from the field house athletic training room.

4. Role of First Responders:

A. Immediate care of the injured or ill student-athlete provided by the most qualified individual on the scene.

B. Emergency equipment retrieval by athletic training staff or coaching staff during competitions and practices.

C. Activation of emergency medical systems (EMS) by athletic staff .

1. 911 call (provide name; address; telephone number; number of individuals injured; condition of injured; first aid given; specific directions; other information as requested).

2. Notify campus police (703-993-2810).

3. Notify building manager (703-993-3222/3206).

D. Direction of EMS to scene will be managed by campus police, event and athletic staff.

1. Make roadway in front of building accessible.

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2. Designate individual to “flag down” EMS and direct to scene.

3. Scene control: limit scene to first responders and move bystanders away from the scene.

5. Venue Directions: Tennis courts are located off Braddock Road and Campus Drive.

6. GPS Address: 10780 West Campus Way, Fairfax, VA 22030

7. Venue Map: http://eagle.Mason.edu/map/fairfax.php

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Emergency Communication Communication is the key to a quick emergency response. Athletic trainers and emergency medical personnel must work together to provide the best emergency response capability and should have contact information such as a telephone tree established as a part of pre-planning for emergency situations.

Communication prior to the event is a good way to establish boundaries and to build rapport between both groups of professionals. If emergency medical transportation is not available on site during a particular sporting event then direct communication with the emergency medical system at the time of injury or illness is necessary. Access to a working telephone or other telecommunications device, whether fixed or mobile, should be assured. The communications system should be checked prior to each practice or competition to ensure proper working order. A back-up communication plan should be in place in case there is a failure of the primary communication system. The most common method of communication is a public telephone. However, a cellular phone is preferred if available. At any athletic venue, whether home or away, it is important to know the location of a workable telephone. Pre-arranged access to the phone should be established if it is not easily accessible. Emergency Equipment All necessary emergency equipment should be at the site and quickly accessible. Personnel should be familiar with the function and operation of each type of emergency equipment. Equipment should be in good operating condition, and personnel must be trained in advance to use it properly. Emergency equipment should be checked on a regular basis and emergency personnel should rehearse its use. The emergency equipment available should be appropriate for the level of training of the emergency medical providers. It is recommended that a few members of the emergency team be trained and responsible for the care of the equipment. It is important to know the proper way to care for and store the equipment as well. Equipment should be stored in a clean and environmentally controlled area. It should be readily available when emergency situations arise. Equipment on Site for Events: Athletic training kit Water and ice Splints Means of communication Spine Board (on site for soccer, lacrosse, basketball) Emergency crash bag (oxygen, rectal thermometer, glucose, bag valve mask) AED (at field house, EBA and RAC and also at furthest venue for field practices and games) 133 2/16/2018

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Medical Emergency Transportation The ambulance in on-call for all events. Ambulances may be coordinated on site for other special events/sports if needed. In the event of an emergency and the ambulance is not present (all other events), the 911 system (9-911 on campus) will still be utilized for activating emergency transport.

In the event that a medical emergency arises, the primary survey is used by the first responder to identify those situations requiring critical intervention and in determining transport decisions. In an emergency situation, the athlete should be transported by ambulance, where the necessary staff and equipment is available to deliver appropriate care. First Responders should refrain from transporting unstable athletes in inappropriate vehicles. Any emergency situations where there is impairment in level of consciousness (LOC), airway, breathing, or circulation (ABC) or there is neurovascular compromise should be considered a “life-compromising situation” and emphasis should be placed on rapid evaluation, treatment and transportation. In order to provide the best possible care for George Mason University athletes, transportation to the nearest hospital is preferred.

Conclusion The importance of being properly prepared when athletic emergencies arise cannot be stressed enough. An athlete’s survival may hinge on how well trained and prepared athletic healthcare providers are. It is prudent to invest athletic department “ownership" in the emergency plan by involving the athletic administration in the development of such policies and sport coaches as well as Sports Medicine personnel. The emergency plan should be reviewed at least once a year. Through development and implementation of the emergency plan, the athletic training department helps ensure that the athlete has the best possible care when an emergency arises.

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CATASTROPHIC INCIDENT RESPONSE PLAN I. INTRODUCTION AND DEFINITION OF CATASTROPHIC INCIDENT The George Mason University Department of Athletics Catastrophic Incident Response Plan will be activated when the following catastrophic incidents (CI) occur: Sudden Death of a Student-Athlete, Coach, and/or athletics Staff Member Death during competition, practice, or conditioning Death during travel Unknown medical conditions (e.g. heart attack, stroke, illness) Disability / Quality of Life Altering Injuries Injuries during George Mason University Athletic Department participation and/or travel, or during non-athletic activities Spinal Cord Injury-resulting in partial or complete paralysis Loss of Paired Organ Severe Head Injury Injuries resulting in severely diminished mental capacity or other neurological injury that results in inability to perform daily functions (e.g.-coma) Irrecoverable loss of speech or hearing (both ears) or sight (both eyes) or both arms or both legs or one arm and one leg II. CATASTROPHIC INCIDENT MANAGEMENT TEAM (CIMT) Director of Athletics (Brad Edwards: 703.993. 3212) Deputy Director of Athletics (Kevin McNamee: 703.993.3209) Sr. Assoc. Athletic Director for Compliance/ SWA (Kelly Webb: 703.993.5420) Associate Athletics Director for Communications (Maureen Nasser: 703.993.3263) Sr. Assoc. Athletic Director for Performance, Well-Being & Risk Management (Debi Corbatto: 703.625.1721/703.993.9536) Team Physician (Dr. Frank Pettrone: number available upon request from Sports Medicine team) Sports Medicine Coordinator (Linda Pullen: 703.402.0969/703.993.3280) Appropriate Sport Supervisor Appropriate Team Athletic Trainer Team Head Coach

George Mason University President (Ángel Cabrera: 703.993.8700) University General Counsel (Brian Walther: 703.993.2619) George Mason University Counseling Center Director (703.993.2380)

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OTHER APPROPRIATE PERSONNEL Assistant Athletic Director for Compliance (Karen Kelly: 703.993.3230) The policy of the George Mason University Department of Athletics with regards to a student- athlete who has sustained a catastrophic injury shall be: HOME PRACTICE or GAME: George Mason University Sports Medicine’s emergency action plan will be followed. George Mason University Sports Medicine personnel, a member of the coaching staff, and/or a member of the Athletics Department will accompany the injured student-athlete to the medical facility with the injured student-athlete’s emergency contact and medical insurance information. While at the medical facility, one of the above-mentioned individuals will keep in contact with the certified athletic trainer with any medical updates. The George Mason University certified athletic trainer will immediately call Linda Pullen Sports Medicine Coordinator (703.993.3280) or Debi Corbatto, Sr. Associate AD (703.625.1721) or a designee, to notify him/her of the emergency situation. Sports Medicine Coordinator, Sr. Assoc. AD, or his designee will immediately notify the Director of Athletics, the Deputy Director of Athletics/SWA, the team’s sport administrator, and the team physician to notify them of the emergency situation and will keep all designated parties updated on a regular basis. The Director of Athletics and/or his designee will notify other athletics and university personnel, as he deems necessary. The Director of Athletics and/or his designee along with the Sr. Assoc. AD or Sports Medicine Coordinator will make every effort possible to notify the injury student-athlete’s family or next of kin of the emergency. o The Director of Athletics or his designee will continue to communicate with the injured student-athlete’s family or next of kin and will provide medical updates as available. o The Director of Athletics or his designee will assign a member of the Athletics staff to assist with travel and lodging arrangements for the injured student-athlete’s family, to be with the family at all times upon arrival, assist the family as needed, and protect them from outside persons. At the conclusion of the practice/game, the team physician and/or his/her designee (if available), the Sr. Associate AD for Performance, Well-Being & Risk Management, the Sports Medicine Coordinator, the head coach, and the Director of Athletics and/or his designee will update the team in the locker room as to the injured student-athlete’s condition. o Team and department personnel are not permitted to speak with the media or produce any social media regarding the injured student-athlete and/or the emergency situation. All are instructed to refer all medial inquires to the Associate Athletic Director for Communications and/or her designee. The Team Physician, the Sr. Assoc. AD for Performance, Well-Being & Risk Management, the Sports Medicine Coordinator and/or her designee, the Director of Athletics and/or his designee, and other appropriate personnel will proceed to the medical facility as soon as possible. 136 2/16/2018

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Once the student-athlete’s family or next of kin has been notified of the emergency situation and gives its consent, the Director of Athletics and/or his designee, in consultation with the team physician, medical personnel from the facility, the Associate Athletic Director for Communications, the George Mason University President’s Office/General Counsel, the Sr. Associate Athletic Director and the Sports Medicine or his designee, may make a statement concerning the injured student-athlete to be released to the media. o The Media Relations Department IS NOT authorized to release information concerning the situation to any member of the press/media until the student-athlete’s family or next of kin has been notified and has given their consent, and the Team Physician, University Counsel, Director of Athletics and/or his designee, and the Associate Director of Athletics for Marketing have approved and authorized the statement. o The Director of Athletics and/or his designee, in consultation with the team physician, medical personnel at the medical facility, the student-athlete’s family or next of kin, the University President’s Office/General Counsel, and the Media relations Department will be the official spokesperson regarding the injured student-athlete and the emergency situation. o At no time is anyone besides the aforementioned personnel authorized to speak to anyone concerning the injured student-athlete and the emergency situation. George Mason University Sports Medicine personnel and/or other appropriate personnel will be responsible for arranging a private meeting space for all team and university personnel at the medical facility. o Members of the Athletic Communications Department shall be responsible for coordinating all media and attempting to secure a safe zone around the private meeting space so that media do not have unauthorized access to team members or University personnel in or around the medical facility. George Mason University Sports Medicine personnel will be responsible for contacting authorities at the medical facility and on the George Mason University campus for the purpose of arranging mental health and grief counseling services for the team, other impacted student- athletes, and University personnel. The Athletics Health Care Administrator., the Sports Medicine Coordinator and or his designee will be responsible for the following: o Compiling complete documentation of the events from everyone involved in the incident with signatures; o Constructing a detailed timeline of events related to tine incident; and o Collecting and securing all equipment and/or materials involved in the incident. The Sr. Assoc. AD for Performance, Well-Being & Risk Management, along with the Sports Medicine Coordinator, the team’s athletic trainer and athletics insurance coordinator will file the appropriate insurance claims (student-athlete’s primary insurance, George Mason Athletics’ secondary insurance, NCAA catastrophic insurance, etc.) as needed.

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AWAY PRACTICE or GAME: The local venue emergency action plan will be followed. George Mason University Sports Medicine personnel, a member of the coaching staff, and/or a member of the Athletics Department will accompany the injured student-athlete to the medical facility with the injured student-athlete’s emergency contact and medical insurance information. While at the medical facility one of the above mentioned individuals will keep in contact with the certified athletic trainer with any medical updates. As permitted, a member of the George Mason University Athletics staff shall remain with the injured person at all times. The George Mason University certified athletic trainer or member of the coaching staff will immediately call Linda Pullen, Sports Medicine Coordinator (703.402.0969), Debi Corbatto, Sr. Assoc. AD (703.625.1721) or their designees to notify him/her of the emergency situation. The Sr. Assoc. Ad for Performance, Well-Being & Risk Management or Sports Medicine Coordinator or her designee will immediately notify the Director of Athletics; the Deputy Director of Athletics/SWA, the team’s sport supervisor, and the team physician to notify them of the emergency situation and will keep all designated parties updated on a regular basis. The Director of Athletics and/or his designee will notify other athletics and university personnel, as he/she deems necessary. The Director of Athletics or his designee along with other Athletics personnel will make every effort possible to notify the injury student-athlete’s family or next of kin of the emergency. o The Athletics Health Care Administrator., the Sports Medicine Coordinator or his designee will continue to communicate with the injured student-athlete’s family or next of kin and will provide medical updates as available. o The Director of Athletics and/or the sport supervisor will assign a member of the Athletics staff to assist with travel and lodging arrangements for the injured student- athlete’s family, be with the family at all times upon arrival, assist the family as needed, and protect them from outside persons. At the conclusion of the practice/game, the team physician and/or his/her designee (if available), Athletics Health Care Administrator., the Sports Medicine Coordinator or his designee, the head coach, and the Director of Athletics and/or his designee will update the team in the locker room as to the injured student-athlete’s condition. o Team and department personnel are not permitted to speak with the media or produce any social media regarding the injured student-athlete and/or the emergency situation. All medical inquires will be referred to the Senior Associate Director of Athletics for Marketing & Communication and/or his designee. The Team Physician (if applicable), the Athletics Health Care Administrator., the Sports Medicine Coordinator and/or his designee, the Director of Athletics and/or his designee, and other appropriate personnel will proceed to the medical facility if at all possible. Once the student-athlete’s family or next of kin has been notified of the emergency situation and gives its consent, the Director of Athletics and/or his designee, in consultation with the team physician, medical personnel from the facility, a member of the George Mason University Media Relations Department, the George Mason University President’s Office/General Counsel and the 138 2/16/2018

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Athletics Health Care Administrator., the Sports Medicine Coordinator or his designee, may make a statement concerning the injured student-athlete to be released to the media. o The Media Relations Department IS NOT authorized to release information concerning the situation to any member of the press/media until the student-athlete’s family or next of kin has been notified and have given their consent, and the Team Physician, University Presenting/General Counsel, and Director of Athletics and/or his designee have approved and authorized the statement. o The Director of Athletics and/or her designee, in consultation with the team physician, medical personnel at the medical facility, the student-athlete’s family or next of kin, the University Presidents Office/General Counsel, and the Media Relations Department will be the official spokesperson regarding the injured student- athlete and the emergency situation. o At no time is anyone besides the aforementioned personnel authorized to speak to anyone concerning the injured student-athlete and the emergency situation. George Mason University Sports Medicine personnel and/or other appropriate personnel will be responsible for arranging a private meeting space for all team and university personnel at the medical facility. o Members of the Media Relations Department shall be responsible for coordinating all media and attempting to secure a safe zone around the private meeting space so that media do not have unauthorized access to team members or University personnel in or around the medical facility. George Mason University Sports Medicine personnel will be responsible for contacting authorities at the medical facility and on the George Mason University campus for the purpose of arranging mental health and grief counseling services for the team, other impacted student- athletes, and University personnel. The Athletics Health Care Administrator., the Sports Medicine Coordinator and/or his designee will be responsible for the following: o Compiling complete documentation of the events from everyone involved in the incident with signatures; o Constructing a detailed timeline of events related to the incident; and o Collecting and securing all equipment and/or materials involved in the incident. The Sports Medicine Coordinator, along with the team’s athletic trainer will file the appropriate insurance claims (student-athlete’s primary insurance, George Mason Athletics’ secondary insurance, NCAA catastrophic insurance, etc.) as needed. III. ROLES AND RESPONSIBILITIES OF INVOLVED PARTIES: In the event of a catastrophic incident, the following individuals are charged with the stated responsibilities: DIRECTOR OF ATHLETICS AND/OR DESIGNEE: Enacts any catastrophic incident procedures for the University. Is notified by the Athletics Health Care Administrator., the Sports Medicine Coordinator and/or his designee of the catastrophic incident. 139 2/16/2018

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Notifies the University President and/or his/her designee of a catastrophic incident and continues to provide updates as warranted. Notifies the University General Counsel of a catastrophic incident and continues to provide updates as warranted. Notifies additional Athletic Department administrative staff (AD Council) as needed. In the event the CI is non-athletic, notifies Sport Supervisor and notifies the Head Coach of the Sport. Assigns Athletic Department Staff to assist with travel and lodging for the injured student- athlete’s family, be with family at all times upon arrival, assist the family as needed, and protect them from outside persons. Notifies the immediate family (emergency contact) of the student-athlete. Assists in connecting family members with the medical personnel overseeing the immediate treatment of the student- athlete. Serves as the University’s official spokesperson regarding the incident. In consultation with the student-athlete’s family or next of kin, medical personnel at the facility, Team physicians, General Counsel, Associate Athletic Director for Communications, Sr. Assoc. AD for Performance, Well-Being & Risk Mgmt., the Sports Medicine Coordinator, and other appropriate personnel, drafts, approves, and makes a public statement regarding the catastrophic incident. Coordinate arrangements for any on campus memorial service.

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TEAM PHYSICIAN Serves as the Department of Athletics’ liaison to communicate directly with medical personnel at the facility regarding the catastrophic incident. Communicates with the Athletics Health Care Administrator., the Sports Medicine Coordinator and/or his designee regarding catastrophic incident. Serves as the medical advisor to the Director of Athletics in drafting, approving, and making a public statement regarding the catastrophic incident. Assists with the coordination of mental health and grief counselors, etc. for the use of all team and university personnel. If appropriate, updates team personnel as to the status of the injured student-athlete in conjunction with other medical professionals, the head coach, the team’s athletic trainer, and the Director of Athletics and/or his designee. Communicates with the General Counsel, and other University and/or Athletics staff as appropriate. ATHLETICS HEALTH CARE ADMINISTRATOR

Assists the Deputy Director of Athletics/SWA with any and all duties as needed or assigned. Assists with notifying the student-athlete’s family or next of kin of a catastrophic incident. If appropriate updates team personnel as to the status of the injured student-athlete, in conjunction with the Team Physician, the head coach, the team’s athletic trainer, and the director of Athletics and/or designee. Assists with the coordination of arranging for a private meeting space for all team and University personnel at the medical facility. Assists with the coordination of mental health and grief counselors etc. for the use of all team and university personnel. Assists with the coordination of travel, lodging, and meal arrangements for team and University Sports Medicine Personnel. Assists with the coordination of return travel for the injured student-athlete back to George Mason, MD or other appropriate location in conjunction with the family or next of kin, medical personnel at the facility, Team physician, and other appropriate persons Communicates with Assistant Athletics Director for Compliance Regarding NCAA compliance issues and the payment of incidental expenses related to the catastrophic incident.

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SPORTS MEDICINE COORDINATOR Notifies the head coach and/or Sport Supervisor of a catastrophic incident and continues to provide updates as warranted. Assists the team athletic trainer with any coordination or support necessary. Assists with notifying the student-athlete’s family or next of kin of a catastrophic incident. Communicates with Athletics Health Care Administrator and the Assistant Athletics Director for Compliance Regarding NCAA compliance issues and the payment of incidental expenses related to the catastrophic incident. Report the student-athlete fatality or catastrophic injury to the NCAA per their instructions at: http://www.ncaa.org/sport-science-institute/ncaa-catastrophic-sport-injury-reporting Other duties as assigned. SPORT ADMINISTRATOR Notifies or is notified by the head coach and/or Athletics Health Care Administrator., the Sports Medicine Coordinator and/or his designee of a catastrophic incident and continues to provide updates as warranted to George Mason Athletics Administration. Assigned duties of the Athletics Health Care Administrator, Deputy Director of Athletics and or SWA as needed or directed. Assists the Associate Athletics Director for Marketing with any and all duties as needed or assigned. Assists with notifying the student-athlete’s family or next of kin of a catastrophic incident. If appropriate, updates team personnel as to the status of the injured student-athlete, in conjunction with the Team Physician, the head coach, the team’s athletic trainer, and the director of Athletics and/or designee. Assists with the coordination of arranging for a private meeting space for all team and University personnel at the medical facility. Assists with the coordination of mental health and grief counselors etc. for the use of all team and university personnel. Assists with the coordination of travel, lodging, and meal arrangements for team and University Sports Medicine Personnel. Assists with the coordination of return travel for the injured student-athlete back to George Mason, or other appropriate location in conjunction with the family or next of kin, medical personnel at the facility, Team physician, the Athletics Health Care Administrator., the Sports Medicine Coordinator, and other appropriate persons. Communicates with Assistant Athletics Director for Compliance Regarding NCAA compliance issues and the payment of incidental expenses related to the catastrophic incident. Other Duties as assigned.

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ATHLETIC TRAINER Performs duties requested by the Athletics Health Care Administrator., the Sports Medicine Coordinator as needed and/or assigned. Updates team personnel as to the status of the injured student-athlete in conjunction with the Team Physician, Head Coach, Sports Medicine Coordinator, and the Director of Athletics. Assists with the compilation of complete documentation of events from everyone involved in the incident with signatures. Assists with the construction of a detailed time line of events related to the incident. Assists with the collection and security of all equipment/materials involved in the incident. Assists with the coordination of travel, lodging, and meal arrangements for Sports Medicine personnel. Assists with the coordination of return travel for the injured student-athlete back to George Mason, or other appropriate location in conjunction with the family or next of kin, medical personnel at the facility, Team physician, the Athletics Health Care Administrator., the Sports Medicine Coordinator, and other appropriate persons. Assists with filing of appropriate insurance claims (student-athlete’s primary insurance, George Mason Athletics secondary insurance, NCAA catastrophic insurance, etc.) as needed. Communicates with the General Counsel and Athletics personnel as needed. Other duties as assigned. HEAD COACH Immediately notifies the team’s sport administrator of the catastrophic incident and continue to provide updates as warranted. Notifies or is notified by the teams Athletic Trainer and/or the Athletics Health Care Administrator. or the Sports Medicine Coordinator of a catastrophic incident. Strictly follows catastrophic incident plan as outlined. Mandates that student-athletes and other team personnel not discuss the catastrophic incident until cleared to do so. Supports student-athletes and other team personnel. Assists with the notification of the students-athletes family or next of kin of the catastrophic incident. If appropriate, updates team personnel as to the status of the injured student-athlete, in conjunction with the medical team and Director of Athletics. Assists with the compilation of complete documentation of the events from everyone involved in the incident with signature. Assists with the construction of a detailed timeline of events related to the incident. Assists with the collection and security of all equipment and materials involved in the incident. 143 2/16/2018

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Assists with coordination of return travel for the injured student-athlete back to George Mason, MD or other appropriate location in conjunction with the family or next of kin, medical personnel at the facility, and George Mason University Medical Team. Communicates with Assistant Athletics Director for Compliance regarding NCAA compliances issues and the payment of incidental expenses related to the catastrophic incident. Communicates with other George Mason University or Athletics Department personnel as needed. Other duties as need and/or assigned. ASSOCIATE DIRECTOR OF ATHLETICS FOR COMMUNICATION Notifies the Director of University Communications and/or his designee of a catastrophic incident and continues to provide updates as necessary. Works with the Athletics Director and Office of President to formalize appropriate communication of the incident. Monitors social media sites for any external communication. Advises the Director of Athletics and/or designee in drafting, approving, and making public statements regarding the catastrophic incident and releases the statement through appropriate media outlets. Assists with the coordination of arranging for a private meeting space for all team and university Personnel at the Medical Facility if at all possible. Responsible for keeping members of the media a safe distance from the team, Athletics and University personnel at the medical facility, hotel, etc. if at all possible. UNIVERSITY GENERAL COUNSEL Communicates with the Director of Athletics and/or his designee on issues related to the catastrophic incident. Advises the Director of Athletics and/or designee, in drafting, approving, and making public statements regarding the catastrophic incident. Oversees the compilation of complete documentation of events from everyone involved in the incident with signatures. Oversees the construction of a detailed time line of events related to the incident. Oversees the collection and security of all equipment/materials involved in the incident. Assists with filing of appropriate insurance claims (student-athlete’s primary insurance, George Mason Athletics secondary insurance, NCAA catastrophic insurance, etc.) as needed. Communicates with other Athletics personnel as needed. Other duties as needed or assigned.

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GEORGE MASON UNIVERSITY and DIRECTOR OF THE COUNSELING CENTER Communicates with the team physicians and/or the Athletics Health Care Administrator., the Sports Medicine Coordinator and/or his designee on issues related to the catastrophic incident Assists with updating team personnel as to the status of the injured student-athlete, in conjunction with the team physician, head coach, the Athletics Health Care Administrator., the Sports Medicine Coordinator, and the Director of Athletics and/or his designee. Assists with the coordination of grief counselors, etc. for the use of all team and university personnel. Provide and/or arrange for follow up counseling post-incident to all needed parties. Other duties as need or assigned. ASSISTANT ATHLETIC DIRECTOR FOR COMPLIANCE Provides guidance regarding the payment of incidental expenses related to the catastrophic incident. Provides interpretive support relating to any NCAA regulations. Other duties as directed. VII. SUMMARY CHRONICLE The Athletics Health Care Administrator., the Sports Medicine Coordinator will provide a detailed written summary of events following any catastrophic incident which identifies and explains the activities of those who participated in and responded to the incident for purposes of documenting the incident.

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AUTOMATED EXTERNAL DEFIBRILLATOR (AED) POLICY Automated External Defibrillators (AEDs) have been shown in a variety of cases to greatly increase the chance of survival during a cardiac emergency. Every minute that defibrillation is delayed decreases the victim’s chance for survival by 10 percent (ARC, AHA). Both the American Red Cross and American Heart Association support the use of AEDs. “Cardiac Chain of Survival” The American Red Cross (ARC) and American Heart Association (AHA) suggest a “Cardiac Chain of Survival” that can be implemented to maximize a victim’s chance of survival. These steps include: Early recognition and early access to Emergency Medical Services (EMS) Early CPR Early defibrillation (AED) Early advanced medical care

Cardiopulmonary Resuscitation (CPR) helps to supply oxygen to the brain and other vital organs. It also increases the chance for a shockable heart rhythm once the AED arrives, especially if it is more than 4 minutes since the victim collapsed.

Definition of an AED An AED is a machine used to analyze a victim’s heart rhythm and deliver a shock, if necessary. The shock that is delivered is called defibrillation. The two most common shockable abnormal rhythms are ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach). Not all heart rhythms are shockable and defibrillation is not designed to restart a heart that has no electrical activity.

Indications and Contraindications of using an AED There are several indications and contraindications that a rescuer should be aware of before using and AED: AEDs should only be used when a victim is unconscious, is not breathing and doesn’t have a pulse. AEDs should NOT be used on children under 8 years of age or less than 55 pounds UNLESS you are using a pediatric AED or pediatric pads. The AED should be not used if the victim is lying in water or is wet. The victim should be moved to dry ground and dried off. All clothing and metal should be removed from the victim’s chest and the chest should be wiped dry. Do NOT use alcohol pads to dry the victim’s chest. No one should touch the victim while the AED is analyzing a victim’s heart rhythm or defibrillating.

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All nitroglycerin patches or other patches on the chests should be removed with a glove before using the AED. Cell phones should not be used within 6 feet of the AED. The AED should not be used around flammable materials. General steps and protocols for using an AED These are the general steps recommended by the ARC and AHA for using an AED, regardless of the brand of AED: Turn on the AED. Wipe the victim’s chest dry. Attach the pads (one pad upper right chest and one pad lower left chest). Plug the connector into the AED, if necessary. Make sure no one, including the rescuer, is touching the victim. Push the “analyze” button, if necessary. If a shock is advised, push the “shock” button.

In 2005, the ARC and AHA created a new protocol for use of the AED. Once the AED is attached and analyzes the heart rhythm, it will either shock the victim or state “no shock advised”. If no shock is advised, the rescuer is to give two minutes of CPR and then have the AED reanalyze the victim. If a shock is advised, the AED will only give one shock. After the one shock, the rescuer is to give two minutes of CPR and then have the AED reanalyze.

