GEORGETOWN COLLEGE SPORTS MEDICINE STUDENT ATHLETE HANDBOOK

TABLE OF CONTENTS Introduction………………………………………………………………………………………………... 4 Mission Statement………………………………………………………………………………………..... 4 General Information……………………………………………………………………………………….. 4 Sports Medicine Personnel……………………………………………………………………….. 4 UK HealthCare Team Physicians………………………………………………………………… 4 UK HealthCare Athletic Trainers………………………………………………………………… 5 Roles & Responsibilities………………………………………………………………………….. 5 Other Members of the Sports Medicine Team……………………………………………………. 7 Coaches…………………………………………………………………………………………… 7 Facilities…………………………………………………………………………………………... 8 Athletic Training Coverage……………………………………………………………………….. 8 Medical Care…………………………………………………………………………………………….… 9 Reporting & Evaluating an Injury………………………………………………………………… 9 Treatment…………………………………………………………………………………………. 9 Rehabilitation…………………………………………………………………………………..... 10 Referrals…………………………………………………………………………………………. 10 Equipment……………………………………………………………………………………….. 11 Transportation of an Athlete…………………………………………………………………….. 12 Illnesses………………………………………………………………………………………….. 12 Non-Athletic Injuries……………………………………………………………………………. 13 Recruits………………………………………………………………………………………….. 13 Try-outs………………………………………………………………………………………….. 13 Documentation…………………………………………………………………………………………… 13 Vivature………………………………………………………………………………………….. 13 Medical Records………………………………………………………………………………… 13 Pre-Participation Exams………………………………………………………………………………….. 14 Exit Physicals……………………………………………………………………………………. 14 Insurance…………………………………………………………………………………………………. 14 Primary Insurance……………………………………………………………………………….. 15

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International Insurance Policy………………………………………………………………...… 15 Secondary Athletic Insurance…………………………………………………………………… 15 Filing a Claim…………………………………………………………………………... 16 Benefit Period…………………………………………………………………………... 16 Pre-Existing Conditions………………………………………………………………… 16 Medication……………………………………………………………………………………………….. 17 Over-the-Counter Medications………………………………………………………………….. 17 Prescription Medication…………………………………………………………………………. 17 Epi-pens…………………………………………………………………………………………. 18 Indications/Contraindications…………………………………………………………... 18 Emergency Care for Anaphylaxis………………………………………………………. 18 Asthma & Meter Dose Inhalers (MDIs)………………………………………………………… 19 Basic Life Support Treatment for Severe Asthma……………………………………… 19 Concussion……………………………………………………………………………………………….. 19 Personnel Roles & Responsibilities……………………………………………………………... 20 Education & Pre-Participation Assessment……………………………………………………... 20 Concussion Management Plan…………………………………………………………………... 21 Reducing Exposure to Head Trauma……………………………………………………………. 22 AED Use…………………………………………………………………………………………………. 22 Catastrophic Incident Management Plan………………………………………………………………… 23 Catastrophic Incident Management Team………………………………………………………. 25 Inclement Weather Plan………………………………………………………………………………….. 28 Lightning Procedure……………………………………………………………………………... 29 Tornado Procedure………………………………………………………………………………. 29 Heat Procedure…………………………………………………………………………………... 30 Cold Procedure…………………………………………………………………………………... 32 Mental Health Management Plan………………………………………………………………………… 34 Multidisciplinary Mental Health Care Team……………………………………………………. 34 Clinical Licensure Practitioners Providing Mental Health Care………………………………… 34 Emergent Mental Health Action & Management Plan………………………………………….. 35 Non-Emergent Mental Health Action & Management Plan…………………………………….. 36

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Pre-Participation Mental Health Screening……………………………………………………… 37 Health Promoting Environments That Support Mental Well-Being & Resilience……………… 38 Pregnancy………………………………………………………………………………………………… 38 Transgender………………………………………………………………………………………………. 40 Student-Athletes Undergoing Hormone Treatment……………………………………………... 40 Student-Athletes Not Undergoing Hormone Treatment………………………………………… 40 Drug Screening & Counseling…………………………………………………………………………… 41 Screening Protocol………………………………………………………………………………. 41 Supplement Policy……………………………………………………………………………………….. 43 Optimal Nutrition & Performance Plan………………………………………………………………….. 43 Multidisciplinary Nutrition Care Team…………………………………………………………. 44 Relative Energy Deficiency in Sport (RED-S) Spectrum……………………………………….. 47 Pre-Participation Assessment…………………………………………………………… 47 Disordered Eating & RED-S Management Plan………………………………………………… 48 Diabetes Management Plan………………………………………………………………………………. 50 Pre-Participation Physical Examination………………………………………………………… 51 Diabetic Plan of Care……………………………………………………………………………. 51 Diabetic Supplies………………………………………………………………………………... 51 Athletic Injury & Glycemic Control…………………………………………………………….. 51 Sickle Cell Disease & Sickle Cell Trait………………………………………………………………….. 52 Sickle Cell Testing………………………………………………………………………………. 52 Sickle Cell Athlete Guidelines…………………………………………………………………... 52 Bloodborne Pathogens & Infectious Diseases…………………………………………………………… 53 Universal Precautions…………………………………………………………………………… 56 Communicable Disease Management…………………………………………………………… 56 Infectious Diseases/Illnesses…………………………………………………………………….. 57 Skin Diseases……………………………………………………………………………………. 57 Education & Prevention…………………………………………………………………………. 58 Appendix…………………………………………………………………………………………………. 60

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INTRODUCTION

The purpose of the sports medicine department is to provide available and affordable health care in an environment that places a high value on health and wellness to all student athletes. The sports medicine team strives to reduce instances of injury and return athletes in a safe and timely manner.

The philosophy of the Sports Medicine Department is to provide a student-athlete centered approach of care. Members of the sports medicine staff will be expected to maintain the highest standards set by their credentialing agency and the credentialing statues of the State of Kentucky.

MISSION STATEMENT

The mission of the Georgetown College Sports Medicine Department is to provide the highest quality healthcare available to student-athletes in a professional and caring manner. Should an injury or illness occur, it is the sports medicine team’s mission to recognize and treat with the appropriate medical care, returning them to competition as quickly and safely as possible.

GENERAL INFORMATION

Sports Medicine Personnel

Certified Athletic Trainers are health care professionals who specialize in preventing, recognizing, managing, and rehabilitating injuries that result from physical activity. As part of a complete health care team, certified athletic trainers operate under the direction of a licensed physician and standing orders and work in cooperation with other health care professionals, athletic administrators, coaches, and parents.

Georgetown College has contracted with UK Healthcare to provide sports medicine services to Georgetown College. The Sports Medicine staff consists of the Medical Director, team physicians, and five athletic trainers. These physicians will conduct weekly clinic visits at Georgetown College as well as be in attendance at ALL football games and all HOME basketball games. Attendance at other events will be left to the discretion of the physician and their schedules.

UK HealthCare Team Physicians

Dr. Srikanth Nithyanandam, MBBS, CAQ Sports Medical Director/Team Primary Care Physician Medicine

Team Orthopaedic Surgeon Dr. Scott Mair, MD

Orthopaedic Fellow As assigned by UK HealthCare

Primary Care- Sports Medicine Fellow As assigned by UK HealthCare

UK HealthCare Athletic Trainers

Senior Athletic Jake Ryan, MS, M Soccer, M/W Tennis, Softball East Campus Athletic Trainer LAT, ATC Training Room

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Staff Athletic Stacee Gibson, W Soccer, XC/Track & Field, Main Campus Athletic Trainer LAT, ATC Baseball Training Room

Staff Athletic Katie Helly, MS, Football, Golf, W Lacrosse East Campus Athletic Trainer LAT, ATC Training Room

Staff Athletic Jacob Whitacre, W Volleyball, W Basketball, M Main Campus Athletic Trainer LAT, ATC Basketball, M Volleyball Training Room

Athletic Training Abby Flynn, MS, Football, Cheer East Campus Athletic Fellow LAT, ATC Training Room

Roles & Responsibilities

Medical Director/Team Physician (including Fellows):

• Oversees the athletic training staff in the development and implementation of all policies and procedures relevant to sports medicine • Guides and directs the sports medicine staff in evaluation, treatment, rehabilitation, and return to play guidelines • Assist in coordination of and attend pre-participation examinations • Coverage of ALL football games/scrimmages including the spring game • Coverage of ALL home basketball games • Communication on athlete care with appropriate sports medicine staff • Availability of office appointments and surgeries in a timely fashion • Has the final authority in determining whether an athlete is medically eligible to participate in Georgetown College athletics including releasing the athlete to return participation post- injury/illness

Senior Athletic Trainer

• Oversee adherence to department sports medicine policies and related NAIA sports medicine policies • Develop, maintain, and update sports medicine policies and procedures • Administrate the daily operation of the athletic training facility. This includes delegation of responsibilities regarding inventory and budgeting, filing of secondary insurance claims, work- study management, and care of student-athletes including event coverage • Coordinate physician and medical referrals via the sports medicine staff • Act as primary liaison between the coaching staff and team physician(s) • Serve primary liaison between the sports medicine staff and electronic medical record company (Vivature) as well as between the sports medicine staff and the Mid-South Conference • Arrange and coordinate yearly pre-participation physicals and health screenings for participating intercollegiate athletes

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• Administrate the establishment and maintenance of records for each student-athlete during the duration of their active participation. Maintain each participants record for a period of seven (7) years post completion of competitive career, per state of Kentucky statute of limitations criteria • Work closely with the sports medicine staff and coaching staff in the area of prevention of athletic injury, as related to: equipment, conditioning, nutrition and body composition, environmental safety factors, pre-participation physical assessment, liability considerations, and guidance/counseling of the student athlete • Carry out specific assigned responsibilities as requested by the Director of Sports Medicine Outreach and/or team physician • Work in conjunction with the Vice President for Athletics to administrate the Drug Testing Program for the student-athletes of Georgetown College • Maintain National and State Credentials in Athletic Training to uphold professional status. i.e., CPR certification, liability insurance as required by conference, continuing education credits

Staff Athletic Trainers

• Assist with the evaluation of athletic injuries and illnesses as they occur • Assist with the arrangement of referrals for all sports injuries/illness of athletes requiring further evaluation • Assist with the development of plans to aid in reducing athletic-related injuries • Assist with the overall supervision of the athletic training facility • Assist in keeping and updating accurate medical records on all student-athletes regarding on-going injuries/illnesses- history to be entered into a computerized injury reporting system • Assist in the design and implementation of rehabilitation programs for all athletic injuries • Assist in the maintenance of accurate record keeping for supply usage, including inventory, and equipment loans/returns • Assist with the scheduling and completion of all pre-participation physicals for all sports • Assist with the coverage of all sports as needed throughout the school year • Assist with the filing of secondary insurance claims

Athletic Training Fellow

• Assist with the evaluation of athletic injuries and illnesses as they occur • Assist with the arrangement of referrals for all sports injuries/illness of athletes requiring team physician evaluations • Assist with the development of plans to aid in reducing athletic-related injuries • Assist in keeping and updating accurate records on all student-athletes regarding on-going injuries/illness history, to be entered into a computerized injury reporting system • Assist in the design and implementation of rehabilitation programs for all athletic injuries • Assist with the coverage of all sports as needed throughout the school year

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Other Members of the Sports Medicine Team

A member of the Georgetown College sports medicine team may refer student athletes to an outside health care resource. Common referral sites may include the following:

• Georgetown Community Hospital • Scott County Physical Therapy • Georgetown College Health Services • Georgetown College Counseling Center • Georgetown College Sodexo Nutritionist

See “Medical Care” section for more information about these referral sites.

Coaches

Coaches are an important part of the athlete’s health care. The sports medicine staff communicates with each head coach regarding playing status for injured/ill student-athletes. Each coach has the role/responsibility to:

• Act a first responder as described in the Georgetown College Athletics Emergency Action Plan • Ensure that all student athletes are completing all necessary sports medicine paperwork and have completed yearly pre-participation physical, prior to the start of sport participation • Abide by the plan of the sports medicine staff and team physicians for injuries and illnesses

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CPR/AED and first aid certifications are required for all full-time coaches. The sports medicine staff recommends that any other member of the Department of Athletics, that has regular contact with student- athletes, is also CPR/AED and first aid certified.

Facilities

Georgetown College has two athletic training facilities on their campus:

• Main Campus Athletic Training Room (Main ATR) is located on the 1st floor of Alumni Gymnasium • East Campus Athletic Training Room (East ATR) is located underneath Toyota Stadium, next to the weight room

Facility hours will be posted at the beginning of each semester. These hours are subject to change. If a conflict with the posted times arises, accommodations can be made on an individual basis with each team’s athletic trainer(s).

Athletic Training Room Rules

1. All student athletes act in an appropriate and respectful manner 2. Proper attire is required at all times 3. All student athletes must sign in prior to treatment 4. Sports equipment needs to be left outside of the athletic training room 5. No shoes on any treatment surfaces or tables 6. Cleated shoes are not allowed in the athletic training room 7. All injuries and illnesses should be reported to the athletic training staff 8. All treatments must be administered by or under the supervision of an athletic trainer 9. No student-athletes are allowed to enter the athletic training room storage areas or offices unless given permission or accompanied by an athletic trainer. Removal of equipment or supplies is strictly prohibited 10. Be on time for all appointments in the athletic training room 11. Be on time for off-campus appointments. Your insurance may be charged if you are tardy to or skip off-campus appointments 12. No tobacco/vape products in the athletic training room 13. All athletes should shower, if possible, after practice/workouts in order to receive treatment

Athletic Training Coverage

Home Game Coverage

A certified athletic trainer will be attendance for all home varsity events. The respective athletic training room will be open for home events based on the sport warm-up times. The sports medicine staff will provide injury ice, ice bags, splints, and appropriate biohazard equipment for the visiting team.

Emergency equipment will be available for all practices and games and consists of first aid supplies, splints, crutches, and AEDs. The location of these supplies is detailed in each facility’s emergency action plan.

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The Georgetown College Department of Athletics administration staff will be responsible in the event of spectator medical emergency.

Away Game Coverage

A minimum of one certified athletic trainer and one team physician will travel to all away football games. For all other sports, coaches must travel with their team’s medical kit and emergency binder.

Medical Kits

Each team will be assigned a medical kit. It will be provided to the coaching staff prior to their first scheduled practice. It is the coach’s responsibility to bring the kit to the sports medicine staff in a timely manner to restock supplies. It is also the coaching staff’s responsibility to have the stocked medical kit at each practice and event, both home and away.

Emergency Binders

Each team will be provided an emergency binder containing demographic, insurance, and other pertinent medical information. The coaching staff will be given the binder once all required information has been obtained. It is the coach’s responsibility to have the emergency binder on their person at each practice and event, both home and away. Football is the only exception, as the sports medicine staff will keep the binder with them.

Hydration

All teams (via coach’s arrangement) will be responsible for the set-up of water for their team practices and hosted events/games/matches/etc. unless prior arrangements have been made with the supervising athletic trainer.

Water coolers and water bottles will be assigned to each team. The team-assigned staff will be responsible for filling their cooler with ice/water in the athletic training facility. It will be the responsibility of the sport team to refill coolers and bottles as needed. The use of paper cups is reserved for competitions only.

Water coolers and lids should be returned to the athletic training room daily. It is the sport team’s responsibility to maintain good condition of their assigned coolers.

MEDICAL CARE

Reporting and Evaluating an Injury

It is the responsibility of the student athlete to report their injuries to the sports medicine staff in a timely fashion. The sports medicine staff will examine the injured athlete and determine an appropriate treatment, rehabilitation, and participation plan. Once an injury is evaluated, the athletic training staff will communicate a plan with the head coach regarding participation.

Treatment

Treatment is available for all student athletes. Treatment is defined as medical care given for an injury that is still allowing a student athlete to participate in practice and competition. Programs are based upon a

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collaboration between certified athletic trainers and team physicians. Treatments of injuries must be done in the athletic training room under the direct supervision of a member of the sports medicine staff during the posted athletic training room hours. If there is a conflict of schedule during athletic training hours, other arrangements can be made.

