Sports Medicine / Athletic Training Services

University of Northern Iowa Sports Medicine / Athletic Training Services

Staff Athletic Trainer (Full Time & Graduate Assistant)

Policy & Procedures Manual

PAGE

Statement of Approval ...... 3

Scope of Practice ...... 4

Introduction ...... 4

Mission/Vision Statement ...... 5

Policies and Procedures- Staff Expectations ...... 6 Professionalism & Dress Code ...... 6 NATA Certification and State License Status ...... 8 Attendance & Request for Leave ...... 8 Policy on Relationships between A.T. Staff and Undergraduate Students ...... 8 Supervision & Mentoring of Graduate & Intern Assistant Athletic Trainers ...... 9 Staff Sport Coverage Assignments ...... 10 Staff Administrative Assignments ...... 10 Staff Discipline Action Policy ...... 11 Grievance Procedures ...... 12 Staff Performance Appraisal ...... 13 Staff Professional Development Policy ...... 13 Medical Records ...... 14 SportsWare Online Program ...... 15 Standing Orders ...... 15 Student-Athlete Privacy and Confidentiality / HIPAA ...... 16 Media Relations ...... 23 Physician Referrals / Consultations / Physical Therapy Referrals ...... 23 Secondary Athletic Insurance / NCAA Catastrophic Insurance Program ...... 24 Transportation of Student Athletes ...... 27 Over the Counter Medications (OTC) ...... 27 Therapeutic Modalities ...... 28 Prescription Medications ...... 28 NCAA Compliance Policies ...... 31 Direct Supervision of Athletic Training Students ...... 31 Morning Treatments ...... 32 Chiropractor Policy ...... 32 New Employee Orientation ...... 32 Daily Injury Reports ...... 32 Return to Play Policy ...... 34 Concussion Policy ...... 34 Turf Burn Protocol ...... 43 STAPH/MRSA Infection Policy ...... 44 Sickle Cell Trait Policy ...... 48 Exertional Rhabdomyolysis Policy ……………… ...... 50 Exertional Heat Illnesses Management & Fluid Replacement/Rehydration Policy ……………… 53 IV Fluid Administration Policies and Procedures ……………………………………………………. 58 IV Fluid Replacement Treatment Form located in Appendix……………………………………….. I Cold Stress and Cold Exposure Policy ...... 59 Powerade Product Use ...... 62

Emergency Action Plan- Emergency Personnel ...... 63 Emergency Communication ...... 64

Emergency Equipment ...... 66 Emergency Action Plans (Venue Specific) ...... 69 Emergency Algorithms ...... 86 Emergency Care and Coverage Procedures for Practices and Events ...... 89 Catastrophic Incident Plan ...... 91 Policy Statement on Thunder & Lightning ...... 97

Exposure Control Plan, Blood-Borne Pathogen Polices- Exposure Control Plan ...... 101 Universal Blood and Body Fluid Guidelines ...... 106 Hepatitis B Vaccinations ...... 117

Hydrotherapy Room Policies- Daily Hydrotherapy Room Maintenance Plan ...... 120 Weekly/Monthly Hydrotherapy Room Maintenance Plan ...... 121 General Hydrotherapy Room Policies and Procedures ...... 122

Student-Athlete Assistance Programs (SAAP)- Introduction to SAAP ...... 123 Procedures for Seeking Assistance ...... 124 Menstrual-Cycle Dysfunction ...... 126 Eating Disorder Policy ...... 126 Sexual Harassment Policy ...... 128 Sexual Assault/Rape Program ...... 128 Mental Health Referral and Treatment Program ...... 129 Substance Abuse Policies and Procedures ...... 130

Appendices- - APPENDIX A UNI DIETARY SUPPLEMENT DISCLOSURE FORM - APPENDIX B DRUG TESTING REASONABLE SUSPICION NOTIFICATION FORM - APPENDIX C NCAA BANNED SUBSTANCE LIST - APPENDIX D ALCOHOL AND DRUG TESTING NOTIFICATION OF POSITIVE TEST RESULT - APPENDIX E UNI NOTIFICATION OF APPEALS OF A POSITIVE TEST FORM - APPENDIX F UNI DRUG AND ALCOHOL POLICY CONSENT FORM - APPENDIX G CATASTROPHIC INCIDENT FORMS - APPENDIX H JOB DESCRIPTIONS - APPENDIX I ATHLETIC TRAINING ROOM ADMINISTRATIVE FORMS  PRIMARY HEALTH INSURANCE INFORMATION / AUTHORIZATION  HIPAA FORM  ADHD MEDICAL EXCEPTIONS FORM  STUDENT-ATHLETE HEALTH HISTORY QUESTIONNAIRE FORM  MEDICAL EXAMINATION & AUTHORIZATION WAIVER  STUDENT-ATHLETE PHYSICAL EXAMINATION  EXIT PHYSICAL FORM  SICKLE CELL DISCLOSURE FORM  SICKLE CELL WAIVER FORM  INITIAL EVALUATION FORM  TREATMENT / REHABILITATION LOG  STUDENT-ATHLETE REFERRAL / CONSULTATION FORM  CONCUSSION FORMS - APPENDIX J 2016 MEDICAL CONSULTANT LIST

STATEMENT OF APPROVAL

The University of Northern Iowa Sports Medicine/Athletic Training Services Policies and Procedures Manual was developed by the staff athletic trainers while in collaboration with the team physicians. The primary team physicians have carefully reviewed and approved the manual in its entirety. Signed review and approval of the manual by each primary team physician shall be kept on file with the Director of Sports Medicine/Athletic Training Services.

______(Print Name - Dr. Jeffrey Clark) (Signature) (Date)

______(Print Name - Dr. Daniel Glascock) (Signature) (Date)

SCOPE OF PRACTICE

"Athletic training" means the form of health care that includes the practice of preventing, recognizing, assessing, managing, treating, disposing of, and reconditioning athletic injuries under the direction of a physician licensed in this state or another qualified, licensed health professional who is authorized to refer for health care services within the scope of the person's license.

University of Northern Iowa (UNI) Sports Medicine/Athletic Training Services Staff shall be licensed under the State of Iowa Department of Public Health. With this license, all staff athletic trainers shall practice under the direction of an Iowa licensed team physician.

INTRODUCTION

The UNI Sports Medicine/Athletic Training Services Staff is dedicated to providing the highest quality medical care for all student–athletes and the university community as a whole. As one component of the UNI Division of Athletic Training, Athletic Training Services personnel are involved in the overall prevention, recognition, management and treatment, and rehabilitating of athletic injuries, as well as the education and counseling of student-athletes.

The UNI Staff Athletic Trainer Handbook and Policy and Procedure Manual is designed to be a guide to inform and assist the UNI staff athletic trainers in their everyday affairs while representing UNI. It is expected that staff members will read this manual thoroughly and have total understanding of all pieces of information. The information contained in this handbook is not intended to be comprehensive, nor all-inclusive.

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING SERVICES

Mission / Vision Statement:

The UNI Athletic Training Services / Sports Medicine Department will provide comprehensive, state-of-the-art health care and wellness services as it pertains to the well being of the student-athlete. Each member of the UNI Athletic Training Services / Sports Medicine Department will do his or her part to provide professional, first-class leadership and counseling necessary to prevent, manage, and rehabilitate the student- athlete. The UNI Athletic Training Services Department strives to provide leadership in education for athletic training students through quality didactic and clinical experiences. UNI Athletic Training Services / Sports Medicine serves as a major intellectual and creative resource for the UNI Division of Athletic Training, School of Kinesiology, Allied Health and Human Services, College of Education and Intercollegiate Athletics developing interactive partnerships with allied health professionals, and participates in the exploration and development of the student-athlete’s health and well-being.

The Vision of the University of Northern Iowa Athletic Training Services / Sports Medicine Department is …

… to become a nationally recognized Athletic Training Services program focusing on first- class, state-of-the-art health care services to the UNI Intercollegiate Athletics Department, and a respected and prominent leader with the reputation of providing quality educational experiences to athletic training students within the Division of Athletic Training at UNI.

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING SERVICES Policies & Procedures

I. STAFF EXPECTATIONS:

All staff athletic trainers should:

 Be intellectually inquisitive;  Be enthusiastic & self-motivated;  Possess good communication skills;  Be good listeners;  Be able to accept constructive criticism;  Show concern & respect for others;  Be punctual & dependable for all assigned tasks & activities.

Above everything else, UNI staff athletic trainers are expected to be honest and forthright in all endeavors, and display dedication and commitment at all times to the health and welfare of their student-athletes, as well as the UNI Athletic Department and UNI Athletic Training Division as a whole.

Insubordination, disloyalty, breach of duty, unprofessional behavior, theft/vandalism, sexual harassment, substance abuse, and conduct unbecoming an athletic trainer among others will not be tolerated and may result in decreased performance evaluations and/or termination of the staff member.

Keep in mind that most problems that arise are due to a lack of communication. It is expected that UNI staff athletic trainers will be familiar with all policies, procedures, and expectations. If there are ever any questions, comments, and/or concerns, it is expected that these will be communicated immediately to Director of Athletic Training Services.

II. PROFESSIONALISM & STAFF/GRADUATE/INTERN ASSISTANT DRESS CODE:

Statement on professionalism- 1. As a staff athletic trainer at the UNI, you are a representative of the University, the Athletic Department, the Athletic Training Services, the Division of Athletic Training and the athletic team in which you are assigned. Your professional conduct and dress is expected to reflect this at all times. 2. Staff athletic trainers are expected to adhere to the NATA Code of Professional Practice and Ethical Principles at all times. 3. Do not publicly express opinions of treatment and/or care rendered by a physician or another athletic trainer. 4. Information heard or discussed at team meetings, practices, games, etc. by coaches, athletes, and/or administrators is considered confidential and should not be discussed with other individuals. 5. Respect all coaches, professional staff, administrators, etc. at all times. Avoid confrontations if at all possible, and if a confrontation or other problem develops, notify the staff athletic trainer responsible for that sport immediately. 6. No tobacco products or alcohol is to be consumed while representing UNI’s Athletic Department and/or the Athletic Training Services. While traveling, alcohol/tobacco use is at the discretion of the team and the policies the team follows.

Daily Dress Code-  Khaki / tan pants  Dress pants/slacks  Khaki shorts during summer months  Wind / warm-up pants  University of Northern Iowa Athletic Training collar shirt  University of Northern Iowa Athletic Training T-shirt  University of Northern Iowa clothing apparel (polo shirts, fleeces, mock turtle necks, etc.)  University of Northern Iowa athletic team apparel  Friday- “Casual Day” (when appropriate) o UNI t-shirts o Collared shirts, button-down collar shirts, business casual, etc.

Game Day Dress Code- (may vary, determined by Staff ATC responsible for sport)  Khaki / tan pants or shorts (if appropriate temperature);  University of Northern Iowa Athletic Training collared shirt as determined by the staff athletic trainer responsible for the sport;  Graduate Assistants directly responsible for a sport can determine game day dress with consultation of the Director of Athletic Training Services/Head Athletic Trainer.

General Dress Code Information-  Athletic trainers are strongly encouraged to keep fingernails relatively short and trim at all times.  Facial hair is permitted as long as it is kept neatly groomed.  Visible body piercings, except earrings in females are prohibited.  When traveling with athletic teams, athletic trainers are expected to adhere to the athletic team’s dress code. However, if no dress code exists for the athletic team, athletic trainers should keep in mind they are representing the UNI Athletic Training Division and dress accordingly.  Athletic trainers not properly attired may be subject to further disciplinary action under the University of Northern Iowa Athletic Training Services Department Discipline Action Policy.  The Director of Athletic Training Services reserves the right to change and/or modify the dress code at any time.

Prohibited Items-  Blue Jeans (exception on occasion casual  Visible body piercings (besides earrings) day); in females;  Jean shorts;  Tongue piercings;  Elastic bottom / cotton sweatpants;  Clothing with holes, stains, etc.;  Cut-off / frayed jeans, pants, and/or  Apparel promoting alcohol, tobacco, sex, shorts; and/or other distasteful items;  Excessively baggy pants, and/or shorts;  Apparel from other schools, Greek  Excessively tight shirts / pants, and/or organizations; and “body-shirts”;  Other apparel and/or accessories as  Cut-off / mid-riff “belly” shirts; deemed by the Certified Athletic Trainer in  Tank tops, sports bras, and/or spandex; charge of the sport and/or the Chair of the  Open-toed shoes, flip flops, and/or Division of Athletic Training / Director of sandals; Athletic Training Services.  Visible tattoos  Earrings and/or other visible body piercings in males;

III. NATA BOARD OF CERTIFICATION STATUS / STATE OF IOWA LICENSURE:

 All full-time staff and graduate assistant athletic trainers must maintain certification and continuing education requirements of the National Athletic Trainers’ Association (NATA) at all times.  All full-time staff and graduate assistant athletic trainers must maintain license requirements of the State of Iowa at all times.  Individuals not in compliance with NATABOC certification and/or State of Iowa licensure requirements may be subject to disciplinary action as outlined in the Discipline Action Policy, including, but not limited to termination of the individual’s contract and/or graduate assistantship.

IV. REQUEST FOR LEAVE:

 All requests for leave (sick, personal, vacation, etc.) must be processed in writing through the Director of Athletic Training Services in accordance with University and the Division of Athletic Training regulations.  Except for emergencies, all requests for leave should be submitted in writing at least two (2) weeks in advance.  UNI Athletic Training Services activities take precedence over all outside employment and athletic training activities.  Staff members are responsible for arranging for coverage of their responsibilities while absent.

V. GRADUATE ASSISTANT ATHLETIC TRAINER ATTENDANCE:

 Graduate assistant athletic trainers must be in attendance during their assigned sport’s competitive season during all of the team’s practices, competitions, full-team strength and conditioning sessions, etc.  Graduate assistant athletic trainers must be in attendance during their assigned sport’s off- season from typically1:00pm to 5:00pm on a daily basis, and as assigned by the Director of Athletic Training Services.  Graduate assistant athletic trainers are required to be in attendance before and after the academic year as needed by their assigned team’s season (determined by contract). Graduate assistant athletic trainers are encouraged to keep class conflicts to a minimum.  Instances in which a 2nd year graduate assistant and a 1st year graduate assistant are enrolled in the same class and a class conflict exists, the 2nd year graduate assistant takes precedence in remaining enrolled in the class.  Graduate assistant athletic trainers are responsible for arranging for coverage of their responsibilities in the event of a class conflict.  UNI Athletic Training Services activities take precedence over all outside employment and athletic training activities.  All requests for leave (personal, vacation, etc.) must be processed in writing through the Director of Athletic Training Services at least two (2) weeks in advance (except for emergencies).

VI. POLICY ON RELATIONSHIPS BETWEEN GRADUATE ASSISTANT ATHLETIC TRAINERS AND UNDERGRADUATE STUDENTS:

The Athletic Training Services Department prohibits staff members (Full Time, Interns and Graduate Assistants) from pursuing romantic relationships with any undergraduate student currently enrolled in classes at the University of Northern Iowa. Violation of this policy constitutes a violation of the terms of appointment. Violation of these policies will be considered by the Director of Athletic Training Services and the Chair of the Division of Athletic Training and may result in withdrawal of support and/or termination from the program.

VII. SUPERVISION OF GRADUATE & INTERN ASSISTANT ATHLETIC TRAINERS:

 Full-time staff members will be responsible for the daily supervision of 1-2 graduate assistant athletic trainers as part of the overall “team” organizational structure.

 Full-Time Athletic Training Staff Supervision Assignments:

Don - Responsible for all Graduate Assistants (no direct report for GA)

Chelsea - Swimming & Diving/Cheer & Dance Graduate Assistant Athletic Trainer (Brekahn)

Travis - Football Graduate Assistant Athletic Trainers (Jacob & Samantha) Football and Tennis/Golf Graduate Assistant Athletic Trainer (Devin)

Katie -Soccer & Softball Graduate Assistant Athletic Trainers (Carly & Rachel)

Troy - Tennis & Golf Graduate Assistant (Devin)

Melissa -Cross Country, Track & Field Graduate Assistant Athletic Trainer (Boone)

 Full-time staff members are expected to supervise their assigned graduate and/or intern assistant athletic trainers on a daily basis, including, but not limited to: o Must review all medical records and SportWare OnLine Injury Tracking Software to insure this has been completed at the start of each season with the graduate assistant in cases where the graduate assistant is responsible for the direct coverage of team/sport; o Observation of knowledge, skills, and abilities in the athletic training room and on the field; o Attendance at a portion of pre-practice and/or practice a minimum of one (1) time per month; o Attendance at a portion of home games/contests; o Meet with the graduate assistant and/or intern assistant(s) once weekly to review the injury report and discuss any problems/concerns that the graduate assistant is experiencing. o Periodically review coaches’ reports, medical records, SportWare OnLine Injury Tracking Software, and communication skills between all involved parties. o Review of interaction with and education of athletic training students; o Serve as an intermediary in times of conflict between the graduate assistant and/or intern and student-athletes, the coaching staff, and/or athletic training student; and o Other duties as assigned.

 In addition to the direct supervisory assignments listed above, full-time staff athletic trainers are also expected to provide supervision to graduate assistant and intern assistant athletic trainers not directly assigned to them, but working in their athletic training room.  Full-time staff members will evaluate their assigned graduate assistant athletic trainer(s) and/or intern assistant athletic trainer(s) as dictated within the guidelines outlined in this manual.  Failure to successfully supervise assigned graduate assistant athletic trainers and/or intern assistant athletic trainers may result in the removal of the graduate assistant athletic trainers and or intern assistant athletic trainers from the full-time staff athletic trainer, a decreased performance appraisal, and/or other disciplinary actions as determined by the Director of Athletic Training Services.

VIII. STAFF SPORT/DUTY COVERAGE ASSIGNMENTS FOR 2018-19:

DUTY / ASSIGNMENT Head Assistant(s) Football Travis Stueve Jacob Psznka, Sammie Phillips & Devin Hasson Men’s Basketball Don Bishop Katie Schulte Women’s Basketball Katie Schulte Rachel Gallaway Women’s Soccer Danielle Schuck Katie Schulte/Rachel Gallaway Volleyball Chelsea Lowe Brekahn Gasvoda Cross Country / Track & Field Melissa Stueve Boone Tomlinson Wrestling Troy Garrett Boone Tomlinson Softball Rachel Gallaway Katie Schulte Tennis Devin Hasson Troy Garrett Swimming & Diving Brekahn Gasvoda Chelsea Lowe Men’s & Women’s Golf Devin Hasson Troy Garrett Cheerleading Brekahn Gasvoda Rachel Gallaway Insurance Coordinator Chelsea Lowe Don Bishop Summer Camps Coordinator Katie Schulte Melissa Stueve CPR/AED Emergency Response Troy Garrett Chelsea Lowe Hydrotherapy Maintenance Travis Stueve Jacob Psznka, Sammie Phillips & Devin Hasson

IX. STAFF ADMINISTRATIVE ASSIGNMENTS FOR 2018-19:

The following administrative assignments have been assigned to each athletic training staff member. It is the expectation that each staff member will oversee their responsibilities. During each staff meeting each staff member will report on the status of his/her duties.