Provisions to Coordinate with Local EMS In the event of a cardiopulmonary emergency, the emergency action plan will be activated as quickly as possible. The first responders will provide initial care as appropriate to the situation and coordinate with other emergency medical service providers upon their arrival in the provision of CPR, defibrillation, basic life support, and advanced life support. In the event that the AED is used on the George Mason University Campus, Environmental Health and Safety is to be notified of the incident so that appropriate data can be access from the unit. Contact Gregg Black (703.993.2795, [email protected]) following the use of any AED on campus.

Operator Considerations The George Mason University Sports Medicine Department utilizes the Heartstart AED unit.. The units are automatic defibrillators that use a Shock Advisory System. This software program analyzes the patient's electrocardiographic (ECG) rhythm and indicates whether or not it detects a shockable rhythm. The units do not require operator interaction in order to defibrillate the patient. The units are intended for use by personnel (Certified Athletic Trainers, coaches, and Athletic training students) who have current training certification in the use of an AED.

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Department of Athletic Training AED Equipment Currently, the Athletic Department has access to 9 AEDs. The AEDs are housed in the Fieldhouse-2, RAC -2, EBA-2, Aquatic & Fitness Center – 2, and the Fairfax County Boathouse- 1. AEDs that permanently housed in the lobby of the Field House, and directly outside the RAC gym on the lower level of the RAC. The AEDs in the Sports Medicine facility is taken to the furthest practices and competitions (from the Field House) by the respective athletic trainer. Every AED is inspected weekly and reports are sent to the office of environmental safety. The office of environmental safety monitors and inspects all AED’s on a regular basis. Ray Yamrus Head Athletic Trainer is the AED coordinator for George Mason University athletics and works with other facility managers to ensure proper operation and regular maintenance checks. Gregg Black of the Department of Environmental Health and Safety will conduct yearly reviews to ensure that all AEDs are updated with the most current protocols.

The AEDs perform an automatic self-test every 24 hours. If service is required, the AED activates an alarm. The non-rechargeable lithium batteries have a four to five-year life. If batteries require replacement, the AED will indicate a change is necessary. The AED is to be checked on a regular basis. Following use the AED is to be inspected to make sure that all necessary supplies and accessories are readily available. All maintenance on the AED units is taken care of by the Department of Environmental Health and Safety

Priority for AED usage will be based on the following conditions: Based upon the sports covered, the AED units may either be maintained in the Sports Medicine facility or carried on-site to the athletic venue. In the event there are more events then AED’s available the following criteria is to be used: Competition/Scrimmage has priority over practice. Home games have priority over away games. The AED will be taken to the field furthest from the Field House, as we have a permanent unit mounted in the lobby of the field house. Procedures for Training and Testing in Use of AED The Athletic Training Staff will complete a training session each two years, including but is not limited to instruction in: The proper use, maintenance, and periodic inspection of the AED Defibrillator safety precautions to enable the user to administer a shock without jeopardizing the safety of the patient, the user, or other individuals Assessment of an unconscious person to determine if cardiac arrest has occurred and the appropriateness of applying an AED Recognizing that when an electrical shock is delivered to a patient and the defibrillator is no longer charged Rapid, accurate assessment of the patient's post-shock status to determine if further activation of the AED is necessary

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The operations of the local emergency medical services system, including methods of access to the emergency response system, and interaction with emergency medical services personnel The role of the user and coordination with other emergency medical service providers in the provision of CPR, defibrillation, basic life support, and advanced life support The responsibility of the user to continue care until the arrival of medically qualified personnel A record will be maintained by Sr. Associate AD for Performance, Well-Being & Risk Management documenting staff competency training.

The full Mason policy is located at: http://ehs.Mason.edu/wp- content/uploads/2015/04/AEDProgram.pdf?_ga=1.108727041.2005167225.1431097620

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OXYGEN ADMINISTRATION POLICY

Team physicians and certified athletic trainers will have oxygen available for use in the management of respiratory failure, acute respiratory distress, sickling events, and for those individuals who have trouble breathing due to pre-existing medical conditions (i.e. asthma, pneumonia, chronic bronchitis, anemia, etc.) Equipment  An oxygen tank will be wall mounted in the field house athletic training room and portable tanks will be stored in the main athletic training room of the Field House, the Recreation Athletic Complex, and Eagle Bank Arena.  Portable tanks are equipped to be transported to fields/courts as needed for event coverage and the management of emergency distress.  Portable tanks are now stored in a transport bag equipped with a rubber hose, face mask, a wrench to open air flow, and a pulse oximeter to measure oxygen saturation levels.  Oxygen tanks will be inspected weekly for oxygen levels and for equipment malfunction. Weekly inspections will be documents. Tanks will be replaced/refilled when oxygen levels reach 500L.  Use of the oxygen tank should be reported to the Sports Medicine Coordinator. Indications and Oxygen Flow Rates  Emergency oxygen delivery should be based on saturation levels rather than fixed flow rates.  Treatment of respiratory distress, with a saturation level less than 94% on the pulse oximeter, initially deliver 10 L/min. Gradually increase flow rate as needed after 1-2 minutes if saturation levels do not reach 94% or above.  EMS should be called if oxygen treatment does not improve symptoms within 10 minutes. If conditions improve, even after calling EMS, oxygen flow can titrate down as long as the saturation level stays above 94%. This should be documented and reported to EMS.  Oxygen administration at a flow rate of 15L/min is recommended for sickling events. EMS should be called if the athlete’s symptoms do not improved within 10 minutes. If symptoms do improve within the 10 minutes of oxygen treatment, the ATC will communicate the athlete’s status with a primary care team physician. A decision will be made by the team physician on how treatment will proceed.  Athletes in respiratory failure should be given pressure ventilations with a bag-valve mask at 15L/m.  In the event an athletic trainer is asked to respond to a spectator in respiratory distress, chronic lung conditions such as COPD do not tolerate high doses of oxygen and may actually be life threatening. Saturation levels for these patients should be no higher than 91%. Oxygen Tank Usage  The pressure gauge should be in place and indicating amount of oxygen available in the tank.  Place the pulse oximeter on the index finger of the patient in distress.

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USE OF EPINEPHRINE AUTO-INJECTOR Introduction Epinephrine is the drug of choice for the emergency treatment of severe allergic reactions to insect stings or bites, foods, drugs or other allergens. Epinephrine mimics the responses of the sympathetic nervous system. It quickly constricts blood vessels to improve blood pressure, reduces the leakage from the blood vessels, relaxes smooth muscle in the bronchioles to improve breathing through bronchodilation and alleviate the wheezing and dyspnea, stimulates the heartbeat, and works to reverse the swelling and hives. The drug takes effect within seconds, but the duration of its effectiveness is short (about 10-20 minutes).

Under a standing order from our team physician, the George Mason University Sports medicine Staff utilizes the Epi-Pen Auto-Injector, a disposable delivery system for self-administration. The Epi-Pen has a spring-activated needle that is designed to deliver a single precise dose (0.3 mg of 1:1000 solution) of epinephrine to adults when activated. It may be necessary in very severe reactions to administer a second dose after five minutes if initial response is inadequate.

Emergency Care for Anaphylaxis Call for EMS (if not on-site or in-route) Maintain a patent airway Be prepared to assist ventilation with positive pressure ventilation with bag-valve-mask Administer epinephrine by a prescribed auto-injector Initiate early emergency transport Indications/Contraindications for Epinephrine Administration Epinephrine is to be administered if the patient exhibits signs and symptoms of a severe allergic reaction (anaphylaxis), including respiratory distress and/or shock. There are no contraindications for the administration of epinephrine in a life-threatening allergic reaction; however, precautions are to be taken with patients with heart disease or hypertension. Administration of Epinephrine Check the Epi-Pen to ensure the medication has not expired, has not become discolored, and does not contain particulates or sediments. Prep skin site with alcohol Remove the gray safety cap from the auto-injector Place the tip of the auto-injector against the lateral aspect of the patient's thigh midway between the waist and knee Push the injector firmly against the thigh until the spring-loaded needle is deployed and the medication is injected (at least 10 seconds) Dispose of the auto-injector in a biohazard container designed for sharp objects. Be careful not to prick yourself since the needle will now be protruding from the end of the injector

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Record that epinephrine was administered, the dose, and the time of administration Side Effects The patient may complain of side effects following the administration of epinephrine. Possible side effects include increased heart rate, pale skin (pallor), dizziness, chest pain, headache, nausea, vomiting, excitability and anxiousness.

Reassessment Following the administration of epinephrine, it is necessary to reassess the patient. Reassessment will include continued evaluation of airway, breathing and circulatory status. Decreasing mental status, decreasing blood pressure and increasing difficulty in breathing indicate the allergic reaction is worsening. If the condition is worsening, provide emergency care for shock, be prepared to administer positive pressure ventilation with supplemental oxygen if breathing becomes inadequate, and be prepared to initiate CPR and apply AED if patient becomes pulseless.

If the patient's condition improves following administration of epinephrine, continue to perform ongoing assessments. Be aware the patient may complain of side effects from the epinephrine. Any patient requiring epinephrine administration is to be transported to the closest available medical facility for follow-up evaluation and treatment as soon as possible. Remember that epinephrine is short-acting (10-20 minutes) and signs and symptoms may return as drug wears off.

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LIGHTNING AND THREATENING WEATHER POLICY The policies and procedures outlined in this policy are adopted from the George Mason University Lightning Policy Statement (updated July 2014) and the National Athletic Trainers Association Position Statement: Lightening safety in Athletics, Journal of Athletic Training, 2013;48(2)258-270. (http://lightningsafety.com/nlsi_pls/NATA_2013.pdf).

Purpose The keys to lightning safety are education and prevention. Education begins with learning appropriate lightning safety tips. Prevention of lightning injuries or casualties should begin long before any athletic event. This policy will outline lightning safety terminology, procedures, and decision-making policies.

Scope This policy governs all George Mason University Athletic Facilities: - George Mason Soccer/Lacrosse/Track Stadium - George Mason Baseball Stadium (Spuhler Field) - George Mason Softball Complex - ICA Practice Fields - ICA Throws Field - George Mason Tennis Courts - Sandy Run Regional Park/ Boathouse

I. Monitor Weather Conditions

Athletics personnel must check weather reports each day before any practice or event. The National Weather Service (NWS) issues severe weather and/or thunderstorm watches and/or warning. A “watch” means conditions are favorable for severe weather to develop in a particular area. A “warning” means the NWS has reported severe weather in an area and for anyone in that area to take the necessary precautions.

Athletics personnel should be aware of the signs of thunderstorms developing nearby. Thunderstorms can grow from towering, “fluffy” cumulus clouds to lightning producers in as little as (30) thirty minutes. Lightning and thunder activity in the local area are the “alarms” for athletics personnel to begin monitoring thunderstorm activity, such as directions of storm movement and distance to the lighting flashes.

II. Evacuation Criteria

A. Authority

The following athletics personnel have the unchallengeable authority to postpone any activity due to the threat of lightning and the authority to restart the postponed activity:

1. Intercollegiate Athletic Contests

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- ICA Game Administrator and Game Officials 2. Intercollegiate Athletic Practices -ICA On-Site Certified Athletic Trainer -Recreation Supervisor when on recreation fields 4. Special Events/Rentals -ICA On-Site Facilities Personnel and Game Officials (if applicable)

B. Weather Monitoring System

Athletics will be using a weather monitoring system called DTN. Approved athletics personnel will have web access to DTN and will also receive text messages from the system alerting them of storms in the area.

DTN is currently set-up to text essential personnel when lightning has reached within 12 miles of ICA facilities. At this point (12 miles), ICA personnel should immediately start tracking the weather system online. Once lightning has reached within 10 miles of ICA facilities the appropriate ICA personnel (see above) will postpone the event and clear all spectators, participants, coaches, and staff from the grounds and direct them to safe shelter. No one may remain outside at these facilities.

If no text messages were received but lightning is seen by an official or ICA personnel, the facility should still be cleared immediately.

Once in a safe location, the ICA personnel and Game Official (if applicable) will be the ones to determine when it is again safe to resume play. Everyone MUST wait at least 30 minutes from the LAST sight of lightning or LAST strike within 10 miles on the DTN system to continue activities.

If a storm is in the area or expected to be in the area before an event, ICA personnel should closely monitor the situation on the DTN weather system. If lightning strikes right before the event – players, coaches, spectators, and game personnel should not be allowed outside on the ICA grounds until the 30 minute mark.

C. Shelter Locations

The following are safe shelter locations: 1. Vehicles fully enclosed with metal roofs 2. George Mason Field House (see chart for facility specific recommended location) 3. Any other building that is fully enclosed and grounded

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The head coach and/or his/her designee are not permitted to override the decision to stop an outdoor game / practice in the event of lightning and/or severe weather. If a coach and/or game official(s) / umpire(s) make the decision to continue to practice and/or continue with a game or other activity despite a National Weather Service Severe Weather Warning, the cancellation of classes, and/or the verbal instruction by a George Mason University Game Administrator, a member of the George Mason University Sports Medicine staff, and/or a member of the George Mason University Athletics Facilities & Event Management staff, he/she will be doing so against the recommendations of the George Mason University Department of Athletics.

A safe structure or location is defined as- “any sturdy, fully enclosed, substantial, and frequently inhabited building that has plumbing and/or electrical wiring that acts to electrically ground the structure”. Examples of locations that routinely DO NOT meet the criteria include: Baseball / softball dugouts; Baseball / softball “covered” batting cages; Convertible / “soft-top” vehicles; Golf carts / John Deere Gator vehicles; Outside storage sheds; and/or Canopy / awning / tent. In the absence of a sturdy, fully enclosed, substantial, and frequently inhabited location as described above, a secondary structure such as a fully enclosed vehicle with a hard metal roof, rubber tires, and completely closed windows can provide a measure of safety. Persons should not touch the sides of the vehicle! Convertible, “soft-top” vehicles and golf carts do not provide a high level of protection and cannot be considered safe from lightning.

If no safe structure or location is within a reasonable distance, personnel should find a thick grove of small trees surrounded by taller trees or a dry ditch. Everyone should assume the “lightning-safe” position- a crouched position on the ground with the feet together, weight on the balls of the feet, head lowered, and ears covered. DO NOT LIE FLAT! Minimize the body’s surface area and minimize contact with the ground.

If unable to reach safe shelter, persons should stay away from the tallest trees or objects (i.e. light poles, flag poles, etc.), metal objects (i.e. fences, bleachers, etc.), individual trees, standing pools of water, and open fields. Persons should avoid being the highest object in an open field.

In situations where thunder and/or lightning may or may not be present, yet someone feels his/her hair stand on end and skin tingle, LIGHTNING IS IMMINENT! Therefore, all persons should assume the “lightning-safe” position as described above.

All individuals have the right to leave a site or activity, without fear of repercussion or penalty, in order to seek a safe structure or location if they feel that they are in danger from impending lightning activity.

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Sandy Run Regional Park and Boathouse LIGHTNING SAFETY POLICY

A lightning prediction system has been installed at Sandy Run Regional Park for the protection of participants and visitors. The system has been calibrated to predict a lightning storm within 20 minutes of the Sandy Run area; it operates 7 days per week during daylight hours only. A horn and a flashing strobe light, installed on top of Boathouse #3 and at the grandstand area, provide audible and visual warnings of the storm’s approach.

Procedures When the storm is within 20 minutes of Sandy Run, the horn will sound one 15‐second blast and the strobe light will flash. If this occurs, all park users must: 1. Clear the water. Rowers and launch operators must proceed as quickly as possible to the docks at Sandy Run, get out of the boats and clear the docks for other boats to return. 2. Clear all open spaces. People in the boathouse area should seek shelter in the buildings or in their vehicles. People at the grandstand area should seek shelter in the bathrooms or in dense woods. Avoid the water, elevated areas, areas under overhead wires and power lines, small shelters and isolated trees. Note: Do not move out of shelter until the ALL CLEAR is sounded which consists of three 5‐second blasts of the horn and the strobe light stops flashing. Note: If the weather is threatening (you see lightning or hear thunder) and the warning horn does not sound, clear the water and seek proper shelter.

Lightning/Severe Weather Statement to be Read at Outside Events

Spectators, severe weather is imminent in the George Mason area. The George Mason University Department of Athletics advises all spectators to immediately evacuate the grandstand and/or bleacher areas. Please evacuate to hard-topped vehicles until it has been determined that it is safe to return to the grandstand and bleacher areas. Pre-Hospital Care of Lightning Strike Victim Because lightning-strike victims do not remain connected to a power source, they do not carry an electric charge. Therefore, it is safe to touch the victim to move him/her to a safe location and to render medical treatment. During an ongoing thunderstorm, lightning activity in the local area still poses a deadly hazard for personnel responding to the victim. Personnel should consider personal safety before venturing into a dangerous situation to render care. The first priority of personnel is to move the lightning strike victim to a safe location. Activation of EMS by calling “911” and prompt, aggressive CPR has been highly effective for the survival of victims of lightning strikes. Therefore, it is critical that CPR and AED use is

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George Mason University Venue Specific Safe Structures- Primary Safe Secondary Safe Unacceptable George Mason University Location(s) Location(s) Location(s) Venue Convertible / “soft-top” Personal vehicles vehicles, golf carts, storage George Mason Stadium Field House w/metal roof and/or sheds, canopy, awning, team bus and/or tents

Convertible / “soft-top” Personal vehicles vehicles, golf carts, storage Soccer Practice Fields Field House w/metal roof and/or sheds, canopy, awning, team bus and/or tents

Softball Restroom Dugouts, SB batting cage structure (when avail) complex, convertible / George Mason Softball “soft-top” vehicles, golf Field House Complex & Additional Personal vehicles carts, storage sheds, outlying Fields w/metal roof and/or canopy, awning, and/or team bus tents Convertible / “soft-top” Personal vehicles George Mason Center vehicles, golf carts, storage Field House w/metal roof and/or Tennis Complex sheds, canopy, awning, team bus and/or tents Convertible / “soft-top” Personal vehicles vehicles, golf carts, storage Throw Field Field House w/metal roof and/or sheds, canopy, awning, team bus and/or tents

Convertible / “soft-top” Boathouse or other Personal vehicles Sandy Run Regional Park/ vehicles, golf carts, storage structures such as w/metal roof and/or Boathouse sheds, canopy, awning, bathrooms team bus and/or tents

Convertible/”soft-top” Personal vehicles vehicles, golf carts, storage RAC Turf Field RAC building w/metal roof and/or sheds, canopy, awnings, team bus and/or tents

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COLD STRESS AND EXPOSURE POLICY The George Mason University Sport Medicine department adopted the following policies and procedures from the National Athletic Trainers Association Position Statement: Environmental Cold Injuries, Journal of Athletic Training, 2008;43(6)640-658 (http://natajournals.org/doi/pdf/10.4085/1062-6050-43.6.640?code=nata-site). The position statement makes it clear that it is the exposure to cold environments and physical activity that lead to cold temperature injuries. Low air or water temperatures mixed with wind decreases the body’s ability to maintain homeostatic body temperatures. PROCEDURE Recommendations The Sports Medicine Staff, coaches and student-athletes: Will be educated in the recognition and treatment of cold stress and cold exposure Wear proper layered clothing around the core Wear pants and sleeves designed to insulate and break the wind Gloves, ear protection, and face protection are also to be worn Socks should wick moisture away. Recognition of Cold Stress Sports Medicine Staff, coaches, and student-athletes need to be educated about the types of environmental and cold stress: Wind-chill Frostbite (chilblain) Hypothermia Signs and Symptoms of hypothermia Decreased core temperature Muscle rigidity Shivering Confusion Numbness Slurred speech Cold extremities Clumsy movements Cyanosis Decreased respiration and pulse

Signs and Symptoms of Frostbite Dry waxy skin Burning, aching, throbbing Erythema Gray, black or purple skin Numbness, tingling Poor circulation Cold extremities

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Guidelines for Cold Temperature Participation: 30°F and below: potential for cold stress injuries 25°F and below: provide additional clothing and cover exposed skin 15°F or wind-chill: limit outside exposure 0°F or wind-chill: Terminate outside activities

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EXERTIONAL RHABDOMYOLYSIS PREVENTION POLICY

The Mason Center for Sports Performance staff adheres to the NCAA best practices regarding avoidance of exertional rhabdomyolysis. These guiding principles are followed:

1. Transition periods are particularly vulnerable times for athletes and demand careful attention to progression in volume, intensity, mode and duration of activity. Examples of transition periods: a. Athletes new to the program. b. Athletes returning after an injury or illness c. Any delayed participation relative to team schedule d. Resumption of training after an academic break (e.g., winter, spring, summer). 2. All strength and conditioning workouts should be exercise-based, scientifically sound and physiologically representative of the sport and its performance requirements. 3. Conditioning programs should begin with a work-to-rest ration of 1-to-4. 4. The first four days of transition periods should be separate-day workouts, and all workouts: a. Should be documented in writing. b. Should reflect the progression, technique, and intentional increase in the volume, intensity, mode and duration of the physical activity. c. Should be available for review by athletics department staff. 5. Coaches and athletes should be aware of signs and symptoms of exertional rhabdomyolysis to include unusual muscle soreness, weakness, and dark urine. Any of the above should prompt evaluation by the athletic training staff or team physicians. We encourage all sport coaches to review their programming with the athletic trainers or strength and conditioning staff to assure the safe participation of all student-athletes.

HEAT ILLNESS POLICY AND PROCEDURES: Introduction: The following policy on heat illness and fluid replacement has been developed by the George Mason Sports Medicine Department in accordance with National Athletic Training Association Position statement: Exertional Heat Illness, Journal of Athletic Training 2002;37(3)329-343 (http://natajournals.org/doi/pdf/10.4085/1062-6050-50-9-07) and information provided from the Korey Stringer Institute protocols(http://ksi.uconn.edu/) to provide highest quality of care to George Mason University student athletes. The policy is reviewed annually with updates as needed based on best practice information. Annual education and training is conducted with the George Mason Sports Medicine staff as well as physicians. This policy is communicated with George Mason University Police and the Fairfax County EMS.

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Exposure to extreme temperatures coupled with physical activity can lead to a range of heat related illnesses. The guidelines outlined in this document provide an evidenced based approach to the diagnosis, treatment, prevention and return to activity for heat related illnesses

Heat Acclimatization Protocol Heat represents a considerable environmental threat to athletes that can affect not only performance, but can also result in exertional heat illness (EHI). If EHI is not properly identified and treated, it can result in significant morbidity and potential mortality. While there are multiple risk factors for EHI, the lack of acclimatization is arguable the most important, and certainly one that can be readily leveraged to minimize the risk to poor performance and injury. Acclimatization is the process of improving the body’s response to heat stress with sequential heat exposure and progressive regular, strenuous exercise. About 2 weeks is required to accomplish heat acclimatization with a minimum exposure of 2 hours per day (can be broken into 1-hour exposures) with some physical exercise requiring cardiovascular endurance, rather than strength training. Acclimatization requires a gradual increase in the exercise intensity each day, working up to an appropriate physical training schedule adapted to the environment. The transitional period from summer break to the fall sports seasons is a period when our student athletes are most susceptible to exertional heat illness, and exertional rhabdomyolysis. Student athletes should be allowed to acclimatize to the heat and exercise load before participating in performance testing. Full acclimatization to the environment requires one to two weeks of gradual exercise exposure to heat. The following guidelines must be implemented in your practice planning to reduce this risk: . During the initial 5-7 days, plan for a gradual increase in the duration and intensity of physical activity as well as gradual exposure in a high heat stress environment. . Frequent rest and hydration breaks should be incorporated as well as awareness of varying the intensity of activity. . During high heat stress, the heat index (WBGT) will be monitored by the athletic training staff and recommendation will be made as follows:   WBGT <80 Fluids as needed  WBGT 80-85 Frequent hydration; 5 minutes break every 30 minutes  WBGT 85-88 Frequent hydration; 5 minutes break every 20 minutes  WBGT 88-90 Frequent hydration; 5 minutes break every 15 minutes Modify practice as necessary  WBGT 90+ Modifications to practice location and time implemented . Rest time should be in a shaded cooler area whenever possible. Ice chests for forearm immersion, ice towels and ice water spray bottles should be available when the heat index (WBGT) is greater than 85. . Performance testing during this initial 1 to 2 week period of heat acclimatization should proceed with caution. Performance testing in a climate controlled environment is permitted at any time during this period e.g. field house, while testing in the heat should be avoided during the first week of training. . Endurance training in the heat during this initial period of acclimatization should again proceed with caution with careful attention to scheduling these stresses during the cooler

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times of the day. Endurance training during the period of acclimatization should be coordinated with the team athletic trainer to optimize hydration strategies, intra-event cooling, and an emergency action plan in the event of a heat casualty. . Athletes should monitor hydration by weighing before and after practices and monitoring the color of their urine. Each pound of weight lost is approximately 20-25 ounces of fluid. Weight lost should be regained prior to the next practice. A greater than 2% loss of body weight will be monitored and may have restriction during practice as determined by the athletic trainer. . Water and PowerAde should be available for athletes to consume during practice. . Light color practice/game gear should be worn to reduce absorption of heat. . Athletes with certain medical conditions (sickle cell trait), acute illness, or taking certain medications may require additional considerations and/or restrictions as deemed necessary. The athlete’s previous months environmental exposure, training activity, type and duration of training, should be considered in the acclimatization plan. . Consecutive days/sessions of training in a high heat stress environment, has a cumulative effect on the athlete and increases the risk of exertional heat illnesses. This risk should be considered when planning successive practices.

EXERTIONAL HEAT ILLNESS PROTOCOLS I. Prevention . Preparticipation Examination (PPE) Screening: Identify student-athletes from the PPE who have a previous history of heat illness, a family or personal history of malignant hyperthermia, and/or other predisposing risk factors. Specific risk factors include an active fever or illness, underlying skin disorders e.g. eczema, or medications that may impair thermoregulation such as antihistamines, decongestants, diuretics, anxiolytics, antidepressants, or ADHD medications. A careful history of supplement use should be screened for. A student- athlete (SA) is additionally more susceptible if they are not acclimated, not aerobically fit, or are overweight or obese. The SA with sickle cell trait warrants special consideration and should be appropriately counseled on exercise acclimatization and hydration strategies (see SCT protocol). SAs with any risks factors identified during the PPE should be evaluated by the team physician. . Acclimatization: Gradually increase exposure to the hot and/or humid environment over 10-14 days. (See Heat Acclimatization Protocol). Modify the clothing and/or equipment worn by the student-athletes to accommodate for heat acclimatization and times of unanticipated severe heat stress. . Hydration: Have fluid breaks every 15-20 minutes with water and carbohydrate electrolyte drinks readily available. Hydration should be adjusted based upon the WGBT (See Heat Acclimatization Protocol). Monitor body weight between and after workouts to reduce progressive dehydration. Loss of 3% body weight requires careful monitoring of fluid intake and loss of 5% requires restriction of activity. Student-athletes should be drinking sodium-containing fluids and urine should be clear to light yellow. . Event Scheduling: When conditions are extreme practices/games should be held during the cooler time of the day or rescheduled. Monitor ambient temperature, 163 2/16/2018

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relative humidity, air motion, and amount of radiant heat from sun when dangerous conditions are expected. WBGT should be utilized via weather monitoring system. Performance testing and endurance training should be specifically discussed with the athletic training staff to coordinate an appropriate emergency action plan in case of a heat casualty. . Intra-event Cooling: Heat dumping techniques should be readily available for athletes when conditions warrant (WBGT or initial period of acclimatization). Techniques include ice chests for arm immersion, cold water bottle misters, and cold towels.