Rehabilitation

Rehabilitation is designated for long-term or post-surgical injuries that do not allow the student athlete to participate fully. Rehabilitation of injuries must be done in the athletic training room under the direct supervision of a member of the sports medicine staff. It is preferred that post-surgical athletes complete their rehabilitation during dedicated rehab times assigned by the team’s athletic trainer(s).

Referrals

Athletic-Related Injuries

Some injuries may require referrals to other healthcare professionals. When a referral is deemed necessary, the sports medicine staff will help coordinate the process. Possible referrals can be, but are not limited to, UK HealthCare Clinic, Urgent Care, GC Wellness Center, GC Counseling Center, and Nutritionist, or other health care providers as needed. After the appointment, the sports medicine staff should follow up with the treating physician regarding the athlete’s care.

If an athlete sees a non-team physician, the athlete is then responsible for having all pertinent information forwarded to the sports medicine staff. If an athlete sees an outside physician without first notifying the sports medicine staff of an injury, there is no guarantee GC’s Secondary Policy will provide coverage.

If surgery is deemed necessary by the physician, the surgery date is set through the physician’s office. This can sometimes take time as pre-approval for the procedure must be obtained through the athlete’s primary insurance. While the athlete is waiting for surgery, pre-rehabilitation exercises will be performed as appropriate. Post-surgery rehab will be performed both in the athletic training room as appropriate and in conjunction with a physical therapy clinic as needed. All protocols are set by the physician and cannot be altered by anyone except the prescribing physician.

All appropriate information regarding the student athlete’s injury, including progress, compliance and status is communicated to the head coach. Statuses can include: Full Participation, Limited Participation, and No Participation. It is the ultimate responsibility of the head coach to follow and enforce these recommendations.

Common Referral Sites

Georgetown Community Hospital

Georgetown Community Hospital (GCH) is located at 1140 Lexington Road in Georgetown, KY. It is a 75-bed acute care facility with an attached emergency department. Athletes may be referred to GCH for x- rays or other emergent conditions that necessitate immediate care.

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Scott County Physical Therapy

Scott County Physical Therapy (SCPT) is located at 208 Bevins Lane in Georgetown, KY. Athletes may be referred to SCPT if they have undergone surgery or have an injury that requires long-term rehabilitation.

Georgetown College Student Wellness

Georgetown College Student Wellness is located on campus at 407 Hollyhock Lane. Student Wellness and houses both Georgetown College Health Services and the Georgetown College Counseling Center. Regular clinic hours are 9AM-4PM Monday through Friday when classes are in session. Students can call for an appointment or go during walk-in hours.

Georgetown College Health Services offers the following services:

• Evaluation and treatment of illness and non-athletic related injuries • Allergy injections • Immunizations • Routine examinations • Women’s well visits • Breast and testicular cancer screenings • Patient education

The Georgetown College Counseling Center is equipped to handle the emotional needs of students. Referrals are made to the Counseling Center for athletes who are exhibiting signs of depression, eating disorders, injury denial, family or personal issues, or other concerns that might warrant counseling services. These referrals are confidential.

Georgetown College Sodexo Nutritionist

Georgetown College partners with Sodexo to meet the dining needs of students. Through Sodexo, Georgetown College students have access to a registered dietitian. The sports medicine staff may refer student-athletes or coaches to the dietitian if there are questions or concerns regarding nutrition.

Equipment

Equipment, such as crutches, braces, walking boots and compression wraps, will be kept in stock in the athletic training rooms. If an athlete needs a piece of equipment, the item, date, and athlete’s name are marked on the Sign-Out Sheet and/or in the electronic medical records system. When the item is no longer needed by the athlete and is returned, the return date is documented. It is the responsibility of the student athlete to return the equipment to the athletic training room when item is no longer needed.

Braces

The sports medicine staff maintains a minimal brace inventory, within the limits of the budget, to include a variety of new and/or unused braces. This stock is contingent upon the budget for each academic year, with no guarantees. These braces are the property of Georgetown College Sports Medicine and must be returned at the end of the season or when there is no longer a need.

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Athletes requesting or needing a new brace should discuss with their assigned athletic trainer about the process of obtaining one.

Transportation of an Injured Athlete

The responsibility to transport an injured athlete varies depending on the situation. If an injury or illness occurs while on a road trip, a coach, player, team manager, or parent must go with the injured athlete while competition is ongoing. This person should be in addition to the person providing transportation. If the athletic trainer travelled with the team, they will join the athlete once competition has concluded. During a home event, the athletic trainer will arrange for transportation in a non-life-threatening situation and will follow the athlete in a separate vehicle if there is another GC athletic trainer present to provide coverage.

For scheduled appointments, the athlete will be responsible for finding transportation to their appointment. If the athlete is unable to find assistance from a friend, teammate or coach, a member of the sports medicine staff may provide transportation. All efforts will be made to ensure appointments do not coincide with the athlete’s class schedule or practice schedule, although it may be unavoidable.

Illnesses

If an athlete reports an illness to the sports medicine staff, they may be referred to Georgetown College Health Services. If Health Services is unable to see the athlete that day, there are several other walk-in clinics in Georgetown. Athletes must be fever-free for 24 hours, without medication, to participate in athletic activities.

The following options are available to athletes for after-hours care:

• Little Clinic (Kroger), 106 Marketplace Circle, Georgetown, KY 40324, (859)317-6075 • Georgetown Urgent Care, 111 Osborne Way #101, Georgetown, KY 40324, (502)570-0007

Neither the athletic department nor the athletic training office is responsible for any general illness expenses. Student-athletes are responsible for all general illness physician costs and medications (ie co- pays, deductibles, ...)

Non-Athletic Injuries

Any injury that occurs outside of NAIA sanctioned practices, competitions and conditioning sessions is considered a “non-athletic injury”. The sports medicine staff cannot treat any injury that may involve litigation, such as injuries resulting from car accidents. Other injuries, such as those that occur during intramural sports, may be treated in the athletic training room, however, any medical expenses resulting from these injuries will not be covered by Georgetown College’s secondary athletic insurance.

Recruits

It is understood that recruits, athletes who are not enrolled in the college, may participate in a team practice or athletic activity. A recruit can receive pre-practice and post-practice care with respect to ice, heat, and tape. Electrical modalities are not provided. In the event a recruit is injured, basic emergency and first aid care is provided.

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Coaches should have the athletic department required forms completed and in-hand prior to allowing recruits to participate in athletic activity. The sports medicine staff does not cover recruit workouts unless they are taking place during a sanctioned team practice.

Try-outs

Students who are currently enrolled in Georgetown College must complete the Try-out Waiver prior to participating in an official tryout. Coaches should have forms completed and in hand prior to allowing a student to try-out. It is not necessary to give these forms to the Sports Medicine Department until after the try-out unless there is an emergency.

Injuries that are sustained during a try-out may not be covered by Georgetown College’s secondary athletic insurance policy.

DOCUMENTATION

Vivature

At Georgetown College, an Electronic Medical Record (EMR) system called Vivature is used. The sports medicine staff uses the system to document injuries, injury evaluation notes, progress notes, physician notes, and rehabilitation sessions. Athletes must sign-in each time they come into the athletic training room to ensure proper documentation of treatments and rehabilitation.

Medical Records

A variety of documents are used in the athletic training room to aide in the care of athletes and the administration needs. All medical records are confidential and are stored in a secure room. Medical records cannot be released to unauthorized personnel without the consent of the athlete. All records are kept for 7 years following an athlete’s last season.

HIPAA

Under the federal health privacy law known as HIPAA, medical/treatment records created and/or maintained by the College’s Department of Athletics and its Sports Medicine Department are designated as educational records subject to the Family Educational Rights and Privacy Act of 1974 (FERPA). Sports Medicine medical/treatment records are not subject to HIPAA. However, the Department of Athletics may need to obtain copies of student-athlete medical records from outside medical providers, or may need to release medical/treatment records to outside providers, to ensure that student-athlete treatment providers have pertinent background information on any medical conditions that may affect the student-athlete’s treatment and athletic performance. To obtain copies of student-athlete medical records, each student- athlete must sign a release form authorizing each health care provider to send the Department of Athletics copies of medical records. Most external medical providers must comply with the requirements of HIPAA and therefore, releases or authorizations regarding medical/treatment records must meet the requirements of HIPAA. Questions regarding medical/treatment records should be directed to the Senior Athletic Trainer.

PRE-PARTICIPATION EXAMS

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All athletes participating in intercollegiate athletics at Georgetown College must be cleared for participation through a pre-participation exam (PPE) prior to engaging in any sanctioned athletic activity. PPE’s are designed to ensure that student-athletes are both physically and mentally healthy to participate in intercollegiate athletics. PPE’s consist of all relevant medical paperwork, vitals screening consisting of height, weight, blood pressure, pulse and vision, and a heart, lung and orthopaedic exam completed by a UK HealthCare team physician.

All athletes should complete their physical paperwork through Vivature at least 48 hours prior to their scheduled PPE date. If any information is missing, the athlete will not be allowed to participate in their sport until the missing information is submitted or completed.

The recommendations of the team physician during a PPE must be followed prior to participation. An individual cannot participate in conditioning, strength training, practice, or competition until being cleared by a UK HealthCare team physician. Any medical expenses for a condition found during the PPE that is considered pre-existing, and may require further testing or medical care, will be the financial responsibility of the student athlete. The sports medicine staff can help facilitate this process.

Exit Physicals

All athletes will be requested to complete an “Exit Physical Questionnaire” at the completion of each competitive season. The questionnaire will allow the athlete to declare any injuries that may still be on- going. The student athlete will then decide if they would like to be seen by a UK HealthCare team physician or if they do not want to be seen for their injury.

INSURANCE

Primary Insurance

All athletes should submit their primary insurance information through Vivature prior to PPEs. The Georgetown College Sports Medicine Department must receive any changes to a health insurance policy as soon as they occur. If proper notification is not received, then Georgetown College will not be responsible for any delays in payment, collections notices, credit reports, etc. that occur. If a cancellation of a policy occurs without proper notification, all bills incurred during that period may be the responsibility of the student-athlete and/or his/her parents(s)/ guardian(s).

International Insurance Policy

Georgetown College requires international students on an F-1 visa to carry health insurance. Students can either purchase a policy through a private insurer or choose the policy that Georgetown College offers through LewerMark Student Insurance that can be added to their tuition. For athletic related injuries, LewerMark will work in conjunction with Georgetown College’s Secondary Insurance Policy.

Please refer to lewermark.com for the plan brochure and more information.

Secondary Athletic Insurance

Georgetown College carries a secondary insurance policy for all student-athletes through NAHGA. This policy does have a $500.00 deductible per injury claim filed that is the responsibility of the student athlete.

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This policy only covers injuries that occur at NAIA sanctioned practices, competitions and workouts. It is the athlete’s responsibility to ensure all athletic related injuries have been reported to the sports medicine department. This does include dental injuries obtained during athletic participation.

Cases not covered by secondary insurance:

• Non-athletic related injuries • Accidents • Illnesses • Pre-existing conditions

If the situation is non-emergent, a member of the sports medicine staff will give the student-athlete the “Secondary Insurance Provider Sheet”. It is expected that the athlete provides this information during the registration process at all appointments for efficient billing. If the athlete goes to a different medical facility, it may be necessary to give this information again. In an emergent situation, where the secondary insurance information cannot be given to the athlete prior to medical care, the athlete must call the medical facility after they receive care to add the secondary insurance information to their patient file.

All bills must be processed by the athlete’s primary insurance first (personal policy limitations vary by insurance company). The primary insurance is usually a group policy carried by a parent/guardian’s workplace. It is the responsibility of the athlete to ensure their insurance information is correct on their Vivature profile.

For athletes that do not have primary insurance, the Georgetown College secondary insurance will act as primary in some cases. Athletes whose primary insurance does not work in the state of Kentucky (ie. Kaiser Permante or other state-specific companies) should consider purchasing a “school-year” policy that will be valid in Kentucky.

Medication, either over the counter and prescription, expenses are not covered under the Georgetown College secondary insurance policy.

Filing a Claim

Once an athletic injury occurs, a member of the sports medicine team will work with the student-athlete to complete and file the NAHGA secondary insurance claim. Filing a claim does not ensure coverage. NAHGA reviews each case on an individual basis. A claim can be denied for the following reasons:

• Incomplete Parent/Athlete Information form • Denial of a claim from primary insurance company • Illness • Pre-existing injury • Chronic and/or overuse injury • Injury occurred other than during an organized athletic practice or competition • Initial bills incurred beyond the 12 months from initial date of injury • Lack of documentation of the injury, including the daily sign-in log

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All members of the athletic department should be careful when discussing athletic insurance. There are no guarantees of coverage, not all injuries are covered, and the athlete is responsible for turning in proper documentation/requested information.

Benefit Period

The Georgetown College secondary insurance benefit period is 104 weeks, or two years, from the time the claim form is submitted. An example: An athlete hurts his elbow in the final month of his senior season. He sees a physician immediately after the injury and it is determined surgery will be needed. The athlete decides to put off surgery for six months. He has the surgery, begins therapy, and progresses. At the two- year mark, regardless of whether the athlete has completed therapy or has had complications, the policies benefits will be terminated. After two years, the athlete’s primary insurance would be the sole source of coverage.

Pre-Existing Conditions

Georgetown College’s Department of Athletics is not responsible for any medical expenses incurred from injures that occur prior to the reporting date set by the head coach. All medical tests ordered by the team physician during the pre-participation exam to determine a student-athlete’s playing ability will be the financial responsibility of the student-athlete and his/her parent/guardian. This may include, but is not limited to, x-rays, MRIs, special bracing, etc.

If an athlete is cleared from PPEs, but has a prior injury that becomes problematic in the absence of any type of acute re-injury mechanism, the injury may still be considered pre-existing. Any additional medical care would be the sole financial responsibility of the student-athlete and not Georgetown College’s Department of Athletics.

Any problem associated with a congenital condition, either previously detected or currently undetected, will NOT be the financial responsibility of Georgetown College’s Department of Athletics, should medical care need to be sought for the condition. If a student-athlete has a known history of a congenital problem that has been well documented via previous testing, the student-athlete should obtain all pertinent records and deliver them to the Sports Medicine Department prior to their scheduled PPE date. This will allow the team physician time to review all records before making a participation decision. If a student-athlete knowingly fails to report a known cardiac or congenital problem on their medical history form or to the team physician at the time of their pre-participation exam, then Georgetown College will not be held responsible for injury or accident due to the undisclosed history.

MEDICATIONS

Over the Counter (OTC) Medications

Per standing orders from Georgetown College Sports Medicine’s Medical Director, OTC medications can be stocked in the athletic training room. OTC medications must be:

• Kept in a locked cabinet/closet in a secure room with limited access during and after working hours • Stored at room temperature (between 59 and 86 degrees °F) • Purchased in unit doses

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• Stored in tight moisture and light resistant containers • Checked for accuracy of the count, dosage, and packaging upon delivery

When dispensing OTC medication, the athletic trainer must complete the OTC Drug Dispensing Log. Log will be located in close proximity of the medication cabinet. OTC medications are not dispensed to an athlete under the following conditions:

• Allergy to the active ingredient • If there is a known interaction with current medication • Recent use of similar medication (within two hours) • Suspicion of providing the medication to another athlete • No more than 24-hour supply • If the athletic trainer is not comfortable dispensing

Inventories of all OTC medications are kept in the athletic training room. End-of-year inventory includes:

• Inventory of current stock and newly arrived stock • Discarding of expired OTC medication • Filing of the OTC Drug Dispensing Log

The medical staff is not responsible for medications dispensed by the coaching staff.

Prescription Medication

Prescription medication can only be dispensed by a pharmacy and prescribed by a physician. If an athletic trainer needs to carry an athlete’s prescription medication (i.e. epinephrine injector or albuterol inhaler), the athlete will be required to sign an Agent of Record.

Georgetown College’s secondary insurance policy does not cover medications that are prescribed by physicians. Student-athletes will be responsible for all costs of medications.