Don Travis Chelsea Lowe Katie Schulte Troy Bishop Stueve Garrett

 Trade Out  Inventory  Insurance  Summer Camps  Emergency Program  Don Joy Coordination  Special Dome Action Plans  Medical  HPC ATR  ATR Forms Events  Emergency Consultants /Hydrotherapy Room  Deadwood Files  McLeod ATR Equipment  Physicals Maintenance &  GameReady Inventory  OSHA  Graduate Assist. Cleaning Program  Staff In-services  West Gym ATR Recruitment  Graduate Assist.  UNI-Student  SAAP Inventory,  Keys Recruitment Health Services  Mental Maintenance &  Staff Polices &  EMPI Program  Hy-Vee Health/Eating Cleaning Procedures  ImPact Program Pharmacy  Marketing &  King-Devick  Clark and Public Relations Program Associates  Substance Abuse  HPC Modalities Education and  Rx / OTC Medication Testing Inventory  Budget/Inventory  SportsWare

Melissa Stueve Samantha Jacob Pszanka Brekahn Rachel Gallaway Phillips Gasvoda

 HPC Hydroc  Hydrotherapy  Hydrotherapy  Hydrotherapy  Hydrotherapy Maintenance Room Room Cleaning Room Cleaning & Room Cleaning &  HPC Athletic Cleaning & & Maintenance Maintenance Maintenance Training Room Maintenance  HPC Athletic  HPC Athletic  HPC Athletic Cleaning  HPC Athletic Training Room Training Room Training Room  SAAP Training Room Cleaning Cleaning Cleaning  Mental Cleaning  McLeod and  McLeod and HPC  HPC Hydroc Health/Eating  McLeod and HPC Storage Storage Maintenance Disorders HPC Storage organization  Van #2 Use &  Hydrotherapy organization  Van #1 Use & Maintenance Room  Van #1 Use & Maintenance Maintenance Maintenance

Boone Carly Miller Devin Hasson Tomlinson  HPC Athletic  HPC Athletic  Hydrotherapy Training Room Training Room Room Cleaning Cleaning Cleaning & Maintenance  HPC Hydroc  HPC Hydroc  HPC Athletic Maintenance Maintenance Training Room  Hydrotherapy  Van #2 Use & Cleaning Room Cleaning Maintenance  McLeod and & Maintenance  Hydrotherapy HPC Storage Room organization Maintenance  Van #1 Use & Maintenance

X. FULL-TIME STAFF / GRADUATE/INTERN ASSISTANT DISCIPLINE ACTION POLICY:

Criteria for Disciplinary Action / Demerit Point Structure: (not all inclusive)-  Late for required activity (1 point)  Unexcused absence for required activity (2 points)  Insubordination (2 – 4 points)  Unprofessional Behavior (2 – 4 points)  Breach of Duty (2 – 4 points)  Dress Code Violations (2 points)  Disloyalty (2 – 4 points)  Failure to meet assigned deadlines (1 – 2 points)  Theft / Vandalism (6 points)  Sexual Harassment (4 – 6 points)  Substance Abuse (6 points)  Conduct Unbecoming an Athletic Trainer (4 – 6 points)  Other actions as determined by the Director of Athletic Training Services (1 – 6 points) Disciplinary Action:  Two (2) points- 1. Written and Verbal Warning; 2. Notation in permanent UNI Athletic Training Services file;

 Four (4) points- 11

1. Written and Verbal Warning; 2. Notation in permanent UNI Athletic Training Services file; 3. Decreased Performance Appraisal; and 4. Scheduled meeting with team leader (if applicable) and/or Director of Athletic Training Services

 Six (6) points- 1. Written and Verbal Warning; 2. Notation in permanent UNI Athletic Training Services file; 3. Decreased Performance Appraisal; and 4. Scheduled meeting with team leader (if applicable), Director of Athletic Training Services, and Athletic Training Division Chair.

 Eight (8) points- 1. Written and Verbal Warning; 2. Notation in permanent UNI Athletic Training Services file; 3. Decreased Performance Appraisal; 4. Scheduled meeting with team leader (if applicable), Director of Athletic Training Services, and Athletic Training Division Chair; and 5. Loss of graduate assistantship.

1. General Guidelines- o “Demerit” / Discipline points are cumulative for the year. o Final determination of the demerit points awarded and disciplinary action taken rests with the Director of Athletic Training Services and/or the Chair of the Division of Athletic Training. o The Director of Athletic Training Services reserves the right to change and/or modify the point structure and/or discipline policy at any time.

XI. GRIEVANCE PROCEDURES:

In the event that a staff member has a grievance against a fellow staff member, the following guidelines should be considered and followed:

Criteria for Grievance-  Harassment  Unprofessional behaviors  Unfair practices  Conduct Unbecoming  Dishonesty  Other

Procedures- 1) Confront the individual with whom you have the grievance. 2) Try to resolve the grievance with the individual. 3) If the problem cannot be resolved, inform the individual that a grievance will be filed. 4) Fill out a UNI Grievance Form and submit it to the Director of Athletic Training Services. o In the event that the grievance is against the Director of Athletic Training Services, submit the UNI Athletic Training Services Grievance Form to the Chair of the Division of Athletic Training. 5) Once the grievance has been received, the Director of Athletic Training Services and/or his/her designee will review the form. 6) If necessary, a meeting will be arranged with all involved parties. 7) Appropriate disciplinary action, if applicable, will be administered as per the UNI Athletic Training Services/Sports Medicine Discipline Policy.

XII. GRADUATE ASSISTANT PERFORMANCE APPRAISAL PROCEDURES:

First year graduate assistant staff members:  Performance appraisal process will take place every 8 (eight) weeks at the end of each field experience clinical rotation, during the months of October, December, February, and May. 12

Second year graduate assistant staff members:  Performance appraisal process will take place on a bi-annual basis, during the months of December and May.

 The performance appraisal process for graduate assistant staff members will consist of: - Completion of the UNI Coach’s Evaluation Form by the Head Coach of the sport(s); - Completion of a self-performance appraisal; - Completion of a goals assessment for the upcoming year (May evaluation only); - Completion of a supervisor performance appraisal (May evaluation only); - Completion of a performance appraisal by the team leader and the Director of Athletic Training Services; - Meeting with the team leader; and - Meeting with the Director of Athletic Training Services.  Performance appraisal ratings of “provisional”, “marginal”, or “unsatisfactory” will result in quarterly performance appraisals and other training and/or corrective actions.  All performance appraisal materials will be maintained in the graduate assistant’s personnel file within the Director of Athletic Training Services office.

XIII. FULL TIME STAFF PERFORMANCE APPRAISAL PROCEDURES:

 Full time staff members will complete the performance appraisal process on an annual basis, during the month of April.  The performance appraisal process will consist of: - Completion of the UNI Coach’s Evaluation Form by the Head Coach of the sport(s); - Completion of a self-performance appraisal; - Completion of a goals assessment for the upcoming year; - Completion of a supervisor performance appraisal; - Completion of a performance appraisal by the Director of Athletic Training Services; - Submission of performance evaluation materials and meeting with the Director of HPELS, Division of Athletic Training Chair, and the Director of Athletic Training Services; - Final meeting with the Director of Athletic Training Services.  Performance appraisal ratings of “provisional”, “marginal”, or “unsatisfactory” will result in quarterly performance appraisals and other training and/or corrective actions.  All performance appraisal materials will be maintained in the staff’s personnel file within the Director of Athletic Training Services office.

XIV. PROFESSIONAL DEVELOPMENT POLICY:

The policy of the UNI Athletic Training Services / Sports Medicine Department with regards to professional development / continuing education by its staff members shall be:

 Funds allocated to the Athletic Training Services / Sports Medicine Department for the purposes of staff professional development, continuing education, and/or travel will be distributed to staff members on a case-by-case basis based on availability of funds. - In most cases, a limit will be placed on the staff member with regards to how much he/she may spend.

 All requests for funding will be processed through the Director of Athletic Training Services / Sports Medicine. Granting of available funding will be determined by the Director of Athletic Training Services / Sports Medicine after approval from UNI Athletics and/or College of Education.

 All requests for funding must be submitted in writing to the Director of Athletic Training Services / Sports Medicine at least 20 business days in advance of the anticipated event / travel.

 If approved, the staff member must submit a completed “Travel Authorization” form at least 10 business days in advance of the anticipated event / travel; 13

 Upon return from said event / travel, the staff member must complete the “Travel Reimbursement” section of the approved travel authorization within five (5) business days.

 The completed reimbursement form is to be submitted for to the appropriate athletic department administrator.

 Deviation from or failure to follow the aforementioned policy may result in the staff member losing future funding opportunities.

XV. MEDICAL RECORDS:

1. All medical records are legal and binding documents and should be treated as such. 2. All medical records and medical information about a student-athlete are private and confidential. Anything seen or heard concerning an athlete should remain confidential. 3. The student-athlete’s folder/chart may not be taken home or out to practices and/or games under any circumstance (other than necessary travel information) 4. The student-athlete’s medical chart/computer file should be updated on a daily basis using an initial SOAP note form and the SportsWare online computerized electronic medical record program. 5. In addition to an initial injury SOAP note, the staff athletic trainer needs to record daily treatments in an appropriate method. 6. The staff athletic trainer for each sport is responsible for preparing a Daily Injury Report for his/her team (under the supervision of the staff athletic trainer assigned to the sport). This report may be done using SportsWare or a document template on Microsoft Word. This report must be reviewed and countersigned by the faculty/staff athletic trainer responsible for your sport before presenting it to the head coach. 7. All referrals to outside physicians and/or specialists must come from a staff athletic trainer only! 8. All notes from doctor visits, including surgical notes, office visits, and diagnostic study reviews must be accumulated in the athlete’s file. 9. All notes MUST be written in BLUE or BLACK ink only! 10. Student-Athlete medical folders will be organized by color and will be stored alphabetically according to sport-  football ...... purple  track & field (men’s & women’s) ...... maroon  cheerleading / spirit squad ...... pink  volleyball ...... red  tennis ...... green  men’s basketball ...... blue  softball ...... goldenrod  women’s basketball ...... yellow  wrestling ...... lavender  women’s soccer ...... gray  swimming & diving ...... white  golf (men’s & women’s) ...... orange 9. Each individual medical folder will be arranged in the following manner-  left side:  health history questionnaire; immunization record; yearly physical examination & recertification information; photo copy of insurance card; health insurance form; HIPPA form; authorization waiver; assumption of risk; permission for student-athlete to participate; CVMS HIPPA form  right side:  daily injury, treatment, & rehabilitation records; prescriptions; physician notes & orders; waivers; letters, etc. 10. All student-athletes will also have a corresponding insurance folder (manila) will be stored and maintained by the staff athletic trainer who serves as the Insurance Coordinator. The insurance folder will be arranged in the following manner:  left side- insurance information form; photocopies of the insurance card 14

 right side- bills; referral forms; explanation of benefits

11. All folders must have a typed label identifying the student-athlete and his/her sport (see example below). A document template for making folder labels can be found on Microsoft Word (C:MSOffice / templates / folder labels.dot)..

DOE, JOHN Men’s Basketball

12. All labels are to be placed on the folders in the following manner, organized by the first letter of the student-athlete’s last name-

LEFT TAB CENTER TAB RIGHT TAB A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Example: . Doe, John- label will be placed on a folder that has a left tab . Lewis, Sam- label will be placed on a folder that has a right tab . Willams, Sandy- label will be placed on a folder that has a center tab 13. All papers are to be secured within the folders at all times.

XVI. SPORTSWARE ONLINE (SWOL)

SportsWareOnLine (SWOL) must be used to record patient profiles, insurance and emergency contact information, injuries, treatments, and physician visits. The program can also be used to document participation logs and coaches reports. SWOL is an injury tracking software that meets FERPA and HIPAA requirements and the staff member is responsible to update his/her direct sports/patients daily on SWOL.

XVII. STANDING ORDERS AND OPERATING GUIDELINES:

The following guidelines have been developed to assist the UNI Athletic Training Services Staff meet current State of Iowa guidelines for licensed athletic trainers. These operating guidelines establish physician approval of general operating guidelines in acute injury care and emergency procedures along with standing orders for rehabilitation and reconditioning programs.

 All initial injury assessment and initial treatments given by the athletic training staff will be entered into SportsWare.  All treatments and rehabilitation sessions must be recorded in SportsWare.  Reassessment must take place every four (4) to six (6) days and be recorded in SportsWare  Each Monday morning the Weekly Physician Report will be emailed to the UNI Sponsoring Team Physician(s) by each staff member for their direct sport responsibility. This report contains a list of ALL athletes currently injured and their status.

 A blanket statement will be attached to the Weekly Physician Report, referring ALL injured student-athletes in the report to the UNI athletic training staff for rehabilitation and reconditioning of those injuries, following the standing orders.

XVIII. STUDENT-ATHLETE PRIVACY, CONFIDENTIALITY & HIPAA PROCEDURES:

All members of the UNI Athletic Training Services Department are expected to respect an injured athlete’s right to privacy. It is the responsibility of all personnel within the Athletic Training Services to ensure that all patient information, personal, medical, or education related, remain confidential. Due to the varied number of staff personnel that may be involved with a student-athlete’s case, it is essential that a policy of confidentiality be observed in order to maintain an atmosphere of mutual trust. It is illegal for any personnel to gain access to patient information, through any and all means, unless the information is needed in order to treat the patient, or because their job would require such access.

All members of the UNI Athletic Training Services must be aware of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA was implemented to standardize electronic management and sharing of individuals’ medical information, curb abuses of the data, and make health insurance easier to obtain and maintain during transition. HIPAA covers health care providers, health insurance plans, and anyone involved with electronic transactions involving individual patients’ medical records, which means the UNI Athletic Training Services Department members are most likely subject to HIPAA rules- termed “covered entities”.

In order to guard against improper disclosure of personal health information (PHI) it is imperative all student athletes complete the Student Athlete Authorization/Consent for Disclosure of Protected Health & Medical Information (HIPAA) Form (see Appendix) as part of their pre- participation paperwork. The student-athlete has the right to revoke authorization to any and all individuals listed on the form at any time, which must be documented in writing.

All University of Northern Iowa student-athletes will also be required to sign a Cedar Valley Medical Specialist (CVMS) HIPPA form that is used directly for any health care professional affiliated with CVMS. This form allows medical records to be released to various agencies such as the NCAA, and the Missouri Valley Conference for the purpose of making decisions regarding a student-athlete’s eligibility status while a student-athlete at the University of Northern Iowa.

Definitions: HIPAA Health Insurance Portability and Accountability Act

Individually Identifiable Health Created or received by a health care provider, health plan, or health- Information care clearinghouse. Must relate to the past, present or future physical or mental health condition of the individual. Identifies an individual or there is reasonable basis to believe the information can be used to identify the individual.

Protected Health Information Information that is individually identifiable since it contains one or (PHI) more patient identifiers such as: Name, SSN, address, phone, medical record entries, photographs, etc.

Notice of Privacy Practices Document which describes a physician’s office / hospital’s legal duties in the use and disclosure of PHI. Also outlines a patient’s individual rights to their PHI.

Covered Entity Organizations that electronically transmit medical information such as claims, enrollment or eligibility information, referrals, or authorizations (e.g. health plans, health care clearinghouses, health care 16

providers).

Business Associates Persons or companies that perform or assist in the performance of health care services on behalf of the covered entity and have access to PHI (e.g. shredding companies, imaging companies, housekeeping services, couriers, etc.) Business Associates are required to sign an agreement that they will maintain confidentiality of patient and business information.

Consent & Authorization Patients may be required to sign Consent to use and disclosure of PHI for purposes of treatment, payment, and health care operations (TPO) at the time of registration. Patients may also be required to sign an Authorization when the use or disclosure of PHI is for any other purpose than TPO.

Minimum Necessary Use or disclosure of PHI must be limited to the “minimum necessary” to accomplish an intended purpose.

Reasonable Safeguards Must be implemented to protect a patient’s privacy.

Confidentiality Policy: The University of Northern Iowa, including its Athletics Department, is committed to safeguarding the confidentiality of protected health information and other confidential information which is or may be contained in the records of the University and to ensuring that protected health information and other confidential information is used and/or disclosed only in accordance with the University’s policies and procedures and applicable state and federal law.

All University employees must hold confidential information used or obtained in the course of their duties in confidence. All protected health information and other individually identifiable health information must be treated as confidential in accordance with professional ethics, accreditation standards, and legal requirements. All employees with access to confidential information, including patient / student-athlete medical records information, employment information, and/or information systems must read and sign the Confidentiality and Security Agreement, which will be kept on file and updated periodically.

PRIVACY REQUIREMENTS: Everyone with access to health information and other confidential information is responsible for safeguarding its confidentiality. Health information and other confidential information may be in paper, electronic, verbal, video, oral, or any other form, and must be protected regardless of form.

Access to health information in any format must be limited to those persons who have a valid business or medical need for the information, or otherwise have a right to know the information. Individuals who access clinical records from other organizations are expected to follow that organization’s requirements.

Any knowledge of a violation of this confidentiality policy must be reported to an immediate supervisor. The supervisor will present the information to the Program Coordinator or Privacy Officer, as appropriate, for review and investigation.

Designated Record Set. A group of records, including medical and billing records, regardless of medium, that contains protected health information, maintained by the University of Northern Iowa and used to help make decisions about patients.

POLICY ELEMENTS:  Discuss patient / student-athlete information with authorized personnel only and only in a private location where unauthorized persons cannot overhear.

 Keep medical records and other confidential information secure and unavailable to persons not authorized to review or obtain those records or information.  Follow specified procedures for use of electronic information systems, including use of individual passwords, logging off when finished, proper data entry techniques, and protection of displayed or printed information from unauthorized users.  Omit the patient / student-athlete’s name and other unique identifiers when using case reports or hypotheticals for educational or training purposes.  Verify with the patient / student-athlete what information may be given to the patient/student-athlete’s family and friends with the patient/student-athlete’s knowledge and permission.  Screen requests for access to all patient / student-athlete and other confidential information so that the minimum necessary amount of information is made available and made available only to those persons who are legitimately involved in patient care, billing or administrative operations.  Release patient / student-athlete medical records and other confidential information to external sources only upon receipt of written authorization from the patient/student-athlete.  Use appropriate information security procedures for users of electronic information systems.