 II. Assessment

. Exertional heat illness (EHI) represents a spectrum of diagnoses with progressive athlete debilitation. These diagnoses include heat or exercise-associated cramps, heat syncope, heat exhaustion and heat stroke. Signs and symptoms of these disorders may include one or more of the following: 1. Exercise-associated muscle cramps: painful involuntary spasms of large muscle groups. Of note, an athlete with a sickle cell trait collapse may have pain in the muscle groups, but may demonstrate a distinct lack of visible and palpable spasms. 2. Heat syncope or pre-syncope: the athlete demonstrates dizziness, lightheadedness, fainting or a distinct a loss of consciousness. 3. Heat exhaustion: athlete with signs of heavy sweating, pallor, weakness, dizziness, headache, nausea, and a body-core temperature between 97 F and 104F. 4. Heat stroke: athlete with signs of tachycardia, hypotension, hyperventilation, altered mental status, vomiting, diarrhea, wet or dry skin, and body-core temperature usually above 104 F. . Exertional heat stroke is life-threatening and represents a true medical emergency. The prompt recognition and treatment of heat illness is critical for recovery. . A rectal thermometer or thermistor is the most accurate device for monitoring body-core temperature, and facilitating an accurate diagnosis. Other methods, to include tympanic, oral and skin devices, have not been demonstrated to be reliable in the athlete population. . Exercise collapse from EHI is best confirmed with the demonstration of an elevated rectal temperature with a rectal thermometer; this insures the collapse is not mistaken for exertional hyponatremia, cardiac arrest, or an exertional sickling event as the clinical presentations of these disorders can be similar. . Exertional hyponatremia will occur when the sodium level in blood is abnormally low with symptoms similar to EHI. The athlete suffering from hyponatremia will generally not demonstrate an elevated rectal temperature. . An athlete with sickle cell trait having a sickling event will also have similar symptoms to EHI, in particular a demonstration of cramping-like pain, but will not have a significantly elevated rectal temperature. Sickling events often occur much earlier with exertion that EHI.

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III. Management

. Student-athletes with signs and symptoms of heat cramps should stop activity and rehydrate with water and sodium-containing beverages. Passive stretching of the affected muscle group can be helpful. Careful consideration should be given to the athlete with SCT who presents with cramping (See Sickle Cell Trait Collapse Protocol). . Student-athletes with signs and symptoms of heat syncope or pre-syncope should be brought inside to cool and rest with legs elevated. Instruction and supervision for rehydration should be provided during recovery. Student-athletes should improve within 20-30 minutes and failure to improve should prompt further evaluation and discussion with the team physician. . Student-athletes with signs and symptoms of heat exhaustion should be brought inside and excess clothing removed. The student-athlete should be cooled with ice towels, ice bags and fans. Instruction and supervision for rehydration should be provided during recovery. Failure to show improvement with 20 minutes should prompt a rectal temperature and further evaluation and discussion with the team physician. . Student-athletes with signs and symptoms of heat stroke to include altered mental status and cognitive function should have a rectal temperature and must be cooled as quickly as possible: 1. Call for transportation and assistance to bring the student-athlete inside for cold whirlpool immersion. Activate EMS and advise of heat stroke and that rapid cooling through water immersion is our management protocol. EMS, campus police, and building managers will be directed to the athletic training room. 2. If transporting is not feasible, call for assistance if equipment (kiddie pool) and/or supplies are needed for cooling. Activate EMS and advise of heat stroke. Remove excess clothing and cool immediately with ice bags, ice towels, or cold water as available. Provide shade and fanning to assist cooling. EMS, Campus Police, and Building Managers will be directed to the incident location. 3. If a physician is present, intravenous fluid replacement can be initiated. 4. If a rectal thermometer is not available for monitoring, the athlete should be cooled until shivering begins or 15-20 minutes. Cooling should be stopped after the rectal temperature reaches 101-102. 5. SAs must be cleared by a team physician prior to return to play after all heat related illnesses.

http://www.nata.org/sites/default/files/exertionalheatillnesses.pdf

Recognition & Management of Heat Illnesses

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Heat Syncope Syncope is common in people who are un-acclimatized to the heat causing peripheral vasodilation and pooling of blood leading to decreased cardiac output and stroke volume, thus leading to transient loss of consciousness Signs & Symptoms o Normal rectal temperature o Brief episode of fainting, improved with supine position o Dizziness, tunnel vision o Pale and wet skin o Often occurs in athletes who have been standing for long periods of time or immediately after the cessation of exercise Treatment o Move the person to shaded/cool area to decrease body temperature o Monitor vital signs o Elevate legs to promote venous return to the heart o Rehydrate to promote expanded plasma volume Heat Cramps: Exercise-associated muscle (heat) cramps represent a condition that presents during or after intense exercise sessions as an acute, painful, involuntary muscle contraction. Proposed causes include fluid deficiencies (dehydration), electrolyte imbalances, neuromuscular fatigue, or any combination of these factors. Signs & symptoms of heat cramps o Normal Rectal temperature for exercising individual (<104 degrees F or 40 degree C) o Commonly affect hamstrings, gastrocnemius, quadriceps, and abdomen o Seen during or following strenuous or long exercise bouts o May see salt stains on the skin or clothes from sodium loss o Normal central nervous system function Treatment o Remove the athlete from the exercise session, workout, or practice and have them rest in the shade or an air-conditioned room. o Stretch, massage and knead the muscle that is cramping in its full-length position (joints should be extended). o Provide the athlete with cold fluids, such as water or an electrolyte sports drink to replace sweat losses. o Provide food high in salt content to replenish the electrolytes lost from sweat. If this is not available consider providing salt supplementation prior to or post cramping. o In cases of heat cramps that persist, use ice massage on the affected muscle Heat Exhaustion: Heat exhaustion is the inability to continue to exercise in the heat and is the most common form of heat illness seen in athletes. Heat Exhaustion does not necessarily progress to heat stroke. Signs & symptoms of heat exhaustion my include: 166 2/16/2018

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o body temperature may be normal or elevated to 102-104 degrees F (39-40 degrees C); o normal blood pressure o tachycardia (rapid heart rate) o cold, damp, & ashen skin o nausea and/or vomiting o headache, dizziness, lightheaded o profuse sweating o rapid & shallow breathing; strong and rapid pulse o muscle spasms/cramps o thirst o syncope Treatment o Rule out other serious conditions that may be present such as o Exertional Heat Stroke o Hyponatremia o Head injury o Hypoglycemia/hyperglycemia o Cardiac Event o Exertional Sickling o Transport athlete into the Sports medicine facility / remove from the environment o Remove equipment and/or constrictive clothing, etc. o Elevate legs to promote venous return o Monitor vital signs (blood pressure, pulse, respirations, body temperature, etc.) o Provide oral fluids if possible o Place ice bags, ice towels, cold water on athlete’s neck, wrists, ankles, groin, back of knees, submerge in cold tub if necessary o Transport to an emergency facility if recovery is not prompt and EHS has been ruled out Exertional Heat Stroke (EHS): Exertional heat stroke is an elevated core temperature (usually 40 C or 104 F) associated with signs of organ system failure due to hyperthermia. The central nervous system neurologic changes are often the first marker of exertional heat stroke. Exertional heat stroke occurs when the temperature regulation system is overwhelmed due to excessive endogenous heat production or inhibited heat loss in challenging environmental conditions and can progress to complete thermoregulatory system failure. This is a serious life threatening condition that requires immediate medical attention. Only Rectal temperatures should be used to accurately assess the patient. EHS is a medical emergency and can be fatal if the individual’s core body temperature remains elevated for an extended period of time (30-60) minutes without induced cooling

Signs & symptoms o sudden onset o high core temperature (104 degrees F or higher) o pulse rate of 160 BPM or greater 167 2/16/2018

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o rapid respirations (20-30 respirations per minute) o nausea and/or vomiting o lack of perspiration or cessation of perspiration o hot and wet or hot and dry skin o dry mouth and/or intense thirst o headache, dizziness, confusion, and/or lethargy o staggering body control o poor judgment o bizarre behavior o convulsions or seizures o decreasing consciousness Treatment Activate EMS immediately and prep the patient for cooling o Immediately submerge entire body in a tub of cold water o Remove excess clothing o Cool first, transport second o Policy review and coordination with Fairfax EMS annually Transport or assist the student-athlete to cold tub area o Cold tubs are checked and filled before every practice session during all preseason practices o Ice is to be located in close proximity to the cold tub o Additional ice is to be placed in the tub Monitor vital signs (blood pressure, pulse, respirations, body temperature, etc.) o Assess core body temperature with a rectal thermistor o Keep thermistor in student athlete’s rectum for continuous monitoring of temperature while immersed o Maintain ABCs o Assess CNS function Begin ice water immersion o Immerse student-athlete in the cold tub up to neck level o Get assistance from medical staff, volunteers, teammates, etc in order to assure a smooth transition in and out of the water Total Body Coverage o Cover as much of the body as possible with water o If full body coverage is not possible due to size of tub, cover torso as much as possible o To keep athletes head and neck above water, use a towel under the arms to hold patient o Place ice towel over the head and neck while body is being cooled in tub o Water temperature should be between 35-58 degrees F

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Vigorously circulate water o While cooling, water is circulated or stirred to enhance the water to skin temperature gradient to optimize cooling o Have an assistant stir water during cooling Continue medical assessment o Vital signs are to be monitored at regular intervals o Take caution that the athlete may become combative o Be prepared to lift or roll patient if vomiting occurs Fluid administration o If a qualified medical professional is available, an intravenous fluid line can be placed for hydration and support of cardiac function Cooling duration o Ideally the patient should be cooled until rectal temperature is between 101-102 degrees F. o If rectal temperature cannot be measured and cold water immersion is indicated, cool for 10-15 minutes and then transport to a medical facility o An estimation of cooling via ice water immersion is 1 °F for every three minutes submerged Cooling rate is slower initially, and will increase the longer the person is in the tub Patient transfer o Remove patient from the immersion tub only after being cooled and EMS is on the scene, then transfer to the nearest medical facility via EMS as quickly as possible o Ensure that the patient is packed in ice during transfer o Notify medical facility that a patient with heat stroke is being transferred and cooling therapy has been preformed Cooling is the primary goal before transport o If appropriate medical staff is available on-site (team physician or Athletic Trainer); an aggressive cooling modality is readily available (cold water immersion); and no other emergency medical services are needed besides the rapid lower of temperature, then always follow the “cool first, transport second” procedure If cold water immersion is not available or feasible given the constraints of the athletic activity being performed or location, then cool via the best available means o A good but not optimal portable alternative is a cooler filed with ice, water, and 12 towels. Place six ice towels all over the body and leave on for 2-3 minutes,

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then place those back in cooler and put the other six on the patient. Continue rotation the towels every 2-3 minutes Heat Illness Risk Factors Athletes with a prior history of cramping and/or heat illnesses (e.g. “crampers”) Athletes with certain medical conditions (e.g. Sickle Cell Trait) Poorly conditioned and/or un-acclimatized athletes Overweight athletes / athletes with a high body-mass index (BMI) Athletes who constantly compete at a high capacity / intensity Athletes with very low body-mass index / low body-fat (e.g. lean & fit) Athletes with a lower “heat tolerance” Athletes who are ill (e.g. infection, fever, diarrhea, vomiting, etc.) Athletes who are taking medications Athletes who are taking certain supplements and/or ergogenic aids (e.g. creatine, steroids, etc.) Athletes with poor dietary / nutrition habits (e.g. caffeine, high-fat foods) Athletes with higher core temperatures Athletes who have greater than 3% body weight loss Athletes who are on restricted and/or low-salt diets Athletes who are heavy salty sweaters Vigorous activity in hot-humid environments High temperature/humidity/sun exposure Equipment-dark colored, heavy clothing, helmets, other protective equipment Inadequate rest breaks Inappropriate work/rest ratios based on exercise intensity, clothing, fitness, heat acclimatization, and medication conditions Lack of education or awareness among coaches, athletes and medical staff No access to shade or fluids during rest breaks Delay in recognition of early heat illness warning signs-lack of proper medical care Prevention Strategies & Recommendations: When appropriate based upon weather conditions where heat illness may occur, proper modifications are to be discussed and implemented prior to pre-season training, conditioning, practices, and games.

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o Note past medical history of heat illness o Note history of sickle cell trait and screening results All student athletes are screened for sickle cell trait prior to participation, If the student-athlete is positive o Student-athlete is counseled and educated about the trait o ATC will notify the coaching staff and strength and conditioning coach o All sports medicine and coaching staff will undergo sickle cell trait education when a member of their team is positive o Coaches will be required to sign off that they have completed training o Note history of any student-athlete taking medication which may include but are not limited to stimulants, vasoconstrictors, beta-blockers, diuretics, anti-depressants and anti-psychotics o Type & duration of training activities within the past 1-2 months o Extent of training done in heat o Acclimatize athletes to heat and humidity gradually over 10-14 days o Ensure appropriate strength and conditioning/acclimatization programs o Education of Staff Athletic Trainers and coaching staff on heat illness recognition, management, and prevention o Review George Mason University Sports Medicine hydration and fluid replacement guidelines o Perform training sessions with emergency medical care team annually

Preparation of Sports medicine Facilities & Practice Facilities o Ice / water o Ice towels o Coolers / water bottles o Powerade / water, salt o Tents / “Cool Area” near practice field o Ice tubs / cold whirlpools Cold tubs available inside all athletic training facilities, means to submerge athletes on athletic fields o WBGT/ Temperature records o IV availability in athletic training facility o Fully stocked and accessible crash bag o Rectal thermistor for core temperatures in field house athletic training room Emergency planning / communication o Communication with Team Physicians & local EMS o Availability of cell phones and radios o Practice Emergency Protocols o Cold tubs Cold whirlpool are kept at 55 degrees in athletic training facility

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Ice tubs filled before practice with ice readily available in case of emergency Additional ice is available next to cold tub location in case of an emergency Cart is available to transport patient

Team meetings o Rest o Diet / nutrition with salty snacks o Communicate with Sports medicine Department personnel Pre-Practice: Monitor weather radar & WBGT, temperature and humidity (beginning and mid practice) Communicate with coaching staff about weather in daily staff meetings Communicate with student-athletes o Diet / nutrition o Hydration (12-20 oz of cold water / Powerade every 10-20 minutes) o Importance of weight charts o Stop taking supplementation and caffeine beverages Weight charts o Monitor daily before and after each practice session o Monitor percent loss based upon body weight o Flag athletes who did not weigh in or any athlete with 2% loss or more o Monitor signs and symptoms closely o At discretion of sports medicine staff, student-athlete will be held from practice if in a dehydrated state Urine Color Chart (posted over urinals & on back of stall doors) How Much Water To Drink Chart (posted over urinals & on back of stall doors) Field preparation o Ice / water / ice towels o Dry towels o “Cool Area” / Shaded area / fans o Ice tubs (in stadium and Sports medicine facilities) Athletic Training staff ensures that there is enough ice in the ice machines to adequately cool cold tubs and checks to make sure the temperatures are appropriate o Emergency equipment (AED, medical kit, splints) During Practice: Sports medicine Staff availability at each drill with water and ice towels

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Monitor WBGT, temperature and humidity at start of practice and half way through. Communication with coaching staff about: o WBGT o Practice modification (extra breaks, equipment, time, intensity, etc.) o Heat Illness recognition Communication with student-athletes o Heat illness recognition o Drink 8 oz cold water every 15-20 minutes throughout practice (NATA fluid replacement position statement) o Use of ice towels o Dry off as much as possible Ice / water / ice towel availability Tent for shade, “Cool Area” Cold tubs (Sports medicine facility) Sports medicine Staff field communication (cellular phones) Heat illness recognition o Any athlete who displays signs and symptoms of heat illness will be removed from participation Practice modification o Rest breaks are planned to match conditions and intensity of activity o Minimize the amount of equipment and clothing worn in hot and humid conditions o Shorten length of practice when indicated due to extreme conditions o Change intensity of practice when indicated due to extreme conditions Hydration throughout practice time o See George Mason University Sports Medicine Hydration and Fluid Replacement Guidelines o Water and Powerade availability Post-Practice: Communicate with student-athletes o Weight charts o Signs placed in locker room about proper hydration o Diet / nutrition (lots of fluids; low-fat meal; no caffeine or alcohol; salty foods; no fast food; supplement salt with meals) o Increase sodium intake based on recommendations especially on multiple practice days o Hydration- Water bottles Replace volume lost (20-24oz of cold water / Powerade for every pound lost) 173 2/16/2018

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Eat a nutritious meal and DRINK water or sports drinks Avoid caffeine or alcohol at all times o Importance of REST (6-8 hours in a cool environment) o Stay out of the sun! Communicate with coaches (injury report; weather forecast, etc.) Weight charts o Monitor after practice o 2% weight loss chart o Flag athletes who did not weigh in or any athlete with 3% loss or more Urine Color Chart (posted over urinals & on back of stall doors) How Much Water To Drink Chart (posted over urinals & on back of stall doors) Availability of water & Powerade (in cafeterias) Availability of cold tubs (field, and Sports medicine facility) Return to Activity If an athlete has experienced any of the previous heat related illnesses, he or she is to be evaluated by a physician to determine a return to play strategy.

Modification of Athletic Activities: Chain of Command The decision to modify and/or terminate a George Mason University intercollegiate athletic activity in the event of excessive heat and/or poor air quality should be made by a member of the George Mason University Sports medicine Department in consultation with the Team Physician and the head coach or his/her designee in consultation with the Events Management Staff and Senior Administration.

Criteria for Modification and/or Termination The policy of the George Mason University Athletic Department with regards to the modification and/or termination of an Athletics practice due to excessive heat will be as follows:

A member of the George Mason University Sports Medicine Department will monitor the weather, specifically the WBGT as measured on the practice field and the National Weather Service and/or National Oceanic & Atmospheric Administration (NOAA) local weather radar (www.noaa.gov or www.weather.com). A member of the George Mason University Sports medicine Department will continually communicate with the Head Coach and/or his/her designee regarding the status of the weather and specifically the WBGT. Modifications may include: o Decrease the total time on the practice field 174 2/16/2018

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o Increase the number of water breaks throughout the practice o Modify the intensity of the practice

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REHYDRATION POLICY The following policy on fluid replacement, rehydration, has been developed in accordance with the National Athletic Trainers Association Position Statement: Fluid Replacement for Athletes, Journal of Athletic Training 2000;35(2)212-224 (http://www.nata.org/sites/default/files/fluidreplacementsforathletes.pdf ) and the George Mason University Sports Medicine Department to provide quality healthcare services and assure the well-being of each student-athlete at George Mason. RATIONALE OF FLUID REPLACEMENT: Student-athletes who are engaged in practices and competitions in hot and humid environments may lose of essential fluids, carbohydrates, and electrolytes that ultimately lead to dehydration and the potential for heat illness.

Dehydration of just 1-2% of body weight can alter physiological function and negatively influence an athlete’s performance. Athletes who are not properly hydrated prior to the start of practice or competition can begin to notice the signs of dehydration within an hour of exercise. Dehydration is a risk factor for athletes developing heat-related illness such as heat cramps, heat exhaustion, and the potentially life-threatening heat stroke. SIGNS AND SYMPTOMS OF DEHYDRATION: Staff athletic trainers, coaches, strength coaches and athletic training students all need to be aware of the signs and symptoms of dehydration to properly recognize and intervene on behalf of the student-athlete.

Signs and Symptoms are: Thirst Nausea

Irritability Cramps

General discomfort Chills

Headache Vomiting

Weakness Decreased performance

Dizziness

REHYDRATION GUIDELINES: The Sports Medicine Staff at George Mason University has developed the following rehydration guidelines based on national accepted criteria. The Sports Medicine Department Staff will assist in promoting the consumption of beverages. Water and sports drinks will be provided onsite when requested or as deemed necessary.

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Prior to Exercise: All athletes will be encouraged to drink 17 to 20 fluid ounces of water or sports beverage 2-3 hours before exercise. Ten to twenty minutes before the beginning of practice or competition, athletes will be encouraged to drink an additional 7-10 fluid ounces of water or sports beverage. During Exercise: Encourage athletes to drink early and often Drink 7-10 fluid ounces or sports drink every 10-20 minutes. It is important to stress to the athletes to drink prior to becoming thirsty. An athlete who is thirsty may already be in the early stages of dehydration. After Exercise: Encourage athletes to replace any fluid loss due to sweating within 2 hours from the end of exercise. Rehydration can include water, carbohydrates, and sodium/potassium to replenish what is lost during exercise. Encourage them to drink 20-24 fluid ounces for every pound of weight lost. Sport beverages ideally will contain a carbohydrate level of no more than 8%. A higher carbohydrate level can slow fluid absorption and cause stomach problems.

Fruit juices, carbohydrate gels, and carbonated beverages are not recommended as a beverage of choice for rehydration. Beverages containing caffeine, alcohol, or carbonation should be avoided and are discouraged due to their diuretic effects and decreased fluid retention. Weight Loss/Gain Guidelines During the pre-season training periods (August) It is recommended that all athletes exercising in hot and humid environments be weighed in prior to and after practice. By weighing in, a determination can be made of the percentage body weight lost due to sweating and the amount of rehydration that must occur prior to the next practice session. Furthermore, athletes are to be weighed wearing the same amount of clothing pre-and post-practice. The percentage of weight lost between practice sessions will be used as one factor to determine if an athlete can safely continue to practice. Athletes should ideally have their pre-exercise body weight remain relatively consistent. Any athlete who has lost between 1- 2% of total body weight during a practice session will be instructed to drink fluids between practices to adequately hydrate themselves before the next practice. Any athlete who has lost 2-5% of body weight during a practice session will be instructed to drink fluids and supplement with sodium between practices. Any athlete who has lost greater than 5% of total body weight during a practice session will be instructed to drink fluids and supplement with sodium between practices and will be required to record a weight to within 1-2% before the next practice. Specific gravity of the athlete’s urine will be assessed the following morning to ensure that optimal hydration status has been achieved.

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Modification in practice the next day The student-athlete who presents with a 2-5% total weight loss prior to a practice session will report to certified athletic trainer for urine specific gravity testing. Specific gravity testing that is not within normal limits will result in practice modifications. If the student-athlete urine specific gravity is within normal limits the athlete will be able to participate without restrictions. Modification could include but are not limited to equipment modifications, duration of practice and/or activities performed and additional rest. The student-athlete who presents with a 5% greater total weight loss prior to a practice session will report to the certified athletic trainer for urine specific gravity testing and urine ketone assessment. If the student-athletes urine specific gravity is not within normal limits the athlete will be removed from participation until total weight loss returns within 1-2%, and specific gravity testing is within normal limits. Each student-athlete will be assessed on an individual bases and medical decisions will be made based on the student athletes overall weight loss, body type, and time frame in which the weight loss has occurred. Intravenous (IV) Fluid Replacement In certain instances an athlete may receive intravenous fluid replacement therapy to combat dehydration or associated heat illnesses. This form of treatment will be conducted at the discretion of the Team Physician. In the absence of the Team Physician, if the attending certified athletic trainer determines that an athlete may be suffering from dehydration or associated heat illness, he/she will make every effort to contact the Team Physician to arrange for treatment to be administered on-site, in the student health center, urgent care facility, or through the closest hospital emergency department. Guidelines for Rehydration Student-athletes are encouraged to drink before, during and after each practice and competition. Student-athletes are to drink early and often during activity in order to compensate for water and electrolytes lost in their sweat. Student-athletes are to replace fluids lost in sweat within 2-hours of the cessation of activity. For every pound of body weight lost 20-24oz of fluids are to be ingested. Student-athletes are encouraged to drink water as their main beverage to replace fluids lost. Student-athletes are encouraged to drink sports drinks containing no more than 8% carbohydrates to replace the electrolytes (Na, K, Cl, Mg, Ca) lost in sweat.

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DISORDERED EATING Background The George Mason University Department of Athletics is keenly aware of the ability of coaches, teammates, parents, professors, and an athletic trainer to observe possible problems in the development of a student-athlete’s eating issues.

Symptoms of eating disorders include: rapid weight loss, exercise obsession, social withdrawal, obsession with weight, diet, and/or appearance, a consistent pattern of stress fractures or overuse injuries, avoidance of social eating situations, variable performance, and binge eating.

Policy The purpose of the George Mason University Athletics Eating Disorder Intervention Policy is to:

 Prevent the development of eating disorders in our student-athlete population through the education of our student-athletes and coaches,  Provide a mechanism of identifying and/or screening for potential eating disorders,  Establish a protocol to treat, follow-up, and communicate with coaches and administrators about any potential cases, and  Utilize a multidisciplinary approach in the recognition and treatment of eating disorders. The multidisciplinary team may consist of a staff athletic trainer, primary care team physician, a clinical psychologist with George Mason Counseling and Psychological services, and a registered dietician.  Any student-athlete, teammate, coach, professor, or athletic trainer who identifies patterns of disordered eating in a student-athlete is to report this observation to the staff athletic trainer overseeing the student-athlete’s sport or Team Physician in Mason Sports Medicine. The staff athletic trainer will, based on the evidence presented, information collected from other individuals, and/or direct discussion with the student-athlete, refer the student-athlete to the registered dietitian or the primary care team physician for initial screening and evaluation.

Common behaviors of eating disorders may include:

 Admits to binging, purging (vomiting) using laxatives or diuretics, strict dieting, restrictive eating, chewing and spitting out food or other unusual dieting practices.  Participating in additional exercise, in addition to regular workouts or practices, not heeding advice from coach or trainer concerning injury, recovery time, etc  Appears depressed and unwilling to participate in social events, team dinners, etc.  Distorted body image; makes comments concerning body weight, body fat, etc.

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 Weighing frequently, denying hunger, preoccupied with food, calories, nutrition or cooking Education All Department of Athletics coaches and staff will complete education in order to understand eating disorders and the associated signs and symptoms. Each coach and staff member will learn how to refer a student-athlete to the appropriate health care provider in the event that there is suspicion of an eating disorder.

All incoming freshmen will have information about the George Mason Eating Disorder Policy and information regarding the appropriate actions to take in order to make a referral in the event that someone they know is suffering from an eating disorder. As a part of our annual Pre- participation physicals, there will be a short screening questionnaire. Should any athlete answer the screening questions in the affirmative, one of the members of the healthcare team will follow up with the athlete and may make referrals to either our sports dietitian, the team physician, or a counselor with MASON Counseling and Psychological Services (CAPS). Procedure A student-athlete, coach, teammate, professor, or athletic trainer who identifies signs and symptoms of disordered eating shall report these observations to the staff athletic trainer assigned to that sport. The staff athletic trainer will, based on the evidence presented, information collected from other individuals, and/or direct discussion with the student-athlete, refer the student-athlete to the primary care team physician for formal evaluation. The primary care team physician will evaluate the student-athlete as soon as possible. This evaluation may include a health history, physical exam, and lab work or additional testing at the discretion of the physician. The primary care team physician will communicate back to the athletic trainer any limitations on athletic participation. A. If an acute or serious concern about the student-athlete’s physical or psychological health exists, the student-athlete will be sent for immediate evaluation to a provider or hospital off campus. The student-athlete may be transported by MASONPD if necessary. High risk medical symptoms include: o Seizures o Blood in vomit or stool o Chest pains o Cognitive impairment B. If no acute or serious concerns exists, the primary care team physician will communicate this to the team athletic trainer who will refer the student-athlete to MASON CAPS for an initial evaluation by: o Contacting the CAPS at 703.993.2380 o Forwarding any labs or additional reports and the signed Release of Information to the CAPS

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The student-athlete will schedule an intake appointment with the Counseling Center as soon as possible. CAPS will evaluate the student-athlete and make recommendations A treatment plan may include psychological treatment, nutrition counseling, medical monitoring, follow up, and/or a contract for medical care (follows). Referral to a higher level of care may be recommended.