Epi-Pens

Epinephrine is the drug for the emergency treatment of severe allergic reactions (anaphylaxis) and for basic life support for severe asthma. In the event of an anaphylactic reaction, the Georgetown College sports medicine staff will utilize the epinephrine auto-injector that has been prescribed to the athlete, if available. In the event of a anaphylactic reaction, EMS will be called (if they are not already on-site) and emergency care will be administered until their arrival.

Indications/Contraindications for Epinephrine Administration

Epinephrine should be administered if the patient exhibits signs and symptoms of anaphylaxis, including respiratory distress and/or shock (hypoperfusion) or severe asthma. Patients who have progressed to severe asthma experience a combination of the following: shortness of breath (>30 respirations/min.), altered mental status (anxious, confused, combative, drowsy), inability to speak in sentences, sweaty and unable to lie down. There are no contraindications for the administration of epinephrine in a life-threatening

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allergic reaction or severe asthma; however, precautions should be taken with elderly patients or patients with heart disease or hypertension.

Emergency Care for Anaphylaxis and/or Severe Asthma with Epinephrine Auto-Injector

The sports medicine staff should:

• Call EMS • Maintain airway • Be prepared to assist ventilation with positive pressure ventilation with bag-valve-mask • Administer epinephrine by a prescribed auto-injector following the steps below o Check the Epi-Pen to ensure the medication has not expired, has not become discolored, and does not contain particulates or sediments o Prep skin site with alcohol o Remove the safety cap from the auto-injector o Place the tip of the auto-injector against the lateral aspect of the patient’s thigh midway between the hip and knee o Ensure administrators fingers are away from injection needle o Push the injector firmly against the thigh until the spring-loaded needle is deployed and medication is injected (at least 10 seconds) o 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) o Record that epinephrine was administered, the dose, and the time of administration o Continue to monitor the athlete until EMS arrives Asthma and Metered Dose Inhaler (MDI) Procedures

Depending on the severity of asthma, medications can be taken on an as-needed basis (prn) or regularly to prevent or decrease breathing difficulty. Most of the medications fall into two major groups: quick relief medications and long-term control medications.

Using the MDI

The student-athlete should use their prescribed MDI as follows. If the student-athlete is unable to do so on their own, a member of the sports medicine staff will assist them.

• Remove the cap from the MDI and hold the inhaler upright • Shake the inhaler • Tilt head back slightly and have the athlete breath out • Open mouth with inhaler 1-3 inches away (Use spacer mouthpiece if available) • Press down on the inhaler to release the medication as athlete starts to breath in slowly • Athlete breathes in slowly for 3-5 seconds • Athlete holds breath for 10 seconds • Repeat as prescribed; waiting 1 minute between puffs to allow the 2nd puff to go deeper into the lungs

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Basic Life Support Treatment for Severe Asthma

Patients who have progressed to severe asthma experience a combination of the following:

• Shortness of breath (>30 respirations/minute) • Altered mental status (anxious, confused, combative, drowsy) • Inability to speak in sentences • Sweaty • Unable to lie down

If the patient is not responding or is unable to properly use their MDI, the sports medicine staff should:

• Call for EMS • Maintain airway • Monitor athlete until EMS arrives

CONCUSSION

The Sports Medicine staff at Georgetown College proposes the following management plan based on the current recommendations from the NCAA, CDC, and the 5th International Conference on Concussion in Sport. This policy represents a multi-faceted approach to treating concussion that includes the education of student-athletes, coaches, and strength & conditioning personnel and delineates the roles of the Sports Medicine staff. This policy in consistent with the Inter-Association Consensus: Diagnosis and Management of Sport-Related Concussion Guidelines and is reviewed annually.

Personnel Roles & Responsibilities

Coach:

• Remove any student-athlete from practice or competition that shows signs of concussion after direct or indirect head trauma • Ensure the student-athlete is evaluated by the appropriate healthcare professional • Allow the student-athlete to return to play only after receiving medical clearance from the appropriate healthcare professional

Certified Athletic Trainer:

• Remove any student-athlete from practice or competition that shows signs of concussion after direct or indirect head trauma • Perform a concussion evaluation and subsequent evaluations as team physician requests • Make proper referral to team physician • Provide home instructions to athlete and/or a responsible caregiver • Supervise activities during the return to play protocol • Allow the student-athlete to play after receiving clearance from the team physician

Team Physician:

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• When present, remove any student-athlete that shows signs of concussion after direct or indirect head trauma • When present, perform a concussion evaluation and subsequent evaluations, as needed • Make proper referrals to specialists for consultation and additional testing, as needed • Direct the athletic trainer in caring for the student-athlete • Determine when the student-athlete can return-to-play and return-to-learn • Remains knowledgeable and contemporary with the Inter-Association Consensus: Diagnosis and Management of Sport-Related Concussion Guidelines

Education and Pre-Participation Assessment

• Student-athletes are presented educational material regarding signs and symptoms of a concussion including the NCAA Concussion Fact Sheet. All student-athletes are required to sign a waiver acknowledging they accept “responsibility to report all injuries and illness to the medical staff including signs and symptoms of a concussion” and that they have read and understand the material. (See appendices 2 and 3) • All members of the coaching staff, strength & conditioning staff, team physicians, athletic training staff, and administrative directors of athletics who serve as liaisons will receive educational material including the NCAA Concussion Fact Sheet to assist in identifying the signs and symptoms of concussion. A signed acknowledgement of receipt of this material is required. (See appendix 4) • Student-athletes at Georgetown College will undergo pre-participation baseline concussion assessment, which currently includes a SCAT5. The team physician determines pre-participation clearance and/or the need for additional consultation.

Concussion Management Plan

1. Any student-athlete that exhibits signs, symptoms, or behaviors consistent with concussion will be removed from practice or competition and evaluated by the sports medicine staff or team physician. The sports medicine staff will have unchallengeable authority in regards to returning the athlete to participation • The evaluation will consist of symptom assessment; physical and neurological exam; cognitive assessment; balance exam; and clinical assessment for cervical spine trauma, skull fracture, and intracranial bleed. 2. Any student-athlete with a suspected concussion following evaluation will be removed from practice or competition for the remainder of the calendar day. 3. The emergency action plan for the specific venue will be activated if an athlete is determined to have a concussion with any of the following signs or symptoms: • Glasgow Coma Scale <13 • Prolonged loss of consciousness • Focal neurological deficit • Repetitive emesis • Persistently diminished or worsening mental status • Spinal injury

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4. The student-athlete will receive serial monitoring and evaluation for deterioration following injury. Athletes and a responsible adult (which may include a roommate, guardian, or other responsible party) will be provided with instructions upon dismissal from a practice or competition, which will include the date and time they will follow up with the sports medicine team. 5. The Associate Dean of Student Success will be notified once an athlete has suffered a concussion for academic adjustments and return-to-learn guidelines and will serve as the point person who will navigate return-to-learn with the student-athlete • A multi-disciplinary team including the team physician, sport athletic trainer, Associate Dean of Student Success, and Disability Services Coordinator will navigate more complex cases of pro-longed return-to-learn. The inclusion of the GC Disability Services Coordinator will ensure compliance with ADAAA 2008 guidelines. • The team physician may recommend further accommodations on an individualized basis if needed based on severity of symptoms. • The student-athlete will be re-evaluated by the team physician (and members of the multi- disciplinary team as deemed appropriate by the team physician) if concussion symptoms worsen with academic challenges and/or symptoms last greater than two weeks. 6. SCAT5 testing will be repeated after sustaining a concussion and reviewed by the team physician. Once an athlete has reached their baseline score, they may begin the 5-step return to play progression. 7. Return to play progression (See Appendix 4 for detailed return to play progression): • Light aerobic exercise • Sport-specific exercises • Non-contact training drills • Full contact training • Return to competition 8. If symptoms recur during any step in the progression, activity will be halted, and the athlete will be re-evaluated the following day. 9. For those student-athletes with prolonged recovery or who are not improving in an expected fashion, the team physician will arrange for appropriate consultations and/or testing to consider additional diagnoses and best management options.

Reducing Exposure to Head Trauma

Georgetown College acknowledges the importance of emphasizing ways to reduce exposure to head trauma. Coaches and student-athletes are responsible for taking a “safety first” approach to sport and are educated regarding safe play and proper technique. In respect to football specifically, the Sports Medicine staff will incorporate adherence to the NCAA Inter-Association Consensus: Year-Round Football Practice Contact Guidelines.

AED USE

This protocol is meant for Georgetown College sports medicine staff holding a Professional Rescuer Certification.

AED Use:

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1. Perform a primary assessment to determine of patient is conscious, breathing, and has a pulse 2. If victim is determined to have a life-threatening emergency, (unconsciousness, no breathing, no pulse, or severe bleeding) call 911 to activate the emergency medical system (EMS). 3. Treat patient according to findings during primary assessment. (e.g. if unconscious and not breathing with a pulse – perform rescue breathing, control bleeding, etc. per AHA Standards) 4. If patient is unconscious, not breathing, and does not have a pulse, initiate CPR (30:2 Adult, 30:2 Child and Infant. Utilize one or two-rescuer techniques as applicable.) 5. Do CPR until AED arrives. AED needs to arrive within 4-6 minutes of starting CPR. Prep the patient’s chest according to the manufacturers’ and AHA recommendation. 6. AED pads should be applied to the appropriate age/weight of the victim being cared for per manufacturer and AHA guidelines. 7. Follow the American Heart Association Guidelines/Protocols for AED use. 8. Notify EMS upon arrival, of duration or CPR and the number of shocks delivered to the patient. Answer all EMS questions. Assist EMS to package and remove the patient from athletic venue for transport to the nearest hospital. 9. Document all actions and submit Incident Report to GC Administration. Notify campus administrators using normal procedures. 10. Notify team physician as soon as feasible for case review.

Disqualification from using AED:

If a case is reviewed and it is determined by the team physician that the AED was improperly deployed (by delivering an unnecessary shock or by failing to deliver appropriate shock), the user may lose privileges to use AED until approved by the team physician. The person will undergo further training and be able to demonstrate proficiency in the use of the AED to the team physician or his/her designee. It will be up to the team physicians’ discretion whether to grant privileges of AED use to a person who has previously lost said privileges.

CATASTROPHIC INCIDENT MANAGEMENT PLAN

Participation in intercollegiate sport does present and expose the student-athlete to the potential of suffering from a catastrophic injury. A catastrophic injury is classified by the Georgetown College Sports Medicine staff as one of the following:

• Sudden death of student-athlete, coach, and/or member of the Georgetown College Department of Athletics • Disability or quality of life-altering injury/illness including, but limited to: • Spinal cord injury resulting in partial or complete paralysis • Loss of paired organ • Severe head injury • Injuries/illnesses resulting in severely diminished mental capacity or other neurological injuries that result in inability to perform daily functions (Coma) • Irrecoverable loss of speech, hearing (both ears), eyesight (both eyes), or one or both arms and/or legs • Other injuries or incidents as deemed appropriate.

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Georgetown College has established a Catastrophic Incident Management Team (CIMT) which includes the following:

• Director of Athletics • UK HealthCare Team Physician(s) • Assistant Athletic Director(s) • Senior Athletic Trainer • Appropriate Georgetown College staff athletic trainers • Appropriate Head Coach • Director of Risk Management • Georgetown College Counseling Services • Other personnel that is deemed appropriate to the situation

The policy of Georgetown College Department of Athletics regarding a student-athlete who has sustained a catastrophic injury shall be as follows:

• The Georgetown College Sports Medicine Emergency Action Plan in relation to all practices, events, and competitions at home will be followed. If away, the host institution’s Emergency Action Plan shall be followed. o A member of the Georgetown College Sports Medicine staff, a member of the coaching staff, and/or a member of the Georgetown College Department of Athletics will accompany the injured student-athlete to the medical facility with the relevant emergency medical/insurance information. If there is no other Georgetown College athletic trainer on site, the person that accompanied the student-athlete will call the athletic trainer with any medical updates. o The athletic trainer providing coverage for the event will call the Senior Athletic Trainer or their designee (if applicable) to notify them of the emergency. . The Senior Athletic Trainer will immediately notify the Team Physician (if not already aware of the situation) and the Vice President of Athletics to inform them of the situation and will keep them updated at regular intervals. . The Vice President of Athletics and/or designee will contact other Athletic Department and College Administration, as they see necessary. • The Georgetown College athletic trainer will make every effort possible to notify the injured student-athlete’s family about the emergency situation. If the family cannot be reached, the emergency contact will be called to try to locate student-athlete’s family. • Communication with the injured student-athlete’s family will remain open and updates given, when available. • The Vice President of Athletics, or their designee, will assign a member of the Georgetown College Department of Athletics’ staff to assist with travel and lodging arrangements for the injured student- athlete’s family, be with the family as needed, and protect them from outside persons. • At the conclusion of the event, either the team physician (if applicable), Assistant Athletic Director, head coach, athletic trainer, or the Vice President of Athletics will update the athletic team in private on the injured student-athlete’s condition.

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o All team and department personnel will be strongly cautioned to not speak with the press/media regarding the injured student-athlete and/or the emergency situation and to refer all media questions to the Vice President of Athletics. • If applicable, the team physician, Assistant Athletic Director and Vice President of Athletics, and/or other personnel will proceed to the medical facility as soon as possible. If not applicable, they are to stay in touch and receive updates when they become available. • Once the student-athlete’s family has been notified of the emergency situation and consent has been given, the team physician and Vice President of Athletics, in consultation with medical personnel from the treating facility, a member of the Georgetown College media relations department, and the Georgetown College President’s office will make a statement regarding the injured student- athlete to be released to the press/media (if necessary). 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 or student-athlete’s family has been notified, consent has been given, and the College President’s office and Vice President of Athletics have approved the authorized statement. o The official spokespersons for the injured student-athlete will consist of the Georgetown College team physician, Vice President of Athletics, the medical staff at the facility in which the student-athlete is receiving treatment, and the Georgetown College media relations department. o At no point is anyone besides the aforementioned personnel authorized to speak to anyone concerning the injured student-athlete. o It is the Georgetown College Media Relations Department’s responsibility to see that all press/media are kept at a safe distance from the private meeting space and are not harassing the team or university personal in or around the medical facility. o Georgetown College Sports Medicine staff will be responsible for contacting authorities at the medical facility and at Georgetown College for the purpose of arranging psychiatrists, psychologists, chaplains, grief counselors, etc for the use of all team and college personnel. o The Assistant Athletic Director(s) and/or their designee, in conjunction with the athletic trainer, if necessary, will be responsible for the following: . Acquiring and compiling complete documentation of events from everyone involved in the incident with signatures (if needed) . Assembling a timeline of events related to the incident before/after if occurred . Collecting and securing all equipment and materials involved in the incident.

Catastrophic Incident Management Team (CIMT)

Vice President for Athletics and/or their Designee:

• Notified by the assistant athletic director or athletic trainer, if not already present, of the injury. • Notify the Georgetown College President of the incident and continually provides updates when possible. • Notify the Georgetown College Risk Management Team of incident and provides updates as needed • Notify any additional college or athletic department staff of the incident as deemed necessary and provides updates as warranted

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• If the catastrophic incident is non-athletic, notify the head coach of the sport and the Senior Athletic Trainer. • Assign Georgetown College Department of Athletics staff to assist with travel and lodging arrangements for the injured student-athlete’s family/guardian, be with the family as needed, assist family upon arrival as needed, protect them from outside persons. • Draft, approve, and make public statements regarding the injury in consultation with the student- athlete’s family/guardian, medical personnel at the treating medical facility, Georgetown College’s team physicians, the Georgetown College Risk Management Team, Assistant Athletic Director, Georgetown College Media Relations personnel, and other appropriate personnel. • Act as the “Official Spokesperson” regarding all aspects of the incident in conjunction with the GC Team Physician’s and on-site medical personnel. • Other duties as needed

Head Coach of Injured Student-Athlete’s Team

• Immediately notify the Vice President of Athletics of the incident and provide updates as they become available. • Notify or is notified by the team’s athletic trainer and/or assistant athletic director of the incident • Follow the plan as outlined above with no deviations • Mandate that the student-athletes and other team entities do not discuss the injury until cleared to do so by the Vice President of Athletics • Offer support to all team student-athletes and personnel • Assist with notification of the student-athlete’s family/guardian, if needed • If the situation is appropriate and deemed necessary, update team personnel as to the status of the injured student-athlete, in conjunction with the Georgetown College Team Physician, Assistant Athletic Director, Athletic Trainer, and Vice President for Athletics • Assist with the collection and compilation of persons involved in the incident, statements, and course of events of the injury. • Assist with the collection and security of all materials/equipment involved in the incident • Help with the arrangements of travel, lodging, meal arrangements of the team • Assist with coordination of return travel for the injured student-athlete back to Georgetown, Kentucky or other appropriate facility as deemed necessary by the medical personnel at the treating facility and Georgetown College Team Physician • Communicate with Assistant Athletic Director regarding NAIA compliance issues and the payment of incidental expenses related to the incident • Communicate with the Georgetown College Risk Management and other appropriate personnel within the athletic department, as necessary • Other duties as needed or assigned

Assistant Athletic Director(s)

• Notify, or is notified by the Vice President of Athletics and/or head coach, that a catastrophic injury has occurred and continue to provide updates, as necessary.