DE-IDENTIFICATION OF HEALTH INFORMATION: Health information is considered de-identified, and therefore not subject to the rules for protected health information only if all the following information has been removed:

 Names, including patient, family, employer, and attending physician  Geographic subdivisions smaller than a state, including street address, city, county, precinct, zip-code  Elements of date (except year) for dates directly related to an individual, including birth- date, admission date, discharge date, date of death  All ages over 89 and all elements of date (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older  Telephone numbers  Fax numbers  Electronic mail addresses  Social security numbers  Medical record numbers  Health plan beneficiary numbers  Account numbers  Certificate or license numbers  Vehicle identifiers and serial numbers, including license plate numbers  Device identifiers and serial numbers  Web universal resource locators (URLs)  Internet Protocol (IP) address numbers  Biometric identifiers, including finger and voice print  Full face photographic images and any comparable images  Any other unique identifying number, characteristic, or code

Information, which has been identified for all of the factors listed above, may be handled outside the constraints of this policy. However, even de-identified health information should be handled with care and with an awareness of the need to protect the identity of the person to whom the information refers.

Information Systems: The University of Northern Iowa Athletic Training Services Department’s information systems contain confidential information pertaining to student-athletes / patients, health care professionals, the department, and the UNI Department of Athletics. These systems may include computer hard drives, removable media storage mediums, filing cabinets, and medical records. This information is a major 18 asset to the UNI Athletic Training Services Department and is required by law to be protected. The use of information systems is shared by many individuals and imposes many obligations. The UNI Athletic Training Services Department’s Confidentiality / Security Agreement aims to inform individuals who use these resources of their responsibilities and to secure their agreement to abide by the associated policies and procedures.

UNI Athletic Training Services Personnel will:  Only disclose information, verbally and in written form, to those authorized to receive it;  Respect the privacy and rules governing the use of any information accessible through an information system or computer network and only utilize information necessary for performance of my job;  Report any violation of confidentiality of computer usage policies;  Respect the ownership of proprietary software;  Respect the finite capability of the systems and limit my use so as not to interfere unreasonably with the activity of others;  Abide by all the procedures and policies established to manage the use of the system.

UNI Athletic Training Services Personnel will not:  Exhibit or divulge the contents of any record or report except to fulfill a work assignment;  Attempt to access information by using a user identification code or password other than my own;  Remove any records, reports, or copies from their storage location except in the performance of my duties;  Release my user identification code or password to anyone or allow anyone to access or alter information under my identity; I will only make incidental person use of these resources;  Use these resources to engage in illegal activities, or harass anyone;  Allow unauthorized use of information maintained, stored or processed by the UNI Athletic Training Services Department;  See personal benefit of, or permit others to benefit personally by any confidential information or use of equipment available through my work assignment;  Remove any documents from the UNI Athletic Training Services Department, for any reason, without prior consent from the Head Athletic Trainer.

By signing the Confidentiality / Security Agreement, UNI Athletic Training Services Personnel understand:  That the information accessed through all UNI Athletic Training Services Department information systems contains sensitive and confidential patient, business, financial, and employee information;  That I may access health information on myself, but must have specific authorization to access information on anyone else;  That I am responsible for logging out of computer information systems and will not leave unattended a display device to which I have logged on;  That all access to UNI Athletic Training Services Department information systems will be monitored;  That my user identification code and password are the equivalent of my signature and that I am accountable for all entries and actions recorded under them;  That my obligation under this agreement will continue after termination of my employment and that my privileges are subject to review, revision, and renewal;  That violators of this agreement will be denied access to information systems (electronic or otherwise), subject to disciplinary action (including termination) and may be subject to penalties under state law and federal laws and regulations.

By signing the Confidentiality / Security Agreement, UNI Athletic Training Services Personnel are fully aware:  The UNI Athletic Training Services Department purchases or licenses the use of copies of computer software from a variety of outside companies.

 The UNI Athletic Training Services Department does not own the copyright to this software or its related documentation and, unless authorized by the software developer, does not have the right to reproduce it for use on more than one computer.  With regard to the use on local area networks or on multiple machines, UNI Athletic Training Services Department personnel shall use the software only in accordance with the license agreement.  UNI Athletic Training Services Department personnel learning of any misuse of software or related documentation within the department shall notify the Head Athletic Trainer and/or the Director of Athletics immediately.  According to the US Copyright Law, illegal reproduction of software can be subjected to civil damages of as much as $100,000 per work copied and criminal penalties, including fines and imprisonment. UNI Athletic Training Services personnel who knowingly make, acquire, or use unauthorized copies of computer software shall be disciplined as appropriate under the circumstances. Such discipline may include termination. The UNI Athletic Training Services Department does not condone the illegal duplication of software.  Of the software protection policies of the UNI Athletic Training Services Department and agree to uphold those policies.

Telephone Procedures:  Members of the UNI Athletic Training Services Department should verify Consent and Authorization before disclosing any PHI.  Members of the UNI Athletic Training Services Department should not disclose PHI over the phone to persons other than UNI Team Physicians and/or medical consultants, except in “Urgent” situations. o If disclosing PHI over the phone, personnel should verify with the recipient that they are in a “private” location before disclosing PHI. o When utilizing Nextel “Direct Connect” to disclose PHI, personnel MUST ensure that their phone and the phone of the person they are talking to are changed to the “private” setting.  Members of the UNI Athletic Training Services Department should verify the identity of the person that they are talking to at all times.

Fax Procedures:  Most unintentional disclosures of PHI occur due to errors in fax transmissions.  Members of the UNI Athletic Training Staff must periodically check / verify all routine fax numbers for accuracy.  All fax cover sheets must contain an approved confidentiality statement. o The documents accompanying this telecopy transmission contains confidential information belonging to the sender that is legally privileged. This information is intended only for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of these documents is strictly prohibited. If you received this telecopy in error, please notify the sender at the contact number above immediately to arrange for return of these documents.

 Members of the UNI Athletic Training Services Department should verify Consent and Authorization before faxing any PHI.  Faxing of PHI should be limited as much as possible to “Urgent” situations.  Fax trays should be routinely emptied, storing PHI in a secure location.

E-mail Procedures:  Members of the UNI Athletic Training Services Department must double-check / verify all email addresses before sending PHI through electronic means.  All outgoing email messages must contain an approved confidentiality statement in the signature line. o The foregoing message may contain confidential information belonging to the sender that is legally protected and/or privileged. This message is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, dissemination, distribution, or 20

action taken in reliance on the contents of this message is strictly prohibited. If you are not the intended recipient, please immediately contact the sender by reply e-mail and destroy all copies of the original message. Thank you.

 Personnel should not disclose their email password to anyone and/or display the password on or near their desk.  Personnel should adhere to all privacy standards relating to the use of computer workstations.

Computer Procedures:  All computer workstations should have screen savers set to the lowest possible “time-out” setting (1 minute) and be password protected.  Computer passwords should be periodically changed to prevent unauthorized use.  Personnel should not disclose their password to anyone and should not leave the password written on or near their desk.  Personnel should position their monitor so that only they can see it, if possible.  All UNI Athletic Training Services Department Personnel will be assigned a log-in to be used in conjunction with the Sports Program.  Personnel should escape to the main menu and/or log out from the SportsWare and/orTOUCHWORKS program when not actively working on a patient file.  Personnel should log out from the SportsWare and/orTOUCHWORKS program when leaving their workstation.

Medical Records / Folders:  All medical records / folders are the property of the UNI Athletic Training Services Department and should remain in a lockable file cabinet and/or desk at all times.  Student-athlete medical records / folders should not be left out on desks and/or stored in mailboxes.  Student-athlete medical records / folders ARE NOT permitted to leave the Athletic Training Services facility at any time.  Only authorized personnel are permitted to handle student-athlete medical records / folders.

Release of Protected Health Information:  All members of the UNI Athletic Training Services Department will receive and verify appropriate Consent and Authorization before releasing PHI.  All releases of PHI must be appropriately documented / logged in the student-athlete’s medical record, SportsWare file.

Daily Injury Reports:  UNI Athletic Trainers will not print paper copies of daily injury reports and/or fax daily injury reports to members of the coaching staff and/or Media Relations Department.  All daily injury reports will be emailed to the appropriate personnel.  UNI Athletic Trainers should also verbally communicate the contents of the daily injury report to the coaching staff and/or Media Relations Department in the privacy of their offices.

Media Relations:  UNI Athletic Trainers and members of the UNI Media Relations Department will only release the following to working media members as necessary: o student-athlete’s name; o game status (e.g. full, probable, questionable, doubtful, or out); and o region of the body that is injured (e.g. upper body; lower body).  UNI Athletic Trainers who release additional information without the written permission of the student-athlete are in direct violation of University of Northern Iowa Athletic Training Services Department policies and are subject to disciplinary action, including, but not limited to a decreased performance appraisal and/or termination.

Surgery Observations: UNI athletic trainers and/or athletic training students wishing to observe surgical procedures must follow the procedures below. 1) The athletic trainer making the surgery appointment must inform the physician’s secretary / surgery scheduler well in advance that a UNI athletic trainer and/or athletic training student wishes to observe the surgery. o The athletic trainer should request that the secretary / surgery scheduler inform physician of such request. 2) A UNI athletic trainer should confirm with the physician’s secretary / surgery scheduler at least 24 hours before the surgery that the request to observe has been made and to clear up any further problems. 3) The student-athlete must fill-out and sign any patient consent form the physician’s office may use authorizing the individual to observe the surgical procedure.

HIPAA Forms: All forms must be completed and signed in BLUE or BLACK INK! All forms are valid for a maximum of one (1) year from the date signed.

Confidentiality and Privacy Policy-  Must be signed by all UNI Athletic Training Services staff and athletic training students every year.  Completed forms will be filed in the employee’s personnel file and athletic training student’s file.

Authorization for Use, Disclosure, and Release of Health Information Form-  Must be completed by every student-athlete during the course of their pre-participation physical examination at the beginning of every school year and whenever needed throughout the course of the year.  Designed to be a blanket authorization for all general uses. Specific entities might require a more specific form to be completed.  UNI Athletic Trainer should sign and print in the “witness” section.  Expires one (1) year from the date signed.  Write student-athlete’s sport on the upper right corner of the form  Make FOUR (4) copies- o Original- File on left side of student-athlete’s medical folder, underneath of health history & physical exams o Travel binder o Give three (3) copies (paper clipped) to Megan for- . Dr. Clark’s Office Binder . Hy-Vee Pharmacy Binder . Cedar Valley Physical Therapy Binder

Student-Athlete Authorization/Consent for Disclosure of Protected Health & Medical Information (HIPAA) Form-  Must be completed by every student-athlete during the course of their pre-participation physical examination at the beginning of every school year and whenever needed throughout the course of the year.  Designed to be a blanket authorization that permits the release of specific PHI to various outlets.  UNI Athletic Trainer should sign and print in the “witness” section.  File the original on left side of student-athlete’s medical folder, underneath of health history, physical exams, and Authorization for the Use, Disclosure, and Release of Health Information Form.

XIX. MEDIA RELATIONS:

All relations with the media concerning an injured member of an UNI athletic team will be handled by the UNI Media Relations Department in consultation with the Team Physician and the Staff Athletic Trainer assigned to a particular sport. At no time are UNI student athletic trainers permitted to talk with members of the working media concerning a member of an UNI athletic team. It is imperative to remember that the student-athletes’ medical information is private and should be respected as such. It is highly recommended the UNI Athletic Training Services staff should only release the fact that an athlete was injured and what body part was involved with a general common terminology of the injury. Additional information can and should be gained from the athlete directly to guard against improper disclosure of PHI.

XX. PHYSICIAN REFERRALS / CONSULTATIONS:

All student-athlete referrals to physicians and specialists must come from an UNI staff athletic trainer, unless it is an emergency. Before leaving for an appointment with a physician / medical specialist, the student-athlete must have a signed Referral/Consultation Form to present to the doctor/specialist and a copy of the student-athlete’s insurance form and card. All bills must first be forwarded to the student-athletes insurance company, and UNI acts as a SECONDARY insurance carrier for athletic related injuries.

Although it is advisable for a staff athletic trainer or athletic trainer student to accompany a student-athlete to his/her appointment, it is not the responsibility of any member of the UNI Athletic Training Services Department to use personal transportation to fulfill these referral situations.

XXI. TEAM PHYSICIANS

The physicians at the Cedar Valley Medical Specialists (CVMS), UnityPoint Clinic, People’s Clinic, Northeast Iowa Family Practice and Covenant Clinic Arrowhead are the team physicians for UNI athletics. Team orthopedic surgeons with CVMS serve as the official team orthopedic surgeons. The athletic training staff at the UNI must work closely with the team physicians to assure the best care for the student athletes. Since the certified athletic trainers work under the direction of the team physician continuous communication is a must.

Key points regarding official team physicians: 1. The designated team physicians are the preferred provider for the medical needs of the student athletes at UNI. All referrals to any outside physicians will be coordinated with the team physicians. 2. The Director of Athletic Training Services/Sports Medicine and team physicians must be regularly updated regarding illnesses, physical and mental, and injuries sustained by the student athletes. 3. The Director of Athletic Training Services/Sports Medicine or his/her designee will decide what athletic events require physician coverage and who will cover what event. 4. When a team physician is present at an athletic event, that physician is the ultimate medical authority for that event. 5. The team physician has the final responsibility to determine when a student athlete is removed or withheld from participation due to injury, illness or pregnancy. 6. Clearance for an individual to return to activity after illness or injury is solely the responsibility of the team physician or that physician’s designated representative.

XXII. TEAM PHYSICAL THERAPIST (REHABILITATION COORDINATION)

The Cedar Valley Medical Specialists Physical Therapy clinic located at the UNI Human Performance Center (CVMS PT UNI) will serve as the official team physical therapy provider for UNI athletics. The CVMS PT UNI lead physical therapist will serve as the official team physical therapist/rehabilitation coordinator for UNI Athletic Training Services/Sports Medicine.

In order to assure the best injury rehabilitation is provided for the UNI student athletes, the athletic training staff will work in conjunction with CVMS PT UNI. All long term and post-surgical cases will be referred to CVMS PT UNI. CVMS PT UNI will also serve as a resource for the staff athletic

trainers at UNI. Any outside referrals must have approval and justification from a team physician and the Director of Athletic Training Services/Sports Medicine.

When a UNI student athlete is being seen at the CVMS PT UNI, the staff certified athletic trainer assigned to the sport he/she is involved in must make sure that they communicate regularly with the PT seeing the athlete. The staff certified athletic trainer must make sure that he/she keeps proper documentation during the rehabilitation process.

XXIII. INSURANCE COVERAGE OF UNI STUDENT-ATHLETES:

All University of Northern Iowa student-athletes MUST be covered by some type of individual health insurance BEFORE PARTICIPATING IN ANY PRACTICE, GAME, AND/OR COMPETITION. All student-athletes are required to have proof of primary health insurance. If a student-athlete is not covered under a parent(s)/ guardian(s) health insurance policy, supplemental health insurance is available at a cost to the student-athlete. The UNI Athletic Department will consider financial hardship cases and may financially assist the student-athlete with the premium expense.

Effective August 1, 2015 all walk-on and non-scholarship athletes will have to provide proof of primary health insurance that will cover them in the Cedar Falls/Waterloo area. If their current primary insurance does not cover them in this area, the student athlete will be asked to purchase at his/her own cost a primary health insurance plan that does so. Scholarship athletes will be able to have their primary health insurance purchased for them through the UNI Athletic Department.

The student-athlete’s insurance shall be considered the PRIMARY insurance coverage for all athletic related injuries. The University of Northern Iowa provides a medical and catastrophic insurance program for its intercollegiate athletes injured in practices, contests, and/or related travel. THIS POLICY, HOWEVER, IS SECONDARY TO, OR IN EXCESS OF, PERSONAL FAMILY MEDICAL INSURANCE COVERAGE. Bills should not be sent to the UNI Athletic Training Services Department until the personal family coverage is applied. Therefore, all medical bills must first go to the student-athlete and/or the student athlete’s parent/guardian. In addition, ALL bills (both paid and unpaid) must be submitted to the Athletic Training Services Department. All medical bills must be submitted to the Athletic Training Services Department within 14 business days of receipt. Bills received after 14 business days MAY NOT be processed by the UNI Athletic Training Services Department and/or Athletic Department and will be the responsibility of the student-athlete and/or the student athlete’s parent(s)/ guardian(s). Bills turned in that are over 30 days old will be processed at a fee of $15 to the student athlete’s university bill.

Please make sure that insurance is provided for the student-athlete at ALL medical appointments. For NON-athletic related injuries, please make sure that the medical office knows to use PRIMARY health insurance ONLY. For athletic related injuries, please make sure that the medical office knows which policy is primary and which is secondary. Again, the student athlete policy can be used as secondary insurance ONLY.

Submit all correspondence to:

University of Northern Iowa Athletic Training Services Attn: Insurance Coordinator Athletic Training HPC 008 Cedar Falls, IA 50614-0244 (319) 273-6108 // fax (319) 273-7023

Personal and family medical insurance will respond first to the cost of injuries incurred by the student-athlete during participation in intercollegiate athletics. (If personal family medical insurance does not cover the student-athlete, the Explanation of Benefits or Denial from the primary insurance MUST be sent to the Athletic Training Services Department before the University medical insurance will be applied as coverage for eligible items within the limits of the policy.) Any costs not covered by insurance become the responsibility of the student- athlete and/or the student-athlete’s parent(s)/ guardian(s).

Many out-of-state student-athletes have primary coverage (especially those with HMO’s), which requires certain criteria to be met to be eligible for coverage by the insurance carrier (i.e. surgery, diagnostic tests, etc. to be performed in the home state). If this is the case, the Athletic Training Services Department must be notified immediately of this situation.

Description of Benefits:

The University of Northern Iowa Athletic Department’s medical insurance policy covers only injuries / accidents resulting from the direct participation in the intercollegiate program during the dates of the primary competitive season and designated off-seasons as approved by the Director of Athletics according to NCAA regulations. UNI’s medical and catastrophic insurance program (which is SECONDARY) will pay for the “Necessary” medical treatment up to the “Usual” and “Customary” charges for such expense incurred within 104 weeks from the date of the injury / accident. The first expense must be incurred within sixty calendar days of the date of the injury / accident. Such expense must be for:

. treatment by a “physician” for outpatient treatment (except treatment in connection with physical therapy and/or spinal manipulation); . surgeon, assistant surgeon, and/or anesthesiologist fees; . “hospital” room and board; . hospital inpatient miscellaneous expenses for services not shown elsewhere; . hospital outpatient treatment; . x-rays, MRI’s, EKG, CT scans, and/or other diagnostic testing; . ground ambulance charges in emergency situations; . prescription drugs; . orthopedic braces and appliances; . physician outpatient treatment in connection with physical therapy and/or spinal manipulation; . treatment of sound natural teeth.