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CONTRACT FOR MEDICAL CARE (Example Only) As a result of the Team Physician’s concern for the health and well-being of the student-athlete concerning a very serious medical issue, the following contract is written to ensure that the student-athlete understands and complies with the requested medical referrals. By signing this contract the student-athlete understands and agrees to follow the contract or athletic participation will not be allowed. At the request of the Head Team Physician, the items circled below are those appointments that must be attended by the student-athlete within the given period. All involved parties will receive a copy of this contract to ensure a team effort in providing this medical care.

1. Appointment with team physicians - ______

2. Appointment with sports nutritionist - ______

3. Appointment with psychologist - ______

4. Weight monitoring - ______

5. Body composition monitoring - ______

6. Diagnostic medical testing - ______

7. Permission for team physician/ - ______ICA Administration to discuss with parents w/ or w/o student-athlete present.

SIGNATURES:

Student-athlete - ______

Team Physician - ______

Sports Med Coordinator -______

Head Coach - ______

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SKIN DISORDERS POLICY The George Mason University Athletics Department has taken many steps to help prevent the spread of contagious skin disorders.

The George Mason University Sports Medicine Department will encourage following NCAA recommendations: Keep hands clean by washing thoroughly with soap and warm water or using an alcohol-based sanitizer routinely Encourage good hygiene Immediate showering after activity and before any treatment or clinic visits (except emergency) in the Athletic Training room. Ensure availability of adequate soap and water Pump soap dispensers are preferred over bar soap Avoid whirlpools or common tubs Individuals with active infections, open wounds, scrapes or scratches could infect others or become infected in this environment Avoid sharing towels, razors, and daily athletic gear Avoid contact with other people’s wounds or material contaminated from wounds Maintain clean facilities and equipment Wash athletic gear and towels after each use Establish routine cleaning schedules for shared equipment Inform or refer to appropriate health care personnel for all active skin lesions and lesions that do not respond to initial therapy Train student-athletes and coaches to recognize potentially infected wounds and seek first aid Encourage coaches and sports medicine staff to assess regularly for skin lesions Encourage health care personnel to seek bacterial cultures to establish a diagnosis Care and cover skin lesions appropriately before participation Keep skin lesions properly covered with a proper dressing until healed (“properly covered" means that the skin infection is covered by a securely attached bandage or dressing that will contain all drainage and will remain intact throughout the sport activity). If wounds can be properly covered, good hygiene is to be stressed to the student-athlete such as performing hand washing before and after changing bandages and throwing used bandages in the trash

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If wound cannot be properly covered, consider excluding players with potentially infectious skin lesions from practice and/or competition until lesions are healed or can be covered adequately PROCEDURE In order to aide in this, student-athletes are asked to immediately report any suspicious skin conditions to their team athletic trainer. If deemed appropriate, the team physician will be notified and will take appropriate steps to assure that the condition is treated promptly and appropriately. In addition, common areas may require cleaning and disinfection in order to control the spread of the condition.

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CONCUSSION MANAGEMENT – NCAA PROTOCOL

This document addresses independent medical care for college student-athletes in all sports.

Background: Diagnosis, management and return to play determinations for student-athletes is the responsibility of the institution’s athletic trainer (working under the supervision of a physician) and the team physician. In the interest of the health and welfare of student- athletes, our student-athlete’s health care providers have clear authority for student- athlete care.

1. The physical and psychosocial welfare of the individual student-athlete will always be the highest priority of the athletic trainer and the team physician. 2. The MASON Sports Medicine program delivering athletic training services to student- athletes will always have a designated athletics health care administrator. The current athletics health care administrator for our University Sports Medicine activities is Deborah Corbatto, MS, ATC. The Head Team Physician for MASON Sports Medicine is Frank Pettrone, MD. 3. Sports medicine physicians and athletic trainers will always practice in a manner that integrates the best current research evidence within the preferences and values of each student-athlete. 4. The clinical responsibilities of an athletic trainer will always be performed in a manner that is consistent with the written or verbal instructions of a physician or standing orders and clinical management protocols that have been approved by a program’s designated athletics health care administrator. 5. Decisions that affect the current or future health status of a student-athlete who has an injury or illness will only be made by a properly credentialed health professional (e.g., a physician or an athletic trainer who has a physician’s authorization to make decisions). 6. In every case that a physician has granted an athletic trainer the discretion to make decisions relating to an individual student-athlete’s injury management or sports participation status, all aspects of the care process and changes in the student-athletes disposition will be thoroughly documented. 7. Coaches will not be allowed to impose demands that are inconsistent with guidelines and recommendations established by the sports medicine and athletic training professionals. 8. The athletic trainer’s role delineation and employment status is determined through a formal administrative role by a physician who provides medical direction. 9. The athletic trainer’s professional qualifications and performance evaluations are not primarily judged by administrative personnel who lack health care expertise, particularly in the context of hiring, promotion and termination decisions. 10. MASON has adopted an administrative structure for delivery of integrated sports medicine and athletic training services to minimize the potential for any conflicts of interest that could adversely affect the health and well-being of student-athletes.

The MASON team physician’s authority is the linchpin for independent medical care of MASON student-athletes. A medical-legal authority is a matter of law in 48 states (including the 185 2/16/2018

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Commonwealth of Virginia) and requires athletic trainers to report to a physician in their medical practice.

Guidelines: Institutional medical line of authority at MASON is established independently of the coach, and is in the sole interest of student-athlete health and welfare. Medical line of authority is transparent and evident in the MASON athletics department, and the organizational structure establishes collaborative interactions with the athletics health care administrator and primary athletics health care providers (defined as all institutional team physicians and athletic trainers) so that the safety, excellence and wellness of student-athletes are evident in all aspects of athletics and are student-athlete centered.

MASON has designated Frank Pettrone, MD to serve as head team physician. He oversees the medical tasks of all primary athletics health care providers. All certified athletic trainers are directed and supervised for medical tasks by a team physician and/or the athletics health care administrator. Deborah B. Corbatto has been designated as the Athletics Health Care Administrator for MASON. The athletics health care administrator and primary athletics health care providers are empowered with unchallengeable autonomous authority to determine medical management and return-to-play decisions for student-athletes.

Frank Pettrone, MD Head Team Physican

Debi Corbatto, MS, ATC Linda Pullen, MEd, ATC Athletics Health Care Concussion Point Person- Administrator Medical Sr. Assoc. AD- Performance, Sports Medicine Coordinator Well-Being,Risk Management

Various components of Team Physicians Certified Athletic Trainers Academic Support (Vary based on date/sporting (Vary based on date/sporting Office of Disability Services event) event) Other student services as required.

George Mason University Medical Line of Authority – 2017/2018

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CONCUSSION ASSESSMENT AND MANAGEMENT PROTOCOL

Concussion Protocol Overview George Mason University follows NCAA sports medicine guidelines for medical and academic return-to-learn criteria. These guidelines can be found at: http://www.ncaa.org/health-and- safety/medical-conditions/concussion and http://www.ncaa.org/health-and-safety/medical- conditions/concussion-return-learn-guidelines. These guidelines are paraphrased here for ease in accessing.

Explanation of Concussion After someone suffers a concussion, there is presumed to be a brain energy crisis. Concussion results in an increased need for brain glucose in order to help the brain to heal and it is accompanied by a reduction in cerebral blood flow, which is a response to the brain injury. The combination of increased brain energy need and decreased brain blood flow is referred to as a “mismatch” and results in a brain energy crisis. The brain energy crisis model is primarily based on data obtained from rat studies and has not been correlated definitively in human subjects. The brain energy crisis is also a common explanation for many concussion symptoms, including delayed reaction time, poor working memory, dizziness, imbalance and a host of other cognitive, emotional and physical symptoms. The brain energy crisis is also the foundation for the stepwise return-to-play guidelines that were referenced in the NCAA Sport Science Institute (SSI) Newsletter Volume 1, Issue 2, and major review articles.

Whereas the brain energy crisis explanation is a tidy model of brain pathophysiology following concussion, it is overly simplistic and does not account for a multitude of other brain-based explanations for concussion symptomatology, including, but not limited to:

 Axonal shearing;  Brain micro-hemorrhage;  Brain inflammation and cytotoxic chemical expression;  Localization of symptomatology to a specified region of the brain (as opposed to viewing concussion as a global brain event), and  Brain plasticity.

It is important to note that the definition of concussion and the understanding of concussion pathophysiology are evolving rapidly. To date, there are over 42 working definitions of concussion and much of the natural history of concussion remains unclear. Consensus-based documents form the backbone of concussion definition and concussion natural history discussions, and these documents are intertwined with the brain energy crisis viewpoint of concussion pathophysiology. Return-to-play is an important component of concussion management and most experts agree that return-to-play should be accomplished in a step-wise

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Questions about the concussion protocol or management of the concussion should be directred to the MASON concussion point persons.

1. Linda Pullen, M.Ed., ATC – medical issues ([email protected]) 2. Debi Corbatto, MS, ATC – administrative issues ([email protected])

CONCUSSION ASSESSMENT AND MANAGEMENT PROTOCOL GUIDELINES

1. Preseason Baseline Testing and Education  All student-athletes are required to complete a baseline neurocognitive test and a balance assessment as part of their pre-participation requirements.  Neurocognitive testing using the ImPACT computer program will be supervised by an athletic trainer and all scores validated by the sports medicine coordinator. Student- athletes with invalid scores will be required to repeat testing. Repeat testing will occur no sooner than 24 hours from the prior testing session.  All student-athletes will be required to disclose any prior brain injury and any prior concussion history at the time of their pre-participation exams.  All returning student-athletes who sustained a concussion during the previous school year will be required to repeat neurocognitive testing during the next (Pre-Participation Examination) PPE.  Balance testing will be conducted by an athletic trainer following the balance component of the SCAT5 assessment model. Testing will be video recorded and saved for future review by the team physician.  All assessments will be reviewed by the team physician, and they will determine pre- participation clearance and/or the need for additional consultation or testing.  Student-athletes, coaches, team physicians, athletic trainers and the Director of Athletics are all provided yearly concussion fact sheets or other educational material from the NCAA and must provide their signature as verification of receipt and understanding of this material, as required by the NCAA. 2. Concussion Safety Sport Coverage  Medical personnel with training in the diagnosis, treatment and initial management of acute concussion must be “present” at all NCAA varsity competitions in the following contact/collision sports: basketball; equestrian; field hockey; football; ice hockey; lacrosse; pole vault; rugby; skiing; soccer; wrestling. To be present means to be on site at the campus or arena of the competition. Medical personnel may be from either team, or may be independently contracted for the event.  Medical personnel with training in the diagnosis, treatment and initial management of acute concussion must be “available” at all NCAA varsity practices in the following contact/collision sports: basketball; equestrian; field hockey; football; ice hockey; lacrosse; pole vault; rugby; skiing; soccer; wrestling. To be available means that, at a 188 2/16/2018

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minimum, medical personnel can be contacted at any time during the practice via telephone, messaging, email, beeper or other immediate communication means. Further, the case can be discussed through such communication, and immediate arrangements can be made for the athlete to be evaluated. 3. Initial Concussion Assessment  Student-athletes who present with a history of trauma and signs/symptoms suggestive of a concussion, or with a confirmed diagnosis of concussion, will be removed and withheld from practice and competition for at least that calendar day.  A sideline assessment, including a symptom assessment and physical assessment including a brief survey of cognitive, vestibular and vision performance will be conducted by an athletic trainer or team physician. This clinical assessment will include evaluation for cervical spine trauma, skull fracture and intracranial bleed. Signs and symptoms of serious trauma such as loss of consciousness, cranial nerve deficits, amnesia lasting longer than 15 minutes, progressive decline in mental status and worsening symptoms or the presence of concussion “red flags”**** will be referred to emergency care for further evaluation and diagnostic testing.  A sideline vestibular/ocular-motor screening (VOMS) will be added prior to return to play. A concussion will be suspected if testing provokes or increases any symptom.  Should a concussion be suspected, a comprehensive evaluation, to include a clinical interview, an evaluation using the SCAT5 Assessment Tool, a neurocognitive test using the ImPACT computer program, a balance exam, a vestibular and ocular screening exam, a clinical assessment for cervical spine trauma, skull fracture and intracranial bleed, will be conducted by a team physician or an athletic trainer within the following 24 hours. Additionally, physical and cognitive rest will be prescribed for the concussed student- athlete at the discretion of the athletic trainer or physician.  With acute head injuries, additional problems could arise over the first 24-48 hours. The concussed student-athlete should not be left alone during this time and must go to a hospital at once if they exhibit any “red flags.”****.  Student-athletes, who have been diagnosed with a concussion by an athletic trainer, will be scheduled to see the team physician at the next available clinic. Evaluations will be discussed via phone if signs/symptoms warrant earlier communication with a team physician.  Any student-athlete that presents with a Glasgow Coma Scale <13, a prolonged loss of consciousness (>1 minute), any focal neurological deficit suggesting intracranial trauma, repetitive emesis, persistently diminished/worsening mental status, other neurological signs/symptoms, or spinal injury will be transported by ambulance to the nearest hospital or emergency room. In the event of any of these signs/symptoms, the athletic trainer/physician/coach present should call 9-1-1 immediately for hospital transport.  A student-athlete who presents with only localized cranial or facial pain after a head trauma and no headache and a normal sideline concussion assessment may be allowed to return to play.  The sideline concussion assessment will include the full SCAT5 assessment tool, as well as smooth pursuits, saccades, and an estimate of near point convergence from VOMS testing. A functional assessment (i.e. sprints, agilities, jumping drills, push-ups, 189 2/16/2018

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crunches) will be tested on the sideline prior to RTP if no symptoms are observed from previous testing.  If a student-athlete has been diagnosed with a concussion, written documentation of oral and/or written care will be provided to both the student-athlete and another responsible adult (e.g., parent, roommate, coach).  After a student-athlete is diagnosed with a concussion, if feasible, he/she will be directed (and monitored) by the athletic trainer to e-mail his/her professors explaining the injury. This e-mail will be copied to the student-athlete’s academic advisor and the senior associate athletic director for academic services. If it is not feasible for the student- athlete to communicate with his/her professors, the athletic trainer will send an email to the senior associate athletic director for academic services and the student-athlete’s academic advisor explaining the injury. It will then be the responsibility of the academic staff to contact the student-athlete’s professors on his/her behalf. The athletic trainer will direct the injured student-athlete to make an appointment with his/her academic coordinator.  Once the student-athlete has seen a physician and academic recommendations/ accommodations have been made, the athletic trainer will communicate these recommendations to the academic advisor and the senior associate athletic director for academic services. After every physician appointment, the athletic trainer will contact the academic advisor and communicate any change in status or accommodations needed.  The diagnosed student-athlete will be seen daily by the athletic training staff for serial evaluation and monitoring of the injury. Concluding each day’s assessment, an appointment will be made for the following day’s monitoring.

4. Concussion Management-Resolving Symptoms (Before 14 days post-injury)  Early management consists of physical and cognitive rest as well as structured sleep, regular meals and adequate hydration.  Once the student-athlete’s concussion symptoms are resolved, a return-to-play progression may be initiated and monitored by the athletic trainers and team physicians.  The athletic training staff and team physicians will use the guidelines of the Consensus Statement revised at the 5th International Consensus Conference on Concussion in Sport (Berlin, 2016) for return-to-play. This graduated return to play protocol*** will be used when the student-athlete is asymptomatic at rest and with cognitive exertion. Until the student-athlete has returned to baseline, they will have limited physical and cognitive activity as directed by our team physicians. Additionally, the student-athlete should demonstrate a normal vestibular/ocular screening exam and a baseline performance on the ImPACT neurocognitive test.  In the event the vestibular/ocular screening exam provokes symptoms, the student-athlete may be prescribed therapy to rehabilitate the specific dysfunction.  For student-athletes with a baseline preseason ImPACT, a normal post-concussion ImPACT will be defined by the team physician. The neurocognitive ImPACT report will be provided to and reviewed by the team physician prior to beginning the graduated return-to-play protocol.  In the event neurocognitive testing is not within an acceptable range, the test scores will be evaluated by the team physician and a treatment plan will be implemented. The 190 2/16/2018

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student-athlete will require a minimum of 24 hours of additional rest prior to repeating the neurocognitive test (ImPACT) and no more than two tests within seven days.  The six-step return to play protocol will progress as long as the student-athlete remains asymptomatic. Steps are progressed every 24 hours at the earliest. If symptoms return, the student-athlete must rest for 24 hours and then drop back to the previous asymptomatic level and may attempt to progression again later. The certified athletic trainer (ATC) will record a daily symptom check before activity and a symptom and balance check after activity.  There may be isolated incidences, where an athlete with mild symptoms and no cognitive deficits, may perform two steps within 2 hours (Steps 2 and 3). A team physician must approve all step combinations.  Final determination of return-to-play is from the team physician or a medically qualified physician designee.

4. Concussion Management – Prolonged Recovery  If symptoms persist longer than seven days with prescribed cognitive and physical rest, current symptoms and test results will be reviewed with the team physician in order to consider additional diagnosis (e.g. post-concussion syndrome, sleep dysfunction, migraine or other headache disorders, mood disorders such as anxiety and depression, ocular or vestibular dysfunction) and a therapy protocol will be individualized for the student-athlete.  The ATC will provide supervision of the therapy protocol and record a daily symptom check after therapy.  The therapy progression will be reviewed weekly with the team physician and progressed as symptoms allow. Symptoms that persist beyond a 14-day period will be considered by the team physician for referral to a dedicated Concussion Clinic for further evaluation and/or management.  The Concussion Clinic, through communication with the team physician or sports medicine coordinator, will provide therapy guidance and return-to-play progressions and recommendations for full clearance.  Final determination of return-to-play is from the team physician or medically qualified physician designee

** Baseline Neurocognitive ImPACT Testing Student-athletes participating in all sports will be required, as part of their PPE, to obtain a cognitive baseline score using the neurocognitive program ImPACT and a baseline balance assessment following the SCAT5 Assessment Tool guidelines for balance testing.

Student-athletes with prior history of concussion or other traumatic brain injury will be retested for a new baseline score during PPE’s in the year following their injury.

***Graduated Return to Play Protocol (SCAT5 Guidelines)  Step #1 – Team physician guided physical and cognitive rest until asymptomatic without medications and returned to baseline cognitive status 191 2/16/2018

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 Step #2 -30 minutes of light activity to include non-impact cardio, core exercises and static balance exercises (<50% MPHR) – no resistance training  Step #3 - 60 minutes of light to moderate activity to include impact cardio, functional and agility drills, (<70% MPHR) with no head impact  Step #4 - 90 minutes of moderate to heavy exertional sport-specific activity, not to include contact activities – may start progressive resistance weight training  Step #5 -Full practice – unrestricted sport and weight training  Step #6 -Return to competition

****Head Injury Red Flags (Prompt heavy consideration for neuroimaging) - Worsening headache - Persistent neck pain - Worsening drowsiness - Inability to awaken from sleep - Repeated vomiting - Becoming less alert - Double vision - Unusual behavior change - Seizure or convulsion - Weak or numb arms or legs - Slurred speech - Increasing confusion or irritability - Lack of balance standing or walking - Inability to recognize people or places

5. Management plan for reducing head trauma exposure

The George Mason University Athletics Department will always emphasize ways to minimize head trauma exposure. This will include, but is not limited to:  Adherence to Inter-Association Consensus: Independent Medical Care Guidelines.  Reducing gratuitous contact during practice.  Taking a ‘safety first’ approach to sport.  Taking the head out of contact.  Coaching and student-athlete education regarding safe play and proper technique.

Concussion Academic Component–Protocols Including Return-to-Learn Criteria

Rationale for Guidelines

Return-to-learn is a parallel concept to return-to-play, but has received less scientific study than its counterpart. The foundation of return-to-learn includes:

 Return-to-learn should be managed in a stepwise program that fits the needs of the individual.  Return-to-learn guidelines assume that both physical and cognitive activities require brain energy utilization, and they similarly assume that such brain energy is not available for physical and cognitive exertion because of the concussion-induced brain energy crisis.  Return-to-learn recommendations are based on consensus statements, with a paucity of evidence-based data to correlate with such consensus recommendations.

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 Return-to-learn recommendations should be made within the context of a multi- disciplinary team that includes physicians, athletic trainers, academic counselors and administrators.  Like return-to-play, it is not always easy to provide prescriptive recommendations for return-to-learn because the student-athlete may appear physically normal, but is unable to perform at his/her expected baseline due to concussive symptomatology.

The hallmark of return-to-learn is cognitive rest immediately following concussion, just as the hallmark of return-to-play is physical rest. Cognitive rest means avoiding potential cognitive stressors such as school work, video games, reading, texting and watching television. The rationale for cognitive rest is that the brain is experiencing an energy crisis, and providing both physical and cognitive rest allows the brain to heal more quickly. Data from small studies suggest a beneficial effect of cognitive rest on concussion recovery. For the college student- athlete, cognitive rest following concussion means avoiding the classroom for at least one day. The gradual return to cognitive activity is based on the return of concussion symptoms following cognitive exposure. The prevailing consensus to date includes:

 There will be no classroom activity on the same day as concussion.  An individualized initial plan for academic participation will be determined by the team physician and/or athletic trainer.  If the student-athlete cannot tolerate 30 minutes of light cognitive activity, he or she should remain at home or in the residence hall.  Once the student-athlete can tolerate 30-45 minutes of cognitive activity without return of symptoms, he/she should return to the classroom in a step-wise manner. Such return should include no more than 30-45 minutes of cognitive activity at one time, followed by at least 15 minutes of rest.  The levels of adjustment needed should be decided by a multi-disciplinary team that may include the team physician, athletic trainer, faculty athletic representative or other faculty representative, coach, individual teachers and psychologist. The level of multi- disciplinary involvement should be made on a case-by-case basis.  The student-athlete should be re-evaluated by the team physician if concussion symptoms worsen with academic challenges.  Should the student-athlete need assistance communicating with his or her professors, this will be done with the assistance of the senior associate athletic director for academic services and the student-athlete’s academic coordinator. This team may request a modification of schedule/academic accommodations for up to two weeks as indicated by physician request.  There will be a re-evaluation by team physician and members of the multi-disciplinary team, as appropriate, for a student-athlete with symptoms lasting more than two weeks.  If the student-athlete’s case cannot be managed through schedule modifications/academic accommodations, appropriate campus resources will be engaged. Such campus resources must be consistent with the Americans with Disabilities Act Amendments Act (ADAAA), and include at least one of the following: Learning specialists, Office of Disability Services and/or the ADAAA office. The academic support staff and the senior associate athletic director for academic services will be managing the interface with the

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other campus units. A plan of action will be developed and returned to the administrative sport concussion coordinator for inclusion in the student-athlete’s medical file.

Academic Terminology

The procedures above form the core of the prevailing consensus for return-to-learn guidelines. The majority of student-athletes who are concussed do not need a detailed return-to- learn program because full recovery occurs within two weeks. Return-to-learn management becomes more difficult when the student-athlete has ongoing symptoms for greater than two weeks. Before discussing management of such student-athletes, it is helpful to discuss educational terminology that can provide the basis for more complicated return-to-learn cases.

Academic adjustment - A student-athlete’s academic schedule requires some modification in the first one to two weeks following a concussion. In this case, full recovery is anticipated and the student-athlete will not require any meaningful curriculum or testing alterations.

Academic accommodation - The student-athlete has persistent symptoms for more than two weeks following concussion. Because the student-athlete has not recovered in the anticipated period of time, he or she may require a change in the class schedule and special arrangements may be required for tests, term papers and projects. Although there is no fixed timeline for academic accommodation, this generally applies to student-athletes who have more prolonged concussion symptoms, or who may be suffering with post-concussion syndrome. It is important to verify, as best as possible, the diagnosis instead of assuming that the student-athlete has prolonged concussion symptoms. As discussed in NCAA SSI Newsletter Volume 1, Issue 3, post- concussion syndrome is not the same as prolonged recovery from concussion, and should be suspected in any student-athlete who has ongoing symptomatology two or more weeks following concussion. Post-concussion syndrome is a neuro-psychiatric condition that is best managed in a multi-disciplinary manner with active intervention. Passive management such as prolonged physical and cognitive rest is counterproductive in post-concussion syndrome.

Academic modification - A more difficult scenario in which the student-athlete suffers with prolonged cognitive difficulties requires a more specialized educational plan, usually within the construct of an individualized education plan. An individualized education plan is a formal educational plan for an individual, and is protected under the Individuals with Disabilities Education Act. This plan is more prescriptive than a 504 plan, which refers to Section 504 of the Rehabilitation Act and the Americans with Disabilities Act. A 504 plan covers students who are not eligible for an individualized education plan, but who require academic modification because of a documented medical condition.

Campus Resources

The successful implementation of return-to-learn depends on several variables:

 Recognition that concussion symptoms vary widely among student-athletes and even within the same individual who may be suffering a repeat concussion. 194 2/16/2018

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 Identification of a point person or case manager for the student-athlete who must navigate the dual obligations of academics and athletics. The MASON point-person who will navigate return-to-learn with the student-athlete is Nena Rogers, Senior Associate AD, Academic Services.  Identification of co-morbid conditions that may further impair recovery including, but not limited to, migraine, attention-deficit hyperactivity disorder, anxiety and depression.  Identification of campus resources that can help assure that student-athletes are provided their full rights (under ADAAA) during this transition period.  The academic point person within athletics who will navigate return-to-learn with the student-athlete will be the senior associate athletic director for academic services.

Campus resources vary and can include the following:

George Mason University has a multi-disciplinary team that will navigate more complex cases of prolonged return-to-learn. The team will be co-led by the Sports Medicine Coordinator, the senior associate athletic director for performance, well-being, and risk-management, and the senior associate athletic director for academic services. This multi-disciplinary team may also include, but is not limited to:

 Team physician  Athletic trainer  Psychologist/counselor  Neuropsychologist consultant  Faculty athletic representative  Academic counselor/ return-to-learn specialist  Course instructor(s)  College administrators  Office of Disability Services. Most campuses have a disability office that is responsible for verifying each student’s impairment under the ADAAA. Sometimes, there is a separate disability office and ADAAA office, and in this case the first resource is the campus disability office. Concussion and mild traumatic brain injury are covered under ADAAA.  Learning Specialists. The MASON college campus has certified learning specialists who have specialized knowledge of medical conditions such as post-concussion syndrome. They usually work directly with the disability office.  Coaches

Student-athletes are more likely to return to full classroom activity in the setting of a proactive and well-integrated management plan.