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• Assist with the notification of the student-athlete’s family or emergency contact of the incident and provide updates as warranted • Update team personnel as to the status of the injured student-athlete, along with the team physician, head coach, athletic trainer, and Vice President of Athletics • Make a public statement regarding the incident in conjunction with the team physician, Vice President of Athletics, Georgetown College Risk Management representative, media relations personnel, and other appropriate personnel • Assist with arranging for a private meeting space for all team and university personnel at the medical facility • Assist with coordinating access to psychiatrists, psychologists, clergy, counselors, etc. for university personnel • Collect and secure all equipment and material involved within the incident. • Assist with the coordination of the return travel plans for the injured student-athlete back to Georgetown, KY or other appropriate location in conjunction with the family/guardian, medical personnel, team physician, and other pertinent personnel • Help with arrangements for follow up care and/or rehabilitation services for the injured student- athlete • Provide interpretative support relating to NAIA compliance regulations • Help with the filing of all appropriate insurance claims (student-athlete, Georgetown College Athletic Department secondary insurance, NAIA catastrophic insurance, etc) as needed. • Other duties as assigned

Team Physician

• Communicate directly with medical personnel at the treating facility regarding the incident • Communicate with the Vice President of Athletics and Assistant Athletic Director(s) about the incident and status of the student-athlete • After consulting with the student-athlete’s family/guardian, medical personal at the treating facility, Vice President of Athletics, Georgetown College Risk Management, athletic trainer; draft, approve, and make a public statement regarding the incident. • Act as an “Official Spokesperson” regarding all aspects, of the incident along with the Vice President of Athletics and medical personnel at the treating facility. • Give input into the coordination of the return travel for the injured student-athlete back to Georgetown, KY or other appropriate destination in conjunction with the medical personnel and the family/guardian. • Other duties as needed

Georgetown College Sports Medicine Staff

• Assist the Vice President of Athletics and Assistant Athletic Director(s) with all duties as needed or assigned. • If appropriate, update team personnel of the status of the injured student-athlete, along with the medical personnel, team physician, head coach, and Vice President for Athletics

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• Communicate with Georgetown College staff members to arrange access to psychiatrists, psychologists, clergy, counselors, etc for the team • Assist with compilation of complete documentation of events from everyone involved in the incident with signatures • Assist with the construction of a detailed timeline of events related to the incident with signatures • Assist with the collection and security of all equipment and materials involved with the incident • Help with the coordination of the return travel for the student-athlete back to Georgetown, KY or other appropriate destination in conjunction with the treating facility’s medical personnel, team physician, and the family/guardian of the student-athlete. • Help with the filing of all appropriate insurance claims (primary insurance, GC Secondary Insurance, NAIA catastrophic insurance, etc) as needed • Communicate with updates and other pertinent information to all appropriate athletic department personnel • Work with the Associate Dean for Student Success to notify professors of the student-athlete’s incident and how it will impact their class and/or grades • Other duties as assigned

Media Relations

• In consultation with the student-athlete’s family/guardian, medical personnel at the treating facility, Vice President of Athletics, Georgetown College team physician(s), Assistant Athletic Director, and appropriate personnel; draft, approve, and make a public statement regarding the incident • Keep members of the media a safe distance from the team, athletic department, and college personnel in and around the treating facility, hotel, etc

INCLEMENT WEATHER PLAN

The Georgetown College Department of Athletics is committed to keeping all student-athletes, staff, guests and fans safe, including from the dangers of the weather and environment. Due to the fact each sport plays at different facilities on campus, each Emergency Action Plan will be site specific in the event of a weather emergency. It is important to know the harms, risks, and appropriate ways to react to a weather emergency or situation. Knowing when to seek shelter and recognizing a potential weather hazard is essential, especially for sports that do not have a certified athletic trainer present at practices and competitions. Various forms of tools and technology [local weather news and websites, thermometers, WeatherSentry (WxSentry) app, and a handheld Wet Bulb Globe Thermometer device] will be used to assist in predicting the likelihood of severe weather so the sports medicine staff, athletic staff, and coaching staff can compete or practice safely.

The same policy will apply to both practices and games. For all outdoor practices, the Certified Athletic Trainer will communicate with the head coach on all weather-related restrictions. It is expected coaches monitor the weather frequently themselves and plan accordingly. For all outdoor games, the Certified Athletic Trainer and administrator on duty will check area weather reports prior to game time. Pre-game cancellations will be at the discretion of the hosting coach, visiting coach, and athletics administration/designated game manager.

Once games or practices have begun, weather will be monitored by

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• WeatherSentry (WxSentry) App • Local Weather Station Radar (WKYT, LEX18, etc.) • Sight & Sound

If a competition is underway, the administrator on duty will notify coaches and officials/umpires of increased weather conditions. In the event no administrator is present, the ATC will notify officials of increased weather conditions. If the game will be delayed or terminated, coaches will notify the athletes and spectators will be notified by the PA system.

Severe Weather Definitions:

• Severe Thunderstorm - A thunderstorm with winds of 58 miles per hour or more and/or hail with a diameter of .75 inches or more. • Thunderstorm Watch - Severe thunderstorms are possible • Thunderstorm Warning - Severe thunderstorm detected; take shelter immediately. • Tornado - A violently rotating column of air produced by a thunderstorm in contact with the ground. • Tornado Watch - Tornadoes and severe thunderstorms are possible • Tornado Warning - Tornado detected; take shelter immediately

Lightning Procedure

Competitions/practices will be suspended once lightning is detected within 10 miles of the venue. At this point, all student-athletes, coaches, and staff should evacuate the field to their appointed safe location immediately.

Alert Meaning

Advisory Chance of storms during practice or competition. Monitor weather appropriately

Caution Lightning within 15 miles. ATC will advise coaching staff of proximity of lightning

Lightning within 10 miles. ATC will notify coaching staff of lightning in warning Warning area. Coaches are to remove student-athletes from the venue to safe location immediately.

All Clear Lightning has not been detected within 10 miles for 30 min

Safe locations at Georgetown College during lightning delay:

• Toyota Stadium & Upper Grass Field: Home athletes to locker room. Visiting athletes to team bus or locker room if available. • Baseball Field: Home athletes to locker room. Visiting athletes to team bus or locker room if available.

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• Softball Field: Home athletes to locker room. Visiting athletes to team bus or locker-room if available. • Tennis Court: To vehicles • Golf Match or Practice: Evacuate to the clubhouse or nearest safe shelter as listed below • Cross Country: Evacuate to the nearest safe shelter as listed below • Other safe shelters include: enclosed buildings, fully enclosed vehicle, and low ground areas as a last resort • Avoid: open fields, golf carts/gators, metal bleachers, umbrellas, light poles, flag poles, tall trees, pools of standing water

Activity may resume once the all clear has been given by a member of the sports medicine or athletic administration staff.

Tornado Procedure

If the National Weather Service or WeatherSentry issues a Tornado Watch for Georgetown, KY (Scott County, KY), the sports medicine staff will notify all members of the coaching staff. All coaches and staff should monitor conditions appropriately throughout the day.

If the National Weather Service or WeatherSentry issues a Tornado Warning for Georgetown, KY (Scott County, KY), the sports medicine staff will notify all members of the coaching staff. The following steps should be taken:

• Coaches are to remove student-athletes from the venue to safe location immediately. • Close all external doors and stay away from windows. • Move all individuals to a pre-planned emergency shelter in your immediate area o Safe shelters include: restrooms, inside walls opposite of corridor from which storm is approaching, or any interior hallway on the lowest ground floor. o Avoid: Lobbies of buildings with glass windows, walkways, atriums, rooms with large roof spans (such as auditoriums, end rooms in a one-store building, rooms with large glass areas, and hallways that could become a “wind tunnel.”

Remain in the shelter until an all clear is given by the sports medicine or athletic administration staff.

Heat Procedure

All outdoor athletic events at Georgetown College operate under guidelines highlighted in the following table. The Sports medicine staff is responsible for communicating to all athletic personnel. In the event a Certified Athletic Trainer is not present, it is the responsibility of the coaches and student-athletes to adhere to the following table to determine the guidelines recommended for your practice conditions.

Temperature zone Guidelines/adjustment

The Wet Bulb Globe Temperature (WBGT) is a composite temperature used to estimate the effect of temperature and humidity on humans. This is different measurement than a standard thermometer reading. Conditions will be monitored at each outdoor location with readings taking place both before and during activities. The frequency of readings will be dependent on the severity of conditions. Activities can

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be changed/suspended after they have started if conditions worsen. See appendix for alternate heat index calculation if a WBGT thermometer is not available

WBGT Practice Recommendations NAIA Game Recommendations

Below Activities can proceed as normal. Activities proceed as normal, per sport regulations. 82°F Ensure proper hydration.

Use discretion for intense or prolonged exercise. Increase attention to at-risk athletes. 82-86.9°F Use discretion for intense or prolonged exercise. Provide at least 3 hydration/rest breaks per hour. Water should be accessible at all times.

For Equipment Intensive Sports: The transitions times following the 1st and 3rd quarters should be extended 2 minutes. Water should be allowed on the field Equipment modification in football to and helmets to be removed for all play stoppage (i.e. injuries, measurements, helmets, shoulder pads, and shorts. etc.). Additional breaks are to be left to the discretion of the game officials, coaches, and medical staff collectively. Ice towels can be available. Athletes should be allowed to remove equipment during breaks (all sports). For Time-Restricted Endurance Sports: All other sports, added hydration 87-89.9°F No equipment should be worn during breaks will be left to discretion of the game officials and medical staff, conditioning activities (all sports). collectively prior to the start of the game. For Endurance Sports: Water and sports drinks will be provided at the Increase length and frequency of start/finish lines of the event, at least 1 hour prior to the start to the event. breaks. Water should be accessible at Cooling tubs will be available. all times. For Anaerobic Sports: Addition of water breaks will be left to discretion of the officials/umpires and medical staff, collectively prior to the start of the game. For Equipment Intensive Sports: A 5-10 minute break after the first possession change and at the halfway point of each quarter shall be utilized. Timeouts and the transition times following the 1st and 3rd quarters should be No equipment should be worn. extended. Water should be allowed on the field and helmets to be removed for all play stoppage (i.e. injuries, measurements, etc.). Ice towels can be available. Practice time is 1 hour MAX with NO conditioning. For Time-Restricted Endurance Sports: A 5-10 minute water break will be 90-91.9°F Consider altering practice time if between the 20-25 minute mark of each half, when there is a stoppage of play possible. and at the discretion of the head referee. Ice towels can be available. Increase length and frequency of For Endurance Sports: Water and sports drinks will be provided at the breaks. Water should be accessible at start/finishlines of the event, at least 1 hour prior to the start to the event. Cooling all times. tubs will be available. Shaded tents and/or ability to cool in an air-conditioned facility is recommended. For Anaerobic Sports: Water and if available, sports drinks in each dugout. Ice towels can be available Over All outdoor activities cancelled until No outdoor events, delay competition until WGBT decreases into a colored 92°F conditions improve. category.

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The charts below list common heat injuries and the corresponding signs and symptoms. If an athlete exhibits the signs and symptoms of exertional heat stroke, cold water immersion in conjunction with rectal thermometer will be utilized before they are transported to the hospital. Every effort will be made to maintain the privacy and modesty of the athlete.

Recognition: Signs & Symptoms of Common Heat Injuries

Heat Cramps Heat Syncope (Fainting )

Dehydration Dehydration Thirst Fatigue and Dizziness Sweating Light headedness Transient muscle cramps Pale/sweaty skin Fatigue Tunnel vision

Exercise (heat) exhaustion Exertional heat stroke Exertional hyponatremia

Core temp (97.0 – Core temp (> 104.0°F) (Over-hydration/insufficient 104.0°F) Dizziness sodium level) Dehydration Drowsiness Core temp (< 104.0°F) Dizziness Irrational behavior Nausea Lightheadedness Confusion/disorientation/irrita Vomiting Syncope bility Swelling of extremities Headache Loss of consciousness Low sodium level Nausea Dehydration Progressive headache Intestinal cramps/diarrhea Weakness Confusion Pallor Hot and wet/dry skin Lethargy Profuse sweating Tachycardia (100-120 bpm) Seizures/coma Cool, clammy skin Hypotension Weakness Hyperventilation Hyperventilation Vomiting Diarrhea

Cold Procedure

All outdoor athletic events at Georgetown College operate under guidelines highlighted in the following table. The sports medicine staff is responsible for communicating to all athletic personnel. In the event a Certified Athletic Trainer is not present, it is the responsibility of the coaches and student-athletes to adhere to the following table to determine the guidelines recommended for your practice conditions.

Cold weather is defined as any temperature that can negatively affect the body’s regulatory system. Air temperatures do not have to be freezing to have this effect. The temperature ranges listed in the chart do

31 include the wind chill factor which is lower than the actual temperature. For example, if the air temperature is 40°F but the wind is blowing at 10MPH, the wind chill temperature becomes 34°F. See Appendix for approximate wind chill calculation based on temperature and wind mph.

Cold temperatures can affect the effectiveness of equipment, such as helmets, bats, sticks, balls, etc. Please refer to manufacturer guidelines on proper use of sport specific equipment.

Temperature (including Game & Practice Recommendations wind chill)

Above 30°F Activities can proceed as normal.

Be aware of conditions 26°F - 30°F Athletes to wear appropriate clothing (leggings, gloves, ear warmers, etc.)

21°F - 25°F Modify workouts to allow athletes to re-warm themselves. Teams must come inside every 45 minutes for 15 minutes re-warming period *Frostbite can occur within Additional clothing must be allowed. Cover as much exposed skin as possible. 30 minutes of exposure

Recommend no outdoor activity. If it is necessary, no longer than 30 minutes 16°F - 20°F TOTAL. Appropriate clothing with as much exposed skin covered as possible.

Below 15°F Absolutely NO outdoor activity

The charts below list common cold injuries and the corresponding signs and symptoms. If an athlete exhibits the signs and symptoms of any of these, they should be taken into a warm environment and evaluated to determine next steps.

Frost Bite At first, cold skin and a prickling feeling Hypothermia Numbness Core temp (<95°F) Red, white, bluish-white or grayish-yellow skin Shivering Hard or waxy-looking skin Slurred speech or mumbling Clumsiness due to joint and muscle stiffness Slow, shallow breathing Blistering after rewarming, in severe cases Weak pulse Intense shivering Clumsiness or lack of coordination Slurred speech Drowsiness or very low energy Drowsiness and loss of coordination Confusion or memory loss Protecting the affected area from further cold Loss of consciousness Not walking on frostbitten feet Bright red, cold skin (in infants) Reducing pain with ibuprofen (Advil, Motrin IB, others)

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MENTAL HEALTH MANAGEMENT PLAN

The Sports Medicine staff at Georgetown College proposes the following management plan based on the current recommendations from the NCAA Inter-Association Consensus Document: Best Practices for Understanding and Supporting Student-Athlete Mental Wellness.

Multidisciplinary Mental Health Care Team

Members of the multidisciplinary healthcare team include the team physician, athletic trainer, mental health professional, and Georgetown College Department of Athletics liaison. Other medical consultants may be utilized as the sports medicine staff sees fit depending on individual situation.