The maximum amount payable is limited to $90,000.00 per person, per accident/injury.

Exclusions and Limitations:

The University of Northern Iowa Athletic Department’s medical insurance policy WILL NOT apply to the situations indicated below. This list is not comprehensive, nor all-inclusive.

1. Covered expenses denied under any other plan as being “out of network” or due to “location”, including any group medical plans, Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs); 2. Non-athletic hernia 3. Experimental procedures; 4. Cosmetic surgery or procedures; 5. Hospital room and board charges in excess of the semi-private room rate unless hospitalized in an intensive care unit; 6. Medical expenses for which the student-athlete is entitled to benefits under any worker’s compensation act or mandatory no-fault automobile insurance contract; 7. Suicide, while sane or insane; or intentional self-inflicted injury; 8. Injuries / illnesses as a result of the student-athlete’s own felonious act or attempt of such an act; or the taking part in any illegal occupation; 9. Injuries / illnesses as the result of the student-athlete being legally intoxicated as defined by the laws of the state or governing territory in which the loss occurs; 10. Injuries / illnesses as the result of the student-athlete being under the influence of any narcotic drug unless taken on the advice of a physician. 11. Any injuries and/or illnesses incurred outside of the dates of the primary competitive or designated off-season periods for the given sport, as approved by the Director of Athletics. 12. Injuries / illnesses that are a result of intramural, club sports, and recreational activities (non- intercollegiate activities); 13. Injuries / illnesses that are recurrences of old injuries/ illnesses which were sustained before participation in the intercollegiate sports program;

14. Any tests and/or consultations needed to gain approval for participation in the intercollegiate athletic program 15. A $15 charge to the student-athlete will take place on any medical bills received by the Athletic Training Services Department thirty (30) business days after receipt by the student-athlete’s parent(s)/guardian(s) and/or health insurance policy holder ; 16. Medical costs related to seeing an outside physician/ consultation WITHOUT a referral by a member of the UNI Athletic Training Services Department. 17. Expenses for athletic injuries incurred after completion of the student-athlete’s intercollegiate athletic eligibility; 18. Medical expenses beyond the limitations and exclusions of, or not covered by the UNI Department of Athletics insurance policy.

The importance of having some form of personal health insurance coverage cannot be overemphasized. Medical bills resulting from the aforementioned activities should first be submitted to the student-athlete’s primary medical insurance. Any unpaid balances are the responsibility of the student-athlete and/or the student-athlete’s parent(s)/guardian(s).

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

Walk-on Student-Athlete Proof of Primary Insurance

All walk-on student-athletes who are competing in a try-out (and not just being automatically added to a team) with any of our teams must complete the Walk-On Waiver -- Proof of Insurance Form and provide proof of primary health insurance to their team staff athletic trainer and to Chelsea Lowe, the Secondary Insurance Coordinator. We will NOT be adding any students participating in a try-out to our secondary insurance until they are officially added to the team AFTER the try-out has concluded. Try-out periods will vary from team to team.

Referral Process When referring a student-athlete to a medical consultant fill out the printable or fillable PDF Medical Referral Form (see Appendix I).

Staff members will need to fill the referral form out for the first appointment of each separate injury/illness. For instance is ABC athlete is seeing Dr. Clark for their knee, and then goes again for their foot, two separate referrals would need to take place. This goes for every provider we refer to, including team chiropractors.

Please print two copies - one for the insurance file that will go to the Insurance Coordinator and one to send/give to the medical provider no later than their first appointment.

NCAA Catastrophic Injury Insurance Program:

The NCAA sponsors a Catastrophic Injury Insurance Program which covers the student-athlete who is catastrophically injured while participating in a covered intercollegiate athletic activity. The policy has a $90,000 deductible and provides benefits in excess of any other valid and collectible insurance.

More info on the NCAA Catastrophic Insurance Program Benefits:

http://www.ncaa.org/sites/default/files/13-14%2BCat%2BBenefit%2BSummary.pdf

NCAA Catastrophic Insurance – Frequently Asked Questions link:

http://www.ncaa.org/sites/default/files/Cat%2BFAQs%2B8.12.pdf 26

XXIV. TRANSPORTATION OF STUDENT-ATHLETES POLICY:

The policy of the University of Northern Iowa Division of Athletic Training with regards to the transportation of student-athletes to doctor’s appointments, diagnostic tests, surgeries, etc. will be:

 UNI certified athletic trainers will make a reasonable effort to attend a student-athlete’s doctor’s appointment, although, this may not be possible in all situations.

 UNI certified athletic trainers are not required to provide transportation to / from and/or attend a student-athlete’s diagnostic tests, physical therapy appointments, etc.

 UNI athletic training students will not transport student-athletes to doctor’s appointments, diagnostic test, physical therapy appointments, etc. with their own personal vehicles under any circumstances.

 If the student-athlete has a viable means of transportation, he/she will be responsible for his/her own transportation to and from the appointment.

 If a student-athlete does not have a viable means of transportation and/or is not able to drive due to an injury / illness, a UNI staff athletic trainer and/or graduate assistant athletic trainer will make every effort to arrange for transportation for the student-athlete in a timely manner.

Due to the time sensitive nature of some appointments and restrictions in an athletic trainer’s availability, members of the coaching staff may be asked to assist with the transportation of student- athletes.

XXV. OVER-THE-COUNTER (OTC) MEDICATIONS POLICY:

 All over-the-counter (OTC) medications will be stored in a locked cabinet within the HPC Athletic Training Room, McLeod Center Athletic Training Room, and the West Gym Athletic Training Room. Only staff certified athletic trainers and team physicians will be permitted to access the medication supply and its contents will be tightly controlled.

 All OTC medications, which are given to student-athletes and/or athletic department staff members, must first be logged on the appropriate form(s) located within the secured storage space recording the following information and/or the student-athletes electronic medical record file in SportsWare: 1. record of the athlete’s name 2. indications for use 3. record the medication, dosage, frequency 4. date dispensed

 The staff certified athletic trainer is expected to convey orally or in writing, information about the drug, indications for use, side effects, and interactions with other drugs or foods.

 The staff certified athletic trainer shall assess the patient’s understanding of compliance with the medication regimen.

 The medication shall be provided in a unit dose package or in an envelope or dispensing container marked with the patient’s name, the dispensing date, the name of the drug, quantity and directions for use.

 Minors shall not be provided with over-the-counter medications without parental consent, such consent and administration being recorded and that record kept on file.

XXVI. THERAPEUTIC MODALITIES TREATMENT POLICY:

1. Athletic training students may not independently use therapeutic modalities. A staff athletic trainer must directly supervise all athletic training students at all times. 2. Once athletic training students have successfully completed the competency check-off for a specific modality, they may use the therapeutic modality under the direct supervision of a staff athletic trainer. 3. A staff athletic trainer must approve all treatment programs using therapeutic modalities before the program is implemented. 4. Athletic training students may not independently change and/or modify therapeutic modality treatment programs. 5. All precautions, warnings, and contraindications must be followed at all times. 6. Proper operating instructions and safety protocols must be followed at all times. 7. If you determine a therapeutic modality is not working properly, do not use the modality and notify the Director of Athletic Training Services immediately. Place a sign on the modality indicating that it is broken and should not be used. 8. Provide the patient with a thorough explanation of the treatment procedure, including sensation(s) to be experienced. Tell the patient to notify you as soon as possible if they experience any adverse reactions. 9. Each year an in-service will be given to the entire Athletic Training Services Staff to review all therapeutic modalities. 10. If a full time staff member or graduate assistant is unfamiliar with a modality they should ask another staff member to demonstrate/teach them how to use the modality.

XXVII. PRESCRIPTION MEDICATION POLICY / FILLING PHARMACY PRESCRIPTIONS:

Distribution of Medication on site: Any distribution of prescription medication in any University of Northern Iowa athletic training room or sideline/bench will be done directly by a UNI team physician.

Procedure: 1. Primary responsibility for the UNI Prescription Medication Policy’s administration shall lie with the UNI Team Physicians.  All UNI Team Physicians must be licensed to practice medicine in the State of Iowa and must be currently registered with the Drug Enforcement Agency (DEA). 2. The physician emergency medicine bag/kit will be on the sideline/bench with the UNI team physician. 3. The primary UNI team physician for each sport will stock the physician’s emergency medicine bag/kit as needed. The purpose of the emergency medicine bag/kit is for the UNI team physician to have immediate medication when needed at games and practices. 4. Before medicine is distributed by the UNI team physician, a prescription medication record must be completed. Complete the student-athlete’s name, date of birth, condition or injury, description of medication, and amount. The UNI team physician will sign and date the form. 5. A copy of the prescription medication record will placed and filed in the student-athlete’s medical file, which is archived for seven years post completion of participation. 6. Each student-athlete that is distributed medicine on site by the UNI team physician must be given the contact number of the supervising staff athletic trainer.

Unsecured Medications: 1. All UNI Team Physicians will sign an Unsecured Emergency Medication Exception List document that authorizes the storage of certain emergency prescription drugs (Asthma Medication Metered Dose Inhalers and Epipen Auto-Injectors) in the UNI athletic training facilities. 2. Only UNI athletic training staff, as delineated in the signed agent of record, is authorized to administer unsecured medications as per orders from the UNI Team Physician. 3. All unsecured medications shall be stored in a designated locked cabinet within the Athletic Training Room and/or a certified staff athletic trainer athletic training kit/bag. 4. Whenever an unsecured medication is administered by the UNI certified athletic training staff member, a written patient note and/or a computerized electronic injury/maintenance record should be generated.

Specific Protocol for Asthma Medication Metered Dose Inhalers (MDI): 1. Only UNI staff certified athletic trainers are authorized to carry and/or administer asthma medication metered dose inhaler (MDI) as per the standing orders established by UNI Team Physicians. 2. Asthma medication metered dose inhalers are to be properly stored in UNI staff certified athletic trainer athletic training kit and/or fanny pack. 3. Whenever an asthma medication metered dose inhaler is dispensed by a Team Physician, a written patient note and/or an electronic computerized injury / maintenance record note should be generated. 4. Whenever an asthma medication metered dose inhaler is administered by UNI Athletic Training personnel, a written patient note and/or a computerized injury / maintenance record note should be generated.

Specific Protocol for Iontophoresis: 1. Only UNI staff certified athletic trainers and physical therapists are authorized to administer Iontophoresis treatments with approved compounding medications (i.e.: Dexamethasone) as per the orders of the UNI Team Physician. 2. All Iontophoresis treatment medications, equipment, and supplies will be stored in a designated cabinet within the CVMS Physical Therapy Clinic Facility. 3. Whenever an Iontophoresis treatment is administered by CVMS PT staff or UNI staff certified athletic training personnel, a written patient note and/or an electronic computerized injury / maintenance record note should be generated.

Specific Protocol for Phonophoresis: 1. Only UNI staff certified athletic trainers or physical therapists are authorized to administer phonophoresis with approved compounding medications as per the orders of the UNI Team Physician. 2. All phonophoresis treatment medications, equipment, and supplies will be stored in a designated locked cabinet within UNI Athletic Training Facilities. 3. Whenever phonophoresis treatment is administered by UNI athletic training personnel, a written patient note and/or an electronic computerized injury / maintenance record note should be generated.

Specific Protocol for Epipen Auto-Injectors: 1. Only UNI staff certified athletic trainers are authorized to carry and/or administer an Epicene Auto-Injector as per the standing orders established by UNI Team Physicians. 2. Epicene Auto-Injectors are to be properly stored in the UNI staff certified athletic trainer treatment kit and/or fanny pack. 3. Whenever an Epicene Auto-Injector is dispensed by a Team Physician, a written patient note and/or an electronic computerized injury / maintenance record note should be generated. 4. Whenever an Epicene Auto-Injector is administered by the UNI Athletic Training personnel, a written patient note and/or an electronic computerized injury / maintenance record note should be generated.

Filling Pharmacy Prescriptions: The UNI Athletic Training Services Department’s policy with regards to prescription medications / pharmacy charges for injuries incurred during and as a result of an approved practice, contest, or related travel as per NCAA regulations will be: 1. All student-athletes must follow the appropriate procedures for referral to a physician as outlined in the UNI Athletic Training Services Department Medical Care Procedures for the Student- Athlete brochure and UNI Student-Athlete Handbook. This includes communicating with a member of the UNI Athletic Training Services Department before making an appointment to see a physician, and obtaining the proper referral form.

. If a student-athlete decides to see a physician/ specialist WITHOUT prior authorization and/or referral from a staff member of the UNI Athletic Training Services, the student- athlete and/or the student athlete’s parent(s)/ guardian(s) will be financially responsible for any and all medical bills incurred.

2. Upon receipt of the prescription from the physician, the student-athlete must return to the athletic training room and obtain a referral form from a member of the UNI Athletic Training Services Department for the prescription.

3. The referral form and a copy of the physician’s prescription must be taken to Hy-Vee Pharmacy (College Square Shopping Center; 319-266-9874) Hours- Monday – Friday 8:00am – 9:00pm Saturday 9:00am – 6:00pm Sunday 10:00am – 5:00pm

. All student-athletes must use Hy-Vee Pharmacy (College Square Shopping Center) for ALL pharmacy needs related to any injury incurred during and as a result of an approved practice, contest, or related travel as per NCAA regulations.

. NuCara Pharmacy (209 E. San Marnan Dr., Waterloo, 319-236-8891) will be used for specialized prescriptions (i.e. Speedgel Lotion, Phonophoresis, etc.).

 Any student-athlete that chooses to utilize another pharmacy without prior authorization from a member of the UNI Athletic Training Services Department will be financially responsible for any and all costs related to the prescription medication.

4. The student-athlete’s primary insurance will be charged and the student-athlete will have to pay for any further charges related to the prescription medication at the time that he/she is picking up the prescription. 5. In order for the student-athlete to be reimbursed for any out-of-pocket expenses related to authorized prescription medication / pharmacy bills, he/she must: o Submit the receipt from pharmacy to a member of the UNI Athletic Training Services Department as soon as possible; o Submit the Explanation of Benefits from the primary insurance company (will be sent to the insurance policyholder 10-12 days after the claim is submitted) to a member of the UNI Athletic Training Services Department within 14 business days of receipt.

Correspondence received after 14 business days MAY NOT be processed by the UNI Athletic Training Services Department and/or Athletic Department and will be the responsibility of the student- athlete and/or the student athlete’s parent(s)/ guardian(s).

. When ALL related receipts and explanation of benefit statements have been received by the UNI Athletic Training Services Department, the student-athlete will be reimbursed for any out-of-pocket expenses related to the prescription medications.

. Student-athletes needing prescription medications from out-of-town pharmacies, for emergency purposes only, must first pay for the prescription and submit all receipts and explanation of benefit statements to the UNI Athletic Training Services Department. When ALL related documents have been received by the UNI Athletic Training Services Department, the student-athlete will be reimbursed for any out-of-pocket expenses related to the prescription medications.

Student-athletes not following the aforementioned UNI Athletic Training Services Department Policy for Filling Prescription Medications will be financially responsible for any and all costs related the prescription medication.

All correspondence may be submitted to: University of Northern Iowa Athletic Training Services Department Attn: Insurance Coordinator Athletic Training HPC 008B Cedar Falls, IA 50614-0244 Office: (319) 273-6476 Fax: (319) 273-7023

XXVIII. NCAA COMPLIANCE POLICIES TO BE AWARE OF:

1. TREATMENT/EXAMINATIONS FOR PROSPECTIVE STUDENT- ATHLETES/RECRUITS

Staff athletic trainers may not provide ongoing treatment to a prospect who has verbally committed until they enroll and attend classes at UNI (summer or fall). However, once a prospect has been accepted for admission (or signed) our athletic training staff may conduct medical examinations at any time. In addition, medical examinations conducted by UNI team physicians may be conducted at any time regardless of whether the prospect has been admitted or signed. Please keep in mind that the prospect must pay all transportation expenses associated with their visit to campus unless they are here on an official visit.

2. PREPARTICIPATION MEDICAL EXAM Before student-athletes can begin participating in any team activities, the student-athlete must undergo a physical examination for medical clearance. The student-athlete must also complete additional athletic training/sports medicine paperwork, complete a sickle cell solubility test or provide previous sickle cell test results and/or sign a written release declining the test (see UNI Sickle Cell Trait Policy), provide their primary health insurance information (see UNI Secondary Insurance Policy), and undergo concussion baseline testing and education (see UNI Concussion Policy).

XXIX. DIRECT SUPERVISION OF ATHLETIC TRANING STUDENTS:

The policy of the University of Northern Iowa Athletic Training Services with regards to direct supervision of athletic training students by staff athletic trainers will be-

“Direct supervision of athletic training students involved in the clinical and/or field experience portion of the Athletic Training Education Program will be through constant and direct line-of-site visual contact between the field experience supervisor and the student athletic trainer.”

In order to remain within the standards set forth by CAATE with regards to direct supervision of athletic training students, the following disciplinary action policy will be in effect.

First Offense-  Meeting with the Athletic Training Education Program Director

Second Offense-  Meeting with the Athletic Training Education Program Director  Notation in the field experience supervisors file

Third Offense-  Meeting with the Athletic Training Education Program Director  Notation in the field experience supervisors file  Athletic training students may be removed from the clinical rotation until the field experience supervisor can properly demonstrate that he/she can supervise athletic training students as outlined in the aforementioned policy statement.

XXX. MORNING TREATMENTS:

Morning treatments will be done in the HPC Athletic Training Room or other satellite facilities Monday through Friday for all student-athletes. Injured student-athletes are to make arrangements with the staff certified athletic trainer assigned to their sport. It is expected that this time will be used for one-on-one interaction between the staff athletic trainer, athletic training student(s) if available, and student-athlete. It is imperative that all injury treatments be recorded and entered into the student’s electronic medical record after treatment is given.

Long term, post-op and specialty rehabs will utilize the CVMS physical therapy staff as directed by the CVMS/UNI Rehabilitation Coordinator.

XXXI. CHIROPRACTOR POLICY:

The procedure of the University of Northern Iowa’s Athletic Training Services Department with regards to the use of chiropractors will be:

1. Referrals to chiropractors for UNI student-athletes will be left to the discretion of the UNI staff athletic trainer responsible for the sport.

2. Trade-out/Gift-In-Kind through the Panther Scholarship Club must be utilized first and foremost. The Director of Athletic Training Services will give periodic updates on trade-out status of all chiropractors who have agreed to provide trade-out/gift-in-kind service.