Education Component – for coaches, student-athletes and staff

1. Because outward signs of a concussion are frequently not observable, it is critical for concussed individuals to report symptoms in order for healthcare professionals to have the opportunity to provide treatment. Student-athletes will sign a statement to their

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acceptance of the responsibility for reporting their injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions. During the intake paperwork process, student-athletes will be presented with educational materials on concussions and are expected to view these documents and videos and sign a statement documenting their understanding of these materials, as well as the opportunity to ask questions; this includes what a concussion is and how it is safely managed. These records will be kept by the concussion coordinator in the Sports Medicine Department and may be accessed as necessary by the NCAA or the institution. a. All of the sports medicine protocols are accessible on the goMason.com website and fully available for all to review. It is recommended that all student-athletes, coaches and other interested parties read these protocols thoroughly. Any questions can be addressed by the concussion coordinator. b. Coaches, team physicians, athletic trainers and the director of athletics will acknowledge annually that they understand MASON’s concussion management plan and their role within the plan and that they have received education about concussions. These records will be kept by the Center for Sports Performance and the athletic department human resources staff and may be accessed as necessary by the NCAA or the institution. 2. Student-athlete responsibilities: a. The student-athlete is required to view an educational video on concussion prepared by the NCAA each year and acknowledge with their signature that they have viewed the video and understand the information presented. This video is located at: (https://s3.amazonaws.com/ncaa/web_video/health_and_safety/concussion/concussion. html) b. If a student-athlete suffers a concussion, it is his/her responsibility to report the injury and accompanying symptoms promptly and follow the protocol prescribed by the medical staff. c. If a student-athlete is requested to take the SCAT5 test, the ImPACT neurocognitive test or any other medical assessment for concussion, he/she agrees to comply with this request. d. Any questions about the concussion protocol or management of the concussion should be directed to the MASON concussion point persons. 1. Linda Pullen, M.Ed., ATC – medical issues ([email protected]) 2. Debi Corbatto, MS, ATC – administrative issues ([email protected])

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ADHD POLICY Attention Deficit/Hyperactivity Disorder is one of the most common neurobehavioral disorders of childhood and can persist through adolescence and into adulthood. For this reason, the NCAA has published its guidelines for the regulation of stimulant medications to treat ADD/ADHD in student-athletes. The George Mason University Sport Medicine Department adheres to those guidelines published by the NCAA in March 2008 in the Sports Medicine Handbook (http://www.ncaapublications.com/p-4374-2014-15-ncaa-sports-medicine-handbook.aspx) . The aim of the guidelines is to document a disorder and the use of the banned substance. PROCEDURE Reporting of ADD/ADHD Medications Each student-athlete will undergo a pre-participation physical (PPE) upon arrival at George Mason University prior to beginning their athletic career. Included in the PPE will be a medical history form that asks for all current medications. The student-athlete is encouraged to list all stimulants or pharmacological agents used in the treating of an attention deficit disorder. Previously diagnosed individuals must present the Sports Medicine Department with the following documentation: Description of the evaluation process which identifies the assessment tools and procedures AND Copies and/or supporting documentation of any neuropsychological testing and/or other diagnostic instruments used to confirm the diagnosis. (George Mason ADHD Exemption Form) NCAA Medical Exemption Form Statement of the diagnosis, including when it was confirmed; History of ADHD treatment (previous / ongoing); Statement that a non-banned ADHD alternative has been considered if a stimulant is currently prescribed; Statement regarding follow-up and monitoring visits; and Copy of the most recent prescription (as documented by the prescribing physician). Testing Student-athletes may undergo testing for ADD/ADHD upon arrival at George Mason if any of the following occur: Academic advisors, learning specialist or tutors see signs of attention deficit disorders The student-athlete requests testing Test Verification The Sports Medicine Department and the Academic Support Services will work together to verify proper diagnosis and to make sure that both departments know and understand who is to

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Follow-up The team certified athletic trainer is in charge of following the student-athlete once a diagnosis has been made. The certified athletic trainer will work closely with the Team Physician and the academic advisor to ensure quality care. The student-athlete will follow-up with the team physician or their home physician when a prescription needs to be refilled. This will allow the physician and the student-athlete to discuss how the medication is working and review possible side effects.

Documentation The team athletic trainer will keep records of the ADD/ADHD diagnostic testing, prescriptions written and filled, and records regarding follow-up visits. All these documents must be kept confidential in the student-athlete’s chart.

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CERVICAL SPINE INJURIES

The purpose of this policy is to provide guidance to staff athletic trainers, team physicians, emergency responders, and other professionals with recommendations and clinical considerations for managing a potentially catastrophic cervical spine injury. A catastrophic cervical spine injury is defined as a structural distortion of the cervical spinal column associated with actual or potential damage to the spinal cord. The information outlined in this policy is taken from the 2009 NATA position statement on the acute management of the cervical spine- injured athlete, Journal of Athletic Training 2009;44(3):306–331

Specifically, this policy and procedure will provide recommendations based on current literature and clinical practice pertaining to the following: Prevention strategies of cervical spine injuries in sport Emergency planning and preparation Maintaining or creating neutral alignment of the cervical spine, Accessing and maintaining the airway, Stabilizing and transferring an athlete with a suspected cervical spine injury, Equipment-related issues

Based on current research and expert consensus related to cervical spine injury, the following are recommendations for prevention and emergency management of the athlete with a suspected catastrophic cervical spine injury. Prevention The athletic training staff will be responsible for the emergency care of athletes and are aware of sport-specific causes of catastrophic cervical spine injury and understand the acute physiologic response of the spinal cord to injury. The Athletic Training staff is versed and educated on safety rules for the prevention of cervical spine injuries and is responsible to ensure that such rules are followed. The athletic training staff is educated on the recommendations made by equipment manufactures for protective equipment relative to fit and maintenance. The athletic training staff participates in education of coaches and athletes about the mechanisms of catastrophic spine injuries, the dangers of head-down contact, and pertinent safety rules enacted for the prevention of cervical spine injuries on an annual basis Planning and Rehearsal The athletic training staff reviews the emergency action plan for George Mason University on an annual basis. All venues at George Mason University have a venue specific emergency action plan which includes appropriate communication, on site equipment, the ability to remove equipment barriers

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George Mason University – Department of Athletics Sports Medicine Policy and Procedure Manual such as a facemask, and how to activate the local emergency medical system. (See Emergency action plan for George Mason University) The George Mason University Sports Medicine department holds annual training sessions to rehearse the emergency action plans and management of cervical spine and other potential catastrophic injury scenarios. Rehearsal includes but is not limited to manual head and neck stabilization techniques, the multiple methods of transferring injured athletes (eg, log-rolling, lift-and slide techniques), equipment management (eg, gaining access to the airway or chest), and immobilization methods (eg, long spine board, cervical collar application). Assessment The George Mason University Sports Medicine department reviews assessment procedures on an annual basis in order to recognize the presence of signs and symptoms that require the initiation of the spine injury management protocol. These include but are not limited to: unconsciousness or altered level of consciousness, bilateral neurologic findings or complaints, significant midline spine pain with or without palpation, and obvious spinal column deformity. Stabilization When a potential spine injury is suspected, the sports medicine staff will ensure that the cervical spine is in a neutral position and will immediately apply manual cervical spine stabilization. It is the policy of George Mason University Sports Medicine and the NATA 2009 position statement for the management of cervical spine injuries that rescuers not apply traction to the cervical spine, as this may cause distraction at the site of injury. Traction in a cervical spine with ligamentous injury can result in excessive distraction and subluxation that can further compromise the spinal cord. It is the policy of the George Mason University Sports Medicine Department and the NATA 2009 position statement for the management of cervical spine injuries to realign the cervical spine to a neutral position in order to minimize secondary injury to the spinal cord. However, the presence or development of any of the following would cause realignment to be contraindicated during the management of a cervical spine injury: movement causes increased pain, neurologic symptoms, muscle spasm, or airway compromise; it is physically difficult to reposition the spine; resistance is encountered during the attempt at realignment; or the patient expresses apprehension. Airway It is the policy of George Mason University Sports Medicine to immediately attempt to expose the airway by removing any existing barriers (e.g., protective face masks) when a decision to transport the student-athlete has been made. If rescue breathing is indicated during management, the individual with the most training and experience should establish an airway and commence rescue breathing using the safest technique. The George Mason University Sports Medicine department policy is that if there is any suspicion of neck injury, the staff will use the jaw-thrust maneuver over the head-tilt technique. Advanced airway management if indicated will be performed by the EMS on scene or a George Mason University Team Physician if present. 200 2/16/2018

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Transfer and Immobilization The athletic training staff will ensure that manual stabilization of the head is converted to immobilization using a combination of external devices (e.g., cervical collars, foam blocks), and stabilization of the cervical spine will be continued until the student-athlete has been transported to the hospital for imaging George Mason University Sports Medicine will use a long board as its primary means to stabilize a student-athlete for transport. It is the policy of George Mason University Sports Medicine that for a supine athlete, a lift-and- slide technique (e.g., 6–plus-person lift, straddle lift and slide) of transferring the athlete to an immobilization device will be used in appropriate situations. Furthermore, for the prone athlete, the log-roll method of transferring a student-athlete to an immobilization device will be used. Equipment-Laden Athletes It is the policy of George Mason University Sports Medicine that all equipment remains in place, unless otherwise indicated until the student-athlete has been transported to an emergency facility. The exception to this policy is when the helmet is not properly fitted to prevent movement of the head independent of the helmet (as might occur in a baseball/softball injury). The second exception is if the equipment prevents neutral alignment of the cervical spine or airway access. Lacrosse helmets will be removed prior to transport. A rigid cervical immobilization collar is to be used on the athlete before transfer to a spine board when a cervical spine injury is suspected. The athletic training staff is responsible for being familiar with their team’s equipment and mounting systems in addition to the tools on hand and techniques used for removal of the facemask. Face masks that interfere with the ability to access the airway are to be completely removed from the helmet. Should an athlete on a team wear a face-mask, the athletic training staff will be aware and well trained in, established face-mask removal techniques. The face mask is to be removed with the tool and technique that is consistent with standard recommendations. A powered (cordless) screwdriver is the tool of choice for George Mason University Sports Medicine. Though a powered screwdriver is effective, there will be a backup cutting tool on site, specifically matched to the sport equipment used. If for some reason the face-mask cannot be removed in a reasonable amount of time, then the helmet is to be removed from the athlete in the safest manner possible. Helmet style will dictate the technique necessary to safely remove the helmet.

Clinical Protocol for Immobilization Any student-athlete suspected of having a spinal injury is not moved and is to be managed as though a spinal injury exists. C-spine in-line stabilization is maintained. EMS is to be activated.

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The student-athlete’s airway, breathing, circulation, level of consciousness (Glasgow Coma Scale) and neurological status are to be assessed. If airway is impaired, maintain c-spine in-line stabilization simultaneously with airway using a modified jaw thrust maneuver. If the student- athlete’s breathing is inadequate, assist ventilations with bag-valve-mask and supplemental oxygen. The student-athlete will not be not be moved until immobilized unless absolutely essential to maintain airway, breathing and circulation. If the student-athlete must be moved, the student- athlete is to be placed in a supine position while maintaining spinal immobilization. In a situation where it may not be appropriate for on-site medical personnel to transfer the student-athlete to a long spine board prior to EMS arrival (lack of enough qualified help or other factors), the rescuer(s) will maintain in-line stabilization, place a rigid cervical collar on (if possible), and continue to monitor baseline vital signs and complete secondary survey while awaiting EMS.

Spine Immobilization If possible, a correctly sized rigid cervical collar is to be placed on student-athlete prior to moving. When moving a suspected spine-injured student-athlete who is prone, the head and trunk are to be moved as a unit by securing the student-athlete to a long spine board. Log-roll maneuver is used to place the student-athlete on the long spine board. It is ideal that at minimum three (3) rescuers with preferably five to six (5-6) be in place to perform the log roll procedure. When moving a suspected spine-injured student-athlete who is supine, the head and trunk are to be moved as a unit by securing the student-athlete to a long spine board. A six-plus man lift maneuver is to be used to place the student-athlete on the long spine board. It is ideal that at minimum seven (7) rescuers, 1 at the head and 3 on each side of the body (2 at shoulder, 2 at hips, 2 at lower legs). The rescuer controlling c-spine stabilization will be in command of lift maneuver and long spine board immobilization. Once positioned onto long spine board, the student-athlete’s torso and legs are first secured, using spider straps or speed clips (if speed clips are used, 5 straps are to be applied: 2 crossing chest from shoulder to opposite axilla, one across chest under axilla, 1 across pelvis, and 1 across distal thighs). Student-athlete’s arms are to be left free from long spine board straps to facilitate vital sign monitoring and IV access. Student-athlete’s wrists may be secured together in front of the body with Velcro straps or tape once secured to long spine board. Once torso and legs are secured, the head is to be secured last. If necessary, padding is to be applied under the student-athlete’s head to fill any voids and maintain neutral in-line position. The head is to be secured with lateral restraint pads and then secured to board with tape over forehead and at the chin. After securing the student-athlete to the board, neurological status is to be reassessed. The secondary survey is to be completed with baseline vital signs (reassessed every 5 minutes), head-to-toe survey, and history.

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The student-athlete is to be transported to the most appropriate emergency medical facility and the Team Physician is notified. Additional Guidelines For Care of Spine-Injured Student-athlete Wearing a Helmet The facemask is to be removed prior to transportation, regardless of current respiratory status. Tools for facemask removal (power screw driver, FM Extractor, Anvil Pruners, or ratcheting PVC pipe cutter) are to be readily accessible. All loop straps of the facemask are to be removed and the facemask lifted from the helmet, rather than being retracted. The helmet is only be removed if: o The helmet and chin strap do not hold the head securely, such that immobilization of the helmet does not immobilize the head; o The design of the helmet is such that, even after removal of the facemask, the airway cannot be controlled nor ventilation provided; o The facemask cannot be removed after a reasonable period of time; or o The helmet prevents immobilization for transportation in an appropriate manner. Procedures for Training in Spine Immobilization: Personnel will review signs and symptoms of spine injury and complete a training session each year with in-line stabilization, rigid cervical collar application, log roll maneuver, six plus man lift, and long spine board packaging.

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SUDDEN CARDIAC DEATH Policy The following policy is intended to assist the George Mason University Sports Medicine Staff and Physicians in establishing the steps necessary to prepare and respond to an unexpected sudden cardiac episode. The policy is based on the recommendations found in the National Athletic Trainers Association consensus statement established by the Inter-Association Task Force on Emergency Preparedness and Management of Sudden Cardiac Arrest in High School and College Athletic Programs 2007;42(1)143-158. Definition of SCA Sudden Cardiac Arrest is a leading cause of death in the United States, claiming an estimated 325,000 lives each year. During a sudden cardiac arrest, heart function ceases abruptly and without warning. When this occurs, the heart is no longer able to pump blood to the rest of the body, and in 95% of victims death occurs.

While Sudden Cardiac Arrest (SCA) is a significant public health crisis, it is often misunderstood. SCA is not a heart attack. A heart attack occurs when a blood vessel becomes blocked and interrupts blood flow to the heart, causing heart muscle to die. Sudden cardiac arrest occurs when the heart's electrical system malfunctions and the heart stops beating. Most of these deaths occur with little or no warning, from a syndrome called sudden cardiac arrest. The most common cause of sudden cardiac arrest is a disturbance in the heart rhythm called ventricular fibrillation. Recognition of SCA Prompt recognition and identification of SCA is critical in the management of this life- threatening emergency. Any collapsed athlete who is unresponsive requires an immediate assessment for SCA. On-site responders must maintain a high level of suspicion for SCA, as unrecognized SCA in a collapsed athlete causes critical delays in the initiation of CPR and defibrillation. Resuscitation is often delayed because the victim is reported to have signs of life. Sudden cardiac arrest can be misdiagnosed as a seizure in the form of involuntary myoclonic jerks; seizure-like activity is present in approximately 20% of patients with cardiogenic collapse. To avoid life-threatening delays in resuscitation, brief seizure-like activity should be assumed to be due to SCA and initial management steps for SCA taken immediately until a non-cardiac cause of the collapse is clearly determined.

Other obstacles to recognizing SCA in athletes include inaccurate rescuer assessment of pulse or respirations. Occasional or agonal gasping can occur in the first minutes after SCA and is often misinterpreted as normal breathing. Occasional gasping does not represent adequate breathing and, if present, should not prevent rescuers from initiating CPR. Health care providers should take no longer than 10 seconds to check for a pulse and should proceed with chest compressions if a pulse is not definitively detected.

Most SCA occurs with no warning. If symptoms precede the event they may include:

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Common Signs and Symptoms of SCA Chest pain (angina pectoris) Difficulty breathing (dyspnea) Rapid/racing heart rate (tachycardia) Nausea/Vomiting Dizziness/Feeling faint (syncope) Sometimes SCA can occur with no prior symptoms Management of SCA Early activation of EMS, emergency action plan, early CPR, early defibrillation, and rapid transition to advanced cardiac life support (ACLS). Sudden cardiac arrest is to be suspected in any collapsed athlete. An AED is to be applied as soon as possible on any collapsed and unresponsive athlete for rhythm analysis and defibrillation if indicated. CPR is to be provided while waiting for the AED. Interruptions in chest compressions are minimized and CPR stopped only for rhythm analysis and shock. CPR is to be resumed immediately after the first shock, beginning with chest compressions, with repeat rhythm analysis after every 2 minutes or 5 cycles of CPR, and continued until advanced life support providers take over or the victim starts to move. Sudden cardiac arrest in athletes can be mistaken for other causes of collapse, and rescuers are trained to recognize SCA in athletes with special focus on potential barriers to recognizing SCA, including inaccurate rescuer assessment of pulse or respirations, occasional or agonal gasping, and myoclonic jerking or seizure-like activity. Any athlete who collapses after being struck in the chest by a firm projectile or by player contact is to be suspected of having SCA from commotio cordis also called a cardiac contusion. Rapid access to the SCA victim is to be facilitated for EMS personnel.

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SICKLE CELL TRAIT POLICY In compliance with the NCAA sickle cell policy, the George Mason University Department of Athletics requires that all student athletes show proof of sickle cell status prior to participation regardless of ethnicity. The student-athlete will be asked to provide newborn screen records or complete a blood test prior to coming to campus as part of the medical forms process. In the event that a student-athlete does not report with the appropriate proof of sickle cell status, the teams Athletic Trainer will facilitate the sickle cell solubility test with the George Mason University Health Center. All walk-on or tryout players must provide results of a sickle cell test prior to participation. PROCEDURE In the event that a student-athlete tests positive for the trait or disease, the student-athlete will meet with the team physician and their staff athletic trainer. The meeting and education will be properly documented. They will be educated on their condition and will sign a Sickle Cell Positive Waiver. The student-athlete will be provided with the NCAA Sickle Cell Trait Fact Sheet for Student-Athletes. All coaches and staff athletic trainer(s) will be notified of a student- athlete who tests positive for either the trait or disease. All coaches and Sports Medicine Staff have received education on how to manage student-athletes with either condition. The coaches will be provided the NCAA Sickle Cell Trait Fact Sheet for Coaches. No student-athlete will be discriminated against due to their sickle cell status.

According to the NCAA and the NATA position statement on preventing sudden death in sports, Journal of Athletic Training 2012;47(1) 96-118, student-athletes with sickle cell trait are encouraged to take the following precautions: Set his/her own pace. Engage in a slow and gradual preseason conditioning regimen to be prepared for sports-specific performance testing and the rigors of competitive intercollegiate athletics. Build up slowly while training (e.g., paced progressions). Use adequate rest and recovery between repetitions, especially intense drills. Not be urged to perform all-out exertion of any kind beyond two to three minutes without a breather. Be excused from performance tests such as serial sprints or timed mile runs, especially if these are not normal sport activities. Stop activity immediately upon struggling or experiencing symptoms such as muscle pain, abnormal weakness, undue fatigue or breathlessness. Stay well hydrated at all times, especially in hot and humid conditions. Maintain proper asthma management. Refrain from extreme exercise during acute illness, if feeling ill, or while experiencing a fever. Access supplemental oxygen at altitude as needed.

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Seek prompt medical care when experiencing unusual distress. TREATMENT Sickling collapse should be treated as a medical emergency. Signs and symptoms of exertional sickling warrant immediate withdrawal from activity. High-flow oxygen at 15 L/min with a non-rebreather face mask is to be administered. The Athletic trainer is to monitor vital signs and activate the EAP if vital signs decline. The Athletic Trainer has a duty to make sure the Team Physician is aware of the presence of exertional sickling event and be prepared to treat the metabolic complications of explosive rhabdomyolysis.

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CONDITIONS OF IMPAIRMENT POLICY A student-athlete with impairment is defined as a person who only has one organ that was originally a pair, I.e. lungs, eyes, kidney, etc. A person with a pre-existing loss of an organ or paired organ is an individual whom lost said organ prior to becoming a student-athlete at George Mason University. Individuals with a pre-existing impairment or an impairment sustained while participating in intercollegiate athletics will have to sign a letter of acknowledgement stating that they understand the risk of competing with only one organ. PROCEDURE Any student-athlete choosing to participate in George Mason University's intercollegiate athletics that has lost or incurs a loss of any organ or paired organ (eye, kidney, etc.) must meet with the team physician to determine the appropriate plan. Each situation will be handled on an individual basis and the physician’s decision will be the final authority on participation.

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PREGNANCY AND PARENTING POLICY

The purpose of this policy is to protect the health and mental well-being of a student athlete and his or her unborn child by establishing the following resources for pregnant or parenting students:

 During and post-partum care and athletic medical procedure  Where the student athlete can access medical and obstetric care  Where the student-athlete can receive confidential counseling  Risks and benefits of physical activity with pregnancy  Address the needs and resources of a male student-athlete who is the father of a child  NCAA guidelines protecting pregnant athletes’ financial aid and eligibility

This document serves only as a general outline of the management of student-athlete pregnancy, each case will be evaluated on an individual basis dependent on personal, familial, and sport risk factors.

Medical and Obstetric Procedure

A student-athlete is not required to inform Sports Medicine staff if she becomes pregnant. However, for the safety of the student-athlete as well as your unborn fetus, we encourage this notification to help insure the utilization of all available resources.

A member of the sports medicine department should be notified at the earliest known date of pregnancy. For the safety of the student-athlete, and the unborn fetus, the student-athlete must first be cleared by her own OB/GYN and then a George Mason University team physician before she may participate in any athletic activity. The student-athlete will know and understand the risks and benefits of exercise as well as the warning signs of fetal harm during exercise before she is cleared to participate.

Whether the pregnancy is carried to term, miscarried, or terminated, a student athlete must be cleared by the OB/GYN who managed the pregnancy, as well as the team physician to return to athletic participation post pregnancy. The student-athlete must provide written documentation of athletic clearance from OB/GYN.

If the student-athlete does not wish to disclose her pregnancy to coaches or other athletics staff, the student-athlete should be reassured that confidentiality will be maintained within the medical team as long as it is medically safe to do so.

Access to Medical and Obstetric Care

George Mason University Student Health Center offers women’s health screenings including pregnancy testing and counseling. The healthcare providers at Mason Student Health Center as well as the team physicians are available to discuss options, resources, and services available. If a student-athlete does not have an OB/GYN in the area, the Sports Medicine Staff has a list of

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Confidential Counseling

Pregnancy is likely to cause considerable changes for a student-athlete. Whether the student- athlete brings the pregnancy to term or not, confidential counseling should be recommended and resources given to student-athletes as an outlet for care. George Mason University Counseling and Psychological Services (CAPS) confidential counseling services may be utilized by calling the CAPS general line at 703-993-2380 or by contacting Student Support and Advocacy Services at 703-993-3686. Team physicians and personal physicians or obstetric providers may also give resources for outside counselors.

Healthy Activity While Pregnant

Evidence suggests that women who exercise during pregnancy have improved cardiovascular function, limited weight gain and fat retention, improved mental state, less complicated labor, and enhanced postpartum recovery. There is little evidence to suggest that increased physical activity increases the risk of spontaneous abortion.

In early pregnancy, physical risk for mother and fetus from athletics is low given appropriate health monitoring by OB/GYN and team physician. First trimester nausea and vomiting may disrupt athletic activity, but does not typically harm the mother or fetus. High level activity, monitored by proper health care providers, typically does not put mother or fetus at risk before 14 weeks of gestation. However, each individual sport and athletic participation is at the discretion of both the providing OB/GYN and the MASON team physician. After 14 weeks, student-athlete should avoid training and competition in the supine position, avoiding Valsalva straining, and avoid activities with a high risk of falling. At this point, the student-athlete may continue cardiovascular and weight lifting workouts, only as advised by their providing OB/GYN and the team physician.

Warning signs to terminate exercise while pregnant:  Vaginal Bleeding  Shortness of Breath Before Exercise  Dizziness  Headache  Chest Pain  Calf Pain or Swelling  Pre-term Labor  Decreased Fetal Movement  Amniotic Fluid Leakage  Muscle Weakness

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Resources for Student-Athletes Whose Partners Become Pregnant

Although partners do not experience the physical changes associated with pregnancy, they too may suffer considerable psychological stress. They may worry about the health of their pregnant partner, their ability to financially and emotionally support a child, or question their readiness for parenthood. They may disagree with their partner on the decision to carry to term, or terminate the pregnancy. Although not physically carrying the child, the student-athlete partner should also be given resources to Counseling and Psychological Services (CAPS) to help manage the emotional and mental well-being associated with the pregnancy.

NCAA Eligibility and Financial Aid Regulations

Title IX of the Education Amendments of 1972 set forth a general ban on pregnancy discrimination stating that schools must treat pregnancy and all related conditions the same way they treat all other temporary disabilities. In addition, schools must provide special protection for pregnant students by requiring an institution to provide them with necessary medical leave, and to reinstate them to the same status as they held when the leave began.

Financial assistance to student-athletes cannot be terminated or reduced on the basis of pregnancy, and institutions cannot require female student-athletes to sign athletic contracts listing pregnancy as an infraction. As long as a student-athlete remains in good standing academically and does not withdraw voluntarily, a pregnant student-athlete’s scholarship is protected from being reduced or withdrawn. Title IX Regulations also apply to a male student- athlete, protecting him from adverse treatment on the basis of his parental, family, or marital status.

Under NCAA bylaws, a student-athlete may be granted an additional year of competition due to hardship, typically referred to as a “red-shirt year”. In addition, the NCAA bylaws permit a one- year extension of the five-year period, allowing a pregnant student-athlete to complete four years of competition within six years. A pregnant student-athlete who competed during, but did not complete the season, may be granted a hardship waiver. In this case, they will be awarded an additional season of competition, provided there is proper medical documentation that the student-athlete was unable to compete for the remainder of the season. All questions regarding possible waivers must be discussed with the compliance officer for verification of eligibility and processing.

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TYPE 1 DIABETES Policy The following policy on management of type 1 diabetes has been developed in accordance with the National Athletic Trainers Association Position Statement: Management of the Athlete with Type 1 Diabetes Mellitus, Journal of Athletic Training 2007;42(4)536-545 and the George Mason University Sports Medicine Department to provide quality healthcare services and assure the well-being of each student-athlete at George Mason. Diabetes Care Plan Each athlete with who has been diagnosed with diabetes will have a diabetes care plan for practices and games. The plan will include the following: Blood glucose monitoring guidelines. Address frequency of monitoring and pre-exercise exclusion values. Insulin therapy guidelines will include the type of insulin used, dosages and adjustment strategies for planned activities types, as well as insulin correction dosages for high blood glucose levels List of other medications. Include those used to assist with glycemic control and/or to treat other diabetes-related conditions. Guidelines for hypoglycemia recognition and treatment. Include prevention, signs, symptoms, and treatment of hypoglycemia, including instructions on the use of glucagon. Guidelines for hyperglycemia recognition and treatment. Include prevention, signs, symptoms, and treatment of hyperglycemia and ketosis. Emergency contact information. Include parents’ and/or other family member’s telephone numbers, physician’s telephone number, and consent for medical treatment (minors) Athletes with diabetes are recommended to have a medic alert bracelet with them at all times. Supplies for Athletic Training Kits Supplies to treat diabetes-related emergencies are available at all practices and games. The athlete provides the following items: A copy of the diabetes care plan from treating endocrinologist Blood glucose monitoring equipment and supplies. The athletic trainer will check the expiration dates of supplies, such as blood glucose testing strips and insulin, on a regular basis. Blood glucose testing strips have a code number located on the outside of the test strip vial. The code number on the blood glucose meter and test strip vial must match. Supplies to treat hypoglycemia, including sugary foods (e.g. glucose tablets, glucose gel, sugar packets) or sugary fluids (e.g. orange juice, non-diet soda) and a glucagon injection kit. Supplies for urine ketone testing A “sharps” container to ensure proper disposal of syringes and lancets Spare batteries (for blood glucose meter and/or insulin pump) and, if applicable, spare infusion sets and reservoirs for insulin pumps.