Team Physician

• Diagnosis mental health issue in conjunction with team mental health professional • Develops treatment plan in relation to medical issues • May manage medications or refer to local psychiatrist • Makes ultimate decision regarding athletic participation

Athletic Trainer

• Makes initial referral of athlete to team physician or GC Counseling Center for evaluation of student-athlete’s mental health • Acts as liaison among members of management team, coaching staff, and the student-athlete

Mental Health Professional

• Assists in evaluation, diagnosis, and counseling regarding mental health issue in conjunction with team physician

Georgetown College Department of Athletics Liaison

• Works with athlete and other services on campus to obtain academic accommodations as needed • Supports the overall well-being of the student-athlete.

Clinical Licensure of Practitioners Providing Mental Health Care

• Evaluation of treatment of student-athletes with possible mental health concerns may be coordinated through the GC Sport Medicine staff. The athletic trainer is often the first point of care who will then contact the team physician to help coordinate care. • Diagnosis and management will be pursued using proper consulting services including mental health services. Student-athletes who display any signs or symptoms or screen positive for multiple risk factors for mental illness may be referred to Georgetown College Counseling Center for psychological assessment and counseling services. The team physician may oversee mental health/psychiatric medication management or may refer the student-athlete to a local psychiatrist on a case-by-case basis based on the team physician’s expertise and student-athlete’s preference. • Athletic trainers, other student-athletes, coaches and other athletic department personnel should refrain from attempts to “counsel” a student-athlete that may be experiencing a mental health issue.

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However, they should encourage a student-athlete to seek help from a properly trained mental health professional. • Student-athletes with certain mental issues may not be cleared to participate in sport if sport participation is deemed detrimental to their treatment. During and after mental health evaluation and treatment, the team physician in conjunction with the mental health care provider will have unchallengeable authority regarding the student-athlete’s participation status. All return-to-play decisions will be made by the team physician in conjunction with the mental health care provider. • Student-athlete confidentiality regarding mental health issues will be maintained. However, all practitioners providing mental health care are required to report imminent risk to self and others, child and elder abuse, and court-ordered release of information as mandated by law. • Individuals providing mental health care to student-athletes should have cultural competency in treating student-athletes from diverse racial, ethnic, gender identified and other unique cultural experiences influencing self-help. They should also have competency in working with collegiate student-athletes as evidenced by professional development activities or experiences related to athletics. • GC Disabilities Services may be utilized on a case-by-case basis. • All student-athletes with pre-existing mental health issues on medications including those for ADHD/ADD will disclose the medication to the sports medicine staff on their pre-participation paperwork as a matter of complete health record. o All student-athletes on medications for any disorder must disclose the medication to the Sports Medicine staff AND update the staff if there are any changes to their medications (additions, removals, dosage changes, etc).

Procedures for Identification and Referral of Student-Athletes to Qualified Practitioners

Emergent Mental Health Action and Management Plan:

A mental health emergency is a situation that is life-threatening to the student-athlete or poses a threatening/dangerous situation for those around the student-athlete. This may include:

• Thoughts of self-harm or suicidal ideation • Thoughts of harming others or homicidal ideation • Acute psychosis (hallucinations, delusions) • Acute delirium or state of confusion • Highly agitated or threatening behavior • Severe paranoia • Acute intoxication or drug overdose

Procedure:

1. Seek emergency help. Do NOT approach the student-athlete if it appears to be a dangerous situation. • Dial 911- immediately inform the operator that you are on campus and provide a street address.

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• If the athlete does not pose an immediate threat to life or others, offer to transport them to the Georgetown Community Hospital Emergency Department. • If a mental health emergency occurs during team travel, the above also apply • If emergency care is initiated by non-medical athletics department personnel, the athletic trainer should be contacted who should then contact the team physician. 2. At the emergency department, a psychiatrist will evaluate the student-athlete and decide the best course of action 3. Once a student-athlete is released, he/she/they will be referred to the GC Counseling Center as well as the appropriate psychiatrist • The sports medicine staff can help facilitate follow-up mental health care for the student- athlete • The team physician will be notified regarding the status of follow-up care • The team’s administrative liaison will be notified that a mental health emergency has occurred. 4. Return to sport participation following a mental health emergency will be determined by the team physician in conjunction with the mental health provider. They will have unchallengeable authority over all return-to-play decisions. 5. If a student-athlete is given a prescription medication as part of their mental health care plan, it needs to be reported to the Sports Medicine staff and team physician. 6. In situations that warrant the notification of the student-athlete’s family, the Sports Medicine staff, in addition to the GC Administration and/or Coaching staff, will be responsible for the notification.

For situations where the student-athlete requires immediate/urgent mental health care but is not imminent danger to him/herself or others, the student-athlete may be referred to the GC Counseling Center for a walk- in appointment. Regular hours are Monday – Friday 8-4. Students in need of crisis services may also call the following for assistance:

• Suicide hotline: 1-800-273-8255 • Crisis text line: test “Hello” to 741741 • National Domestic Violence Hotline: 1-800-799-7233 • RAINN (Rape, Abuse, Incest National Network)- 1-800-656-4673 • Trevor Project (LGBTQIA+)- 1-866-488-7386 or text START to 678678 • Trans Lifeline- 1-877-565-8860 • New Vista Community Crisis Center: 1-800-928-8000 • Ampersand Sexual Violence Resource Center: 1-800-656-4673 • GC Campus Police: 1-502-863-8111

Non-Emergent Mental Health Referral Plan:

1. If athletic department personnel believe a student-athlete is exhibiting symptoms or behaviors concerning for a mental health issue, they should notify the Sports Medicine staff or the team physician. These behaviors are a cause for concern when they are a change from a student-athlete’s normal lifestyle and may include: • Changes in eating or sleeping habits • Unexplained weight loss

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• Drug and/or alcohol use • Withdrawal from social contact • Decreased interest in activities that have been enjoyable • Risky behaviors • Loss of emotion or sudden changes of emotion within a short time period • Difficulty concentrating, focusing, or remembering • Frequent complaints of fatigue, illness, or being injured that prevent participation • Increased irritability or difficulty managing anger 2. Athletic department personnel should communicate directly with the Sports Medicine staff or Team Physician if they witness or are aware of any of the following behaviors: • Reported suicidal thoughts • Reported homicidal thoughts • Multiple depressive symptoms • A few depressive symptoms that persist for several weeks • Depressive symptoms that lead to more severe symptoms or destructive behavior • Alcohol and drug abuse as an attempt to self-treat • Overtraining or burnout 3. Student-athletes who exhibit signs or symptoms of a mental health issue may be referred by the Sports Medicine staff to the GC Counseling Center or may meet with the Team Physician to further develop a plan of care. A referral to a local psychiatrist may be performed through the recommendation of the Counseling Center or the Team Physician on a case-by-case basis or at the request of the student-athlete. 4. If a student-athlete is given a prescription medication as part of the mental health care plan, it needs to be reported to the Sports Medicine staff and Team Physician. 5. Ideally, the student-athlete will sign a release of information to allow the Sports Medicine staff to obtain information ensuring the student-athlete’s overall mental health and ability to participate in sport as well as monitor for student-athlete compliance to care.

Pre-Participation Mental Health Screening:

• A Mental Health Screening Questionnaire will be administered during an athlete’s pre-participation physical exam in addition to the student-athlete’s health history questionnaire. A positive response to any of the questions leads to a follow-up individualized mental health screening administered by the Sports Medicine staff. (See appendix 2, adapted from the National Athletic Trainers’ Association position statement: Pre-Participation Physical Examinations and Disqualifying Conditions.) o Additional screening questionnaires that may be utilized include: . Beck Anxiety Inventory . Alcohol Use Disorders Identification Test . Cannabis Use Disorder Identification Test . STOP-BANG Questionnaire . Insomnia Severity Index . Adult ADHD Self-Report Scale

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• All mental health screening questionnaires will be scored according to recommended guidelines. Student-athletes who record scores that may indicate a possible mental health concern will be referred on the team physician for further evaluation and management.

Health-Promoting Environments that Support Mental Well-Being and Resilience:

• The Mental Health Management Team will meet annually to review the GC Mental Health Plans and develop strategies to educate student-athletes about institutional procedures for mental health referrals and management. • All SAAC representatives will annually receive the GC Mental Health Plan as well as the names of local practitioners who are qualified to provide mental health services. They will also receive information about preventing and responding to sexual assault, interpersonal violence, and hazing as well as programming about peer intervention in the event of a teammate with mental health distress. • All coaches will annually receive the GC Mental Health Plans which includes signs and symptoms of mental health disorders. Additional information will be presented at the annual compliance meeting including o The importance of, and how to, create a positive team culture that promotes personal growth, autonomy, and positive team culture. o Information about sexual assault, interpersonal violence, and hazing o The importance of understanding and helping minimize the possible tension that can exist in student-athletes about adverse consequences for seeking mental health care.

PREGNANCY

The Georgetown College athletics department strives to provide and environment that respects pregnancy and parenting decisions and urges all participants to work cooperatively toward degree completion. This policy delineates the rights provided for pregnant and parenting students including those with pregnancy- related conditions. It also prohibits retaliation against any student or employee regarding issues related to the enforcement of this policy.

Title IX of the Education Amendments of 1972 bars discrimination on the basis of sex which includes the guarantee of equal educational opportunity to pregnant and parenting students. Student-athletes cannot be discriminated against because of their parental or marital status, pregnancy, childbirth, false pregnancy, termination of pregnancy or recovery there from.

The safety to participate in each sport is dictated by the movements and physical demands required to compete in that sport.

• Athlete activities associated with a high risk of falling (gymnastics, equestrian, downhill skiing, volleyball) or increased incidences of bodily contact (basketball, ice hockey, field hockey, lacrosse, soccer, rugby) are considered higher risk after the first trimester because of the potential risk of abdominal trauma. • Because of the nutritional requirements during pregnancy, pregnant student-athletes who participate in non-contact endurance sports should consider participating at a non-competitive level

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If a student-athlete becomes pregnant, it is recommended they discuss this with their athletic trainer and team physician. The risks and benefits of continued athletic participation will be further discussed by the team physician and the student-athlete. This includes the effects of pregnancy on competitive ability, effects of strenuous physical training and competition on both the pregnant student-athlete and the fetus, and the warning signs to terminate exercise while pregnant. The student-athlete will also be informed that the NAIA rules permit a one year extension of the five-year eligibility for a female student-athlete for reasons of pregnancy.

A pregnant or parenting student-athlete may fully participate on the team including all team-related activities unless the student-athlete’s physician or other medical caregiver certifies that participation is not medical safe. Medically necessary absences from team activities due to pregnancy shall be considered excused absences. Pregnant and formerly pregnant students who wish to continue to participate in athletics are entitled to assistance and rehabilitation on the same basis as the assistance is provided to student-athletes with other temporary disabilities. The athletics department will renew a pregnant, formerly pregnant, or parenting student-athlete’s award as long as the student-athlete is in good standing academically, remains engaged with the athletic department and meets NAIA eligibility standards. Returning student-athletes post-partum may be evaluated in the same manner as any other team member to determine specific position on the team.

The athletics department, in conjunction with the team physician and others designated by the College President, will regularly review student-athlete pregnancy and parenting cases as they occur to monitor compliance with the given laws and policies.

A pregnant student-athlete must be under the medical care of a licensed obstetrician. Provided that the pregnant student-athlete receives medical clearance from the obstetrician in conjunction with approval of athletic participation by the team physician, participation in and termination of practice and competitive events because of pregnancy will be at the discretion of the student-athlete and within the prerogatives grated by the head coach regarding participation by any student-athlete. The Department of Athletics will abide by the recommendations of the obstetrician and team physician regarding participation during and following pregnancy but assumes no responsibility for complications which may result from continued participation in intercollegiate athletics.

If athletics personnel is informed or suspects a student-athlete is pregnant, he or she should report their concerns to a member of the Sports Medicine staff, team physician, or college designated representative trained in pregnancy and parenting support options. Teammates of pregnant student-athletes should report their concerns to a member of the Sports Medicine staff or team physician. Similar to other health issues no athletics department personnel will publicly release personally identifiable health information about pregnancy without written timely authorization from the student-athlete.

No insurance coverage for pregnancy is provided by Georgetown College. GC does not provide medical coverage for gynecologic and/or obstetric services not related to participation in athletics. It is the responsibility of the student-athlete to seek medical confirmation of pregnancy and to be responsible for all medical expenses related to testing or actual pregnancy and delivery.

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TRANSGENDER

The Georgetown College Athletics Department and Sports Medicine Department strives to identify ways to ensure fair competition for all intercollegiate athletes and avoid discrimination against transgender student-athletes. This policy is based on recommendations in the report “On the team: Equal Opportunities for Transgender Student-Athletes” compiled but the Women’s Sports Foundation and the National Center for Lesbian Rights and is in accordance with recommendations by the NAIA

Student-Athletes who are Undergoing Hormone Treatment:

• A male-to-female (MTF) transgender student-athlete who is taking medically prescribed hormone treatment related to gender transition may participate on a men’s team at any time but must complete one year of hormone treatment related to gender transition before competing on a women’s team • A female-to-male (FTM) transgender student-athlete who is taking medically prescribed testosterone related to gender transition may not participate on a women’s team after beginning hormone treatment The student-athlete may compete on a men’s team but also must request a medical exemption from the NAIA since testosterone is a banned substance prior to competing on a men’s team.

Student-Athletes who are NOT Undergoing Hormone Treatment:

• Any transgender student-athlete who is not taking hormone treatment related to gender transition may participate in sex-separated sports activities or mixed team competition in accordance with his or her birth sex. • A female-to-male transgender student-athlete who is not taking testosterone related to gender transition may participate on a men’s or women’s team. • A male-to-female transgender student-athlete who is not taking hormone treatments related to gender transition may compete only on a men’s team.

The Student-Athlete’s Responsibility:

• To avoid challenges to a transgender student’s participation during a sport season, a student-athlete who has completed, plans to initiate, or is in the process of taking hormones as part of a gender transition must submit a written request to participate on a sports team to the Vice President for Athletics upon matriculation or when the decision to undergo hormonal treatment is made. The student-athlete must notify a member of the Sports Medicine staff in order to help facilitate the process and compliance with the NAIA. • The request must 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 been initiated. • The letter will also identify the prescribed hormonal treatment for the student’s gender transition and document the student’s testosterone levels (if applicable)

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DRUG SCREENING & COUNSELING

All Georgetown College student-athletes must participate in drug education and testing program. The following policy was developed in conjunction with the recommendations and regulations of the NCAA/NAIA.

Objectives:

• Educate student-athletes on the dangers inherent to the abuse of substances which may affect mental and/or physical performance. • Prevent potential harm, injury, or long-term complications associated with misuse of substances which may affect mental and/or physical performance. • Identify student-athletes that appear to be improperly using substances which may affect mental and/or physical performance. • Provide information regarding rules as they relate to continuing eligibility for participation in athletics-related activities.

Education:

• Educational materials, which may include seminars, pamphlets, etc., regarding substance abuse and its detrimental effects on athletic performance may be made available to all student-athletes. These seminars will be presented by professional and/or experienced drug educators and counselors through the GC Counseling Center • At the team orientation conducted during the first week of classes each fall semester, student- athletes are advised of the drug screening program and individual consequences for failed drug tests.

