Management of Suspected Head Injuries

Holly Springs High School

Emergency Action Plan Holly Springs High School Athletic Department The following is a protocol to be used for emergency situations that may occur during an athletic practice or event at Holly Springs High School. Review the protocol for your particular sport. It is your responsibility as a coach to know the proper procedure to follow in order to ensure proper care for your athletes in the event of an emergency.

General Protocol: The protocol will vary according to who is in attendance at the game/practice. In most instances, the athletic trainer/assistant athletic trainer and/or athletic director is on site. During practice, this is not always the case. It is the coach’s responsibility to activate the Emergency Action Plan in the absence of these individuals. If you are in doubt about activating EMS-make the call. An athletic trainer will cover all football and home athletic events and will be accompanied by an MD for all home football games.

Emergency Protocol: All suspected concussions will be referred to either Carolina Family Practice & Sports Medicine. Life threatening heat related illnesses and cardiac conditions will be referred to the activation of EMS/local hospital. There will be an AED on site of all home athletic events. The head athletic trainer and first responders are trained to use an AED.

Chain of Command  Head Athletic Trainer or First Responder  Athletic Director  Head Coach  Assistant Coach  Sports Medicine Student Assistant

1. The person on site that is highest in the chain of command should always stay with the injured athlete. 2. If a cellular phone is not available, send the next person on the list to make the necessary phone calls. 3. If EMS has been called, designate someone to go to Cass Holt Rd. and direct the emergency vehicle to the proper location. 4. Call the parent/guardian after EMS has arrived and the situation has been properly assessed and accurate information can be given.

Emergency Telephone Numbers Phone Locations are as follows: Gym Conference Room-dial 9 then the number for both phones. Holly Springs EMS 911 Holly Springs Fire Dept. 567-4733 Holly Springs Police (Emergency) 557-9111 Holly Springs Police (Non-Emergency) 552-7110 Wake Co. Sheriff 755-6910 Western Wake Medical Center 233-2300 WakeMed Apex Healthplex 350-4300 Wake Medical Center 250-8000 Molly Arey, LAT, ATC (Home) 704-517-9668 (Cell) 919-669-3702 Tamara Young (Cell) 919-749-6349 School 577-1444 Activating EMS

The following information should be given when calling 911:

 Description of the problem  Report what emergency care has been given  Your name  Athlete’s name  Exact location  The phone number from which you are calling  Do not hang up until the dispatcher instructs you to do so

Calling Parents:

You should keep your Student Athlete Travel forms available at all times to contact parents/guardians in case of an emergency. All pertinent athlete history, medical conditions, prescriptions, and allergies will be listed. Keep the forms available at all times.

*Impending Lightning Protocol

1. The Athletic Trainer, Athletic Director, and Head Coach will be aware of the weather forecast.

2. Should conditions exist for a possible thunderstorm, the following “chain of command” will monitor the weather conditions during the event: 1) Athletic Trainer 2) Athletic Director 3) School Administrator 4) Head Coach

3. The designated monitor(s) will discuss with the game officials prior to the start of the game the impending lightning plan.

4. All play will be stopped and the field and stands immediately evacuated if: a) Thunderstorm warning for the area has been announced by radio or TV b) Lightning storm detector signals thunderstorm warnings c) Conditions are right for the development of a thunderstorm d) Lightning is within 6 miles of the playing field

5. A PA announcement will be made that all spectators are to immediately evacuate the area and go to a designated shelter. At Holly Springs High School the designated “Safe Site” is the Auxillary Gym.

6. Play will not resume for a minimum of 30 minutes. This may need to be longer depending on the weather conditions.

7. Following the initial 30 minutes, reassessments will be made at 15 minute intervals to determine if conditions are appropriate for resumption of play. Practice Protocol for Lightning:

Coaches are expected to follow the above protocol for practice. Refer to #4, 6, & 7 (above).

Using the “flash-bang” method where the seconds between seeing lightning and hearing the clap of thunder is divided by 5 to determine how far away the lightning is occurring (in miles). A count of 30 seconds will tell you that lightning is occurring about 6 miles away.

*Based upon recommendations of the Sports Medicine Committee of the North Carolina Medical Society. Important Conditions

Management of Suspected Head Injuries

Signs and symptoms of a possible concussion are listed below. If you observe an athlete experiencing even one of these symptoms, the athlete MUST be removed immediately from all participation. If the ATC/First Responder is available, contact him/her immediately so an evaluation can be performed. If the ATC/First Responder is not accessible, contact parent and recommend a prompt physician evaluation. Make sure that you contact the parent if EMS has been activated.

What is a concussion? A concussion is a brain injury that:  Is caused by a bump, blow, or jolt to the head  Can change the way your brain normally works  Can range from mild to severe  Can occur during practices or games in any sport  Can happen even if you haven’t been knocked out  Can be serious even if you’ve just been “dinged” or had your “bell rung”

What are the symptoms of a concussion? Nausea (feeling that you might vomit) Balance problems or dizziness Double or fuzzy vision Sensitivity to light or noise Headache Feeling sluggish Feeling foggy or groggy Concentration or memory problems (forgetting game plays) Confusion

 All athletes that are suspected of having a concussion are required to go to a physician for evaluation. Each athlete must be released, in writing on the approved NCHSAA form, by a physician to return to play. The Athletic Trainer must have the written clearance before the athlete can begin their return to play protocol.