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Pre-participation Physical Examination Athletes with diabetes should have a glycosylated hemoglobin (HbA1c) assay every 3 to 4 months to assess overall long-term glycemic control. However, the HbA1c value is not used to make day-to-day decisions concerning participation. It can help team physicians with management and evaluate the student-athlete’s treatment compliance.

An annual examination for retinopathy, nephropathy, and neuropathy is recommended along with an annual foot examination to check sensory function and ankle reflexes. Screening for cardiovascular disease should occur at intervals recommended by the athlete’s endocrinologist or cardiologist. Exercise limitations or restrictions for athletes with diabetes-related complications should be determined by the athlete’s physician. Recognition, Treatment, and Prevention of Hypoglycemia Strategies to recognize, treat, and prevent hypoglycemia typically include blood glucose monitoring, carbohydrate supplementation, and/or insulin adjustments. Athletes with diabetes are to discuss carbohydrate counting and an insulin plan for athletic activity.

Athletic trainers are to know the signs, symptoms, and treatment guidelines for mild and severe hypoglycemia. Hypoglycemia is defined as mild if the athlete is conscious and able to swallow and follow directions or severe if the athlete is unable to swallow, follow directions, or is unconscious. Treatment of severe hypoglycemia requires a glucagon injection, and athletic trainers are trained in mixing and administering glucagon. Mild Hypoglycemia (athlete is conscious, able to follow directions and swallow) o Administer 10-15g of fast acting carbohydrates (4-8 glucose tablets) o Measure blood glucose level o Wait 15min and re-check blood glucose o If blood glucose level remains low, administer another 10-15g of fast acting carbohydrates o Re-check blood glucose level in 15min o If blood glucose level does not return to the normal range after second dosage of carbohydrates, activate EMS Severe Hypoglycemia (athlete is unconscious, unable to follow direction or swallow) o Activate EMS o Prepare glucagon for injection following directions in the glucagon kit. The glucagon kit has either (1) a fluid-filled syringe and a vial of glucagon powder or (2) a syringe, 1 vial of glucagon powder, and 1 vial of fluid. o Inject the fluid into the vial of glucagon. Note: if the vial of fluid is separate, draw the fluid into the syringe and inject it into the vial of glucagon powder o Gently shake the vial until the glucagon powder dissolves and the solution is clear. o Draw fluid back into the syringe and then inject glucagon into the arm, thigh, or buttock o Glucagon administration may cause nausea and/or vomiting when the athlete awakens. Place the athlete on his or her side to prevent aspiration 213 2/16/2018

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Recognition, Treatment, and Prevention of Hyperglycemia

Athletes with Diabetes and athletic trainers are advised to follow the American Diabetes Association (ADA) guidelines for avoiding exercise during periods of hyperglycemia. Athletes with Diabetes who experience hyperglycemia during short-term, intense, and stressful periods of exercise should consult with their physicians concerning an increased basal rate or the use of small insulin boluses to counteract this phenomenon.

Athletes are to drink non-carbohydrate fluids when blood glucose levels exceed the renal glucose threshold (180mg/dL, or 10mmol/L), which may lead to increased urination, fluid loss, and dehydration. Hyperglycemia (unusual fatigue, sleepiness, inattentiveness, loss of appetite, increased thirst, frequent urination, fruity odor to breath, rapid breathing) o Fasting blood glucose level is greater than 250mg/dL. Test urine and/or blood for ketones. If ketones are present, exercise is contraindicated. If ketones are not present, exercise is not contraindicated. o Blood glucose value is greater than 300mg/dL and without ketones. Exercise with caution and continue to monitor blood glucose levels. Carbohydrate Supplementation Before exercise o When blood glucose is less than 100mg/dL carbohydrates are to be consumed per the requirement set forth in the athletes management plan o If blood glucose is greater than 300 mg/dL exercise should be withheld until blood sugar lowers During Exercise o Additional carbohydrate supplementation may be needed for practices or games lasting more than 60min when the pre-exercise insulin dosage has not been reduce by at least 50% o Athletes who are exercising at the peak of insulin activity may require additional carbohydrates. Post Exercise o Athletes are encouraged to eat a snack and/or meal shortly after exercise. Insulin Administration Insulin should be administered into the subcutaneous tissue. The abdomen, upper thigh, and upper arms are common sites for injection. Intramuscular injections of insulin should always be avoided as muscle contractions may accelerate insulin absorption.

Depending on the type of insulin used by the athlete, extremes in temperature should be avoided for 1 to 3 hours after an injection of rapid-acting insulin and up to 4 hours for fast-acting insulin. Heat may increase insulin absorption rates. Thus, athletes with diabetes should avoid warm whirlpools, saunas, showers, hot tubs, and baths after injection. Local heat-producing modalities 214 2/16/2018

George Mason University – Department of Athletics Sports Medicine Policy and Procedure Manual such as moist hot packs, diathermy, and thermal ultrasound should not be applied directly over an infusion or injection site. By contrast, cold may decrease insulin absorption rates. Therefore, athletes with Diabetes should avoid using ice and cold sprays directly over the injection or infusion site after insulin administration. Similarly, cold whirlpools should be avoided after insulin injection.

Insulin pump users should replace insulin infusion sets every 2 to 3 days to reduce skin and infusion site irritation.

Extreme ambient temperature (<36 deg F or > 86 deg F) can reduce insulin action. Athletes with Diabetes are advised to check blood glucose levels frequently and replace the entire insulin-filled cartridge and infusion set if any signs of unusual hyperglycemia occur in extreme environmental conditions. Travel Recommendations Athletic trainers are advised review the advice provided by the Transportation Security Administration (TSA) in conjunction with the AADA for airline passengers with diabetes traveling within the US. In addition, athletes are advised to carry diabetes supplies with them and have prescriptions available in the event that medication or supplies need to be replaced. Due to extreme temperature fluctuations that could affect insulin action, insulin is not to be stored in the cargo hold of the airplane.

When traveling, athletes with Type I Diabetes are advised to carry prepackaged meals and snack in case food availability is interrupted. If travel occurs over several time zones, insulin therapy may need to be adjusted to coordinate with changes in eating and activity patterns.

Athletic Injury and Glycemic Control Trauma, even in persons without diabetes, often causes a hyperglycemic state. Hyperglycemia is known to impair the wound healing process; thus, for athletes with Type I Diabetes, monitoring of blood glucose is imperative when recovering from injury, including increased frequency of blood glucose monitoring.

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ASTHMA POLICY POLICY Asthma is a disorder of the airway characterized by chronic hyper-responsiveness of the bronchi. The George Mason University Sports Medicine Department aligns itself with the position statement published by the National Athletic Trainer’s Association (NATA) in the Journal of Athletic Training, 2005;40(3)224-245 in regards to the identification, treatment and follow-up care of student-athletes with asthma.

If a student-athlete has been diagnosed as an asthmatic prior to their arrival at George Mason University, further medical exams will be performed if necessary to make sure that the symptoms are under control and that the medication is correct for that student-athlete. All first- year student-athletes will undergo a thorough pre-participation exam. If signs or symptoms of asthma are found, a more in-depth work-up will be performed to determine the extent of the disease. Every student-athlete will undergo a yearly physical exam with a team physician. If signs or symptoms of asthma become evident during the academic year, the team athletic trainer will refer the student-athlete to the team physician for evaluation or follow-up. Signs and Symptoms Chest tightness (or chest pain in children) Coughing Prolonged shortness of breath (dyspnea) Wheezing (especially after exercise) Performance affected by breathing difficulty Use of accessory muscles to breathe Dyspnea when exposed to allergens or irritants Exercise-induced symptoms Family history of asthma Personal history of atopic dermatitis/eczema or hay fever PROCEDURE After a student-athlete is diagnosed with asthma, an individualized plan of care will be developed by the team physician, team athletic trainer and student-athlete. The plan includes preventative components and asthmatic episode treatment protocols. The treatment plan will also include the following: Baseline Peak flow testing Periodic pulmonary function testing (as needed) List of prescriptions used by student-athlete Directions for each prescription for asthma

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Plan that takes into account practice dynamics and how to prevent asthmatic episodes during practice and competition Acute Care Plan if an emergency arises Treatment for Exercise Induced Asthma (EIA) In the event that a previously diagnosed asthmatic student-athlete experiences EIA during athletic activity, the George Mason University Sports medicine Staff may assist the student- athlete in the use of his/her prescribed metered dose inhaler (MDI). The student-athlete is removed from athletic competition and is assisted with the administration of the MDI, followed by assessment of FEV using the peak flow meter (PFM).

The following instructions shall be provided when assisting a student-athlete in the use of a MDI: Remove the cap and hold the inhaler upright Shake the inhaler for about 5 seconds Tilt head back slightly and breathe out Hold the inhaler 1-2” away from mouth If spacer is available, place directly in mouth Press down on the inhaler to release the medicine as he/she begins to breathe in slowly Breathe in slowly for 3 to 5 seconds Hold your breath for 10 seconds to allow medicine to go deeply into the lungs Repeat the process after about 1 minute Assess FEV using PFM

The following instructions shall be provided when assisting a student-athlete in the use of a PFM:

Following the administration of a quick relief medication via a MDI the student-athlete is to wait 5 minutes prior to using a PRM (See previous listed procedures for assessing FEV). Should a PFM not be readily available, the athletic trainer should assess the situation and make a return to play decision based on athlete’s condition, playing conditions, etc.

Make sure the sliding marker or arrow on the PFM is at the bottom of the numbered scale (zero or the lowest number on the scale). Have the student-athlete stand up straight. Take a deep breath. Place the mouthpiece of the PFM into mouth, securing lips tightly around the mouthpiece In one second, blow out as hard and as quickly as possible until emptying all of the air from the lungs (Forced Expiratory Volume) 217 2/16/2018

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Note the Forced Expiratory Volume (FEV) and repeat the routine three times. (Note: if done correctly the numbers should be close together.) Record the highest number of the three trials

Return to Play Criteria Following EIA Attack Respiration rate is to be within normal limits Assess pulse rate (80-100 bpm) If a PFM is not readily available, the athletic trainer should assess the situation and make a return to play decision based on the athlete’s condition, playing conditions, etc. If the athletic trainer has a PFM available, the following steps will be implemented: At 5 minutes post MDI administration the student-athletes FEV must be within 10% of his/her baseline reading to return to competition. If the athlete does not have a baseline, a female athlete should hit a minimum of 35 ml/kg/min and a male athlete should hit a baseline of 45 ml/kg/min. In the event the EIA is not relieved after the re-assessment of FEV the student-athlete is to remain out of competition for an additional five minutes Re-assesses FEV using the PFM as many times as needed by repeating the above steps until the student-athlete’s FEV is within 10% of baseline. If the student-athlete’s respirations do not return to normal or the FEV does not return to within 10% the student-athlete will be referred to a team physician Basic Life Support Treatment for Severe Asthma

Student-athletes who have progressed to a severe asthma attack, experience a combination of the following: Patients who have progressed to severe asthma experience a combination of the following: Shortness of breath (>25 respirations/min.) Mental status changes (anxious, confused, combative, drowsy) Inability to speak in sentences Sweating profusely Unable to lie down. If the patient is not responding to or is unable to properly use their MDI, the Sports medicine Staff will: Assess the oxygen saturation level using a pulse oximeter and deliver oxygen beginning at a rate of 10 L/min until saturation levels are above 94%. Oxygen will be titrated up as needed to obtain the recommended saturation level. If the athlete’s symptoms do not improve and saturation levels do not rise above 94% within 10 minutes of treatment, EMS should be called. 218 2/16/2018

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Athletic trainers should be prepared to assist ventilation with a bag-valve mask if the athlete suffers respiratory arrest. Education Each student-athlete who is diagnosed with asthma will be educated on the extent of their condition and have an opportunity to ask questions of a George Mason medical staff member in regard to the condition. The Team Physician will educate the student-athlete in the proper usage of any medication that is prescribed to them for the control of asthma and how they may interact with other prescriptions they may be on. Follow-up Student-athletes who have well-controlled asthma will follow-up with the team physician at least once a year during the annual pre-participation physical exam. Any student-athlete whose asthma is not under control, having frequent episodes or worsening signs and symptoms shall be referred to the team physician for further examination as soon as possible.

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INFLUENZA Assessment

Student-athletes with flu-like signs and symptoms that include low-grade fever (>100), chills, cough, sore throat, head ache, body aches and/or fatigue, that present to the athletic training staff or who contact the staff by phone, will be advised of medical care and how to self-isolate.

Student-athletes that contact coaches or any other staff, in regards to an illness, should be advised to contact the athletic training staff.

The athletic training staff will triage (by phone) those student-athletes with a history of chronic disease (e.g. asthma, or significant signs and/or symptoms) to be seen by the team physician, or student health.

Ill athletes will be given a mask and have as much isolation in the field house as possible when they report to a team physician.

Information concerning the illness, medical care, housing, meal plan and any concerns about the student-athlete will be recorded in the athletic training room and reported to team physicians and student health.

An anti-viral medication will only be prescribed to those student-athletes with a history of chronic illness, or significant disease, as determined by the team physician.

Management

Coaches will be contacted and advised on the student-athlete’s status and any other effects the illness may have on other team members.

Team members should avoid direct contact with the ill student-athlete. Instruction will be given for roommates especially those who may be involved in the care of the ill student-athlete.

If at all possible ill student-athletes should go home during the self-isolation period.

In the event a student- athlete presents with symptoms during travel, the athletic trainer will coordinate with our coaches on how to best isolate that student-athlete at the hotel or at the athletic venue and on the bus. Providing travel for the student-athlete to return to Mason or home will also be considered. If the situation could require assistance from the host team, the athletic training staff at the host school will be contacted prior to arrival. In the event it is best to leave a student-athlete at a hotel, the student-athlete must have access to the athletic trainer via phone. A plan will be made to return a staff member to the hotel if the student-athlete’s symptoms worsen. Emergency contact information for the hotel should also be obtained.

When an ill student-athlete is traveling by bus or plane, the bus driver or airline should be notified as soon as possible. The athletic trainer will identify themselves as the health care

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As the host institution, the athletic training staff will provide assistance to a visiting team who has an ill student-athlete. The staff will coordinate with the visiting athletic trainer or coaches to provide an area for isolation and medical care as needed. The athletic training staff will alert the Mason team physician as appropriate. The isolation areas at Mason athletic facilities are as follows: family changing room at the Field House. An unused locker room at Eagle Bank Arena. The family changing room beside the athletic training room at the Recreation and Athletic Complex.

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HYPERTENSION Introduction George Mason University student-athletes will be screened for hypertension yearly. This will occur in August for all incoming freshmen and transfer student-athletes and in May for all returning student-athletes. The screening will consist of a blood pressure check by the Athletic Training staff and/or Team Physician(s). Every effort will be made to conduct screening in such a way that minimizes external forces effecting blood pressure measurements. Student-athletes must be at least 2 hours removed from physical activity and every effort will be made to conduct screening in a calm, quiet environment.

Those student-athletes who are diagnosed with elevated blood pressure or hypertension will be monitored on a regular basis. The following table will be used in the classification of Blood Pressure:

Classification of Blood Pressure* Class Systolic blood pressure (mm Hg) / Diastolic blood pressure (mm Hg) Optimal <120 / <80 Normal <130 / <85 High normal 130 to 139 / 85 to 89 Hypertension Stage 1 140 to 159 / 90 to 99 Stage 2 160 to 179 /100 to 109 Stage 3 >=180 / >=110

Any student-athlete who has chronic elevated blood pressure readings will be referred to a Team Physician for further evaluation.

Exercise and Sports Participation in Student-Athletes with Hypertension

Exercise o The recommended mode, frequency, duration, and intensity of exercise are generally the same as those for persons without hypertension.

Sports participation o Blood pressure should be controlled before resumption of participation in vigorous sports, because both dynamic and isometric exercise can cause remarkable increases in blood pressure.

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Recommendations on Exercise Restrictions High-normal blood pressure - No restrictions Controlled mild to moderate hypertension (<140/90 mm Hg) - No restrictions on dynamic exercise; possible limit on isometric training or sports in some patients Uncontrolled hypertension (>140/90 mm Hg) - Limited to low-intensity dynamic exercise; avoid isometric sports. Controlled hypertension with end organ damage - Limited to low-intensity dynamic exercise; avoid isometric sports. Severe hypertension with no end organ involvement - Limited to low-intensity dynamic exercise, with participation only if blood pressure is under adequate control. Secondary hypertension of renal origin - Limited to low-intensity dynamic exercise; avoid "collision" sports that could lead to kidney damage. Information from 26th Bethesda Conference: Eligibility recommendations for Competitive Athletes with Cardiovascular Abnormalities, 2005. J Am Coll Cardiology 2005 ;45:8, 1314-1375.

Risk Factors for Hypertension in Student-Athletes and Other Physically Active Patients High sodium intake Excessive alcohol consumption (binge drinking) Illicit drug use (e.g., cocaine) Anabolic steroid use Stimulant use (e.g., in supplements taken to enhance energy or control weight) High stress levels Male gender Race (Afro-Americans are affected more often than Caucasians by about a 2-to-1 ratio, and Asians affected the least) Family history of hypertension or cardiac disease in men over 55 years of age and women over 65 years of age Diabetes mellitus or glucose intolerance Smoking or chewing tobacco Obesity or poor diet habits

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TRANSGENDER POLICY Introduction George Mason University along with the NCAA believes in and is committed to diversity and gender equity among its student-athletes, coaches, and administrators. Our goal is to create a safe and welcoming environment in which our student-athletes are able to achieve success on and off the field. With that in mind, George Mason University has implemented a policy for the inclusion of transgender student-athletes in intercollegiate competition. In order to better understand the policy and promote a non-discriminatory environment for our student-athletes we must first become familiar with the terms associated with gender identity while understanding that gender identity is more complex than our society generally acknowledges.

“Transgender” or “trans” means that a person’s internal sense of gender differs from their sex assigned at birth. A trans male (or FTM, female-to-male) is a person who was assigned the sex of female at birth, but identifies as a man. The same goes for a trans female (or MTF, male-to- female), someone who was assigned the sex of male at birth, but identifies as being a woman.

In the 2011 NCAA Inclusion of Transgender Student-Athletes handbook the following guidelines are listed to be used by collegiate athletics when creating policies that govern the participation of transgender student-athletes. Please keep in mind that as new research becomes available in relation to the physiological effects of gender transition on athletic performance these policies may be re-evaluated to ensure they reflect the most current research-based information. Participation in intercollegiate athletics is a valuable part of the education experience for all students. Transgender student-athletes should have equal opportunity to participate in sports. The integrity of women’s sports should be preserved. Policies governing sports should be based on sound medical knowledge and scientific validity. Policies governing sports should be objective, workable, and practicable; they should also be written, available, and equitably enforced. Policies governing the participation of transgender students in sports should be fair in light of the tremendous variation among individuals in strength, size, musculature, and ability. The legitimate privacy interests of all student-athletes should be protected. The medical privacy of transgender students should be preserved. Athletic administrators, staff, parents of athletes, and student-athletes should have access to sound and effective educational resources and training related to the participation of transgender and gender-variant students in athletics. Policies governing the participation of transgender students in athletics are to comply with state and federal laws protecting from discrimination based on sex, disability, and gender identity and expression. 224 2/16/2018

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Policies for Intercollegiate Teams (Adopted from the NCAA Inclusion of Transgender Student-Athletes handbook, 12-14 and On the Team: Equal Opportunity for Transgender Student Athletes)

A transgender student-athlete is allowed to participate in any sports activity so long as that athlete’s use of hormone therapy, if any, is consistent with the NCAA existing policies on banned medications. Specifically, a transgender student-athlete is allowed to participate in sex separated sports activities under the following conditions:

Transgender Student-Athletes Undergoing Hormone Treatment o A trans male (FTM) student-athlete who has received medical exception for treatment with testosterone for diagnosed Gender Identity Disorder or gender dysphoria and/or Transsexualism, for purposes of NCAA competition may compete on a men’s team, but is no longer eligible to compete on a women’s team without changing that team status to a mixed team.

o A trans female (MTF) student-athlete being treated with testosterone suppression medication for Gender Identity Disorder or gender dysphoria and/or Transsexualism, for the purpose of NCAA competition may continue to compete on a men’s team but may not compete on a women’s team without changing it to a mixed team status until completing once calendar year of testosterone suppression treatment.

o Mixed Team: A mixed team has both female and male participants and may be restricted in championship play according to specific national governing body rules. Transgender Student-Athletes Not Undergoing Hormone Treatment o Any transgender student-athlete who is not taking hormone treatment related to gender transition may participate in sex-separated sports activities in accordance with his or her assigned birth gender.

o A trans male student-athlete who is not taking testosterone related to gender transition may participate on a men’s or women’s team (If male team, mixed team status is required).

o A trans female student-athlete who is not taking hormone treatments related to gender transition may not compete on a women’s team.

Recommended Implementation Process The Student’s Responsibilities A student-athlete that has completed, plans to initiate, or is in the process of taking hormones as part of a gender transition is to submit the request to participate on a sports team in writing to the Director of Athletics upon matriculation or when the decision to undergo hormone treatment is made.

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The request will include a letter from the student’s physician documenting the student-athlete’s intention to transition or the student’s transition status if the process has already begun. This letter will identify the prescribed hormonal treatment for the student’s gender transition and documentation of the student’s testosterone levels, if applicable.

George Mason University’s Responsibilities The Director of Athletics or his/her designee and Assistant AD for Compliance will meet with the student to review eligibility requirements and procedures for approval of participation of transgender student-athletes. If hormone treatment is involved in the student-athlete’s transition, the Director of Athletics or his/her designee will notify the NCAA of the student’s request to participate with a medical exception request. All information about an individual student’s transgender identify, medical information, discussions among involved parties, and required written support documentation will be kept confidential, unless the student-athlete makes a specific request otherwise. Furthermore, a student-athlete who is denied the ability to participate based upon hormone treatment will be offered an accommodation in some other capacity with their team (e.g. manager, student assistant, etc.) and will be able maintain scholarship as a result of the choice if denied the ability to continue with competition.

Facilities, Support and Education Facilities Access o Changing Areas, Toilets, Showers – Transgender student-athletes will be able to use the locker room, shower, and toilet facilities in accordance with the student’s gender identity. When requested by a transgender student-athlete, George Mason will provide private, separate changing, showering, and toilet facilities for the student’s use, but transgender students will not be required to use separate facilities.

o Competition At Another School – If a transgender student-athlete requires a particular accommodation to ensure access to appropriate changing, showering, or bathroom facilities, athletic directors, and coaches, in consultation with the transgender student- athlete, will notify their counterparts at other schools prior to competitions to ensure that the student has access to facilities that are comfortable and safe. This notification will maintain the student’s confidentiality. Under no circumstances will a student- athlete’s identity as a transgender person be disclosed without the student’s express permission.

o Hotel Rooms – Transgender student-athletes generally will be assigned to share hotel rooms based on their gender identity, with recognition that any student who needs extra privacy will be accommodated whenever possible. Support o Language – In all cases, teammates, coaches, and all others part of George Mason University athletics will refer to transgender student-athletes by a student’s preferred name. Similarly, in all cases, pronoun references to transgender student-athletes will reflect the student’s gender and pronoun preferences. 226 2/16/2018

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o Dress Codes and Team Uniforms – Transgender student-athletes will be permitted to dress consistently with their gender identities. That is, a female-to-male transgender athlete will be permitted to dress as a male. A male-to-female will be permitted to dress as a female.

o Dress codes for athletic teams when traveling or during a game day at school are to be gender neutral. All team members will have access to uniforms that are appropriate for their sport and that they feel comfortable wearing. No student will be required to wear a gendered uniform that conflicts with the student’s gender identity. Education o Institutions – All members of George Mason University community will receive information and education regarding the policies and procedures related to transgender student-athletes. George Mason University and the NCAA will ensure its staff understands non-discrimination policies, the mandatory use of preferred names and pronouns, and expectations for creating a respectful team and university climate for all students, including transgender and gender variant students.

o Opposing Teams/Universities – Without violating a transgender student’s confidentiality or privacy, school leaders, athletic directors, and coaches will communicate with their counterparts at other schools prior to competitions in which a transgender athlete is participating about expectations for treatment of transgender student-athletes on and off the field. This does not require “outing” or otherwise identifying a particular student-athlete as transgender, but rather establishing general expectations for the treatment of all student-athletes, including those who may be transgender.

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MENTAL HEALTH/ SPORTS PSYCHOLOGY

POLICY

George Mason University Athletics adopts a comprehensive and holistic approach to supporting the well-being, safety, and optimal performance of student-athletes. This approach entails collaboration between the University Counseling and Psychological Services unit, Athletics, and other University support services. Prevention, mental health promotion, early intervention, and access to effective clinical care inform all efforts to support student-athletes’ emotional health.

There are two main areas of impact in the mental health of our athletes; the psychology of working toward optimum performances, and the positive mental health of our athletes.

In the area of performance psychology, counselors are available to teams and athletes for work around goal setting/leadership/ etc. These visits are coordinated through the Sr. Assoc. Athletic Director for Performance, Well-Being, & Risk Management.

Counselors at CAPS are also available to address personal mental health concerns among student-athletes or to provide support for student-athletes and Athletics staff following an emotionally charged event or trauma. Services are free and confidential and include routine and emergency responses. Student-athletes can self-refer for services or referrals can be facilitated by Athletics staff or another concerned party. CAPS counselors also provide consultation to Athletics staff or those concerned about a student-athlete’s mental health and well-being. For a full description of the referral process, please see the section below titled Referral for Mental Health Concerns. At all times, student-athletes have the right to limit information shared with Athletics and Coaching staff, including information about attendance or contact with CAPS (for additional information regarding release/exchange of information, refer to the section below titled Confidentiality and Privacy).

At times, student-athletes may be prescribed a medication to address psychological symptoms. Student-athletes are responsible for managing all matters related to the medication, including physician appointments, prescription fills/refills, etc. The Sports Medicine Department is not responsible for paying for these medications; though the Sports Medicine Department may assist student-athletes with the cost in various circumstances. These circumstances will be considered on an individual basis and payment may be made from the Department’s Student Assistant Fund.