Screening Protocol:

• All student-athletes participating in Georgetown College Athletics sponsored sports are subject to drug screening on a random or targeted selection based on reasonable suspicion. • All student-athletes selected to participate in NAIA postseason competition may be tested prior to departure for competition or at the NAIA Competition Site. • If a student-athlete is suspected of using illegal drugs, a request for drug testing can be made to a member of the athletics staff. • Substances tested for may include any or all banned substances including but not limited to: o Depressants o Mind-altering substances o Marijuana o Ephedrine o Diuretics o Ecstasy o Anabolic steroids o Stimulants • Screening will be accomplished by the analysis of a urine specimen or other recognized analytical procedure i.e. saliva sample. All specimens will be coded to ensure confidentiality and the specific

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identity will be known to only one member of the Sports Medicine staff designated by the head athletic trainer. All chemical analyses will be conducted by a professional laboratory. Screening will be administered in a confidential setting and each collection will be witnessed by a designated same sex member of the Sports Medicine staff. The designated member of the Sports Medicine staff, along with the student-athlete being tested, will validate package specimens on site prior to specimens being sent to the professional laboratory. • If a banned substance is being used at the prescription of a physician, the student may continue to participate in athletics-related activities without violation of the drug testing policy. o The student-athlete must have the prescription medication listed in their athlete profile on Vivature and be able to produce valid proof the prescription (not expired, correct dosage, etc). • If a student-athlete fails to report at the designated time and place for testing without a pre-approved excuse acceptable to the Drug Testing Coordinator, the student-athlete will receive disciplinary action from Athletics Administration. • If the student-athlete reports for the test at the designated time and place, but either refuses or is unable to produce a sample, the student-athlete will receive disciplinary action from the Athletics Administration. • Student-athletes will not be able to leave the testing site until a valid specimen is collected, otherwise sample will not be accepted and may result in a failed test, resulting in disciplinary action by the Athletics Administration. • The NCAA list of banned drug classes is subject to change by the NCAA Executive Committee. No substance belonging to the prohibited class may be used regardless of whether it is specifically listed on the label. The use of supplements is at the student-athlete’s own risk. • If results of a drug test are reported as a dilute specimen, a new specimen will be collected at an approved time shortly thereafter the notification of the results. • All student-athletes testing positive for banned substances will be retested within 90 days. • Notification o Random Selection – The drug testing schedule will be set by the Sports Medicine staff with the approval of the Vice President for Athletics. The head coach will be notified prior to the screening. Individual student-athletes will be randomly chosen for screening. All student-athletes will be eligible for testing each time. The Sports Medicine staff, head coach, or his/her designee will notify the selected student-athletes and they will sign a notification form, if deemed necessary. The Vice President for Athletics or head coaches have the authority to request additional student-athlete (with probable cause) or team screenings at any time o Probable Cause – Student-athletes will be drug screened if there is probable cause to suspect alcohol or drug use/abuse. The coaching staff, administrators, academic advisors, athletic trainers, or strength coaches may receive a report of substance abuse or observe certain signs, symptoms, or changes in behaviors that may cause him/her to suspect substance abuse. Such behaviors may include but are not limited to the following signs, symptoms, and behaviors of a student-athlete: . Begins to show poor motivation, sloppy hygiene and appearance, lack of hustle on the field, irritability or loss of temper, failure to follow orders or a lack of

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discipline, unexplained absences, or has common and routine injuries which will not heal or are recurrent. . Has a recurrent problem with being late to practice, team meetings, or functions, missing appointments, ignoring curfews, staying up to late, or falling asleep during the day. . Has the appearance of the following signs and/or evidence of illness such as dilated or constricted pupils, droopy eyelids or reddish eyes, excessive scratching or breaking out of the skin, consistently running red nose, or recurrent bouts of flu/cold that require medical attention. . Appears over stimulated or hyper, becomes withdrawn and less communicative, or has repeated automobile and traffic violations. . Student Life incident reports. • Results – All of the test results shall be reported to the Vice President for Athletics and the Drug Testing Coordinator. Should a test be reported as positive (i.e. one in which a prohibited drug is found in the specimen), the Drug Testing Coordinator will inform the team physician and the appropriate head coach. In addition, the Counseling Center will be notified of the positive test and the date that student-athlete must contact them by. Athletes will have seven days from notification of a failed test to make an appointment with the Counseling Center and will have 30 days to complete requirements. If the sessions are considered unsuccessful or the athlete is non-compliant with recommendations, student-athlete will be referred to the administration for additional disciplinary actions. • Please refer to the Georgetown College Department of Athletics for more information about the action taken by the college for a positive test result

Safe Harbor Program

A student-athlete is encouraged to voluntarily come forward to seek assistance with substance abuse problems without punitive sanctions. Requests should be made to the Head Athletics Trainer. A student-athlete is not eligible for the program after being informed of an impending drug test or after having received a positive Georgetown College drug test.

Georgetown College will work with the student to prepare a Safe Harbor treatment plan, which may include confidential drug testing. If the student tests positive upon entering the Safe Harbor Program, that positive test result will not result in any administrative sanction unless the student tests positive in a subsequent retest or fails to comply with the treatment plan. A student will be permitted to remain in the Safe Harbor Program for a reasonable amount of time, not to exceed 30 days, as determined by the treatment plan.

If a student-athlete tests positive for any banned substance after entering the Safe Harbor Program or fails to comply with the Safe Harbor Treatment Plan, the student-athlete will be removed from the Safe Harbor Program, an initial Safe Harbor positive test will be treated as a first positive, and the student-athlete will be subject to the sanctions explained in this policy.

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While in compliance with the Safe Harbor Program Treatment Plan, the student-athlete will not be included in the list of students eligible in for the random drug testing at Georgetown College. The Director of Athletics, head coach, and team physician may be informed.

SUPPLEMENT POLICY

Georgetown College Department of Athletics and its employees neither distributes nor encourages the use of dietary supplements. However, if student-athletes have, or are currently taking, a dietary supplement, the student-athlete must inform the certified athletic trainer assigned to their team. The sports medicine staff wants student-athletes to be as informed as possible about the potential side effects and implications for training associated with supplement use.

It is imperative student-athletes research any supplements before taking them. Most supplement products have not been approved by the Food and Drug Administration (FDA) and purity cannot be guaranteed. While the listed ingredients may not be banned, they may naturally breakdown into banned substances in the body.

Some dietary supplements have resulted in student-athletes testing positive during routine drug screening. This positive screening will be subject to the sanctions of the Georgetown College Drug Testing Policy. Ignorance of the impact of dietary supplements is not a justifiable defense in appealing loss of eligibility or other sanctions for a positive drug test.

OPTIMAL NUTRITION & PERFORMANCE PLAN

The sports medicine staff at Georgetown College proposes the following management plan. It is based on the current recommendations from the NCAA, IOC, Female Athlete Triad Coalition, ACSM, and AMSSM. This policy represents a multi-faceted approach to treating disordered eating, relative energy deficiency in sport, and the female athlete triad spectrum that includes the education of student-athletes, coaches, and strength and conditioning personnel. It also delineates the roles of the Sports Medicine staff (see appendix 1). It includes clinical guidelines for risk stratification and management of athletes with disordered eating and relative energy deficiency which includes the female athlete triad spectrum disorders. This policy in consistent with the 2014 Female Athlete Triad Coalition Consensus Statement which is endorsed by the American College of Sports Medicine and American Medical Society for Sports Medicine as well as the IOC Consensus Statement: Beyond the Female Athlete Triad – Relative Energy Deficiency in Sport (RED- S). This policy is reviewed annually.

Objectives:

• To provide education and clinical guidelines for the Georgetown College athletic department including administrators, coaches, strength and conditioning staff, managers, and student-athletes for the screening, diagnosis, and treatment of the relative energy deficiency in sport and spectrum of disordered eating. • To provide clinical guidelines for the Georgetown College Sports Medicine staff including physicians, athletic trainers, and other healthcare providers for the screening, diagnosis, and treatment of the relative energy deficiency in sport and spectrum of disordered eating.

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• To provide recommendations for clearance and return to play for athletes with RED-S and/or athletes with disordered eating by using a risk stratification scoring system assessing magnitude of risk based on the 2014 Female Athlete Triad Coalition Consensus Statement.

Multidisciplinary Nutrition Care Team

Members of the multidisciplinary healthcare team include the team physician, athletic training staff, sports dietician, and mental health professional. Other medical consultants may be utilized as the sports medicine staff sees fit depending on individual situation.

Team Physician

• Diagnosis disordered eating, eating disorder, or relative energy deficiency in sport including female athlete triad in conjunction with team psychologist and dietician • Develops treatment plan in relation to medical issues, including Optimal Nutrition and Performance Plan if deemed necessary • Makes ultimate decision regarding athletic participation • Participates in all management team meetings

Athletic Trainer

• Makes initial referral of athlete to the management team • Acts as a liaison between the members of the management team, the coaching staff, and the athlete • Assists and administers medical surveillance plans characterized by periodic weigh-ins, check-ins, testing, etc. to monitor athlete’s compliance with treatment plan

Nutritionist

• Monitors nutritional patterns of the athlete • Educates athlete about proper nutrition as related to general health as well as athletic performance • Develops treatment plan as related to energy availability and regulating eating patterns

Mental Health Professional

• Assist in evaluation of individual suspected of having disordered eating • Assists in diagnosis of eating disorder in conjunction with team physician • Conducts psychological assessment and develops treatment plan as related to psychological issues and considerations

Definitions:

• Anorexia Nervosa – as defined by DSM-V: o Persistent restriction of energy intake leading to significantly low body weight in context of age, sex, developmental trajectory, and physical health o Either an intense fear of gaining weight or of becoming fat or persistent behavior that interferes with weight gain, even though at a significantly low weight

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o Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight • Bulimia Nervosa – as defined by DMS-V: o Recurrent episodes of binge eating as defined by eating within any two hour period an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. Or individual has sense of lack of control over eating during episode . Recurrent inappropriate compensatory behaviors in order to prevent weight gain including self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; excessive exercise . Binge eating and compensatory behaviors both occur, on average, at least once per week for three months . Self-evaluation is unduly influenced by body shape and weight . Disturbance does not occur extensively during episodes of anorexia nervosa • Binge-Eating Disorder- as defined by DMS-V: o Recurrent episodes of binge eating and the episodes are associated with three (or more) of the following: eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of feeling embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty afterward. o Marked distress regarding binge eating is present o Binge eating occurs, on average, at least once a week for 3 months o Binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur extensively during the course of bulimia nervosa or anorexia nervosa. • Avoidant/Restrictive Food Intake Disorder- as defined by DSM-V o Eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: significant weight loss (or failure to achieve expected weight gain or faltering growth in children); significant nutritional deficiency; o Disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice o Disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way which one’s body weight or shape is experienced o The disturbance is not attributed to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention. • Other Specified Feeding or Eating Disorder (OSFED) – behaviors that cause clinically significant distress and impairment in areas of functioning but do not meet full criteria o Atypical Anorexia Nervosa – all criteria met, except significant weight loss, individual’s weight is within or above the normal range

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o Bulimia Nervosa (of low frequency and/or limited duration) – all criteria are met except at lower frequency and/or less than three months o Binge-eating disorder (of low frequency and/or limited duration) – all criteria for binge- eating disorder are met, except that binge eating occurs on average less than once a week and/or for less than 3 months. o Purging Disorder – recurrent purging behavior to influence weight or shape in the absence of binge eating • Relative Energy Deficiency in Sport (RED-S) o Formally known as Female Athlete Triad o Condition that involves any one of three components: . Low energy availability (EA) with or without disordered eating . Menstrual dysfunction . Low bone mineral density o Is diagnosed in men as well (minus menstrual dysfunction) o Energy availability = energy intake (kcals) – exercise energy expenditure (kcals)/fat free mass (kcals) o Fat free mass obtained from measurement of body weight (kg) and from estimate of percent body fat by BodPod or DXA o Recommended foal of >45kcal/kg FFM/day to ensure adequate energy availability

Relative Energy Deficiency in Sport (RED-S) Spectrum (Female Athlete Triad)

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Why is the RED-S harmful to athlete’s health?

• Low energy availability plays a causal role in induction of exercise-associated menstrual disturbances • Low levels of estrogen can negatively impact musculoskeletal and cardiovascular health • Bone stress reactions and fractures are more common in female athletes with menstrual irregularities and/or low BMD • Poorer sport performance is documented in athletes with energy deficiency • Many athletes are being cleared without being adequately assessed, managed, or treated • Many athletes often return to play after RED-S -related injuries or illnesses without adequate management and follow-up • RED-S is largely preventable

Pre-Participation Assessment

• Student-athletes are presented educational material regarding energy availability and female athlete triad including the NCAA Energy Availability Fact Sheet and the NCAA Female Athlete Triad Fact Sheet (see Appendix 2). • All female athletes will complete a “Female Athlete Heath Questionnaire” at their yearly PPE (see appendix 3). All athletes will complete a “Nutrition Questionnaire” and “Patient Mental Health Questionnaire” at their yearly PPE (see appendix 4 and 5). o Risk factors assessed: . History of menstrual irregularities and amenorrhea . History of stress reactions/fractures . History of critical comments about eating or weight from parent, coach, or teammate . History of depression/anxiety . History of dieting . Personality factors such as perfectionism and obsessiveness . Pressure to lose weight and/or frequent weight cycling . Overtraining . Recurrent and non-healing injuries . Low body mass index or recent weight loss o These forms will be reviewed by the Sports Medicine staff and team physician • Student-athletes participating in athletics at Georgetown College who screen positive for multiple risk factors for disordered eating or RED-S will be evaluated further by the team physician. • Because life-threatening events from syncope to cardiac arrest can occur due to relative energy deficiency during exercise, Georgetown College maintains an Emergency Action Plan for each venue of athletic competition to respond to catastrophic injuries and illnesses. The Sports Medicine staff review and practice this plan annually, and coaches review the plan annually.

Disordered Eating and RED-S Management Plan

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1. If any student-athlete exhibits signs, symptoms, or behaviors consistent with disordered eating or relative energy deficiency in sport, the Sports Medicine staff should be notified immediately who will then notify the team physician and the Management Team. Evaluation and risk stratification will be performed per the “RED-S Cumulative Risk Assessment” (see appendix 6). The evaluation will consist of risk factor screening (as previously discussed), menstrual dysfunction screening, symptom assessment, and physical exam.  Menstrual dysfunction screening: o If primary or secondary amenorrhea or prolonged oligomenorrhea is present, the female athlete may undergo laboratory testing to rule out pregnancy and endocrinopathies as the etiology. Gynecologic services may be utilized for this purpose. o Diagnosis of functional hypothalamic amenorrhea due to low energy availability is a diagnosis of exclusion. o Initial investigation of primary or secondary amenorrhea may include LH, FSH, hcG, prolactin, TSH, free T4, estradiol, total and free testosterone, DHEA/S, +/- 8AM 17-(OH)-progesterone, progesterone challenge test, +/- pelvic ultrasound. 2. Diagnosis and management will be pursued using proper consulting services including gynecologic and mental health services as applicable. Student-athletes who display any signs or symptoms or screen positive for multiple risk factors of disordered eating may be referred to the Georgetown College Counseling Center for psychological assessment and counseling services. 3. Once disordered eating or RED-S is diagnosed, the student-athlete will be evaluated by the team physician and other members of the Management Team who will outline a plan for return to play. The plan for return to play clearance is based on the 2014 Female Athlete Triad Consensus Guidelines.  Full Clearance: 0 – 1 point – low risk o Follow up as determined by physician  Provisional/Limited Clearance: 2 – 5 points o Provisional – moderate risk . Athlete is cleared but must follow up with requested members of the multi- disciplinary team as determined by the team physician and have necessary tests within a defined time period . Written contract may be considered to be signed by the athlete and team physician. o Limited – moderate-high risk . Athlete is cleared but team physician determines training and/or competition is limited due to current risk factors . Must follow up with requested multi-disciplinary team members as determined by the team physician and have necessary tests within a defined time period . Written contract must be signed by athlete and team physician  Not Cleared: 6 or more points o Provisional – high risk . Athlete is not cleared