3. Referrals will be for evaluation, diagnostic testing, and limited treatment and rehabilitation of the injury/problem. Referrals will be for a maximum of four (4) visits. After the fourth visit, student- athletes must obtain another referral for chiropractic care from the UNI staff athletic trainer responsible for the sport.

4. Student-athletes are not to continue with the chiropractic visits for treatment that can be done in the athletic training room (i.e. ice, heat, muscle stimulation, ultrasound, therapeutic exercise, etc.)

5. Student-athletes will be referred for chiropractic evaluation and treatment only after an initial evaluation is performed by a member of the UNI Athletic Training Services Department, and an attempt at appropriate treatment and/or rehabilitation exercises is made and is unsuccessful.

6. A member of the UNI Athletic Training Services Department must make the referral for chiropractic care. If a student-athlete decides to see a chiropractor WITHOUT prior authorization/ referral from a member of the UNI Athletic Training Services Department, the student-athlete and/or the student athlete’s parent(s)/ guardian(s) will be financially responsible for any and all medical bills incurred.

XXXII. NEW EMPLOYEE ORIENTATION:

When an employee (faculty/staff athletic trainer, graduate assistant athletic trainer, etc.) begins employment with UNI, it is the responsibility of the staff to orient this person to the rules, regulations, and procedures of the Athletic Training Services Department. The responsibilities are as follows:

 General Department/Athletic Training Rules & Regulations Don  Medical Consultants / Trade-Out Program Don  Insurance and Referral Procedures Chelsea  Filing System Chelsea  SportsWare /Athletic Training Room Computers Travis  Athletic Training Room Forms Don  Student-Athlete Physical Exams Don  Emergency Plans / Sideline Procedures / Catastrophic Injury Plan Troy  OSHA Plan Troy  Student-Athlete Assistance Program (SAAP) Melissa 32

 Substance Abuse Education and Testing Don  Mental Illness / Eating Disorders Prevention, Education, & Treatment Melissa  Concussion Evaluation Procedures Travis  Hydrotherapy Room Travis  Staff In-services Katie  Van / Golf Cart / Gator Use Travis  Athletic Training Education Program Don  Graduate/Intern Office Don  Housing / Community / Campus Don  Athletic Training Education Program Tour / Introductions / Overview Troy  Coach’s Report Procedures Don  Staff I.D. and Parking Pass Don  Cell Phone Don  Email Don

XXXIII. COACHING STAFF DAILY INJURY REPORT PROCEDURES:

In order to maintain continuity among all UNI Athletic Training staff and athletic training students, as well as the UNI Coaching Staff, UNI Athletics Administration, the UNI Media Relations Department and the local media, the following procedures for reporting the status of injured student-athletes will be utilized.

Format- Delivery Options-  SportsWare generated report  e-mail  MS Word Coach’s Report template  In-person communications in office refer  e-mail template to HIPAA Policies.

Frequency- SPORT IN-SEASON OFF-SEASON Football Daily Weekly Women’s Soccer Daily Weekly (as needed) Volleyball Daily Weekly (as needed) Men’s / Women’s Basketball Daily days Weekly (as needed) Wrestling Daily Weekly (as needed) Softball Every 2-3 days Weekly (as needed) Tennis Every 2-3 days As needed Cross Country, Track & Field Every 2-3 days Weekly (as needed) Swimming & Diving Every 2-3 days As needed Golf As needed As needed Cheerleading & Dance Every 2-3 days As needed

Terminology-

Game Status- DEFINITION Full No limitations

Probable 75% chance that the athlete will play / 25% chance that the athlete will not play

Questionable 50 / 50 that the athlete will or will not play

Doubtful 25% chance that the athlete will play / 75% chance that the athlete will not play

Out Athlete will not play 33

Game-Day / Game-Time Decision on the athlete’s status will be made on the day of Decision the game / before the game after further observation of the athlete Practice Status-

DEFINITION Full No limitations to the athlete’s participation

Limited Athlete is limited in what he/she can do at practice; must list limitations (i.e. no sprinting; weight room limitations/modifications; drill/activity exclusions, etc.)

No Contact Athlete is not allowed to participate in drills / activities that involve physical contact

Activity to Tolerance / Athlete is allowed to participate in activities to his/her As Tolerated tolerance

Out Athlete will not participate in practice  It is imperative the head coach is in constant communication with the staff athletic trainer responsible for their sport. The staff athletic trainer is encouraged to meet with the head coach to determine the best means of communication possible (face to face meetings, phone conversation, text messaging, written report and electronic written report). If an injury/illness occurs outside of practice/competition the head coach must be notified immediately once the staff athletic trainer is made aware of the situation.

XXXIV. NOTIFICATION OF ATHLETICS ACADEMIC SUPPORT REGARDING INJURIES:

Athletics Academic Support staff should be notified when any student-athlete will be missing classes due to injury/illness/surgery. Please be sure to email Stacia Eggers at [email protected] when you have these cases. This is extremely important she be notified for concussions & surgical cases.

XXXV. RETURN TO PLAY CRITERIA:

The University of Northern Iowa Team Physician or his/her designee, in consultation with the staff certified athletic trainer, has the final authority in deciding if and when an injured student-athlete may return to practice and/or competition. Any student-athlete seen by an outside (off-campus) physician must return to the athletic training room for follow-up and final clearance prior to active participation status. If a student-athlete is under the care of a private physician for an injury or illness and the physician’s treatment precludes or alters the activity in intercollegiate athletics, the student-athlete must secure in writing, a release to reinstate the student-athlete to full participation. No student- athlete will be allowed to return to participation until the UNI Athletic Training Services Department has received a release and it is added to the medical records.

XXXVI. CONCUSSION MANAGEMENT PLAN:

The following policy and procedures on baseline testing, subsequent assessment and management of concussions as well as return to play guidelines have been developed in accordance with the University of Northern Iowa Sports Medicine/Athletic Training Services Department Mission Statement to provide quality healthcare services and assure the well-being of each student-athlete at UNI.

PURPOSE

The University of Northern Iowa Sports Medicine/Athletic Training Services Department recognizes that sport induced concussions pose a significant health risk for those student-athletes participating in athletics at UNI. With this in mind, the UNI Sports Medicine/Athletic Training Services Department has implemented policies and procedures to assess and identify those student-athletes who have suffered a

34 concussion. The Department also recognizes that baseline neurocognitive testing on student-athletes who participate in those sports which have been identified as collision and or contact sports and/or who have had a history of concussions prior to entering the University of Northern Iowa will provide significant data for return to competition decisions. Baseline testing data combined with clinical assessment and a 5-step progressive exertional testing protocol will allow student-athletes to return to play only when their injuries are completely healed and they are physically prepared to return to competition.

CONCUSSION DEFINITION

A Concussion occurs when there is direct or indirect insult to the brain itself. As a result of this trauma, transient impairment of mental functions such as memory, balance/equilibrium and vision may occur. A concussion will not necessarily result in a loss of consciousness and, therefore, all suspected head injuries should be taken seriously. All UNI coaches and teammates can be helpful in identifying those who may potentially have a concussion, because a concussed athlete may not be aware of their condition or may potentially be trying to hide the injury to stay in a game or practice.

The University of Northern Iowa recognizes that concussions may occur outside of participating in a sport. Therefore the acute management of the student-athlete with such a concussion may occur outside the scope of this document. However, return to play decisions for the student athlete that may have suffered a concussion outside of sport participation will be guided by this policy. This policy includes, but is not limited to the management principles mandated by the NCAA.

Signs and Symptoms of Concussion:

Staff certified athletic trainers and athletic training students all need to be aware of the signs and symptoms of concussion to properly recognize and intervene on behalf of the student-athlete. Signs and symptoms of a concussion may include, but are not limited to the following:

Physical Symptoms Cognitive Symptoms Emotionality Symptoms

Headache Memory Loss Irritability

Vision Difficulty Attention Disorders Sadness

Nausea/Vomiting Reasoning difficulty Nervousness

Dizziness Sleep Disturbances

Balance Difficulties

Light sensitivity

Fatigue

Tinnitus (ringing ears)

Exercise or activities that require a lot of concentration may cause symptoms to re-appear or worsen, thus increasing the time one needs to recover from a concussion.

EDUCATION/RESPONSIBILIITES

The University of Northern Iowa will make the Concussion Management Plan and other education materials available on unipanthers.com.

1. Student-Athletes: University of Northern Iowa student-athletes must be truthful and forthcoming about symptoms of illness and injury, both at the time of an injury as well as upon the emergence 35

of any reoccurring or new symptoms. In conjunction with the annual pre-participation physical, student-athletes will sign a questionnaire in which they acknowledge their responsibility to be truthful and forthcoming about symptoms of illness and injury. Each year, the athletic training/sports medicine staff will educate University of Northern Iowa student-athletes specifically about concussions. As part of that education, each student-athlete will receive the NCAA Concussion Fact Sheet and will sign the UNI Student-Athlete Concussion Responsibility Form. In signing the form, student-athletes will acknowledge that:

 they have received and reviewed the NCAA Concussion Fact Sheet for Student-Athletes and participated in education related thereto; and

 they accept the responsibility for truthfully and promptly reporting their illnesses and injuries to the athletic training/sports medicine staff, including any signs or symptoms of a concussion, regardless of whether any such illnesses, injuries, signs, or symptoms are related to participation in intercollegiate athletics.

2. Coaches All University of Northern Iowa coaches (and appropriate athletics administrators) will receive the NCAA Concussion Fact Sheet for Coaches and will sign the Coach’s Concussion Responsibility Form, acknowledging that:

 they have received and reviewed the NCAA Concussion Fact Sheet for Coaches and participated in education related thereto;

 they will encourage their student-athletes to report their illnesses and injuries to the athletic training/sports medicine staff, especially any signs or symptoms of a concussion;

 they will refer any student-athlete whom they suspect of sustaining a concussion to the proper medical authority; and

 they have read and understand the University of Northern Iowa Concussion Management Plan, including the fact that team physicians (and, in their absence, athletic trainers) have unchallengeable authority to withhold a student-athlete from practice or competition, and that team physicians and athletic training/sports medicine staff members have unchallengeable authority to determine concussion management, return-to-play, and medical clearance.

3. Athletic Training/Sports Medicine Staff: The University of Northern Iowa Athletic Training/Sports Medicine staff (athletic trainers and team physicians) will undergo at least annual training sessions on the diagnosis and treatment of head injuries and this Concussion Management Plan. Each member will receive the NCAA Concussion Fact Sheet for Coaches and will sign the Athletic Training/Sports Medicine Staff Concussion Responsibility Form, acknowledging that:

 they have received and reviewed the NCAA Concussion Fact Sheet for Coaches and participated in education related thereto;

 they will encourage the coaching staff and the student-athletes to report their illnesses and injuries, especially any signs or symptoms of a concussion;

4. Director of Athletics/Associate Directors of Athletics with Sport Oversight will receive the NCAA Concussion Fact Sheet for Coaches and will sign the Coach’s Concussion Responsibility Form, acknowledging that:

 they have received and reviewed the NCAA Concussion Fact Sheet for Coaches and participated in education related thereto;

 they will encourage the coaching staff and the student-athletes to report their illnesses and injuries to the athletic training/sports medicine staff, especially any signs or symptoms of a concussion;

PRE-PARTICIPATION/BASELINE ASSESSMENT  All student-athletes will undergo a pre-participation history and physical examination by a University of Northern Iowa Team Physician which includes brain injury and concussion history.  All student-athletes will undergo pre-participation baseline concussion assessment testing – specifically computerized neurocognitive testing using ImPACT and the Sport Concussion Assessment Tool – 3rd Edition (SCAT 3). These assessment tools include brain injury and concussion history, symptom evaluation, cognitive assessment, visual tracking, saccadic eye movements and balance evaluation.  Team physician judgment will determine pre-participation clearance and/or the need for additional consultation or testing based upon known individual concussion modifiers.  New baseline concussion assessment will be considered at six months or beyond for any student-athlete with a documented concussion, especially those with complicated or multiple concussion history. This will be determined by the team physician.  Additionally, for all first year or transfer student-athletes in the following UNI contact/collision sports: football, basketball, pole vault, soccer and wrestling or new student-athletes with any pertinent medical history of concussion(s) a King-Devick baseline test.

RECOGNITION AND EVALUATION

1. Medical personnel from the UNI Athletic Training/Sports Medicine staff with training in the diagnosis, treatment and initial management of acute concussion must be present at all UNI NCAA competitions in the following contact/collision sports: football, basketball, pole vault, soccer and wrestling. To be present means to be on site directly at the NCAA competition site. Medical personnel may be from either team, or may be independently contracted for the event.

2. Medical personnel from the UNI Athletic Training/Sports Medicine staff with training in the diagnosis, treatment and initial management of acute concussion must be available at all UNI NCAA practices in the following contact/collision sports: football, basketball, pole vault, soccer and wrestling. To be available means that, at a minimum, the UNI medical personnel can be contacted at any time during the practice via telephone, message, email or other immediate communications means and arrangements can be made for the athlete to be evaluated.

3. If a student-athlete reports or displays signs, symptoms, or behaviors that a University of Northern Iowa athletics staff member believes are consistent with a concussion, the University of Northern Iowa athletics staff member shall inform the student-athlete’s coach, as well as the student-athlete’s team physician and/or team staff athletic trainer. The student-athlete shall be 37

removed from any practice or competition, and will be evaluated by a team physician or athletic trainer with concussion management experience who will make a determination of whether there is a basis for a suspected concussion.

4. A student-athlete with a suspected concussion shall be evaluated by the by a team physician or athletic trainer for cognitive, physical, and behavioral signs and symptoms of a concussion, included but not limited to: headaches, amnesia, nausea, dizziness, balance and visual disturbances, poor SCAT3 scores versus the baseline, and light sensitivity. If these symptoms are present following the SCAT3 test, the student-athlete will be initially withheld from athletic activity for the remainder of the calendar day.

5. A student-athlete with a suspected concussion shall be clinically assessed for cervical spine trauma, skull fractures and inter-cranial bleeding by a team physician or staff athletic trainer.

6. The University of Northern Iowa Athletic Training/Sports Medicine Emergency Action Plan is enacted if any student-athlete shows signs of prolonged unconsciousness, spinal injury, repetitive emesis (vomiting), focal neural deficit or a diminishing neurological status or Glasgow Coma Scale <13. A physician will evaluate the student-athlete at the hospital and the student-athlete will be hospitalized if their condition warrants.

7. A student-athlete with a suspected concussion shall be withheld from practice or competition and shall not return to athletic activity for the remainder of that day. The team physician or team staff athletic trainer making such decision should notify the coaching staff that the student-athlete will not return to athletic activity for the remainder of the day.

8. A treating team staff athletic trainer or team physician shall have the authority to require that a student-athlete be continuously monitored during a period that the student-athlete, in the judgment of the athletic trainer or team physician, is acutely symptomatic.

9. A student-athlete with a suspected concussion will be evaluated by a team physician for a diagnosis as soon as possible in accordance with the severity of the symptoms. Such evaluation will generally include follow-up testing (which may include but is not limited to SCAT III testing); the timing and nature of any follow-up testing are in the discretion of the treating team physician.

10. Student-athletes and/or athletic training/sports medicine staff may not be able to recognize the possibility of a concussion until hours or days after the precipitating event. Under these circumstances, once a student-athlete reports or displays signs, symptoms, or behaviors that a University of Northern Iowa athletics staff member believes are consistent with a concussion, the athletics staff member shall inform the student-athlete’s coach, as well as the student athlete’s team physician and/or team staff athletic trainer, and the team physician or athletic trainer shall initiate normal evaluation and return-to-play procedures.

11. If a student-athlete sustains a potential concussion outside of participation in intercollegiate athletics, the student-athlete is responsible for truthfully and promptly reporting the injury to the athletic training/sports medicine staff, including any signs or symptoms of a concussion, at which point the potential concussion will be managed in the same manner as potential concussions sustained during participation in intercollegiate athletics.

12. Visiting team student-athletes evaluated by University of Northern Iowa athletic training/sports medicine staff will be managed under the same guidelines as University of Northern Iowa student-athletes while under the evaluation of University of Northern Iowa athletic training/sports medicine staff.

13. If a University of Northern Iowa student-athlete reports or displays signs, symptoms, or behaviors that a University of Northern Iowa athletics staff member believes are consistent with a concussion while away from campus in connection with team activities and a team physician is not present, the athletics staff member shall inform the student-athlete’s coach and the student 38

athlete’s athletic trainer. The University of Northern Iowa athletic trainer shall manage the student-athlete under the guidelines set forth in this Plan, and should consult with a local physician experienced in the evaluation and management of concussions, if deemed necessary by the athletic trainer. Regardless, the student-athlete will be evaluated by a team physician as soon as possible upon return to campus. EMERGENCY REFERRALS

In the event that a student-athlete displays one or more of the following symptoms during an initial evaluation, a team physician and/or athletic trainer should consider activation of the applicable UNI Emergency Action Plan/Medical Emergency Response Procedures and/or immediate referral to the Emergency Room:

 Prolonged loss of consciousness

 Deteriorating level of consciousness

 Suspicion of spine or skull injury

 Seizure activity

 Evidence of hemodynamic instability/deteriorating of vital signs

 Repetitive vomiting

 Focal neural deficit or a diminishing neurologic status or Glasgow Coma Scale <13

MONITORING/FOLLOW-UP CARE

1. Due to the need for ongoing monitoring for deterioration of symptoms, when an athletic trainer or team physician determines that a student-athlete who displays signs, symptoms, or behaviors consistent with a concussion or who is diagnosed with a concussion may be released from immediate care, the student-athlete should be accompanied by an individual who can provide reliable supervision (such as a roommate, parent/guardian, coach, member of residence hall staff or a teammate). In the alternative, such student-athletes should be liberally referred to Sartori Hospital for observation.

2. Upon release from immediate care, the student-athlete and the individual who accompanies him/her will be provided with verbal or written instructions, which may include monitoring, limitation of certain activity, and additional assessments (see Concussion Take-Home Instructions for an example of information typically provided upon discharge).

3. As appropriate, the athletic training/sports medicine staff should communicate with UNI Academic Services for Student-Athletes to assist in managing the return-to-learn protocol; Residence Hall or other Student Affairs staff to assist in managing supervision and other issues; and coaches and other University of Northern Iowa athletics staff to assist in managing athletics-related issues.

4. Student-athletes with a prolonged recovery shall be evaluated by a physician to consider additional diagnoses (e.g., post-concussion syndrome, sleep dysfunction, migraine or other headache disorders, mood disorders, or ocular or vestibular dysfunction) and proper management options.