Mental Health Screening

All student-athletes are required to participate in mental health screenings as part of the comprehensive pre-participation exam. Brief screening tools are administered to all student- athletes and address topics such as general mental health and disordered eating. These tools are 228 2/16/2018

George Mason University – Department of Athletics Sports Medicine Policy and Procedure Manual not diagnostic and do not take the place of a clinical health assessment completed by a trained mental health professional. Additionally, mental health can be fluid and student-athletes may not endorse items even though they may be experiencing challenges. As such, Athletics staff should be alert for indicators that a student-athlete may be in distress and should follow procedures described in the section below titled for Referrals for Mental Health Concerns. Below is a brief outline of the procedures for mental health screenings:

1) Student-athletes complete the mental health screening questionnaires as part of the series of documents completed in the pre-participation exam. 2) Sports Medicine staff review student-athletes’ responses to mental health screening questionnaires and meet in-person with student-athletes who endorse any items indicative of a potential concern (note. review of responses will occur the same day as the student- athlete completes the questionnaire to ensure that any items endorsed relative to safety are addressed the same day). 3) During the in-person or telephone meeting with the student-athlete, Sports Medicine staff inquire about the student-athlete’s mental health and general functioning and ask follow- up questions related to items of concern/challenge endorsed by the student-athlete (Counseling and Psychological Services or other resource to provide training to Sports Medicine staff on how to facilitate such discussions and gather additional information). 4) If, following discussion with the student-athlete, the Sports Medicine staff member has a concern for the student-athlete’s mental health, they will discuss the concern with the student-athlete and make a referral to Counseling and Psychological Services per the procedures outlined in the section titled Referrals for Mental Health Concerns (this section includes procedures for addressing concerns about a student-athlete’s immediate safety).

Referral to University Support Services

Referral for Sport Performance:

1) Referrals for sport performance are coordinated through the Sr. Associate Director for Sport Performance, Well-Being and Risk Management, who alerts the Associate Director, Clinical Services of CAPS (or designee) of an impending referral.

2) Student-athletes must contact CAPS telephonically or in-person to schedule the appointment as services at CAPS must be initiated by the individual seeking the services.

3) Student-athletes may choose to provide written authorization to CAPS to release and exchange information with designated staff in Athletics or others (e.g., faculty, university staff, family, community health providers, etc.). This authorization specifies the type of information to be released/exchanged as well as the duration for which the authorization is valid.

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4) Services at CAPS are focused and time-limited. If student-athletes would benefit from more extensive long-term support, they will be provided with case management services to facilitate successful connection with community providers. CAPS will request a written authorization from the student-athlete to permit release/exchange of information to facilitate transfer and coordination of care with community providers.

Referral for Mental Health Concerns: Counseling and Psychological Services partners with the University Student Support and Advocacy Center to help address student, faculty, staff, and/or parent concerns about student behaviors that may raise concerns about emotional health and safety. To streamline the referral process for student-athletes and Athletics staff, Counseling and Psychological Services serves as the primary portal for consultation and referrals for all student-athlete mental health concerns with the exception of sexual assault/interpersonal violence and mild to moderate alcohol/drug use concerns (see sections below titled Referral for Alcohol and Other Drug Use Concerns and Referral for Sexual Assault/Interpersonal Violence for additional information regarding referral processes for these matters).

1) Athletics staff may refer student-athletes directly to CAPS or may consult with their supervisor and/or the Sr. Associate Athletic Director for Sport Performance, Well-Being & Risk Management for assistance with facilitating the referral. Should a direct referral be made, please inform the Sr. Associate Athletic Director for Sport Performance, Well- Being & Risk Management as soon as practicably possible, so follow-up can be arranged.

2) In most situations, it is recommended that he Athletics staff member who observed the concerns share the information directly with a CAPS counselor. This affords the counselor an opportunity to provide guidance on next steps and also ensures the information is recorded into the CAPS confidential health record so that the counselor who meets with the student-athlete will have complete information to guide their assessment. (note. authorization or permission from the student-athlete is not necessary for Athletics staff and others concerned about a student-athlete to share information with CAPS). a. During business hours: Athletics staff should contact the CAPS main telephone number (703-993-2380) and ask to speak with the Counselor on Call. There are several Counselors on Call available at all times during business hours to consult with those concerned about a student-athlete. b. For urgent concerns after hours and on weekends: staff members should contact the GMU Police Department (703-993-2810) and ask to speak with the CAPS Counselor on Call. c. For life threatening emergencies (including those in which a staff member is unsure if an immediate safety concern may arise), staff members should dial 911.

3) CAPS will not initiate a contact with a student who is not currently participating in services because students have a right to decide whether they want to engage with a psychological service. As a result, CAPS may request that the Athletics staff member

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contact the Student Support and Advocacy Center (703-993-3686) to report the concern and request assistance from SSAC staff in engaging the student-athlete in seeking professional assistance.

4) Student-athletes must contact CAPS directly (either telephonically or in-person) to arrange to speak with a counselor (Athletics staff can assist the student-athlete in identifying available times to meet with a counselor but they cannot schedule an appointment on behalf of the student-athlete).

5) Student-athletes may choose to provide written authorization to CAPS to release and exchange information with designated staff in Athletics. This authorization specifies the type of information to be released/exchanged as well as the duration for which the authorization is valid.

6) Services at CAPS are focused and time-limited. If student-athletes would benefit from more extensive long-term professional services, they will be provided with case management services to facilitate successful connection with community providers. CAPS will request a written authorization from the student-athlete to permit release/exchange of information to facilitate transfer and coordination of care with community providers.

7) In the event of an acute emergency (i.e. threat or perceived suicide attempt, threat to others, significant changes in mental status, or destructive or aggressive behaviors) the student-athlete's parents/guardians, Sports Medicine Coordinator, Team Physician, George Mason police department, sport administrator, and Director of Athletics will be notified immediately by the athletics staff member who observed the behavior of concern. The student-athlete will be directed to the nearest emergency department or to CAPS for initial intervention and stabilization when appropriate. The Emergency Department and/or CAPS will coordinate further treatment and will provide recommendations for treatment to designated Athletics staff when the student-athlete has provided written authorization permitting such communication. The Team Physician and Sports Medicine Coordinator will determine proper return to athletic participation. * Note. CAPS does not make determinations or recommendations regarding a student-athlete’s athletic participation with the exception of acute mental health emergencies where there is imminent concern for the safety of the student-athlete or others and the assistance of Athletics staff is required to neutralize the threat to self or others.

8) Mental health visits with a psychiatrist, psychologist or other mental health professional or service provider outside of CAPS are billed to the student-athlete’s primary insurance and are the financial responsibility of the student-athlete.

* Please refer to the section below titled Training for documents provided to Athletics staff that briefly outline the referral processes for mental health concerns.

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Referral for Alcohol and Other Drug Use Concerns:

Athletics staff may refer student-athletes to Student Support and Advocacy Center when concerns about alcohol and/or other drug use emerge. You may also refer to the SSAC for any concerns about sexual assault/interpersonal violence. Please see the attached graphics for additional guidance.

Referral for Sexual Assault/Interpersonal Violence:

Athletics staff members are mandatory reporters under the Cleary Act and should report any known act of sexual violence to the Title IX coordinator for further action. You do NOT need to disclose names if the party asks for anonymity.

Sexual-Violence-an d-Misconduct-Support-and-Reporting-Options_Flow-Chart_George-Mason-University_updated-11-7-2017.pdf

Confidentiality and Information Sharing

Services at CAPS are confidential and CAPS staff are ethically and legally bound to ensure confidentiality is protected. This means that CAPS will not disclose information about a student- athlete to any other office or individual unless the student-athlete has provided written authorization to do so. In the absence of this authorization, CAPS will neither confirm nor deny that any student-athlete has contacted them or participated in services.

Exceptions to confidentiality occur in the following situations: (1) there exists a substantial likelihood that in the near future, the student-athlete may cause serious harm to themselves or others or that they will suffer serious harm due to a lack of capacity to protect themselves from harm or to provide for their basic human needs; (2) reasonable suspicion of current abuse or neglect of a child, elderly adult, or incapacitated adult, or (3) criminal proceedings, or a valid court order or subpoena, to disclose relevant information in a legal proceeding or investigation. In addition, by Virginia statute, if the university threat assessment team receives information that results in the threat assessment team opening an investigation regarding the student-athlete, CAPS may be required to provide information from the student-athlete’s CAPS health record to the threat assessment team as part of the investigation.

CAPS staff recognize that support from others can be beneficial to student-athletes when they are addressing emotional challenges or mental health concerns. As such, CAPS counselors will encourage student-athletes to consider whether there are University staff/faculty or others in their social support network who may be helpful to include in their care. They will then discuss the option to complete the Release of Information form to provide written authorization permitting CAPS to disclose information to identified individuals.

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Student-athletes can complete the Release of Information form at CAPS during business hours. If the student-athlete is unable to go to CAPS, they may download the Release of Information form from the CAPS website and fax it to CAPS (the original should then be mailed to CAPS). Any form that is not completed in the presence of a CAPS staff member or an approved mental health provider must be witnessed by a notary public. The faxed form should be also accompanied by a clear and legible copy of a photo ID (ID’s for both current and previous last names, if applicable). *Note. Consult with CAPS to determine who qualifies as an approved mental health provider as this may vary by situation.

Sharing Information with CAPS

Although CAPS is unable to disclose information with others without a student’s written authorization (with the exception of the above-noted circumstances), staff and faculty at the University may freely share information with CAPS, Student Support and Advocacy Center, GMU Police Department, and other University officials when they have concerns about a student. The Federal Education Rights and Privacy Act’s (FERPA’s) disclosure restrictions do not apply to personal knowledge derived from direct, personal experience regarding a student’s emotional well-being and safety or the safety of others. In addition, there are certain situations related to safety of students/others and sexual or interpersonal violence when University staff are required to report the information to a designated official/department. As a result, it is recommended that Athletics staff do not promise to keep disclosures from student-athletes confidential. Rather, staff should explain to the student-athlete that there are certain circumstances in which they may have to share the information with other University officials but they promise to honor the student-athlete’s privacy by only telling those who need to know to address safety and well-being of the student-athlete or others.

Training and Education

CAPS will provide annual training for all Athletics staff who directly interact with student- athletes. The training will cover topics related to prevention, mental health promotion, CAPS and University support services, and recognizing and responding to student-athletes experiencing stress/distress and creating an emotionally healthy culture that promotes personal growth and optimal performance in sport and in academics. Additional topics will be included upon request of the Sr. Associate Athletic Director for Sport Performance, Well-Being and Risk Management.

As part of their annual training, Athletics staff will be provided with a copy of the information below regarding recognizing and responding to students experiencing emotional or mental health concerns.

Recognizing and Responding to Student Experiencing Stress or Distress

At Mason, we are committed to the health and well-being of students. While most students face stress and other life challenges with no significant problems, a small but significant portion of students may experience more serious mental health issues. For these students, mental health

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Indicators of Potential Distress

We are aware that it can be difficult to know when to be concerned about a student, especially for those who are not mental health professionals. Students experiencing stress or a sense of being overwhelmed may exhibit their problems in a variety of ways. While there is no "template" for identifying a concerning student, the following table provides some warning signs that may indicate a distress or significant emotional concern as well as guidance for responding and referring students to professional services:

Often times, you may find yourself in a situation that warrants direct interaction with the student before you have had a chance to consult with a professional. Below is a helpful guide of strategies and approaches to consider when engaging with students about whom you are concerned:

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University Support Services

Consultation and assistance is always available to you. We are here to help so please don’t hesitate contact the resources below when you have a question or are seeking guidance about how to support a student of concern.

Counseling and Psychological Services: provides confidential psychological services, including 24/7 crisis intervention and consultation to faculty and staff  8:30 a.m.-5:00 p.m., Monday thru Friday- 703-993-2380 (*extended evening hours on Tuesdays and Wednesdays when classes in session)  After business hours/weekends, call the GMU Police Department at 703-993-2810 and ask to speak with the CAPS Counselor on Call.

Student Support and Advocacy Center: Assists students who encounter barriers to their academic success or personal growth by connecting them with on- and off-campus resources. Supports student survivors of interpersonal violence by responding to crisis needs including emergency housing assistance, aid with reporting, guiding students to psychological, medical, legal and judicial resources, and advocating for students within the Mason community  8:30 a.m.-5:00 p.m., Monday thru Friday – 703-993-3686  24-hour Sexual Assault & Intimate Partner Violence Crisis Line – 703-380-1434 235 2/16/2018

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 On-line referral system (for non-emergencies only): http://ssac.gmu.edu/make-a-referral/

GMU Police Department:  Emergencies: 911  Non-Emergencies: 703-993-2810

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We hope you find this information helpful. If you have any questions please do not hesitate to contact the Sr. Assoc. AD for Performance, Well-Being, & Risk Management.

Educational Programming for Student-Athletes

Members of the Student-Athlete Advisory Committee (SAAC) and other student-athletes informal or informal leadership roles will be provided annual training on recognizing and responding to peers experiencing stress/distress. This training will also be made available to any student-athletes who wish to participate. The Sr. Associate Athletic Director for Sport Performance, Well-Being, and Risk Management may also arrange for additional educational programming to be provided to all student-athletes or designated teams as needed. These additional topics may include stress management, sleep hygiene, nutrition and disordered eating, etc.

Training for University Support Services Staff

Annual training by a representative from Athletics will be provided to staff at Counseling and Psychological Services, Disability Services, and Student Support and Advocacy Center. Topics covered will include understanding the culture of sport and Division 1 Athletics, factors to consider when making recommendations for additional services for student-athletes (e.g., eligibility requirements, medication policy, etc.), services provided to student-athletes by Athletics, and other relevant issues that are deemed beneficial for University support services staff members to know in order to optimally support student-athletes.

Coordinated Approach to Mental Health Promotion

Athletics will establish an interdisciplinary team to provide a coordinated approach to support student-athlete mental health and well-being. This team will be led by Sr. Assoc. AD for Performance, Well-Being & Risk Management and will include members from the following University departments: Counseling and Psychological Services, Learning Services, Sports Medicine, Athletics Academic Services, Sports Dietician, Disability Services, Student Support and Advocacy Center, and other departments/staff designated by the Sr. Associate Athletic Director for Sport Performance, Well-Being, and Risk Management. This interdisciplinary team will be charged with identifying and responding to trends impacting the health, well-being and academic and sport performance of student-athletes. This team may also be responsible for monitoring coordination of care for student-athletes identified as at-risk.

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SPORTS NUTRITION

Sports Nutrition Nutrition plays an integral role in promoting athletic success. Proper nutritional habits help student-athletes stay healthy and optimally fueled in order to maximize training, conditioning, and recovery. Good nutrition habits can equate to greater gains in lean body mass, minimize fatigue related to poor hydration and under-fueling, enhance recovery, and injury prevention and rehabilitation, which supports all future training and competition. To accomplish these goals, the student-athletes must get appropriate calories and nutrients essential for fueling the body throughout the day at the optimal times.

Nutrition Education Student-athletes are encouraged to work with the George Mason University performance team that includes a Registered Dietician, Strength and Conditioning staff, Certified Athletic Trainers, and coaches to work toward their nutrition goals through nutrition coaching, counseling, and/or meal planning. All nutrition advice and educational material shall be in accordance with NCAA guidelines and will be developed by a member of the performance team. Furthermore, nutrition education will be part of the Center for Sports Performance program and will be conducted by a registered dietician (RD) with a board certification in sports dietetics (CSSD). Student athletes will have required education components that they will need to attend on an annual basis. If a student-athlete has a medical condition (i.e. diabetes, celiac disease, food allergies, lactose intolerance, high blood pressure, vitamin or mineral deficiency, an eating disorder etc.), that impacts health and nutrition, the student-athlete will be referred to the team physician by the certified athletic trainer for further evaluation If the student-athlete is in need of nutrition counseling, they shall be referred by the team physician, to the Sports Dietitian.

BODY COMPOSITION ASSESSMENT AND WEIGHT MANAGEMENT

It is the goal of the Center for Sports Performance (CSP) to assist the student athlete and athletic coach in evaluating and enhancing student athlete performance goals. The CSP will provide the professional assistance for body composition parameters such as lean body mass, fat mass and total body mass as appropriate for the athlete’s sport and position. Student-athletes (SA) should strive to achieve a body composition that is both within a range associated with good health and performance in their respective sport, as well as within the SA’s natural genetic predisposition. There are potential performance and long-term health benefits that result from ideal ranges of body fat percentage and lean body mass. Our goal will be to emphasize healthy personal improvements in performance based nutrition and body composition while recognizing individual differences of student athletes. The NCAA, NATA, ACSM, and Academy of Nutrition and Dietetics have developed guidelines that provide a safe and consistent method of evaluating body composition. Counseling of the student athlete on weight management will be conducted by a registered dietitian specifically trained to work with athletes. The following protocol is written based on these guidelines and our goal of individual personal improvement in 239 2/16/2018

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Body Composition Assessment

. Student-athletes and/or team coaches should report their concerns about body weight/composition to the CSP (athletic trainer, sports dietician, strength and conditioning coach). The CSP will work with SAs to evaluate the overall health, functional performance measures and sport performance. Body composition is inclusive of total body mass, fat free mass, fat mass, percent fat free mass and percent fat mass. Body mass index (BMI) is a health risk parameter for the general population and is not an accurate measure in the athletic population. CSP team will utilize skin-fold calipers and the bod pod for SA assessment. Body composition changes will be voluntary and the athletic trainer will approach the SA to determine if a change is desired. . If body composition modifications are desired by the SA to improve overall health and performance, the SA will be referred to the sports dietician. The CSP and the SA will set individualized goals. The CSP team will continue to monitor and educate the SA in order to avoid unhealthy eating and exercise behaviors. The CSP team may involve other medical staff in the goal-setting process as warranted. . Team coaches may not weigh SAs, measure or observe assessments of SAs, or share weight/body composition information publicly. SAs have the right to refuse testing and to determine who has access to their private information. Body composition assessment will be evaluated in a setting that protects the SA’s right to privacy . Prior to medical clearance, height and weight will be assessed by an athletic trainer and may be repeated at the request of the team physician or sports dietitian. . Body composition assessment will be performed by the athletic trainer or sports dietician, using skin fold measurements, or by the sport scientist (approved staff) or sports dietitian using the BOD POD unit. A SA may be assessed 2-3times an academic year unless more frequent monitoring is requested by team physicians. The CSP team may refrain from doing measurements if it is contraindicated for health reasons.

Body Composition Protocol

. Sports performance and body composition assessments will be reviewed by the CSP. Assessment results, individual goals and management strategies will be provided to the SA. This may be part of a team’s yearly assessment plan. . SA will be encouraged to focus their training and dietary intake on developing lean muscle mass rather than reducing body fat. SAs who desire to make body composition change will set goals with the sports dietician and will be offered an individualized nutrition plan to support improved body composition, strength, and performance goals.

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. The CSP team will also establish functional performance measures and goals in combination with body composition goals. These factors will help establish overall improvement in athletic performance. With the permission of the SA, the coach may also receive information about the body composition and weight assessment measurements and goals. Coaches will not post or publicly discuss individual assessments. . The CSP team will monitor a SA’s progress in performance measures and goals, and assist the SA in achieving personal goals. Reassessment intervals will be established. This monitoring by the CSP team will also be focused on reducing the risk of unhealthy eating and exercise habits. . Coaches, peers, and family members should not provide information on diet, body composition, weight, or weight management practices and should refrain from making comments about or participating in the monitoring of body composition and weight.

Disordered Eating and Eating Disorders

. SAs are at an increased risk of developing and/or maintaining patterns of disordered eating due to their participation in collegiate sports. These eating habits can have short-term and long-term health consequences including increased risk of injury, vitamin and mineral deficiencies, frequent illnesses, depression, gastrointestinal issues, cardiac abnormalities and even death. Disordered eating will negatively affect athletic performance over time as well. Training and education about eating disorders will be provided to sports teams and to athletic personnel working with SAs. . Team coaches who witness or have reports of a SA displaying signs or symptoms of an eating disorder should report this information to the team athletic trainer, team physician, or the Sports Medicine Coordinator. SAs are encouraged to report concerns about these behaviors in their teammates as well. Signs and symptoms of eating disorders may include withdrawal, fatigue, frequent illnesses, refusal to eat with others, frequent trips to the bathroom after eating, noticeable weight loss or weight gain, chewing and spitting out food, or preoccupation with food and body weight. . An appropriate intervention involves an expression of concern that the SA is displaying specific eating attitudes and behaviors that may interfere with his/her health and athletic performance. A treatment team which may include an athletic trainer, team physician, sports dietician, psychologist, and team coach will determine the method of this communication. . The SA will meet with the team physician for evaluation, and establish a diagnosis and treatment plan. The treatment plan may include required visits with the team physician, the sports dietitian, a psychologist, body composition assessments, diagnostic labs and tests, limitation of physical activity or any other intervention as deemed medically or psychologically necessary. . The team physician and the Sports Medicine Coordinator will oversee compliance of the treatment plan. If the SA refuses to comply with the treatment plan, a contract

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will be established by the Head Team Physician that will restrict or terminate sport participation without the SA compliance.

Hydration monitoring

For the purpose of monitoring hydration, weight monitoring will also be required during August pre-season practices for men’s and women’s soccer. Athletic trainers will record body weight before and after each pre-season practice. Any SA who loses three percent of his original hydrated weight will be restricted in practice activities. SAs with a five percent loss from their original body weight will not be allowed to practice until hydration is improved and body weight is regained.

CONTRACT FOR MEDICAL CARE (Example Only) As a result of the Team Physician’s concern for the health and well-being of the student athlete concerning a very serious medical issue, the following contract is written to ensure that the student athlete understands and complies with the requested medical referrals. By signing this contract the student athlete understands and agrees to follow the contract or athletic participation will not be allowed. At the request of the Head Team Physician, the items circled below are those appointments that must be attended by the student athlete within the given time frame. All involved parties will receive a copy of this contract to ensure a team effort in providing this medical care.

1. Appointment with team physicians - ______

2. Appointment with sports nutritionist - ______

3. Appointment with psychologist - ______

4. Weight monitoring - ______

5. Body composition monitoring - ______

6. Diagnostic medical testing - ______

7. Permission for team physician/ - ______ICA Administration to discuss with parents w/ or w/o student athlete present.

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SIGNATURES:

Student Athlete - ______

Team Physician - ______

Sports Med Coordinator -______

Head Coach - ______

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STRENGTH & CONDITIONING/WEIGHT ROOM

Mission Statement

Enhance the student-athlete’s experience, through the design and implementation of training programs to increase athletic performance and reduce the risk of injury. This should be accomplished without jeopardizing the safety of any individual or the integrity of the Department of Intercollegiate Athletics.

Staff Policies & Procedures

Be on time…for all meetings, team training sessions and any travel involved with a team you are assigned. If for some reason you will be late for any of the above, contact the person you are to meet. Wear proper George Mason athletic attire. This includes t-shirts, polos, sweatshirts, shorts, warm-up pants and sneakers. Athletic attire from another institution is not permitted in our facility. Meet your assigned teams with enthusiasm! Give them the feeling they are important and you care about them as student-athletes. Give your full attention and energy to your assigned responsibilities. Prepare the weight room / training area before your team arrives for their workout. Do not discuss coaching decisions with athletes or coaches. Enforce all weight room policies. Any topic discussed in a staff meeting or an individual meeting is confidential and should not be discussed outside the meeting. Be loyal to the Department of Intercollegiate Athletics. Be careful what you say, where you say it and to whom you say it. If you have a complaint or issue bring it to the attention of the Head Strength and Conditioning Coordinator. Be professional at all time. Athletic training must approve each athlete prior to their initial participation in training activities. Contact the athletic training staff daily for injury updates. Follow the athletic training staff recommendations on rehabilitative exercise modalities and volume.

Chain of Command

Department of Intercollegiate Athletics

Assistant Vice President, Director of Athletics Brad Edwards

Senior Associate AD – Sports Performance, Well-Being & Risk Managment Debi Corbatto

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Head Strength and Conditioning Coordinator Robert “Handy” Handerahan

Assistant Strength and Conditioning Coordinators John Delgado, Alex Milton

Graduate Assistant Strength and Conditioning Coach Brad Turnbaugh

Interns

Weight Room Policies

 Only George Mason student-athletes and those associated with the Department of Intercollegiate Athletes are permitted to use the weight room.  Pre-participation approval is required from the athletic training staff prior to your first training session in the weight room.  Proper George Mason athletic attire is required. Shorts, Warm-up pants, t-shirt, sweatshirt, sneakers. No jeans, no boots, no shower shoes permitted for workouts. No clothing representing another university is permitted.  Prepare for your training session prior to coming to the weight room. Do not show-up to train without having had something to eat or drink before coming to the weight room.  Approach your training session with enthusiasm.  All training sessions are pre-scheduled. There are no drop-in training sessions. Contact the strength staff to inquire if the room schedule is favorable for an unscheduled training session.  If you feel ill and can’t attend a scheduled training session contact your athletic trainer and the strength staff.  If you cancel your team’s scheduled training session contact the staff.  All bags, balls and jackets are to be kept outside.  Glass containers and chewing gum are not permitted.  Strip and rack weights from equipment after use.  Clean equipment vinyl surfaces after use.  Staff will control the music selection and volume.  Staff is not responsible for holding any personal items.  Use common sense.  Any violation may result in a loss of weight room privileges.

Daily Cleaning and Maintenance

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 All vinyl surfaces of weight room equipment are to be cleaned throughout the day.  Clean equipment utilized at the conclusion of each team training session.  Re-rack and evenly distribute weight plates at the conclusion of each training session.  Clean all vinyl surfaces at the conclusion of each day.  Refill bottles of cleaning solution and replace towels that are located on the weight room floor. One full bottle and one clean towel for each area of the weight room.  Refill cleaning solution dispensers as needed. They are located in the supply closet.  All weight room equipment is to be inspected throughout each day for safety. Address at once any loose bolts, cracked plates or frayed cables.  Bring to the attention of the Head Strength and Conditioning Coordinator any equipment that is in need of repair of replacement.  Cardio equipment located on the balcony will be inspected and cleaned by staff once per day by the strength and conditioning staff. Staff will be sure to place cleaning solution and a clean towel on the balcony for patrons to utilize to clean the equipment they used.  Used towels will be placed in the laundry bag located in the supply closet.  Take the used towel bag to the laundry at the conclusion of each day.  Pick-up the bag of clean towels at the start of each day.

Intern staff policies

The following rules and regulation have been designed to instill a sense of professionalism in your duties and appearance as an intern. Please read and direct any questions to your intern site supervisor.  Adhere to all staff policies and procedures. Failure to do so may result in immediate dismissal.  Be on time and dress appropriately.  If you will be unable to make it on time for your scheduled shift, contact your intern site supervisor.  Be professional at all times. There will be no fraternizing with student-athletes during training sessions.  Our interns are to maintain a safe workout environment for all using the weight room. Interns accomplish this by providing a clean and organized facility and assisting the strength staff with the set-up and breakdown of each workout session.  All interns are expected to embrace what we promote to our student-athletes, i.e. a healthy lifestyle including exercise, sound nutrition and a positive outlook.  Interns will only do what they have been empowered to do by their intern site supervisor. There will be no unsolicited health or training advice, no better way to do that exercise and no recommendations on supplements or ergogenic aids, etc.  You may experience stressful situations. It is vital you control your actions and maintain a professional attitude.