Concussion Referral:

Carolina Family Practice and Sports Medicine 3700 NW Cary Parkway, Suite 110 Cary, NC 27513 (919) 238-2000

Dr. Michael Hart Carolina Family Practice and Sports Medicine 190 Rosewood Center Drive Holly Springs, NC 27540 919-238-2000 Management of Suspected Heat Related Illness

Signs and symptoms of a possible heat illness are listed below. If you observe an athlete experiencing even one of these symptoms, the athlete MUST immediately be removed from all participation. If the ATC/First Responder is available, contact him/her immediately so an evaluation can be performed. If the ATC/First Responder is not accessible provide the following care. Please note that if the athlete is unconscious or has an altered level of consciousness 911 should be called immediately. Make sure that you contact the parent if EMS has been activated.

1. Place athlete in shade or in cooler area. 2. Provide cold fluid to drink, preferably water (unless unconscious). 3. Remove excess clothing and equipment. 4. Monitor signs and symptoms. If in 10 minutes the athlete does not improve, or if condition worsens at any point, call 911. 5. Contact parents regardless of whether 911 has been called. 6. Contact ATC/First Responder to notify of incident.

Signs and Symptoms of Heat Illness: Early Stages (sometimes called heat exhaustion)  Cool, moist, pale, ashen, or flushed skin  Headache, nausea, dizziness  Weakness, exhaustion Late Stages (sometimes called heat stroke)  Heavy sweating  Red, hot, dry skin  Changes in level of consciousness  Vomiting

Management of Asthma or Difficulty Breathing

The following are signs and symptoms of an asthma attack. If any of these signs are observed in an athlete that you suspect of having an asthma attack, remove them from the practice or game immediately. If they have an inhaler, have the student administer it as directed. If they do not have an inhaler; have them sit, try to remain calm, breath slowly and deeply in through the nose and out through the mouth. If the ATC/First Responder is available, contact him/her immediately so emergency care can be provided. If you are certified in CPR/FA, provide appropriate care until the ATC/First Responder arrives.

Signs and Symptoms Uncontrollable coughing Wheezing Rapid breathing Flaring nostrils Feeling “tightness” in their chest

 If you are aware one of your athlete’s has Asthma it is best to keep an extra inhaler, labeled with the athlete’s name, with you at all times. Management of Anaphylaxis

The following are signs and symptoms of anaphylaxis. If any of these signs are observed in an athlete that you suspect of having an anaphylactic reaction, have the athlete administer their prescribed medication (usually an Epi-Pin) and call the ATC/First Responder immediately so emergency care can be provided, then call the athlete’s parent. Once the ATC/First Responder arrives they will determine if EMS needs to be activated. If you are certified in CPR/FA, provide appropriate care until EMS, ATC/First Responder, or another professional rescuer arrives. If the athlete has a delayed anaphylactic reaction and are having difficulty breathing, call 911 immediately. If the ATC/First Responder is available, contact him/her immediately so emergency care can be provided. If you are certified in CPR/FA, provide appropriate care until EMS, ATC/First Responder, or another professional rescuer arrives..Make sure that you contact the parent if EMS has been activated.

Severe Allergic Reaction Mild Allergic Reaction Flushed face Hives all over the body Red, watery eyes Dizziness Difficulty breathing Itchy, sneezing, runny nose Seizures Blue tint around the mouth and eyes Hives or rash in one area Confusion Difficulty swallowing Weakness Loss of consciousness Paleness

 If you are aware that one of your athlete’s had a severe allergy, and has a prescription medication, you should keep it with you at all times. The athlete must administer the medication themselves if they are having a reaction.

Management of Cardiac Emergencies

The following are signs and symptoms of a cardiac emergency. If any of these signs are observed in an athlete that you suspect of having a cardiac issue, call 911 immediately. If the ATC/First Responder is available, contact him/her immediately so emergency care can be provided. If you are certified in CPR/FA, provide appropriate care until EMS, ATC/First Responder, or another professional rescuer arrives. Make sure that you contact the parent if EMS has been activated.

Signs and Symptoms of a Cardiac Emergency:  Chest Discomfort  Jaw, neck, shoulder or arm pain  Shortness of Breath  Nausea  Lightheadedness  Profuse Sweating

Location of AED’s at Holly Springs High School  Athletic Training Room (1416) on the top shelf of the bookcase  1st floor on the 1600 Hallway (near the stairwell)  2nd floor on the 2600 Hallway (near the stairwell)  3rd floor on the 3700 Hallway (near the elevator & stairwell)  An AED will be present at all home athletic events with the ATC or First Responder covering the event.