RETURN TO PLAY GUIDELINES  A student-athlete diagnosed with a concussion is required to be medically cleared by a physician (i.e., team physician or other medical physician designated by the University of Northern Iowa Athletic Training/Sports Medicine staff) before returning to practice or competition.  Team physicians shall have unchallengeable authority to determine concussion management, return-to-play and medical clearance. In the absence of a team physician, athletic trainers have unchallengeable authority to withhold a student-athlete from practice or competition.  A team physician may allow monitored exertional activity prior to asymptomatic status. 39

 After symptoms return to baseline, follow up ImPACT, King-Devick and SCAT3 will be completed and results reviewed by team physician.  Rate of return to play progression shall be determined and supervised by a team physician and the team staff athletic trainer.  Return to play progression involves a gradual, step-wise increase in physical demand, sport specific activities and the risk for contact. Each step requires the student athlete to progress through each step listed below without his/her condition becoming worse before with 24 hours taking place between each step before he/she will be allowed to return to activity and play. If during the course of the progressive steps any signs or symptoms reoccur, the student-athlete must return to the previous step until the signs and symptoms no longer occur.

Step 1: Light aerobic exercise without resistance training (e.g. exercise bike). HR 100-140/RPE 3-4

Step 2: Sport specific activity without head impact (e.g. strength training and sport specific agility drills). HR 120-160/RPE 4-6

Step 3: Non-contact practice or equivalent with progressive resistance training. HR 140-180/RPE 6-8

Step 4: Unrestricted training including contact drills. HR 160-200/RPE 8-10

Step 5: Return to game/competition activity.  If symptoms return with activity, the progression should be halted and restarted at the preceding symptom-free step.  RPE: Rate of Perceived Exertion=subjective measurement of exercise intensity on a 0-10 scale.

RETURN TO LEARN GUIDELINES  Following a diagnosis of concussion cognitive rest will be immediately prescribed. No classroom activity on the same day as a concussion injury.  In consultation with the athletic training services/sports medicine staff, the athletic department academic services staff member assigned to the student-athlete’s sport will be considered the point-person(s) to assist the student-athlete in navigating the return to academic and team cognitive activities. This academic services staff member will assist with modification of schedule and academic accommodations as appropriate.  The gradual return to cognitive (classroom/studying) activity is based on the return of concussion symptoms following cognitive exposure and involves a step-wise increase in cognitive demand: a. If the student-athlete cannot tolerate light cognitive activity, he/she should remain at home/dorm. b. Gradual return to classroom/studying as tolerated.  Student-athletes with concussion symptoms lasting greater than two weeks should be reevaluated by a team physician as appropriate.  Student-athletes with symptoms that worsen with academic challenges should be re-evaluated by a team physician.  For complex cases of prolonged return-to-learn, the level of academic adjustment needed will be decided by a multi-disciplinary team that may include, but is not limited to: the team physician, staff team athletic trainer, team neurologist, faculty athletics representatives, academic services staff, course instructors, administrators, disability services, coaches, etc.  A student-athlete with persistent or prolonged concussion symptoms whose academic challenges cannot be managed through schedule modification/academic accommodations will be referred to the Office of Disability Services on campus for consideration of additional academic accommodations consistent with the ADAAA.

DOCUMENTATION OF CONCUSSION MANAGEMENT

 Team physicians will document their clinical care for each concussion in the student athlete’s patient record/file.  The team staff athletic trainer(s) will document their clinical care and details about return to play progression for each concussion in the student athlete’s SportsWare electronic medical record/file.

REDUCING EXPOSURE TO HEAD TRAUMA

The University of Northern Iowa is committed to creating a culture of reducing exposure to head trauma. The following principles will be adhered to:  The University of Northern Iowa will take a “safety first” approach to all of our sports.  The University of Northern Iowa will provide education to coaches and student-athletes regarding safe play, proper technique and taking the head out of contact.  The University of Northern Iowa will adhere to the NCAA Inter-Association Consensus: Year- Round Football Practice Contact Guidelines.  The University of Northern Iowa will adhere to the NCAA Inter-Association Consensus: Independent Medical Care Guidelines.  The University of Northern Iowa will aim to reduce gratuitous contact during practices in all sports.

KEY LITERATURE REVIEWED: NCAA Sports Medicine Handbook, Guideline 2 I Sport-Related Concussion. July 2014. NCAA Concussion: Return-to-Learn Guidelines: http://www.ncaa.org/health-and-safety/medicalconditions/concussion-return- learn-guidelines National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. Journal of Athletic Training, 2014; 49(2): 245-265. Inter-Association Guidelines from the NCAA and College Athletic Trainers’ Society. Concussion Guidelines: Diagnosis and Management of Sport-Related Concussion Guidelines. Available at: http://www.ncaa.org/healthand-safety/concussion- guidelines. Accessed July 8, 2014. Consensus statement on Concussion in Sport-4th International Conference on Concussion in Sport held in Zurich, 2012. BR J Sports Med 2013; 47: 250-258. American Medical Society for Sports Medicine Position Statement: Concussion in Sport. Clin J Sport Med 2013; 23(1): 1-18.

UNI POST-CONCUSSION RETURN TO LEARN PROTOCOL

STEPS PROGRESSION DESCRIPTION

1.) HOME- No mental exertion- Total Rest (first 24 hours) No Computer, Texting, Video Games or Homework. Stay at home. No Driving. 2.) HOME- Up to 30 minutes mental exertion. Light Mental Activity No prolonged concentration. Stay at home. No Driving.

Progress to the next level when able to handle up to 30 minutes mental exertion without worsening of symptoms. RETURN TO ACADEMICS PART TIME- 3.) (30 minutes per class) Provide quiet place for scheduled Maximum Accommodations mental rest. Shortened Classes/Schedule No significant testing. Built-in Breaks Modify academics. Provide extra time and extra help. Progress to the next level when able to handle up to 45 minutes mental exertion without worsening of symptoms. 4.) RETURN TO ACADEMICS PART TIME- Modified classroom testing. (45 minutes per class) Moderate Accommodations Moderate decrease of extra time, help, and modification of assignments.

Progress to the next level when able to handle 60 minutes mental exertion without worsening of symptoms. At this point student-athlete may be considered for Exertional Testing Protocol. 5.) RETURN TO ACADEMICS FULL TIME- Attends all courses. Minimal to No Accommodations Routine testing to be resumed. Continue decrease of extra time, help, and modification of assignments.

It is important to note: Progression is individual, all concussions are different. The student-athlete may start at any step as symptoms dictate and remain at that step as long as needed. Return to previous step if symptoms worsen. 42

XXXVII. TURF BURN PROTOCOL:

Due to the increased numbers of MRSA infections nationally and within our program an aggressive and comprehensive Turf Burn Protocol has been established.

Definitions:

First Degree Turf Burn-  Epidermis has been damaged;

Second Degree Turf Burn-  Epidermis and dermis have been damaged;  Consider the use of prescription Silvadene Cream or similar antibiotic cream;

Third Degree Turf Burn-  Epidermis, dermis, and subcutaneous tissue have been damaged;  Refer to physician for sterile debridement and antibiotics (oral and topical)

Signs of Infection: S welling H eat A ching / pain R edness / red streaks P us

The policy of the University of Northern Iowa Athletic Training Services Department with regards to the care and treatment of turn burn abrasion injuries shall be:

General Procedures (On-the-Field)--

 Adhere to Universal Precautions and OSHA engineering and work practice controls;  Stop the bleeding via direct pressure with sterile gauze;  Clean the wound and surrounding area by using saline, water, and/or hydrogen peroxide;  Begin at the center of the wound and move outward;  Never retrace the area;  If using hydrogen peroxide, rinse the wound with saline / water following the application of hydrogen peroxide;  Cover the wound with an appropriate sized sterile gauze pad, telfa pad, and/or adhesive bandage. Secure the bandage with elastic tape if needed.  Dispose of all soiled materials & gloves in a RED BIOHAZARD BAG.  Hands should be washed immediately after treating the wound and removing the gloves.  Blood stained towels, uniforms, and other linens should not be placed in the dirty laundry basket. Instead, place the blood-soiled linens in a red bag and take them specifically to the equipment personnel for special laundering.

 Current NCAA policy mandates that participants with active bleeding be removed from activity as soon as is practical. Any participant whose uniform is saturated with blood, regardless of the source, must have that uniform evaluated by appropriate medical personnel for infection potential and changed if necessary before return to competition. Furthermore, any open wound must be covered with a dressing sturdy enough to withstand the activity demands of the student-athlete before he/she may continue participation in a practice or competition.

General Procedures (Athletic Training Room)-

 Ensure that the athlete has taken a shower and cleansed the wound with soap and water before reporting to the training room for care;  Adhere to Universal Precautions and OSHA engineering and work practice controls; 43

 Stop the bleeding via direct pressure with sterile gauze;  Clean the wound and surrounding area by using saline, water, and/or hydrogen peroxide;  Begin at the center of the wound and move outward;  Never retrace the area;  If using hydrogen peroxide, rinse the wound with saline / water following the application of hydrogen peroxide;  Evaluate the wound to determine the severity of the turf burn;  Assess whether or not the athlete has any allergies and/or has ever had any adverse reactions to antibiotic ointments;  If no allergies / adverse reactions are present, apply antibiotic ointment (i.e. triple antibiotic, bacitracin, Neosporin, etc.) to the wound using cotton tipped applicator and/or a tongue depressor. Do not re-use the cotton tipped applicator to get more antibiotic ointment.  Clean the surfaces and areas touched by the athlete with a disinfectant and towel.

Acute Turf Burns (1-3 Days)-  Cover the wound with an appropriate sized sterile gauze pad, telfa pad, and/or adhesive bandage.  Secure the bandage with elastic tape if needed.  Advise the athlete on how to care for the wound and to watch for signs of infection;  Give the athlete additional bandages and 1-2 foil packets of antibiotic ointment for dressing the wound at home;  Advise the athlete to periodically clean the wound and re-dress the wound;  Advise the athlete to keep the wound covered at all times;  Advise the athlete to return to the athletic training room everyday before and after practice for re-evaluation and re-dressing of the wound;  If signs of infection are present, refer the athlete to appropriate medical personnel for evaluation and treatment.

Subacute – Chronic Turf Burns (> 3 days)-  Advise the athlete to cover the wound only if he/she will be have clothing over the wound, will be participating in an athletic activity, and/or at night before going to bed;  Advise the athlete on how to care for the wound and to watch for signs of infection;  Give the athlete additional bandages and 1-2 foil packets of antibiotic ointment for dressing the wound at home;  Advise the athlete to return to the athletic training room everyday before and after practice for re-evaluation and re-dressing of the wound;  If signs of infection are present, refer the athlete to appropriate medical personnel for evaluation and treatment.

Reminders:  Dispose of all soiled materials in a RED BAG.  Hands should be washed immediately after treating the wound and removing the gloves.  Blood stained towels, uniforms, and other linens should not be placed in the dirty laundry basket. Instead, place the blood-soiled linens in a red bag and take them specifically to the equipment personnel for special laundering.  Use disinfectant on all possible contaminated areas.

XXXVIII. STAPH INFECTION / MRSA INFECTION POLICY

BACKGROUND

Outbreaks of skin infections caused by antibiotic-resistant bacteria have been increasingly reported in sports teams. This policy is provided to assist in the control and prevention of these infections. The athletic department, coach, athletic trainers, physical plant building services and athletes share responsibility and must work together to ensure prevention and control of these skin infections.

Staphylococcus aureus Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Approximately 25% to 30% of the population is colonized (when bacteria are present, but not causing an infection) in the nose with staph bacteria. It can also be carried in the armpit, groin, or genital area. Staph bacteria are one of the most common causes of skin infections in the United States. Most of these skin infections are minor (such as pimples and boils) and can be treated without antibiotics. However, staph also can cause serious infections such as pneumonia, bloodstream infections, and joint infections. Most infections occur through direct physical contact of the staphylococci with a break in the skin (cut or scrape). The staph can be spread by the infected person to someone else or to an object. Inanimate objects, such as clothing, bed linens, sports equipment, personal items (soap or wash cloths) or furniture, may be a source of infection if they become soiled with wound drainage and a non-infected person comes into contact with them. If there is no break in the skin, contact with infected persons or contaminated objects may result in colonization. Susceptibility to infection depends on factors such as immunity and general state of health. In the past, these staph infections typically have been easy to treat with an inexpensive, short course, usually well-tolerated antibiotics. Now in most communities in the U.S., over half of the staph causing skin infections are resistant to commonly used antibiotics.

Methicillin-resistant Staphylococcus aureus (MRSA) MRSA is Staphylococcus aureus that is resistant to the penicillin, including dicloxacillin or other methicillin-related antibiotics. These bacteria are also resistant to the cephalosporins, such as Keflex ®. Originally MRSA was confined to hospitals and long-term care facilities; talking antibiotics was a risk factor for infection with MRSA. Many of these hospital-associated MRSA infections caused very serious complications and were resistant to all oral antibiotics. More recently a newer, more virulent strain of MRSA has emerged in the community that causes boils, abscesses, and other soft tissue infections that is not linked to previous antibiotic use. It is called community-associated MRSA. The frequency of infections with community associated MRSA appears to be higher than those caused by staph in the past, particularly in athletic teams. The reasons for this increase are not known, but it is clear that the community associated MRSA strains did not originate with from the strains of MRSA that cause infections in hospitals and other healthcare facilities.

I. PREVENTION AND MANAGEMENT OF STAPH & CAMRSA INFECTIONS a. Surveillance (Monitoring and Recording Infections) Community-associated MRSA is easily spread from person to person, either through direct contact or through contact with surfaces contaminated with the bacteria. A single infected athlete can quickly become the source of an outbreak that can affect the entire team. Therefore it is essential that athletic trainers and coaches know about every skin infection as soon as it occurs, and that every athlete know to be evaluated at the first sign of a possible infection.

Each team’s athletic trainer will evaluate all skin infections and maintain a record of such infections. At the beginning of each athletic season, all team members should be told that they must report all possible skin infections, such as a red bump that is larger than a pimple, to the team’s athletic trainer. The team athletic trainer will make a determination if the student athlete will be excluded from specific activities, and when excluded student athletes can return to those activities. The athletic trainer will maintain a record of these reports

b. Hygiene HAND WASHING IS THE SINGLE MOST IMPORTANT BEHAVIOR IN PREVENTING THE SPREAD OF INFECTIOUS DISEASE. AN INDIVIDUALS HANDS MUST BE CLEAN BEFORE THEY TOUCH THEIR EYES, MOUTH, NOSE, OR ANY CUTS OR SCRAPES ON THE SKIN.

1. Hand washing a. Use warm water. b. Wet hands and wrists. c. Use a bar or liquid soap. Antimicrobial soap is not necessary to disinfect against MRSA. d. Work soap into a lather and wash palms, back of hands up to wrists, between fingers, around thumbs, and under fingernails for at least 15 seconds. e. Dry hands, using a disposable paper towel or hand-dryer.

f. Provide and encourage the use of alcohol-based hand sanitizers to wash hands in places where hand-washing facilities are not available or to wash hands immediately if personnel or athletes come in contact with any body fluid on the playing field.

All staff and student-athletes should wash their hands as described above: • After sneezing, blowing or touching the nose; • After using the toilet; • Before and after practice, games, working out, or whenever there is bare skin contact with others or with shared surfaces or equipment.

2. Personal Hygiene a. Shower with soap and water as soon as possible after direct contact sports. b. Dry using a clean, dry towel. c. Do not share towels, soap, or other personal care items.

3. Equipment Room (Laundry) a. When handling dirty laundry or clothing, it should be held away from the body to keep the handler from contaminating their clothing. b. Prewash or rinse items that have been grossly contaminated with body fluids c. Wash towels, uniforms, scrimmage shirts, and any other laundry in hot water (>160°F for at least 25 minutes) and ordinary detergent and dry on the hottest cycle the fabric will tolerate. Items that can be bleached should be bleached. Alternatively, shared linens may be washed at a lower temperature if an oxygenated detergent is used. d. Dry linens with a mechanical dryer. e. Distribute towels, uniforms, etc. only when they are completely dry. f. Student-athletes should follow these precautions if laundry is taken home (laundry must be in an impervious container or plastic bag for transporting home).

4. Cleaning of Athletic Facilities and Equipment a. Disinfect frequently touched areas on shared equipment and in the athletic area daily using a commercial Environmental Protection Agency (EPA)- registered detergent disinfectant with a label claim for Staphylococcus aureus, or a fresh (mixed daily) solution of one part bleach and 100 parts water (1 tablespoon bleach in one quart of water). For disinfection to occur, the surface must be clean, and there must be 10 minutes wet contact time. b. Equipment that comes into contact with bare skin such as athletic training tables should be thoroughly cleaned between each use. Consider making spray bottles of disinfectant active against Staphylococcus aureus available for use; provide instructions for safe use. Alternately, containers of disinfectant wipes may be used. c. Repair or dispose of equipment and furniture with damaged surfaces that cannot be adequately cleaned. d. Student-athletes with open wounds, whether covered or not, should not use athletic training therapeutic pools or whirlpools, and should be discouraged from using private hot tubs. If they use a whirlpool or tub, the equipment must be cleaned and disinfected immediately after use following manufacturer’s recommendations for disinfection.

II. INFECTION OUTBREAK REPORTING ROLES If an athlete develops a staph infection during the course of a season, the possibility of an outbreak should be considered and must be immediately reported by the staff athletic trainer to the Director of Athletic Training Services/Head Athletic Trainer who will report the outbreak to the following: a. Department of Intercollegiate Athletics Administration; b. Physical Plant Building Services Department for increased cleaning measures; c. Equipment room.

If there are more than two (2) student-athletes infected additional measures should be considered, including cultures of uninfected athletes to detect those carrying the bacteria without illness (colonized), and eradication of MRSA colonization (decolonization). Culturing should only be done in consultation with the local and State health departments.

III. TREATMENT/CARE & RETURN TO PLAY RECOMMENDATIONS Consider a wound infectious if there is any purulent drainage (pus) from the wound, especially if accompanied by fever, redness or tenderness around the wound or if the person is receiving treatment for a wound that had pus drainage. Once the wound has no drainage, and the treating clinician and/or a representative from the athletic training staff clears the athlete, the person can be considered non- infectious. Additional information is available for physicians (see last page).

A. INITIAL PRECAUTIONS: 1. Treat any draining wound as a potential MRSA infection. 2. Remove the infected student-athlete from direct physical contact with other students. 3. The student-athlete with an active infection, as indicated above, must be evaluated by a physician or other advanced practice clinician (Nurse Practitioner or Physicians’ Assistant). 4. Inform the clinician of the possibility of MRSA. 5. Treat uncultured wounds as MRSA. 6. Wounds that contain significant amounts of pus and which are not yet draining should be evaluated by a clinician to see if medical drainage of the pus is indicated. (Significant amount of pus can render antibiotics ineffective at the wound site.)