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. Management/treatment of triad condition and follow up within defined time period and reassessed for clearance/RTP . Written contract must be signed by athlete and team physician o Disqualified – high risk . Athlete unable to safely train/compete . Athlete treated for medical condition  A follow up interval is established with the team physician. During this time, an athlete meets with the selectee members of the multi- disciplinary team. The athlete may not be cleared if he/she does not comply with the recommended follow up. 4. DXA assessment may be utilized to further assess a student-athlete’s health status. Recommendations to obtain DXA assessment by Triad risk stratification based on the 2014 Female Athlete Triad Consensus include:  >1 “high risk” triad risk factor: o History of DSM-V- diagnosed eating disorder o BMI <17.5, <85% estimated body weight, or recent weight loss >10% in 1 month o Menarche >16 years of age o Current or history of <6 menses over 12 months o 2 prior stress fractures, 1 high risk stress fracture, or low energy non-traumatic fracture o Prior Z-score of <2.0 (after at least one year from baseline DXA)  >2 “moderate risk” triad risk factors: o Current or history of disordered eating for 6 months or greater o BMI 17.5 – 18.5, <90% estimated weight, or recent weight loss of 5 – 10% in 1 month o Menarche between 15 – 16 years of age o Current or history of 6 – 8 menses over 12 months o One prior stress reaction/fracture o Prior Z-score between -1.0 and -2.0 5. Once disordered eating or RED-S is diagnosed, treatment will be pursued which includes primarily non-pharmacologic treatment including:  Increasing energy intake gradually by 20-30% over baseline energy needs  Weight gain of approximately 0.5 kg every 7 – 10 days  Regular monitoring of energy availability by sports nutritionist  Vitamin D and calcium supplementation if necessary to achieve a goal of 600-4000 IU Vitamin D/day and 1300mg calcium/day o Higher doses may be needed if clinical hypovitaminosis D is present  Goals of non-pharmacologic treatment include: o Reversal of recent weight loss o Return of body weight associated with normal menses o Weight gain to achieve BMI >18.5% or >90% of predicted weight o Optimize vitamin D status (30-50ng/ml) 6. If appropriate (as determined by the student-athlete and the Management Team), the student- athlete’s parental unit will be notified of the athlete’s current condition as well as his/her management plan. This will help to reinforce the athlete’s management plan, widen the support

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system for the athlete, and establish a communicable relationship if the athlete’s health status should decline. 7. For moderate and high risk athletes, a written plan will be signed by the student-athlete, and team physician (see appendix 5). This plan establishes the guidelines that the athlete must follow for treatment and follow up in order to remain in active participation with his/her team. Athletes diagnosed with disordered eating or RED-S may be prohibited from athletic participation if the athlete fails to comply with treatment or if deemed medically necessary by the Management Team. 8. Only medical personnel including team physicians, athletic trainers, and dieticians may recommend dietary supplements to an athlete based on proper individual nutrition evaluation. 9. Athletes may request nutritional counseling at any time for any reason. 10. Coaches are not permitted to weight or measure body composition of their athletes. If coaches have questions or concerns regarding weight or nutrition issues (disordered eating, weight loss, weight gain, body composition, decreased performance), these issues should be taken to the athletic training assigned to that particular sport. Coaches should not approach that athlete directly. The athletic trainer will then communicate these concerns to the rest of the Management Team. Discussion with the coaches will then occur and appropriate evaluation/intervention will be planned. All medical referrals will be coordinated through the Sports Medicine Department only. 11. Georgetown College is not responsible for the athlete’s treatment or complications from disordered eating once the athlete leaves the athletic program 12. Georgetown College is not fiscally responsible for inpatient medical treatment for an athlete with disordered eating if recommended by consulting physicians and/or the management team.

DIABETES MANAGEMENT PLAN

The sports medicine staff at Georgetown College proposes the following diabetes management plan based on recommendations from the National Athletic Trainer’s Association’s 2007 position statement on Type 1 diabetes management.

Pre-Participation Physical Exam

Prior to participating in any athletic activity at Georgetown College, all student-athletes must complete a full medical history and undergo a physical exam with a team physician. Any student-athlete who has been previously diagnosed with diabetes should indicate so on their medical history forms. Previous medical records should be brought to the scheduled physical time for the team physician to review. If a student- athlete exhibits signs and/or symptoms associated with diabetes and has not previously been diagnosed, the team physician will instruct them of follow up care, as needed.

Diabetic Plan of Care

Upon clearance from the team physician, each student-athlete diagnosed with diabetes will have a plan of care devised for practice, home, and away competitions. For previously diagnosed student-athletes, this plan of care should already be in place from their treating physician. For newly diagnosed student-athletes, the treating physician will work with the sports medicine staff in the devising of a plan. Regardless of diagnosis time, each plan of care should encompass, but not limited to the following:

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• Blood glucose monitoring and documentation guidelines • Insulin therapy and documentation guidelines • A thorough understanding of any other medications that aid in glycemic control • A thorough understanding of signs and symptoms of hyper-/hypo-glycemia for all involved with the student-athlete (i.e. coaching staffs, strength and conditioning, etc) • Emergency contact information

It is strongly recommended that a medical alert tap be worn at all times.

Diabetic Supplies

The student-athlete is responsible for providing their athletic trainer all the necessary supplies, within reason, to treat a diabetic emergency. These supplies are to present at each practice and competition. The supplies should include, but are not limed to, the following:

• Plan of care • Blood glucose monitoring equipment and supplies (glucometer, testing strips, lancet, insulin, extra batteries) • Supplies to treat hypoglycemia (i.e. non-diet soda, glucose tablets/gel, candy, etc) • Sharps container (provided by sports medicine staff)

Recognition, Treatment, and Prevention of Hyperglycemic Events

The team athletic trainer responsible for the care of the student-athlete with diabetes shall be aware and have the responsibility and ability to prevent, recognize and treat episodes of hyper- and hypoglycemia. If exercise or any other activity is seen to elevate the risk or frequency or hyperglycemic events, it is recommended that the student-athlete follow up with the team physician.

Athletic Injury and Glycemic Control

Athletic injuries are an inherent risk to sport. The body responds to such injuries by secreting stress hormones to aid in the healing process. Some of these hormones are the culprits of hyperglycemic states. For diabetic student-athletes, this can hinder the healing process as the hyperglycemic response is an exaggerated one. Diabetic student-athletes should strive to maintain normal glucose levels by consistent monitoring and adequate insulin administration, if needed. When a diabetic student-athlete suffers an injury, they and the sports medicine team should develop a plan for the care of the injury that includes glucose level monitoring.

SICKLE CELL DISEASE & SICKLE CELL TRAIT

Sickle-Cell Disease (SCD) is an inherited condition of the oxygen carrying protein, hemoglobin, within the red blood cells. Sickle Cell Trait (SCT) is when an individual carries the gene for Sickle Cell Disease. SCD/SCT is most predominant in African Americans and those of Mediterranean, Middle Eastern, Indian, Caribbean, and South and Central American ancestry, although persons from all races and ancestry may test positive for SCD/SCT.

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SCT is typically benign, but during intense, sustained exercise, hypoxia (lack of oxygen) in the muscles may cause sickling of the red blood cells (red blood cells changing from a normal disc shape to a crescent or sickle shape). This sickling effect can accumulate in the bloodstream and logjam blood vessels, leading to rapid muscle breakdown due to lack of blood and oxygen. This breakdown of muscles is called rhabdomyolysis.

Sickle Cell Testing

The NAIA encourages that all student-athletes have knowledge of their sickle cell status before they participate in any intercollegiate athletics event, including strength and conditioning sessions, practices, competitions, etc.

Testing can be accomplished with a simple blood test that is relatively inexpensive. If a test is positive, the athlete will not be disqualified from participating in sports, but will however, be offered counseling on the implications of sickle cell trait, including health, athletics, and family planning. Student-athletes will also receive further information of the sickle cell trait and precautions that should be taken.

In the U.S. (all 50 states and the District of Columbia), infants born after 2006 and under the supervision of a physician are tested at birth for their sickle cell status.

Sickle Cell Athlete Guidelines

For a student-athlete with SCD or SCT, the following guidelines should be adhered to:

• Educate to create an environment that encourages athletes with sickle cell trait to report any symptoms immediately; any signs or symptoms such as fatigue, difficulty breathing, leg/low back pain, or leg/low back cramping in an athlete with sickle cell trait should be assumed to be sickling. • Encourage participation in preseason sports-specific strength and conditioning programs to enhance the preparedness of athletes for performance testing • Allow athletes with sickle cell to alter performance tests such as mile runs, serial sprints, etc, based on recommendations from team physicians • Cessation of activity with onset of symptoms (muscle “cramping”, pain, swelling, weakness, tenderness, inability to “catch breath”, fatigue). • Allow sickle cell athletes to set their own pace • Allow athletes with sickle cell trait, who perform repetitive high-speed sprints and/or interval training that induces high levels of lactic acid, extended recovery between repetitions • Adjust to work/rest cycles for environmental heat stress • Emphasize hydration • Control asthma • Do not allow a sickle cell athlete to participate if they are ill • Watch athlete with sickle cell trait closely if training at new altitude o Modify training and have supplemental oxygen available for competitions. BLOODBORNE PATHOGENS & INFECTIOUS DISEASES

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Exposure to bloodborne pathogens is a risk assumed by all healthcare providers. The Georgetown College Sports Medicine staff has undergone training to minimize their risk and undergoes yearly refresher courses.

The principle of universal precautions recognizes that any patient may be infected with micro-organisms that could be transmitted to other persons. Of particular concern are the primarily blood-borne pathogens HIV (human immunodeficiency virus) and HBV (hepatitis B virus). However, body fluids other than blood, secretions, and excretions are included in universal precautions. Since infected patients may be asymptomatic, it becomes necessary to use basic precautions with every patient. Observance will help to provide better protection for every staff member.

The NAIA policy pertaining to AIDS and Intercollegiate Athletics is intended to be used as a guideline only and recognizes that all OSHA or specific state law requirements may not be met within the limits of the policy. Therefore, the NAIA recommends that individual officials be contacted to obtain complete state regulations.

The following information is the policy adapted by the NAIA:

The Acquired Immune Deficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV) which infects cells of the immune system and other tissues such as the brain. The virus is transmitted through sexual contact, exposure to infected blood or blood components, and perinatally from mother to neonate.

It is estimated that 1.5 million persons in the United States are infected with HIV. Sixty to seventy percent of HIV-infected adults develop AIDS or AIDS-related complex (ARC) within eight to ten years after their initial infection. Some experts believe all infected persons will eventually develop AIDS.

HIV has been isolated from blood, semen, vaginal secretions, saliva, tears, breast milk, cerebrospinal fluid, amniotic fluid, and urine. Available evidence, however, has implicated only blood, semen, vaginal secretions, and breast milk in the transmission of HIV.

The risk of infection is increased by having multiple sexual partners, homosexual activities among males, and sharing of needles among intravenous drug users. The virus can be transmitted heterosexually as well as homosexually. There is no evidence to date to suggest that HIV can be transmitted through casual contact (such as members of the same household), by aerosols, by mosquitoes or other insect vector, or through the air.

The precise risk of transmission during exposure of open wounds or mucous membrane to contaminated blood is not known, but evidence suggests it is extremely low. Therefore, while the theoretical possibility of HIV transmission by blood from one student-athlete to the open wound or mucous membrane of another student-athlete exists, the probability of this occurring is extremely low.

Because of its chemical composition, the virus is susceptible to certain agents or procedures, including alcohol, bleach, household detergents, ultraviolent light, and air-drying.

Healthcare workers, including doctors and athletic trainers, who care for student-athletes should employ the universal precautions recommended currently by the Center for Disease Control in the care of all athletes, since medical history and examination cannot reliably identify patients infected with HIV.

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Universal Precautions:

• Routine use of barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids is anticipated. Gloves should be worn for touching blood, body fluids, mucous membranes, or non-intact skin (e.g. abrasions, dermatitis) of all athletes, for handling items or surfaces soiled with blood or body fluids, and for performing venipuncture. Gloves should be changed after contact with each student-athlete. Masks and protective eyewear or face shields should be worn during procedures that are likely to generate droplets of blood or other body fluids to prevent exposure of mucous membrane of the mouth, nose, and eyes. • Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids. Hands should be washed immediately after gloves are removed. • Surfaces contaminated with blood should be cleaned with a solutions made from a 1-10 (10%) dilution of household bleach. • Precautions should be taken to prevent injuries caused by needles, scalpels, and other sharp instruments or devices. To prevent needle-stick injuries, needles should not be recapped, purposely bent or broken by hand, removed from disposable syringes, or otherwise manipulated by hand. • Although saliva has not been implicated in HIV transmission, to minimize the need for emergency mouth-to-mouth resuscitation, mouthpieces, resuscitation bags, or other ventilation devices should be available for use. • Healthcare workers who have exudative lesions or weeping dermatitis should refrain from all direct patient care until the condition resolves. • Soiled linens should be bagged and washed in hot water with detergent and bleach.

In the athletic department, universal guidelines should be considered in the immediate control of bleeding and when handling bloody dressing, mouth guards, and other articles containing bodily fluids.

Member institutions should ensure the policies exist for the orientation and education of all healthcare workers on the prevention of transmission of HIV and the need for routing use of the above universal precautions. Additionally, provision and supplies necessary to minimize the risk of infection, as well as the monitoring of adherence to recommend protective measures, needs to be guaranteed.

In our present state of knowledge, no cure exists for this preventable, fatal disease. It is imperative that education and prevention be emphasized to student-athletes in specific programs designed to address these issues. These should include a candid discussion of modes of transmission of HIV, and awareness of high- risk behaviors.

Special mention of testing for antibodies to HIV needs to be made. Mandatory testing should not be considered as an alternate to a sound educational program that emphasizes prevention. Realistically, the prevalence of infection is extremely low and the risk of transmission is thought to be low within the environment of athletic activity. Routine HIV testing of student-athletes is not recommended at this time, however, in cases where exposure to blood has occurred to an open wound or mucous membrane of another person, HIV counseling should be made available to both individuals.

Finally, it is recommended that individual NAIA sports committees examine current practices in an effort to minimalize the risk of transmission of AIDS and all other blood borne infectious diseases.

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The following information is adapted from the NATA:

The risk of blood-borne pathogens transmission at athletic events is directly associated with contact with blood or other body fluids. Athletic trainers who have responsibility for overseeing events at which such contact is possible should use appropriate preventative measures and be prepared to administer appropriate treatment, consistent with the requirements and restrictions of their job, and local, state, and federal law.

In most cases these measures include:

• Pre-event care and covering of existing wounds, cuts, and abrasions • Provisions of the necessary or usual equipment and supplies for compliance with universal precautions, including, for example, latex/nitrile gloves, biohazard containers, disinfectants, bleach solutions, antiseptics, and sharps containers. • Early recognition and control of a bleeding athlete, including measures such as appropriated cleaning and covering procedures, or changing of blood saturated clothes • Requiring all athletes to report wounds immediately • Insistence that universal precaution guidelines be followed at all times in the management of acute blood exposure • Appropriate cleaning and disposal policies and procedures for contaminated areas or equipment • Post-event management including, as appropriate, re-evaluation, coverage of wounds, cuts, and abrasions • Appropriate policy development, including incorporation, with necessary legal and administrative assistance, or existing OSHA and other legal guidelines and conference or school rules and regulations.

Universal Precautions and OSHA Regulations:

Athletic trainers should, consistent with their job descriptions, time, legal requirements and limitations of their jobs and professions, inform themselves and other affected and interested parties of the relevant legal guidance and requirements affecting the handling and treatment of blood borne pathogens.

Athletic trainers cannot be expected to practice law or medicine, and efforts with respect to compliance with these guidelines. Requirements must be commensurate with the athletic trainer’s profession and professional requirements. It may be appropriate for athletic trainers to keep copies of the Center for Disease Control regulations and OSHA regulations and guidelines available for their own and others’ use.

The Georgetown College Sports Medicine Department will adapt the following blood borne pathogen policy:

• All sports medicine staff will utilize latex/nitrile gloves as a barrier for the routine care of all wounds, which expose blood or body fluids to the environment. Any refuse generated from such treatment will be separated from other trash and placed in appropriately marked biohazard bags for disposal. • Routine washing of hands with a cleansing soap and water, or an alcohol-based hand washing (no water needed) gel, or a prepackaged sanitary wipe will be encouraged once gloves are removed following treatment.

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• All exposed working surfaces will be immediately cleaned with a 10% bleach solution or equivalent cleaner, as well as all surfaces being wiped down during and at the end of each business day. • No needles will be exposed in the athletic training room unless being handled by a team physician or by physician approval. Any scalpel blades or Shark replacement blades will be disposed of properly in a provided sharp’s container. • All sports medicine staff will be provided with a CPR mouth barrier. • Athletes or sports medicine staff with open weeping wound conditions will be held from participation of work until their condition is controlled. The sports medicine staff, with the advice of the team physician, will be responsible for making this decision. • All bloodied towels will be separated from other linens and properly cleaned with detergent and bleach or disposed of if beyond normal cleaning ability. • Biohazard cleaning materials will be purchased and available at appropriate contact events in case of an emergency involving significant exposure to blood or body fluid.