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Exertional Rhabdomyolysis Policy

The Mason Strength & Conditioning staff adheres to the NCAA best practices regarding avoidance of exertional rhabdomyolysis. These guiding principles are followed:

1. Transition periods are particularly vulnerable times for athletes and demand careful attention to progression in volume, intensity, mode and duration of activity. Examples of transition periods: a. Athletes new to the program. b. Athletes returning after an injury or illness c. Any delayed participation relative to team schedule d. Resumption of training after an academic break (e.g., winter, spring, summer). 6. All strength and conditioning workouts should be exercise-based, scientifically sound and physiologically representative of the sport and its performance requirements. 7. Conditioning programs should begin with a work-to-rest ration of 1-to-4. 8. The first four days of transition periods should be separate-day workouts, and all workouts: a. Should be documented in writing. b. Should reflect the progression, technique, and intentional increase in the volume, intensity, mode and duration of the physical activity. c. Should be available for review by athletics department staff. 9. Coaches and athletes should be aware of signs and symptoms of exertional rhabdomyolysis to include unusual muscle soreness, weakness, and dark urine. Any of the above should prompt evaluation by the athletic training staff or team physicians. 10. Strength and conditioning coaches will report any concerns they have with sport coaches programming within 24 hours to the Sr. Assoc. AD for Performance, Well-Being and Risk Management and/or the sport supervisor for follow up investigation and remediation. 11. Strength and conditioning coaches and sport coaches will not use conditioning sessions for punishment. We encourage all sport coaches to review their programming with the strength and conditioning staff to assure the safe participation of all student-athletes.

Commercial Activity Policy

No commercial or private “for profit” activity may be conducted in the weight room without required pre-approval. Examples of these activities include but are not limited to personal training or team training.

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Weather Related Closing

When the university is closed or on a delayed opening due to inclement weather the field house manager will email the building’s practice schedule for that day. This may impact the weight room schedule. We will make every attempt to accommodate all teams impacted. When the university is closed or delayed due to inclement weather you are not obligated to be on the roads if you feel the conditions are hazardous. Stay safe! Contact the affected sport coaches and the head strength and conditioning coordinator to make the necessary accommodations.

Frequently Asked Questions

What are the facility hours? The weight room is available for team scheduling from 7am-7pm Monday through Friday. The weight room hours and days of operation for each semester are set by the team training schedule, which is posted outside the weight room. Spring break, summer and holiday hours vary; check with weight room staff. There are no drop-in workouts. Each training session is scheduled prior. Contact a staff member to find out if supervision and floor space is favorable for any unscheduled training sessions.

Why can’t we play our music during our workout? You may be able to play your music provided it is not vulgar or offensive. We have outside people come through our facility on a daily basis. These people include recruits and their parents, financial boosters, university employees and professional contacts. We will not negatively compromise the first impression of George Mason University Intercollegiate Athletics.

Can you hold my (wallet, phone, jewelry, etc.) while I workout? No. Weight room staff is not responsible for your valuables. There are lockers available in the locker room that can secure your personal items. If you don’t have an assigned team locker in the field house, you can see the front desk for a temporary locker and lock to hold your items. The athletics staff is not responsible for lost or stolen items should you choose not to use the offered secure lockers.

Why can’t I workout in jeans, boots or shower shoes? Jean material (denim) does not tear easily should you get caught in a piece of moving equipment; additionally the rivets in jeans mar the equipment upholstery. The soles of boots bring in stones, dirt and mud, making areas of the floor unusable for floor-based exercises. Change into sneakers prior to entering the weight room. Shower shoes can slide off your foot during an exercise movement which is a safety concern.

Do you have cardio equipment? Yes. Our cardio equipment is located on our upstairs balcony. We have Spinner bikes, recumbent bikes, elliptical trainers and treadmills. All are available for your use.

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Do you have Band-Aids? Yes. They are in the first aid kit located in the supply room closet.

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Field House Weight Room Emergency Action Plan

Contact numbers Medical Emergency: 911 Campus police: 703-993-2810 Field House Front Desk: 703-993-3222

If an accident or medical emergency occurs in the weight room or the cardio area the following Emergency Plan must be enacted.

Do not move the victim or allow anyone else to move the victim. Send someone to get the AED, located at the front desk on the wall next to the water fountain.

Call 911 The dispatcher will ask… Victim’s age and sex. Is the victim conscious? Is the victim breathing? Where is the victim injured or bleeding? Does the victim have a head injury? Where are you located? George Mason University Field House. Answer all of the dispatcher’s questions the best that you can, do not hang up the phone until the dispatcher has hung up; the dispatcher may have more questions.

When the AED is brought to the scene follow the AED instructions.

Once EMS personnel arrive they will take over.

Complete incident report and turn into supervisor.

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Weight Room Incident Report

Date and time of the incident.

Name of victim.

Staff member at the time of the incident.

Brief description of the incident.

Did EMS respond?

Names of witnesses.

Sign and date.

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SPORTS SCIENCE/ RESEARCH- PATRIOT PERFORMANCE LAB

Primary Mission The PPL focuses on sports performance and athlete health as its primary mission. We assess and provide information concerning, musculoskeletal strength and power, body composition, and overall physical conditioning to colleagues of the Center for Sports Performance. This information is used for program design and implementation in the areas of nutrition, training, and athletic health care, which can lead to reduction in the number of injuries and improved sport performance. This innovative research lab is an ongoing collaboration between the Department of Athletics and the College of Education and Human Development.

Goals:

1. To provide relevant and innovative services that contribute to the evidence-based emphasis of the Center for Sports Performance 2. To advance knowledge of athlete health, sport performance, and sport science through promotion of collaborative research among colleagues of the Center for Sports Performance and George Mason University faculty.

Vision To advance the treatment, care, and performance of the George Mason University athlete through an interdisciplinary, team-based approach which involves athletic training, sports nutrition, strength and conditioning, and sports science.

Staff

Dr. Margaret T. Jones Margaret Jones is an Associate Professor of Kinesiology and an affiliate of the Sports Medicine Assessment Research Testing Laboratory at George Mason University. Previously, as Springfield College’s Director of Strength and Conditioning she supervised programming for 500 collegiate athletes. Her research objective is to ask and answer questions that will benefit the sports science practitioner and contribute to the development of research-based practice. She uses resistance exercise to addresses research topics that are integral to sports performance and athlete health: assessment of muscular strength and power, methods for neuromuscular development, and intervention strategies for injury reduction.

Dr. Jason White Dr. Jason White has been an assistant professor of kinesiology at George Mason University since 2015. After earning a Bachelor of Science degree (2001) in biology and a Master of Science degree (2002) in sport physiology, he was employed by Emory University as an exercise physiologist. After a brief stay at Emory University, he returned to school to attain a Doctor of Philosophy degree in human physiology and muscle biology from Ohio University. He became a

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Various Graduate Students/Interns

Research Requests regarding Intercollegiate Athletics

The attached Policy and Procedure regarding Research Requests in in effect immediately. This policy pertains to all current and planned research involving George Mason University student- athletes.

Debi Corbatto has been appointed as the department gatekeeper regarding research requests. Additional staff members involved in the evaluation of research and in the protection of our student-athletes are: Nena Rogers, Dr. Frank Pettrone and Kevin McNamee. Please direct any questions you may have regarding research to one of the above individuals.

Research Requests

Scope: This policy and procedure applies to all George Mason University faculty, staff and students, as well as researchers from outside the University.

Policy Statement: All research involving students and/or staff in the George Mason University Department of Intercollegiate Athletics must be reported to the Director of Intercollegiate Athletics and receive approval from him/her prior to implementation.

The Director if Intercollegiate Athletics may appoint an evaluator to review research proposals and provide recommendations regarding its acceptance or rejection.

Any information which becomes available to the researcher(s) as the result of research activities involving students and/or staff in the Department of Intercollegiate Athletics may be used only for the purpose(s) specified and only in the manner which has been pre-approved by the Director of Intercollegiate Athletics. This policy applies to information gathered through current 253 2/16/2018

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In keeping with George Mason University policy, only research requests which have received a favorable written review by the MASON Institutional Review Board (Office of Research Integrity & Assurance) will be considered for approval by the Director of Intercollegiate Athletics. Reviews by Human Subject Review Boards or Institutional Review Boards from other agencies or institutions will not be sufficient.

Responsible Parties: Researcher(s) Director of Intercollegiate Athletics MASON Institutional Review Board

Contacts: Director if Intercollegiate Athletics MASON Athletic Department Research Gatekeeper – Debi Corbatto MASON Institutional Review Board

Procedure: It is incumbent on all Athletic Department Personnel to refer any research requests to the appropriate Responsible Parties and/or Contact(s) listed above.

The researcher will submit their research documents to the MASON Institutional Review Board (Office of Research Integrity & Assurance). The MASON IRB will triage and review the project according to University standards and will be responsible for assuring the project meets ethical and risk standards acceptable to the University. Once the MASON IRB has approved the project, you will receive a letter of approval contingent on the Director of Athletics final review and consent for the Intercollegiate Athletic Department participation.

The researcher will contact the Director of Intercollegiate Athletics or his/her appointed research evaluator to provide notice of an intent to submit a request to conduct research involving staff or students in the George Mason University Department of Intercollegiate Athletics. The researcher should submit the entire research packet (including the IRB letter) to the MASON Athletic Department Research Gatekeeper. The gatekeeper will review the project and submit to other impacted parties, and others on the intercollegiate athletics research resource list for their input. The researcher will provide other information as requested.

The Director of Intercollegiate Athletics will accept or reject the request to conduct research and inform the primary researcher of his/her decision.

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Once IRB approval is obtained, you may contact the athletic department for internal review process. Step 1 - Register your interest with Debi Corbatto (gatekeeper- When research is complete OR when [email protected]). She will direct coach no longer wishes to participate IRB approval from MASON-IRB you regarding availability of subjects. in research, you will need to close out (http://oria.Mason.edu/research-with- your research file with Debi Corbatto humans-or-animals/institutional- Step 2 - If subject pool is available,you review-board) will need to contact coach and have All research conducted with the his/her letter of approval and interest in athletic department student-athletes Contingent on athletics approval letter participating. must have our express written from D. Corbatto (Gatekeeper) NOTE: during this process, you may be approval prior to any publication or directed to present your research to presentation to the public. others the department for review. Step 3- Letter will be provided to IRB that authorizes your access to subject pool.

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STUDENT-ATHLETE FORMS Medical History Questionnaire and Pre-Participation Exam Student-athletes must complete a medical history questionnaire through our online portal in the two weeks prior to the pre-participation exams (PPE) and prior to participation each year. Failure to complete the form in its entirety and accurately will disqualify the student-athlete from participation until it is completed. Please note: Student-athletes that willfully withhold information pertaining to their health status will relieve George Mason University of all responsibilities should a subsequent injury, re-injury, or illness occurs.

Medical History and PPE2017.docx

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Receipt of Insurance Procedures The George Mason University Athletics Department has specific guidelines for insurance coverage of student-athlete injuries prior to participation. All student- athlete’s or their parent(s)/guardian(s) for those under 18 years old must read this information and electronically sign this form in the Vivature Portal acknowledging that they have read and accept the procedures established by George Mason University Athletics.

2017-2018 ACADEMIC YEAR

MEDICAL INSURANCE INFORMATION

PERSONAL HEALTH INSURANCE:

Every student-athlete should be covered under a personal or family insurance policy and is encouraged to obtain complete, personal health insurance. This is the primary policy. Mandatory requirements accompany most primary policies. It is the responsibility of the student-athlete to know the requirements of their personal policy. If the personal policy guidelines are not followed, the Department of Intercollegiate Athletics will not be responsible for the incurred expenses. Student-athletes with Tricare Military or any HMO insurance will be required to follow the requirements of their insurance policy. It is highly recommended that a primary care physician in the Tricare North region, be selected in the Fairfax vicinity. By completing this process in advance, health care needs can be addressed in a timely manner for Tricare student-athletes. Please contact Linda Pullen at [email protected] for appropriate forms and further information concerning this procedure.

1. It is the responsibility of the student-athlete to have the following information current and on file in the Vivature portal at all times:

A. Personal/Family Insurance Information Form. B. Insurance Card (copy of front and back); and

2. It is the responsibility of the student-athlete and/or the policyholder to keep insurance information current and notify Athletic Training Staff immediately when changes occur.

3. It is the responsibility of the student-athlete to know and abide by the rules and regulations of his/her insurance policy.  George Mason University Sports Medicine Billing Process

George Mason University Sports Medicine offsets the rising costs of healthcare by billing insurance carriers for physician directed rehabilitation and treatment services rendered in the George Mason University Athletic Training Rooms. When a student-athlete requires medical care from a George Mason University Sports Medicine practitioner for an injury or illness, the student-athlete’s primary insurance policy will be billed for the services. The student 257 2/16/2018

George Mason University – Department of Athletics Sports Medicine Policy and Procedure Manual athlete will not be billed for any copays, coinsurance, or deductibles not paid by the primary insurance policy. The policyholder will not be billed for any balances as well. This should facilitate a continuation of improving health care services without putting the financial burden on you or your student-athlete. Please note under the current healthcare legislation, your premiums will not go up due to these types of claims, nor will your student-athlete be negatively impacted and labeled as uninsurable. Please note the following important information about charges, health insurance and health insurance information:

1. George Mason University Sports Medicine will ONLY BILL the student-athlete’s primary insurance policy and WILL NOT bill the student-athlete or the policyholder for any balance for these services. You will receive an Explanation of Benefits (EOB) from your primary insurance policy either in the mail or online each time a charge is filed. THIS IS NOT A BILL. 2. Some insurance carriers will only send payment(s) to the policyholder and not directly to George Mason University Sports Medicine Providers (i.e.: Frank Pettrone MD, John McConnell MD). The policyholder will be responsible for forwarding the payment(s).

a. If you receive a check from your primary insurance policy, please sign and endorse the back of the check to George Mason University Sports Medicine. You should mail the check along with EOB’s (Explanation of Benefits) or EOP (Explanation of Payment) to George Mason University Sports Medicine. b. If you receive and cash a check from your primary insurance policy, please write a personal check or cashier check, paid to the order of George Mason University Sports Medicine. Please mail the personal check along with the EOB’s OR EOP’s to George Mason University Sports Medicine.

Failure to forward pavement to George Mason University Sports Medicine can effect student- athlete NCAA eligibility.



Please see address below:

George Mason University Sports Medicine 4400 University Dr MSN 3A5 Fairfax, VA 22030 Attn: Deborah Corbatto

OFF- CAMPUS MEDICAL SERVICES AND THE BILLING PROCESS

The following are examples of off-campus services for which you may also receive a bill from the provider and an Explanation of Benefits (EOB) from your primary insurance policy: - Medical labs for blood work or urinalysis - Radiology for X-rays, MRIs, Bone scans, etc. -Office appointments for specialists - Charges related to surgery such as surgeon, hospital, anesthesiology, lab work - Emergency room visit - Ambulance/Emergency transport 258 2/16/2018

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-Mental health counselling

1. In the event a student-athlete is injured during official competition or practice and is referred to an off-campus medical facility or lab by a George Mason University Sports Medicine practitioner, it is the responsibility of the student-athlete and/or policyholder to provide the medical facility with the student-athlete’s primary insurance information for billing. An itemized bill and the explanation of benefits from the primary insurance should be sent to George Mason University Sport Medicine once the primary insurance has processed and a remaining balance is due the provider.

2. Medical expenses acquired due to illness, pre-existing injuries, injuries outside of official practice or competition, self-inflicted injuries and injuries not reported in a timely manner are the sole financial responsibility of the parent, guardian or student-athlete. Student-athletes without primary medical insurance assume this risk.

3. The student-athlete must coordinate any treatment of an athletically related injury with the Athletic Training Room Staff. In the event the student-athlete chooses to independently acquire medical services without a referral from a team physician or athletic trainer, the costs of such services shall be the sole responsibility of the student-athlete. If the student-athlete chooses to obtain medical or physical therapy services normally available through the University from an outside source, the cost of such services will be the sole responsibility of the student-athlete unless prior approval has been obtained from a George Mason University Sports Medicine Provider. Health care providers are available to student-athletes through the Athletic Training Room (i.e., certified athletic trainers, orthopedics, family practice, podiatrist, chiropractic).

4. The student -athlete must comply with the recommended treatment and rehab protocol as instructed by the George Mason University Sports Medicine Providers. In the event the student-athlete does not comply with the recommended treatment/rehab protocol, the cost of additional medical services for this injury will be the sole responsibility of the student-athlete. A student-athlete must consistently report to the athletic training room for treatment and rehab a minimum of 3 days each week to be in compliance with this policy. Written documentation from an athletic trainer will be required for exception to this policy.

5. Student-athletes/policyholders SHOULD NOT PAY MEDICAL BILLS that are athletically related. Reimbursement of these medical bills is not guaranteed by the university.

6. The Department of Intercollegiate Athletics has a secondary insurance policy. This policy is utilized in the event of certain athletic related injuries. This policy is only in effect for a period of TWO YEARS from the date of injury. Therefore, in order to successfully process your claim, timely submission of excess claims and all documentation to the George Mason University Sport Medicine Providers is essential.

7. The secondary policy will not be in effect in instances where the student-athlete has not properly followed their primary policy’s rules and regulations and/or has been non-compliant with recommended treatment and rehab protocols as provided by George Mason University Sports Medicine Providers.

It is the responsibility of each student-athlete to know all policies and procedures related to the Athletic Training Room and Insurance (consult your Student-Athlete Handbook, the Sports Medicine Coordinator, or an administrator if you need further information.)

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CERTIFICATION

I HEREBY CERTIFY THAT I HAVE READ, UNDERSTAND, AND WILL ABIDE BY ALL GEORGE MASON UNIVERSITY ATHLETIC INSURANCE AND ATHLETIC TRAINING STAFF REGULATIONS. I AM ALSO AWARE THAT MY MEDICAL RECORDS WILL BE DESTROYED 8 YEARS AFTER MY LAST YEAR OF ATHLETIC ELIGIBILITY.

PARENT/LEGAL GUARDIAN (if student-athlete is a minor), please print, sign your name, and date:

Name (printed) Signature Date

STUDENT-ATHLETE, please print, sign your name, and date:

Name (printed) Signature Date

PLEASE RETAIN A COPY OF THIS INFORMATION SHEET FOR FURTHER REFERENCE.

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Insurance Form/ Copy of insurance cards Student-athletes must complete and return the health insurance form and a front and back copy of the up to date insurance card on their Vivature portal page prior to participation. Student-athletes should have one of the following primary insurance coverage plans: personal insurance, covered under parents/guardians policy, or through George Mason University student primary health insurance. Student- athletes should carry primary insurance that covers athletic injuries PRIOR to participation in any George Mason athletic event.

Sample Card scan:

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Consent to Disclose protected health information Due to the concern over medical record confidentiality, it is necessary for the Sports Medicine Staff at George Mason University to obtain your written authorization to gather and release your medical information. By signing this form, you release the Sports medicine Staff at George Mason University of any and all legal responsibility or liability that may arise from this authorization. These questions must be completed on your athlete portal, electronically signed and submitted prior to participation.

 I hereby consent to allow the Mason Athletic Training Staff to disclose Protected Health Information concerning any injury or athletically related illness to my coaching staff and Mason Athletics Administration.

 I hereby consent to allow Mason Athletic Department Personnel to disclose Protected Health Information concerning any injury or athletically related illness to my parents, legal guardians, or wards.

 I authorize payment of medical benefits to all providers of services for all services and materials they provide during the care of any injury/illness.

 I agree to supply any information requested by my primary insurance, Mason, the secondary insurance company, or the NCAA and its affiliates in a timely manner in order to expedite the claim process.

 I hereby authorize Mason and their secondary insurance company to secure and inspect copies of case history records, lab reports, diagnoses, x-rays, and other data pertaining to the injury/illness I am receiving care for or previous confinements, if disabilities relevant, to the care of the injury/illness.

 I authorize the Mason Athletic Training staff and/or my coach to hospitalize and secure treatment for me for any athletic injury/illness.

 This consent is irrevocable for the duration of any executed disclosure due to an athletically related illness or injury.

 A copy of this consent shall be deemed as effective and valid as the original.

 I will notify the Mason Athletic Training staff immediately upon any change in the above health insurance information.

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Agreement, Injury Release, Assumption of Risk, and Athlete Responsibility Form

Prior to participation student-athletes must complete this statement in the Vivature Portal in order for the Sports Medicine Staff to provide medical aide and treatment. Student-athletes must understand there is an apparent risk of injury in intercollegiate athletics. Each student must read and electronically acknowledge this agreement prior to participation.

STATEMENT: I am aware that trying out for, practicing or playing in any sport can be a dangerous activity involving MANY RISKS OF INJURY. I understand the inherent potential dangers and risks of trying out for, playing and practicing in the above intercollegiate sports may be catastrophic in nature and may include, but are not limited to, death; serious neck and spinal injuries which may result in complete or partial paralysis or brain damage; serious injury to virtually all bones, joints, ligaments, muscles, tendons and other elements of the musculoskeletal system, including loss of limb; and serious injury or impairment to other parts of my body, general health and well- being.

Because of the dangers of participating in any of the above sports, I recognize the importance of following the coach’s instructions regarding playing techniques, training, rules of the sport and other team rules, and of following such instructions. I also realize that during my entire athletic career at Mason I have a responsibility to my own physical well-being and must accurately report any injury in a timely manner to the Mason Sports Medicine Staff. I will follow the guidelines established by the Mason Sports Medicine Staff for rehabilitation from any injury. If I have any questions regarding my injury or care, I will ask the Mason Sports Medicine Staff. I will also abide by the rules of the sport in which I participate. I realize that adherence to these responsibilities in no way assures me of avoiding or lessening all injuries, including those of catastrophic nature, but by following them, I may decrease the severity of some injuries.

In consideration of Mason permitting me to try out for, practice, play or otherwise participate in the above listed intercollegiate sports and to engage in all activities related to the team, including, but not limited to practicing, playing and traveling, I hereby voluntarily assume all risks associated with participation and agree to hold harmless George Mason University, its agents, officers and employees including, but not limited to, the Mason Athletics staff from any and all liability, claims, causes of action or demands of any kind and any nature whatsoever which may arise by or in conjunction with my participation in any activities related to the Mason except in the event of their gross negligence. The terms of this Agreement shall serve as a release and assumption of risk for my heirs, estate, executor, administrators, assignees and all members of my family.

To the best of my knowledge, I am in good health and suffer no disability or condition that renders my participation in the sport(s) or other athletics activity medically inadvisable, or otherwise limits my ability to participate in such sport(s) or athletics activity without restriction.

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I hereby authorize the coach or other appropriate Mason personnel to obtain in my behalf first aid, emergency medical care, or if necessary admission to an accredited hospital, when such care is necessary for the treatment of any injuries I may sustain while participating in any activity associated with Mason intercollegiate sports, including practices, competition and travel. I also hereby consent to the administration of emergency medical treatment in the event I am unable subsequent to such injury to give such consent as otherwise necessary.

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Supplement Disclosure George Mason University and the NCAA strongly discourage the use of supplements due to lack of FDA regulations and the potential of such containing banned substances. Any student-athlete who is using supplements must notify that the Sports Medicine Staff. All Supplementation must be disclosed upon filing of the medical packet. Students who disclose the use of supplementation will be counseled by the Sports Performance staff, and all supplements will be evaluated. Students who disclose the use of supplements assume all risk with associated practices.

Student-Athlete Supplement Disclosure (after medical packet/PPE)

George Mason University and the NCAA strongly discourage the use of supplements due to lack of FDA regulations and the potential of such containing banned substances. Students who disclose the use of supplementation will be counseled by the Sports Performance staff, and all supplements will be evaluated. Students who disclose the use of supplements assume all risk with associated practices.

Student-Athlete name:______Student-Athlete sport:______Supplement used:______Has this supplement been cleared by Sports Dietitian, Physician? Y N

By signing this document, you acknowledge that you are assuming all risk associated with consuming this product.

______Signature Date

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Drug-testing Consent

George Mason University along with the NCAA Division I regulations, reserve the right to randomly test any student-athlete for any and all substances banned by the NCAA. This form must be signed and returned to the Sports Medicine Staff prior to participation.

NCAA Drug Testing Consent forms and Banned Drugs can be found at: http://www.ncaa.org/sites/default/files/2016- 17_DI_Form_16_3b_Drug_Testing_Consent_20160531.pdf

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Student-athlete Concussion Statement George Mason University student athletes are required to complete concussion education. Each student is made aware of concussion signs and symptoms as well as the concussion policies upon entry to the Athletics Department. The following form is a part of their annual medical forms completed through the Vivature portal. The student-athlete must show compliance with the George Mason University concussion management policies.

MEDICAL DISCLOSURE AGREEMENT

I, ______, accept the responsibility for reporting all injuries and illnesses including signs and symptoms of concussions to the George Mason University Athletic Training Staff. I understand that the University assumes no financial or legal responsibility for . Unreported injuries including concussions . Unreported illnesses and medical conditions including pregnancy . Any charges from a healthcare provider to which a student-athlete was not referred to by a member of the Athletic Training Room Staff or team physician . Any injuries or conditions not occurring during, or as a result of, participation in a scheduled, supervised practice and/or competition

I, ______, acknowledge that I have watched the NCAA’s concussion video (https://s3.amazonaws.com/ncaa/web_video/health_and_safety/concussion/concussion.html) and understand that by signing this document I understand the information presented in the video. Signs/symptoms and more educational information on concussions are available at www.ncaa.org/health- safety .

All arrangements for the care of injuries and concussions are to be made and processed before the student- athlete withdraws, leaves, or graduates from George Mason University.

PARENT/LEGAL GUARDIAN (if student-athlete is a minor), please print, sign your name, and date:

______Name (printed) Signature Date

STUDENT-ATHLETE, please print, sign your name, and date:

____ Name (printed) Signature Date

PLEASE RETAIN A COPY OF THIS INFORMATION SHEET FOR FURTHER REFERENCE.

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FERPA Disclosure Forms

The Family Educational Rights and Privacy Act of 1974 (FERPA) is a federal law that governs the educational records of eligible students. It grants students continuous access to their educational records upon request, allows students to amend their records if they feel they are inaccurate, and restricts how and when their educational records can be disclosed.

When a student turns 18, or attends a postsecondary institution, FERPA rights belong to the student, not the parent. This means all students at Mason control access to all of their educational records and must give consent before that information is disclosed to any third party, including parents. The best way for families to stay involved and informed about their student’s progress is to communicate directly with the student.

Information about FERPA at Mason can be obtained at: http://registrar.gmu.edu/ferpa/

The form used by students to allow others outside the school to discuss/view their records is: http://registrar.gmu.edu/wp-content/uploads/FERPA-Release-Form.pdf

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SICKLE CELL TRAIT POSITIVE

MEDICAL INFORMATION AND PARTICIPATION WAIVER

I, have been informed that I am sickle cell trait positive. I have been counseled by a team physician on the implications of sickle cell trait to my participation in athletics, and to my overall health and future family planning. I have been informed of the NCAA precautions and guidelines to follow while participating in athletics. My coaches, team physicians and athletic trainers are informed of my sickle cell status and have reviewed the NCAA precautions and guidelines as well as the treatment and management guidelines should I have a sickling event during athletic participation. I fully understand these precautions and guidelines and have had any and all questions answered to my satisfaction. I have been advised to inform my parents or guardian and my family physician of my sickle cell trait positive status. I agree to notify an athletic trainer or team physician immediately if I begin to have physical symptoms during athletic participation to include muscle cramping, muscle weakness, difficulty breathing, and/or any other signs or symptoms of distress during or after exercise. I have been advised that my participation in athletics is not compromised by testing positive and I may report symptoms without fear of repercussion.

(Student-Athlete) (Date)

(Team Physician) (Date)

(Head Coach) (Date)

(Athletic Trainer) (Date)

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