B. PARTICIPATION / RETURN TO PLAY: An athlete who has a draining wound and is in a sport where there is regular physical contact with others should be evaluated by a physician or qualified health provider for participation in that sport. Considerations for continuing participation in the sport while the wound is still leaking fluid would include: 1. Ability to completely contain the drainage with a clean, dry bandage; 2. Stability of equipment/padding that covers the wound; 3. Amount of drainage; 4. Location of the draining wound; and/or 5. The nature of the contact. Frequent pressure on a bandaged wound (for example, against a piece of athletic equipment) may both delay healing and contaminate the point of contact.

C. TREATMENT: 1. The physician should perform a culture and susceptibility test to determine what bacteria the athlete has and what antibiotic will be the most effective with the fewest side effects. If the physician determines that the athlete does not have a bacterial infection, the athlete will not receive an antibiotic as antibiotics are not effective for nonbacterial infections. Also many of the community-associated MRSA infections, while caused by bacteria, may not require antibiotics for treatment: good wound care could be sufficient to clear the infection. 2. If an antibiotic is prescribed, it is essential that the student-athlete take all medication even after the infection seems to have healed. Student -athletes may participate in sports even while on antibiotics. If a topical ointment is prescribed, it should be applied as directed. Note that student-athletes should be educated that ointments or antibiotics must not be shared. 3. The athlete should follow all other directions as instructed by the responsible clinician. The clinician must be informed if the athlete does not respond to treatment, and consideration be given to not clearing the non-compliant athlete.

D. HOME WOUND CARE FOR THE STUDENT-ATHLETE: 1. The wound must remain covered. The dressing must be changed at least twice a day or more frequently if drainage is apparent or as directed by the clinician. Consider using clean, disposable, nonsterile gloves to change bandages. 2. The athlete must wash hands frequently, especially before and after changing band aids, bandages, or wound dressings.

3. Isopropyl alcohol and friction should be used to disinfect reusable materials, such as scissors or tweezers. 4. Reusable equipment that come in contact with the wound must be disinfected with a fresh (daily) mix of one tablespoon of household bleach to one quart of water or a phenol- containing product . Contact time of the item in the disinfectant solution should be limited to manufacturer’s recommendations so as to not corrode the reusable item. A phenol- containing spray can also be used to disinfect any cloth or upholstered surface. 5. Place disposable items that have come in contact with the infected site, including soiled dressings, in a separate trash bag and close the bag before placing in the common garbage or household trash.

E. PREVENTION OF SPREAD TO OTHERS 1. Anyone with close contact with the infected student-athlete should wash their hands frequently with soap and warm water, especially if they change the athlete’s bandages or touch the infected area or anything that might have come in contact with the infected area. 2. Laundry should be carried away from the body in a plastic or other lined bag that will not allow wet articles to drain through. 3. All clothing, towels, linens that come in contact with the wound should be handled separately from those of other members of the household. This includes using a separate hamper or laundry bag. 4. Articles that come in contact with the wound should be washed in the hottest water the fabric will tolerate with the usual detergent. 5. Clothing should be dried thoroughly using the hottest setting the fabric will tolerate. 6. Change towels and linens daily if possible. 7. The athlete should be instructed to not share personal items (e.g., towels, washcloths, razors, clothing, or uniforms) or other items that may have been contaminated by wound drainage with family members or housemates. 8. Utensils and dishes do not require special handling. They should be washed in the usual manner with soap and hot tap water or using a standard home dishwasher.

F. WOUND CARE IN THE UNI ATHLEITC TRAINING FACILITIES: 1. Instruct the athlete to carry and use an alcohol-based hand sanitizer when soap and water are not available. 2. Clean and disinfect sports equipment or any part of the athletic area that comes in contact with the wound with commercial disinfectant or fresh solution of diluted bleach before any other athlete comes in contact with the equipment or area. 3. Athletic trainers or others who care for the wound should use clean non-sterile gloves. 4. Put on clean gloves just before touching broken skin. 5. Remove gloves promptly after use and discard. 6. Wash hands immediately after contact with the wound even if gloves were worn. 7. Wash hands between tasks and procedures on the same athlete to prevent cross contamination of different body sites. 8. Place disposable items that have come in contact with the infected site in a Red Biohazard bag for proper disposal. 9. Do not give other team members prophylactic antibiotics.

XXXIX. SICKLE CELL TRAIT (SCT) POLICY:

Sickle Cell trait is a rare condition that affects the type of hemoglobin found within the red blood cell. Hemoglobin is responsible for carrying oxygen within the red blood cell. During normal daily activities, those affected by sickle cell trait show no symptoms and have no adverse health issues related to the abnormal hemoglobin. However, when stressed physically under extreme conditions (extreme heat, high level exertion in the presence of an active illness, exertion at altitude, or exertion at intensity levels greater than normally experienced by the student-athlete), the individual may begin to manifest symptoms of the disorder. Symptoms can include severe muscle cramps, dizziness, nausea, and extreme shortness of breath. If not recognized and treated relatively early, it may progress to multi organ damage and possibly sudden death. Although rare, sudden death among athletes has occurred and been linked to carrying the trait. For a variety of reasons, the condition seems to affect those aged 18-24 years of age at 48 greater degrees than younger individuals. Although sickle cell trait is most prominent in African- Americans, and those of Mediterranean, Middle Eastern, Indian, Caribbean, and South and Central American ancestry, persons of all races and ancestry may test positive for sickle cell trait.

Policy

The NCAA mandates that all student-athletes must be tested for sickle cell trait, show proof of a prior test or sign a waiver releasing the Institution of liability if they decline to be tested. In accordance with this legislation the University of Northern Iowa Sports Medicine / Athletic Training Services is mandating that all student-athletes must be tested for sickle cell trait, show proof of a prior test or sign a waiver releasing the State of Iowa, the University of Northern Iowa, its officers, employees and agents from any and all costs, liability, expense claims, demands or causes of action on account of any loss or personal injury that might result from my non-compliance with the mandate of the NCAA and the University of Northern Iowa Sports Medicine / Athletic Training Services and Intercollegiate Athletics.

If identified as carrying the abnormal hemoglobin, you can continue to participate in your respective sport without significant restrictions. Care would be taken and restrictions imposed only if you had an active febrile infection or one that affected your respiratory system, if you were training at altitude, or in extreme weather conditions (especially heat). Ensuring adequate hydration during practice and competition, and training at reasonable exertion levels is another important factor in preventing adverse health issues.

Infants born after 1984 were tested for the sickle cell trait and therefore the documentation should be available from your family pediatrician. The screening test can be performed at the University of Northern Iowa Human Performance Center medical facilities and the University of Northern Iowa Student Health Center for a fee or with your family physician. If the initial screening test does come back positive for sickle cell, a follow up test can be performed to determine if you have Sickle Cell Disease vs. Sickle Cell Trait. Educational sessions around the topic of sickle cell and the precautions that need to be undertaken due to the serious nature of the condition will be required for all those individuals who are sickle cell trait positive.

See Appendix I: UNI Sickle Cell Disclosure Form and UNI Sickle Cell Waiver Form

For athletes who carry the sickle cell trait the following simple steps will be taken:

1. The athlete will watch the NCAA educational video about sickle cell trait and athletic participation. 2. The athlete will meet with a team physician to answer any questions and to make sure the athlete understands the issue and the steps he/she needs to take to make remain safe while participating (staying hydrated, recognize early symptoms of heat illness/sickle cell crisis, and report them to sports medicine staff and coaches immediately). 3. Sport and strength/conditioning coaches will be notified of athlete's trait status to ensure that the athlete is allowed access to fluids as needed, is not forced to participate in timed physical tests before becoming acclimated to heat and exertion at the beginning of a season, and any complaints of exhaustion are taken seriously and activity stopped until evaluation by sports medicine staff is completed. 4. Sports medicine / athletic training staff present at official practices and workouts will monitor the athlete's status closely and encourage adequate hydration. The sports medicine / athletic training staff will also monitor environmental conditions and possibly limit or halt exercise if risk is determined to be high.

Note: The vast majority of the time if the student-athlete is allowed to self regulate when they start to struggle they will recover on their own and be ready for the next day’s activities. The majority of the deaths associated with sickle cell trait have occurred when the student-athlete was brow-beaten or cursed, or even allowed, to finish when they obviously struggling, pushing them into the abyss.

XL. EXERTIONAL RHABDOMYOLYSIS (ER) POLICY:

BACKGROUND INFORMATION ON ER

Skeletal muscle breakdown occurs normally with exercise, followed by muscle repair and physiologic adaptation. Strenuous, unaccustomed, prolonged, and repetitive exercise, particularly when associated with other risk factors such as hot and humid climate or sickle cell trait can cause clinically significant exertional rhabdomyolysis (ER). Although most cases are asymptomatic and resolve without sequelae, ER is the most common cause of exercise-related myoglobinuric acute renal injury and acute renal failure in athletes. Exercise-related muscle pain, elevated serum creatine kinase (CK), and "cola-colored" urine have been described as a classic presentation of ER. The exact mechanism of ER has not been clearly elucidated. Most studies suggest a cascade of events that include depletion of adenosine triphosphate (ATP), impaired function of the Na+- K+ ATPase system, intracellular excess calcium accumulation, sarcolemma damage, and release of intracellular proteins and other substances into blood. Excess myoglobin that is filtered at the glomerulus can lead to myoglobinuric acute renal injury. The many causes of rhabdomyolysis can be categorized as: 1) trauma; 2) muscle hypoxia; 3) genetic defects; 4) infections; 5) body temperature changes; 6) metabolic or electrolyte disturbances; 7) drugs or toxins; and 8) exercise.

RECOGNITION OF ER

ER occurs in the setting of strenuous exercise and can range from mild to severe. Clinical signs are often nonspecific: muscle pain, soreness, stiffness, and, in severe cases, weakness, loss of mobility, and swollen, tender muscles. Severe ER is far more problematic than the milder form known as delayed onset muscle soreness (DOMS), in which the muscles become sore and stiff in the first few days after a bout of unaccustomed, moderately strenuous exercise. DOMS is rarely a clinical problem and tends to be self-limited with only relative rest or a cutback in level of training. An even milder form of ER is the physiologic breakdown of muscle that commonly occurs while athletes train. This physiological muscle adaptation to exercise overload has few or no symptoms, or only mild muscle symptoms that are generally ignored by the athlete, and so is manifest only by an elevation in CK – a condition sometimes calls hyperCKemia.

Unlike hyperCKemia or DOMS, severe ER is a major health concern for any athlete. Signs and symptoms of ER during an intense exercise session can be very subtle. Coaches and athletic training/sports medicine staff should watch for clues during exercise sessions. The following ten (10) factors that can increase the risk of ER should be carefully considered by coaches and athletic training/sports medicine personnel:

1. Athletes who try the hardest. Those who give it their all to meet the demands of the coach (externally driven) or are considered the hardest workers (internally driven) are at greater risk.

2. Workouts not part of a periodized, progressive performance development program (e.g., workouts not part of the annual plan).

3. Novel workouts or exercises immediately following a transitional period (winter/spring break).

4. Irrationally intense workouts intended to punish or intimidate a team for perceived underperformance, or to foster discipline and “toughness.”

5. Performing exercise to muscle failure during the eccentric phase, such as repetitive squats, and then pushing the athlete beyond his or her capacity.

6. Focusing an intense drill or exercise on one muscle group with progressive overload within the same workout and fast repetitions to failure.

7. Increasing the number of exercise sets and reducing the time needed to finish. (e.g. 100 squats).

8. Increasing the amount of weight lifted solely as a percentage of body weight without respect to the athlete’s conditioning status or level of fatigue.

9. Trying to “condition” athletes into shape in a day or over several days, especially with novel exercises or loads.

10. Conducting an unduly intense ad hoc workout after a game loss and/or perceived poor practice effort.

RISK FACTORS FOR ER

Exertional rhabdomyolysis in an athlete is commonly linked to three conditions:

 Novel overexertion.

 Exertional heatstroke.

 Exertional collapse with complications in athletes with sickle cell trait.

Novel overexertion is by far the most common cause of ER; with early diagnosis and proper therapy, this condition is benign. During exercise, athletes, athletic training/sports medicine staff members and coaches can monitor distress by watching an athlete’s posture. Figure 1 depicts green, yellow and red situations which correspond to a series of postures showing an athlete moving into a distressful condition.

Recovery during serial sets is important for proper fitness development. Athletes who are showing signs of physical distress should be allowed to set their own pace while conditioning as depicted by the position in yellow. Taking a knee during a workout can be the universal sign for the need for additional recovery. Athletes that are allowed an active rest period while experiencing distressful symptoms may soon feel

51 better and may continue. If symptoms do not resolve, reoccur or progress, the athlete should discontinue exercise and be assessed by a healthcare provider.

Athletes unable to stand on their own from a kneeling position or who have trouble walking normally under their own control during recovery may be in considerable physical distress and additional medical intervention should be considered. Athletes depicted in red should not be pushed to continue. Provided with enough recovery, they may be able to complete the workout at their own pace.

It is vital that all coaches, strength and conditioning personnel and athletic trainer/sports medicine staff members avoid exposing athletes to risk factors for ER, while also recognizing any early signs or symptoms of ER and then activating their emergency action plan.

Cessation of physical activity, relative rest during clinical recovery, and early aggressive fluid replacement are mainstays of treatment. Return to play after recovery from ER is influenced by associated risk factors that may predispose the athlete to recurrence and is guided by signs, symptoms, and CK levels.

TIPS FOR PREVENTION AND EARLY RECOGNITION OF ER FROM NOVEL OVEREXERTION

Moderation. Avoid too much, too soon, too fast

Sport performance team. The design of a workout should reflect a collaborative effort between the strength and conditioning coach, sport coach and athletic training/sports medicine staff. However, athlete safety assumes the individual conducting the exercise session takes reasonable actions to allow recovery and prevent exertional collapse.

Set the right tone. Workouts are to enhance performance, not to punish or intimidate. Never use exercise as a form of punishment, and never push an athlete to exercise more if he or she is showing signs of physical distress. Athletes should feel free to report any symptom at any time and obtain immediate help. The athletic training/sports medicine staff has the authorization to step in to provide care for an athlete in distress at any time, without retribution.

Monitor hydration. Assess Your Hydration Status information sheets should be displayed in the locker rooms, athletic training rooms and near urinals and restroom stalls. Athletes should report dark urine immediately.

Team effort. If one athlete on a team develops early signs or symptoms of possible ER, evaluate all members of the team who participated in the exercise session for ER.

Emergency action plan. Design, file and practice an emergency action plan (EAP) for exertional heatstroke (EHS) and for exertional sickling in sickle cell trait (SCT). Coaches should be ready to intervene when athletes show signs of distress. Minutes count in these life-threatening emergencies (See the NCAA Sports Medicine Handbook). If an athlete is suspected of developing ER from novel overexertion (absent EHS or SCT), the EAP should be activated, and the team physician should be promptly notified.

XLI. EXERTIONAL HEAT ILLNESSES MANAGEMENT & FLUID REPLACEMENT/REHYDRATION PROTOCOL:

INTRODUCTION:

The following policy on fluid replacement, rehydration, and exertional heat illnesses has been developed in accordance with the NATA Fluid Replacement Position Statement, the NATA Exertional Heat Illnesses Position Statement, and the University of Northern Iowa Athletic Training Services/Sports Medicine Mission Statement to provide quality healthcare services and assure the well-being of each student- athlete at UNI.

DEFINITION OF EXERTIONAL HEAT ILLNESS:

Exertional Heat illness if closely associated with physical activity and its occurrence increases with a rise in temperature and relative humidity. It is usually classified in three categories: heat cramps, heat exhaustion, and heat stroke. Although most often occurring in hot, humid weather, heat illness can also occur with the absence of both heat and/or humidity.

Exercise-Associated Muscle (Heat) Cramps:  Occurs during or after intense exercise as an acute, painful, and involuntary muscle contraction  Causes may include dehydration, electrolyte imbalances, neuromuscular fatigue, or a combination of factors.  Signs and Symptoms: dehydration, thirst, sweating, transient muscle cramps, fatigue.

Exercise (Heat) Exhaustion:  Occurs most frequently in hot, humid conditions and causes an inability to continue exercise.  May be caused by dehydration, heavy sweating, sodium loss, and energy depletion.  Signs and Symptoms: pallor, persistent muscle cramps, urge to defecate, weakness, fainting, nausea, decreased urine-output, cool and clammy skin, anorexia, diarrhea, body temp between 97-104°F.

Exertional Heat Stroke:  Occurs when core temperature is elevated (usually greater than 104°F) with associated signs of organ system failure due to hyperthermia and physical activity.  Caused by an overwhelmed temperature regulation system due to excessive endogenous heat production or inhibited heat loss due to environmental conditions.  Signs and Symptoms: tachycardia, hypotension, sweating (although skin may be wet or dry), hyperventilation, altered mental status, vomiting, diarrhea, seizures, coma, CNS changes  Life-threatening condition that can be fatal unless promptly recognized and treated.

PREVENTION OF HEAT ILLNESS GUIDELINES:

 All pre-participation examinations will identify student-athletes who may be predisposed to heat illness or have a history of heat illness.

 The Athletic Training Services/Sports Medicine Staff will be onsite at practices and competitions to assist in providing hydration and access to further cooling supplies. Along with graduate assistant athletic trainers and athletic training students, the staff will be aware of the signs and symptoms of heat illness to properly recognize and intervene on behalf of the student-athlete.

 The certified athletic trainer will also help educate athletes and coaches regarding the necessary time needed to have student-athletes adapt to their environment. Acclimatization should be a 53

gradual progression. Well-acclimatized athletes should be able to train 1 to 2 hours under the same heat conditions that will be present for their event.

 In addition, the certified athletic trainer should know how to use a wet-bulb globe temperature (WBGT) and/or a sling psychrometer, decipher the corresponding temperature graphs for these instruments, and base the level of physical activity upon the gathered information. This will be used as one of the factors in determining any risk of heat illness associated with relevant environmental conditions.

5 PILARS OF EXERTIONAL HEAT STROKE PREVENTION

The 5 Pillars of Exertional Heat Stroke Prevention will be followed:

 Hydration  Body Cooling  Work to Rest Ratios  Acclimatization  Education

TREATMENT OF HEAT ILLNESS:

The Athletic Training Services/Sports Medicine Staff will treat heat illness by recognizing its signs and symptoms, understanding the causes of heat illness, and taking the necessary measures to ensure an efficient and safe recovery for the student-athlete.