Communicable Disease Management

The Occupational Safety and Health Administration (OSHA) guidelines should be followed when dealing with all bodily fluids. Any cross-contamination incidents should be documented and reported as outlined in the OSHA guidelines. Athletes are a high-risk population often due to their increased exposure to different people, environments, and outgoing lifestyles and behaviors.

While risk of one athlete infecting another with AIDS/HIV during competition is close to non-existent, there is a risk that other bloodborne infectious diseases can be transmitted. Procedures for reducing the potential for transmission of these infectious agents should include, but are not limited to, all standard bloodborne pathogens procedures.

Infectious Diseases/Illnesses

Any athlete that reports systemic problems (fever malaise, productive cough, etc) to the sports medicine staff should be referred to a physician for further evaluation.

Skin Diseases

Any suspicious lesions should be reported, documented, and inspected by an AT. If further examination is required, the AT will refer the athlete to a physician. All return to competition decisions will be based on the physician recommendations. Suspicious lesions may include the following:

• Ringworm o A fungal lesion that is caused by dermatophytes. As they are easily transmissible, the athlete should be treated with an oral or topical antifungal medication for minimum of 72 hours prior to participation. Once the lesion is considered to be no longer contagious, it may be covered with a bio occlusive dressing • Impetigo, Folliculitis, Carbuncle, Furuncle o While these infections may be secondary to a variety of bacteria, they should be treated as Methicillin-Resistant Staphylcoccus aureus (MRSA) infections. The athlete should be removed from practices and competition and treated with oral antibiotics. Return to contact

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practices and competition may occur after 72 hours of treatment provided the infection is resolving o All lesions are considered infectious until each one has a well-adhered scab without any drainage or weeping fluids. Once a lesion is no longer considered infectious, it should be covered with a bio occlusive dressing until complete resolution. All team members should be carefully screened for similar infections. If multiple athletes are infected, consideration should be given to obtaining nasal cultures of all teammates • Shingles/Cold Sores o These are viral infections which are transmitted by skin-to-skin contact. Lesions on exposed areas of skin that are not covered by clothing, uniform, or equipment require the player to be withdrawn from any activity that may result in direct skin-to-skin contact with another participant. Covering infectious lesions with an occlusive dressing is not acceptable. Primary outbreaks require 10-14 days of oral antiviral medications. Recurrent outbreaks require five days of treatment prior to returning to participation. “Non- contagious” lesions must be scabbed over with no oozing or discharge for 48 hours. • Herpes Gladiatorum o This skin infections is caused by Herpes Simplex Virus Type 1 (HSV-1). The spreading of this virus is strictly skin-to-skin with the preponderance of the of the outbreaks developing on the head, face, and neck, reflecting the typical lock-up position in wrestling. The initial outbreak is characterized by a raised rash with groupings of 6-10 vesicles (blisters). The skin findings are accompanied by sore throat, fever, malaise, and swollen cervical lymph nodes. The infected individual should be removed from contact and treated with antiviral medications. They may return to contact only after all lesions are healed with well adherent scabs, no new vesicle formation, and no swollen lymph nodes near the affected area. o As HSV-1 may spread prior to vesicle formation, anyone in contact with the infected individual during the three days prior to the outbreak must be isolated from any contact activity for eight days and be examined daily for suspicious skin lesions. To be considered “non-contagious,” all lesions must be scabbed over with no oozing or discharge and no new lesions should have occurred in the preceding 48 hours. • Miscellaneous Viral Infections o Molluscum contagiosum and verruca are types of warts that are caused by viruses, but are not considered highly contagious. Therefore, these lesions require no treatment or restrictions, but should be covered if prone to bleeding when abraded. • MRSA o Any athlete who is suspected to have MRSA or who has MRSA should be immediately isolated from the rest of the team and referred to a physician. As a precaution, the athletic training facility, locker room, and any other facility (weight room/gym/etc) used by the athlete should be disinfected.

Education and Prevention

• Administration, coaching staff, and custodial staff must be informed of the importance of institutional support for maintaining proper infection control policies.

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• Coaches must be informed of the importance of being vigilant with their athletes following infection control policies to minimize transmission of infectious disease • Athletes must be educated on the following: o Avoid sharing towels, athletic gear, water bottles, razors, deodorant, shower shoes, hair and body clippers, and other toiletry items that come in contact with the body o Perform daily self-surveillance and report abrasions, cuts, and skin lesions to and seek attention from the athletic training staff immediately for proper assessment, cleansing, treatment, and wound dressing o The necessary hygiene materials must be provided to the athletes including antimicrobial liquid soap in showers and by all sinks • Visibly dirty hands should be washed with and antimicrobial soap utilizing the following hand washing technique: wet the hands, apply antimicrobial liquid soap, rub hands together vigorously for at least 15 seconds making sure to get all surfaces, rinse the hands with running water, then dry thoroughly with a disposable towel • If hands are not visibly dirty, the use of an alcohol based hand rub (hand sanitizer) to decontaminate is acceptable • Hands should be decontaminated before and touching a patient’s skin or clothing. • Athletes must shower after every practice and game using antimicrobial soap and water over the entire body • Athletes should refrain from cosmetic body shaving • Soiled clothing, including practice gear, undergarments, outerwear, and uniforms, must be laundered on a daily basis • Equipment, including joint sleeves and braces, should be disinfected on a daily basis • Frequently touched surface including mats, treatment tables, rehabilitation equipment, locker room benches, and floors should be cleaned and disinfected after contact with each individual patient • Surfaces should be disinfected with a bleach-water solution with a 1:10 ratio

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Appendix 1

Student-Athlete Concussion Statement and Assumption of Risk

I understand that it is my responsibility to report all injuries and illnesses to my athletic trainer and/or the team physician

I have read and understand the NCAA Concussion Fact Sheet and all questions have been answered to my satisfaction

Initial each statement below

After reading the NCAA Concussion Fact Sheet, I am aware of the following information:

______A concussion is a brain injury which I am responsible for reporting to my athletic trainer and/or team physician.

______A concussion can affect my ability to perform everyday activities and affect reaction time, balance, sleep, and classroom performance.

______A concussion cannot be seen, but some of the symptoms may be noticed right away. Other symptoms may show up hours or days after the injury.

______If I suspect a teammate has a concussion, I am responsible for reporting the injury to my athletic trainer and/or team physician.

______I will not return to play in a game or practice if I have received a blow to the head or body that results in concussion-related symptoms until cleared by the team physician or athletic trainer.

______Following a concussion, the brain needs time to heal. If I return to play before my symptoms resolve, a repeat concussion is more likely to occur.

______In rare cases, repeat concussions can cause permanent brain damage and even death

Signature of Student-Athlete: ______

Printed Name of Student-Athlete: ______

Date: ______

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Appendix 2

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Appendix 3

Concussion/Head Injury Information Take-Home Instructions You have sustained a concussion/or are exhibiting concussion like symptoms. No signs of serious complications have been found and a full recovery is expected. This take-home sheet will inform you, a roommate, and/or responsible friend of common signs and symptoms of a concussion. If you notice any changes in behavior, vomiting, dizziness, worsening headache, double vision or excessive drowsiness, contact your Athletic Trainer or report to the Athletic Training Room immediately. If you are unable to reach the Sports Medicine Staff and it is after Athletic Training Room hours, then you may activate emergency medical services by having someone drive you to Georgetown Community Hospital. DO NOT ignore any changes in the symptoms of your concussion.

Important Notes: Do Not Do: Seek Immediate Help:

• Rest and • Drink alcohol • Repeated vomiting Avoid Strenuous activity for at • Drugs/painkillers that may • Severe headache that least 24 hours. alter awareness does not improve with • You may take • Drive until cleared by Tylenol Tylenol/Acetaminophen if SMS • Increasing Confusion, instructed to do so by SMS Restlessness or • LIMIT use of electronic Irritability devices (cell phone, computer, • Convulsions, Seizures, TV, etc.) or Coma • Trouble using arms or legs • Blurry or Double vision • Slurred or Garbled Speech • Unusual sleepiness, decreasing alertness, or cannot be awakened

Report to Athletic Training Room at ______am/pm on ______to be re-evaluated prior Team or Academic activity.

Signature of Student-Athlete: ______

Signature of AT: ______

Phone Number: ______

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Appendix 4

Concussion Return to Play Protocol

Day 1: Light Cardio Activity

Walk/Jog 15 mins. May complete on elliptical, treadmill, or outside.

Day 2: Light Work-out with cardio warm up.

Walk/Jog 15 mins. May be completed on elliptical, treadmill, or outside. Sprinting may be incorporated.

Light weight lifting with team or complete the following workout. Completed with 30’’-1’ Rest period in between each set.

3X10 Burpees 3X1’ Wall Sits 3X15 Push Ups 3X1’ Plank Hold 3X15 Crunches 3X20 Mountain Climbers 3X15 BW Squats 3X20 Scissors 3X30 Jumping Jacks 3X10 SL Bridge

Cool Down walk/Jog 5 min

Day 3: Agility Exercise and Sport Specific Exercise

Warm Up with Walk/Jog 5 min Line Jumps: Lateral 3X50 (30’’REST in 1’ REST between each set) 25 yd run with back pedaling 5X Zig Zag Run 25 yd 3X 2’ REST 2’ REST Ladder (in in out out) 5X Lateral Shuffles 10 yd (switch directions) 5X 1’ REST (10’’ REST in between each set.) Karaoke 20 yds (switch directions) 3X (down SL Hops 10 yd (switch directions) 3X (10’’ and back =1) REST in between each set) 2’ REST Sport Specific workout 10 min Cool down Line Jumps: F/B 3X50 (30’’ REST in between walk/jog 5 min each set)

Day 4: No Contact PX

Day 5: Full RTP

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Appendix 5

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Appendix 6

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Appendix 7

Patient Health Questionnaire

Name: Sport: Date:

Over the last 2 weeks, how often have you been bothered by any of the following problems? Please only select one option per questions. Not at all Several More than half Nearly every days the days day

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless 3. Trouble falling or staying asleep, or sleeping too much

4. Feeling tired or having little energy

5. Poor appetite or overeating 6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down 7. Trouble concentrating on things, such as reading the newspaper or watching television 8. Moving or speaking so slowly that other people could have noticed. Or the opposite – being so figety or restless that you have been moving around a lot more than usual

9. Thoughts that you would be better off dead, or of hurting yourself

Add columns: Total:

(Healthcare professional: for interpretation of TOTAL please refer to accompanying scorecard)

10. If you checked off any Not difficult at all problem, how difficult have those problems Somewhat difficult made it for you to do your work, take care of Very Difficult things at home, or get along with other people? Extremely Difficult

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PHQ-9 Patient Depression Questionnaire

For initial diagnosis:

1. Patient completes the PHQ-9 Quick Depression Assessment 2. If there are at least 4 checks in the shaded section (including questions 1 and 2), consider a depressive disorder. Add score to determine severity

Consider Major Depressive Disorder - If there are at least 5 checks in the shaded sections (one of which corresponds to questions 1 or 2)

Consider Other Depressive Disorder - if there are 2-4 checks in the shaded sections (one of which corresponds to question 1 or 2)

Note: Since the questionnaire relies on patient self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient. Diagnosis of Major Depressive Disorder or Other Depressive Disorder also require impairment of social, occupational, or other important areas of functioning (Question 10) and ruling out normal bereavement, a history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms.

To monitor severity of time for newly diagnosed patients or patients in current treatment for depression: 1. Patients should complete the questionnaire during each scheduled appointment. 2. Add up checks by column. For every check: Several days = 1 More than half the days = 2 Nearly every day = 3 3. Add together column scores to get a TOTAL score. 4. Refer to the accompanying PHQ-9 Scoring Box to interpret the TOTAL score 5. Results may be included in patient files to assist you in setting up a treatment goal, determining degree of response, as well as guiding treatment intervention.

Scoring: Add up all checked boxes on PHQ-9

For every check Not at all = 0; Several days = 1; More than half the days = 2; Nearly every day = 3

Interpretation of Total Score

Total Score Depression Severity 1 – 4 Minimal depression 5 – 9 Mild depression 10 – 14 Moderate depression 15 – 19 Moderately severe depression 20 - 27 Severe depression

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Appendix 7

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Appendix 8

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Appendix 9

Female Athlete Health Questionnaire

1. Have you ever had a menstrual period? a. Yes b. No

2. How old were you when you had your first menstrual period?

3. When was your most recent menstrual period?

4. How many menstrual periods have you had in the past 12 months?

5. Have you ever missed 3 or more consecutive months of your menstrual period? a. Yes b. No

6. Are you on birth control pills or use another form on contraceptive device (patches, vaginal rings, depo shot, Nexplanon, IUD)? a. Yes b. No

If the above answer is “yes”, what brand?

7. Have you ever had anemia? Do you eat red meat? Do you take an iron supplement? Do you have a heavy period?

8. Are menstrual problems such as cramps and irregularity common in your family?

9. Have you ever had a stress fracture or bone stress reaction? a. Yes b. No

If “yes”, where was the stress fracture/stress reaction located?

10. Do you take a calcium supplement? If yes, please list brand

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Appendix 10

Nutrition Questionnaire

Name: Age: Primary Sport:

Sex: Number of training Hours/Week:

Yes No Are you trying to gain or lose weight? Has anyone recommended you change your weight or eating habits?

Do you limit or carefully control what you eat?

Have there been any significant changes in your weight in the last year?

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Appendix 11

EAT-26 Questions Always Usually Often Sometimes Rarely Never S S Y R

1. Am terrified about being overweight

2. Avoid eating when I am hungry 3. Find myself preoccupied with eating 4. Have gone on eating binges where I feel I may not be able to stop 5. Cut my food into small pieces 6. Aware of the calorie content of the food I eat 7. Particularly avoid foods with high carbohydrate content (bread, rice, potatoes, etc) 8. Feel others would prefer I eat more

9. Vomit after I have eaten 10. Feel extremely guilty after eating 11. Am preoccupied with a desire to be thinner 12. Think about burning up calories when I exercise 13. Other people think I am too thin

14. Am preoccupied with the thought of having fat on my body 15. Take longer than others to eat my meals 16. Avoid eating foods with sugar in them 17. Eat diet foods 18. Feel that food controls my life 19. Display self-control around food 20. Feel that others pressure me to eat 21. Five too much time and thought to food 22. Feel uncomfortable after eating sweets 23. Engaged in dieting behavior 24. Like my stomach to be empty 25. Have the impulse to vomit after meals 26. Enjoy trying new rich foods

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Appendix 12

Georgetown College Optimal Nutrition and Performance Treatment Plan

Athlete: Sport:

The following items are mandatory and must be completed as prescribed. Failure to do so will result in the consequences listed below the requirements. All benefits and consequences are subject to change at any time and are at the discretion of the Management Team.

Requirements:

• Meet with ______(mental health provider) 1x per week, or as recommended by mental health provider.

• Meet with (dietician) 1x per week, or as recommended by dietician.

• Meet with team physician 1-2x per month, or as recommended by team physician.

• Follow daily meal plan set forth by sports dietician.

• Keep daily workout log updated with specific type, length and effort.

• Weight gain of ______lbs per week.

• Weekly weigh-in with ______(team member), or at time intervals of ______weeks.

• Must achieve minimal acceptable body weight of ______lbs by ______(date).

• After this date, must maintain weight at or above minimal acceptable body weight.

• Limit of ______workout sessions per week with no one session being more than ______minutes in length. All activity counts (e.g. biking, running, weight lifting, swimming).

Benefits:

If ALL requirements are met, clearance to participate in team activities and use of athletic facilities will

• Be granted

• Continue

Consequences:

If ANY requirement(s) are not met, clearance to participate in team activities and use of athletic facilities will be revoked, and re-instatement will be at the discretion of the team physician and multidisciplinary team. I, ______, have read this contract and all of my questions were answered.

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