Exercise-Associated Muscle (Heat) Cramps:  The student-athlete should stop activity, replace lost fluids (containing sodium), and begin mild stretching and massage of the muscle spasm.  Instruct the student-athlete to lie down, as this may allow blood flow to be distributed more rapidly to cramping leg muscles.

Exercise (Heat) Exhaustion:  Assess cognitive function and vital signs, taking body-core temperature if possible.  Transport the athletes to a cool and/or shaded environment, remove excess clothing, start fluid replacement, and cool the student-athlete with fans, ice towels, or ice bags (placed in armpits, neck, and groin).  The student-athlete should be referred to the team physician and/or the emergency room of the closest hospital if in the judgment of the attending certified athletic trainer symptoms warrant further immediate attention.

Exertional Heat Stroke:  Activate the emergency medical system.  Assess cognitive function and vital signs, measuring rectal temperature if feasible to differentiate between heat exhaustion and heat stroke (heat stroke is 104°F or higher).  Lower the body-core temperature as quickly as possible by removing excess clothing and immersing the body into a tub of cool water (35 - 59°F) while checking temperature every 5 to 10 minutes. Remove athlete from water if temperature reaches 101 to 102°F to prevent overcooling.  A rectal temperature is the only viable field option to assess body temperature in an exercising individual. Aural, oral, tympanic, axillary and forehead measurements have all been shown to not to be effective for measuring body temperature in exercising individuals.  Continue using cooling methods mentioned for heat exhaustion while transporting to decrease body-core temperature.  Maintain and monitor airway for breathing and circulation.

RECOVERY OF HEAT ILLNESS:

Athletes who experience a heat stroke may have impaired thermoregulation, persistent CNS dysfunction, and hepatic or renal insufficiency following recovery. Decreased heat tolerance has been shown to affect 15% to 20% of athletes experiencing a heat stroke-related collapse. Following recovery, the student- athlete’s activity should be restricted with a gradual return regulated by the Team Physician.

EMERGENCY PREPAREDNESS:

The UNI Intercollegiate Athletics Department and the UNI Sports Medicine/Athletic Training Services will have available for use the following supplies on the field, in the locker room, and at various other stations:

 Rectal thermometer;  Lubricating gel;  A supply of cool water or sports drinks or both to meet the needs of student-athletes;  Towels;  Water source;  Ice for active cooling (ice bags, tub cooling) and to keep beverages cool during exercise;  Telephone/Cell Phone or 2-way radio to communicate with medical personnel and to summon emergency medical transportation if necessary;  Tub, wading pool, kiddy pool, or whirlpool to cool the trunk and extremities for immersion cooling therapy.

The University of Northern Iowa UNI Sports Medicine/Athletic Training Services will use the Marine Corps Heat Index Physical Exercise Chart for guidelines in regards to physical activity and/or practices conducted outside:

Heat Index and Physical Exercise Chart WBGT Index (F) Heat Condition Warning System Below 82 Normal Activities, but at least separate rest breaks (involving both unlimited hydration intake, e.g. water or sports drinks, and rest (football helmet removed) in a “cooling zone” out of direct sunlight each hour of minimum duration of 3 minutes each during workout. 82.0 – 86.9 Use discretion for intense or prolonged exercise; watch at-risk players carefully; Provide at least three separate rest breaks each hour of a minimum of 4 minutes duration each [Note: if WBGT reading over 86.0, ice towels and spray bottles filled with ice water should be available at the “cooling zone” and cold immersion tubs must be available for practices for the benefit of any player showing early signs of heat illness]. 87.0 – 89.9 Maximum practice times are two hours. For football: players restricted to helmet, shoulder pads, and shorts during practice. All protective equipment must be removed for conditioning activities. For all sports: Provide at least four separate rest breaks each hour of a minimum of 4 minutes each. 90.0 – 92.0 Maximum practice length is one hour; no protective equipment may be worn during practice and there may be no conditioning activities. There must be 10 minutes of rest breaks provided during the hour of practice. No outdoor workouts; cancel exercise; delay practices until a cooler WGBT Above 92.0 reading occurs.

RETURN-TO-PLAY AFER EXERTIONAL HEAT STROKE

 A student-athlete who survives exertional heat stroke should be fully evaluated by a team physician prior return-to-play.  Prior to return-to-play the individual who suffered exertional heat stroke should demonstrate the ability to tolerate exercise in the heat.  Student-athletes who suffered exertional heat stroke likely had a predisposing factor at the time of their injury. Predisposing factors should be identified and remediated before returning an athlete to activity.  Return-to-play should be gradual and medically monitored throughout. When medically cleared, exercise should begin at a low intensity in a temperate environment. The student- athlete can progress intensity in a temperate environment if no complications persist. The athlete should then perform the same progression of intensity in a hot environment before they are allowed to full return.

RATIONALE OF FLUID REPLACEMENT:

Student-athletes who are exposed to prolonged practices and competitions in an excessively hot and humid environment may be deprived of essential fluids, carbohydrates, and electrolytes that an ultimately lead to dehydration and potential heat illness.

It has been demonstrated that dehydration of just 1-2% of body weight can alter physiological function and negatively influence an athlete’s performance. Athletes who are not properly hydrated prior to the start of practice or competition can begin to notice the signs of dehydration in just one hour or sooner of exercise. Dehydration has been identified as an increased risk factor for athletes developing heat-related illness such as heat cramps, heat exhaustion, and the potentially life-threatening heat stroke.

SIGNS AND SYMPTOMS OF DEHYDRATION:

Staff athletic trainers, graduate assistant athletic trainers, and athletic training students all need to be aware of the signs and symptoms of dehydration to properly recognize and intervene on behalf of the student-athlete.

Signs and Symptoms are:

1. Thirst 7. Nausea 2. Irritability 8. Cramps 3. General discomfort 9. Chills 4. Headache 10. Vomiting 5. Weakness 11. Head or neck heat sensations 6. Dizziness 12. Decreased performance

REHYDRATION GUIDELINES:

The Athletic Training Services/Sports Medicine Staff at the University of Northern Iowa has developed the following rehydration guidelines based on national accepted criteria. The Athletic Training Services/Sports Medicine Staff and UNI athletic training students will assist in promoting the consumption of fluids/beverages. All fluids/beverages will be provided onsite when requested or as deemed necessary.

1. Prior to Exercise:

 All athletes should be encouraged to drink 17 to 20 fluid ounces of water or sports beverage 2-3 hours before exercise; 56

 Ten to twenty minutes before the beginning of practice or competition, athletes should be encouraged to drink an additional 7-10 fluid ounces of water or sports beverage.

2. During Exercise:

 Encourage athletes to drink early and often;  Drink 7-10 fluid ounces or sports drink every 10-20 minutes;  It is important to stress to the athletes to drink prior to becoming thirsty. An athlete who is thirsty may already be in the early stages of dehydration.

3. After Exercise:

 Encourage athletes to replace any fluid loss due to sweating within 2 hours from the end of exercise;  This rehydration should include water, carbohydrates, and electrolytes to allow the immediate return of physiologic function;  Encourage them to drink 20-24 fluid ounces for every pound of weight lost.

**Sport beverages should ideally contain a carbohydrate level of no more than 8%. A higher carbohydrate level can retard fluid absorption and cause stomach problems.

**Fruit juices, carbohydrate gels, and carbonated beverages should not be recommended as the sole rehydration beverage of choice. Beverages containing caffeine, alcohol, or carbonation should be avoided and discouraged due to their diuretic effects and decreased fluid retention.

WEIGHT LOSS/GAIN GUIDELINES:

It is recommended that all athletes exercising in hot and humid environments as well as those sports such as wrestling with closely regulated weight classes be weighed in prior to and after practice or competition. By weighing in, a determination can be made of the percentage body weight lost due to sweating and the amount of rehydration that must occur prior to the next practice session. Furthermore, athletes should be weighed preferably in the nude, in clean/dry undergarments, or wearing the same amount of clothing pre-and post-practice. The percentage of weight lost between practice sessions will be used as one factor to determine if an athlete can safely continue to practice. Athletes should ideally have their pre-exercise body weight remain relatively consistent.

 A 2% body weight difference should be noted by the athletic trainer and that athlete should be closely monitored for any signs or symptoms of dehydration.  An athlete with greater than 2% body weight loss should not be allowed to return to practice until proper fluid replacement has taken place.

INTRAVENOUS (IV) FLUID REPLACEMENT:

In certain instances IV fluids may be administered for athletes experiencing dehydration, severe cramping, shock, or as a prophylactic means of hydration. Need for IV fluids will be determined by the team medical staff including the team physician, team nurse, emergency medical technicians, and athletic trainers. IV administration will be performed by the team physician, team nurse, or paramedics with assistance by the certified athletic trainers and athletic training students. For more details concerning IV Fluid Replacement, refer to the UNI IV Fluid Replacement Policy.

XLII. IV FLUID ADMINISTRATION POLICIES AND PROCEDURES

Policy Purpose Statement: This policy outlines the procedures for administrations of IV fluids and the role of healthcare providers in this process.

Rational for IV Administration: IV fluids may be administered for athletes experiencing dehydration, severe cramping, shock, or as a prophylactic means of hydration. Need for IV fluids will be determined by the team medical staff including the team physician, team nurse, emergency medical technicians, and athletic trainers. IV administration will be performed by the team physician, team nurse, or paramedics with assistance by the certified athletic trainers and athletic training students.

Administration: Once the need for an IV is determined, all necessary supplies will be gathered for the procedure. Necessary supplies include:  1 Bag of IV fluid  1 box of latex gloves  2 Iodine swab sticks  1 box of alcohol prep pads  5 sterile gauze packs (4x4)  2 Band-aids  1 18g. catheter  1 20g. catheter  1 drop set IV tubing  1 IV pressure cuff

Procedures for IV Fluid Replacement: 1. Be sure to don personal protective equipment (per OSHA guidelines); 2. Attempt to perform IV in the most appropriate clinical environment unless a true medical emergency exists; 3. Document patient’s symptoms and vital signs on IV documentation form (consider orthostatic B/P and pulse in patients who may be dehydrated); 4. Select proper fluid; 5. Inform the patient of need for IV; 6. Assemble necessary equipment and supplies; 7. Check fluid for condition and date of expiration; 8. Connect proper drip set to IV bag; 9. Hang fluid for gravity flow and fill chamber properly; 10. Clear line of all air bubbles; 11. Select appropriate site and apply constricting band above site; 12. Prep site using aseptic technique with alcohol and/or betadine; 13. Open venipuncture device and inspect; 14. Advise patient of stick; 15. Apply distal traction to vein; 16. Enter vein at appropriate angle, obtain flashback, lower catheter and advance into vein; 17. Remove needle and place in sharps container; 18. Connect IV tubing to catheter; 19. Release constricting band and turn on fluid flow (may actually precede connecting the IV tubing to catheter in some individual’s sequence); 20. Stabilize IV site; 21. Monitor for infiltration/troubleshoot IV.

Training Procedures: The athletic training staff will be trained yearly by the team nurse to keep up to date on assisting with the administration of IV fluids. Athletic Training Students (assigned to applicable sports) will also be trained to gather the appropriate items and assist the administering clinician as needed. This policy and procedure document will be reviewed yearly by the medical staff to determine any necessary changes.

XLIII. COLD STRESS AND COLD EXPOSURE:

UNIVERSITY OF NORTHERN IOWA COLD WEATHER POLICY

Cold weather is defined as any temperature that can negatively affect the body’s regulatory system. It is important to remember that temperatures do not have to be freezing to have this effect. Individuals engaged in sports activities in cold, wet or windy conditions are at risk for environmental cold injuries

Recommended Preventative Strategies:

Competition/Practice Modifications:  The team Athletic Trainer(s) (ATC) will monitor and issue an advisory when applicable.  The team ATC(s) and/or Athletics event manager will monitor temperature, wind speed, wind chill, and precipitation through the National Weather Service and will be in contact with the coaching staff.  Based on information from the National Weather Service and local weather stations, measurements, ATC will determine the risk of potential danger to participants.

RISK TEMP/WINDCHILL MODIFICATIONS

o  Low Risk 30 F & above Outside participation allowed w/ appropriate clothing.

o o  Moderate Risk 30 F -20 F Additional protective clothing (hat, gloves) and provide re-warming facilities.

o o  High Risk 20 F -10 F Outside participation limited to 45 minutes* All participants must have appropriate clothing. Provide re-warming facilities.

o  Extreme Risk 10 F or below Termination of all outside activities#

* Frostbite can occur in 30 minutes. See Wind Chill Chart

Competition Modifications:

When necessary, competition modifications should be considered to ensure the safety of the athletes. This may include: - Extended half times -access to a warm building - Abbreviated introductions -ensuring/mandating proper clothing

Additional Directives for coaches and student athletes: - Exercise in windy or rainy conditions or water immersion in cold temperatures has unique challenges to the body’s ability to maintain normal temperature. The transfer of body heat in water may be 70 times greater than in air. - In Cold exposure; activity requires more energy from the body. Additional calorie intake may be required. - In Cold exposure; activity requires similar hydration to room temperature; however the thirst reflex is not activated. Conscious efforts before and after practice to hydrate should be initiated. - Never train alone. A simple ankle sprain in cold weather may become life threatening. - Appropriate clothing must be closely monitored and mandated.

Clothing Guidelines: In cold weather conditions appropriate clothing should be worn to prevent cold exposure. Both the Athletic Trainer(s) and the coaches should mandate the student-athletes to implement the following:  Wear several layers around the core of the body (especially those who are not very active). O The first layer should wick moisture away from the body O The top layers should trap heat and block the wind O The Outer layer should be wind and water-resistant or waterproof O No cotton as inside layer.  Long pants designed to insulate. O Sweatpants are a good choice as a base layer O On windy or wet days wind pants or a nylon shell should be worn on the surface layer  Long sleeved garment that will break the wind  Gloves  Hat or helmet to protect the ears (cover/tape ear holes of helmets for wind, cold protection)  Face protection  Moisture wicking socks

* It is important that athletes avoid wearing multiple layers of cotton. When the body sweats the cotton will become dense and permeated with sweat.

Signs/ Symptoms of Cold Stress:  Fatigue  Blurred vision  Confusion  Numbness/tingling of skin  Slurred Speech  Uncontrollable shivering  Red or Painful extremities  Swollen Extremities  Dizziness  Headache

COLD INJURY

Hypothermia: Body Core Temperature below 95oF

Symptoms include:

-Shivering -Lethargy, amnesia

-Impaired motor control -Pale, cold face and extremities

-Decreased heart rate -Slurred speech

-Impaired mental function

Treatment: Remove wet clothing, warm with dry insulating blankets, cover the head, and get to a warm environment. Provide warm beverages, avoid friction, and avoid warming extremities initially.

Frostnip/Frostbite: Frostbite is actual freezing of body tissues.

Symptoms include:

-Dry, waxy skin -Swelling

-Burning, tingling -Limited movement

-White/blue/gray patches -Aching, throbbing, and shooting pain

Treatment: Re-warm slowly in warm water (not hot); avoid friction/rubbing tissue.

Chilblain: is an exaggerated or uncharacteristic inflammatory response to cold exposure.

Symptoms include:

-Red or blue lesions -Swelling -Increased temperature

-Tenderness -Itching, numbness, burning

Treatment: Wash, dry area; elevate, cover with loose clothing/blankets; avoid friction, lotion.

XLIV. POWERADE POLICY:

. Practices- Days, in which the outside temperature, at the time of practice, is greater than 78 degrees Fahrenheit, POWERADE will be available (based on availability) for consumption by student- athletes.

. Games- Based on availability, POWERADE will be made available at all games/competitions in UNI’s locker room and/or UNI’s team bench. Each staff athletic trainer is to meet with the Director of Athletic Training Services to determine their team’s needs and allotment.

. Sport Allocations- Refer to the Appendix for sport specific POWERADE/Soda/Cup allocations. This spread sheet is intended as a guide for each sport to follow in order to accurately stay within budget and allocations of product.

 NOTE: THE DIRECTOR OF ATHLETIC TRAINING SERVICES SHOULD BE CONSULTED ON THE DECISION FOR USE OF GATORADE PRODUCTS.

XLV. EMERGENCY ACTION PLANS

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING SERVICES Emergency Action Plans {updated as of 08/11/17 }

The following emergency plan is a general outline for the University of Northern Iowa’s Athletic Training Services/Sports Medicine and UNI Athletic Department. Specific emergency plans for each individual sport and/or athletic facility detailing emergency phone numbers, entrances and access routes, emergency phone locations, etc. are available in each athletic training room and/or can be found in the Appendix of the Athletic Training Services/Sports Medicine Policies & Procedures Manual.

An emergency is any sudden life threatening injury or illness that requires immediate medical attention. Emergency situations can occur at any time during athletic participation. Expedient action must be taken in order to provide the best possible treatment. This emergency plan will help ensure the best care is provided.

Athletic personnel should review the policy at the beginning of each academic year. Coaches should discuss the policy in detail with the athletic trainer assigned to their sport. An emergency plan must exist for all organized practices and competitions, including out of season training, strength training and conditioning workouts. Those with the highest level of health training, such as a Team Physician, Certified Athletic Trainer, Emergency Medical Staff, Strength and Conditioning Staff, or Athletic Training Student are responsible for the emergency plan at a session or event. If a member of the sports medicine or strength training staff is not available at a practice, then the Coach is responsible for the emergency plan. Legal liability is very important to consider, and ALL athletic staff should understand this plan.

Hopefully, potential emergencies will be avoided by thorough physical screenings of an athlete prior to participation in any sport. Also, safe practices, including training techniques, and adequate medical coverage should be taken into consideration. However, accidents and injuries are inherent with sports participation. Therefore, proper preparation on the part of the athletic staff will enable each emergency situation to be managed appropriately.

There are three basic components of this plan: Emergency Personnel, Emergency Communication, and Emergency Equipment. A summary emergency template is provided at the end for your convenience.

1) EMERGENCY PERSONNEL

The type and degree of athletic training/sports medicine coverage for an athletic event (practice or contest) may vary based on factors such as the particular sport or activity, the setting, and the type of training or competition. With the majority of athletic contests and practices, the first responder to an emergency situation is typically a member of the athletic training/sports medicine staff, most commonly a Certified Athletic Trainer (ATC). A Team Physician may also be present at some high-risk events and practices. Other members of the emergency team may include Strength and Conditioning Staff, Emergency Medical Technicians (EMT), Athletic Training Students, Team Coaches, and/or Equipment Managers. EMTs will be available at the following contests: football, women’s soccer, men’s and women’s basketball and men’s wrestling. They are also at all Missouri Valley, Mid-American Conference and NCAA championship events hosted by the University of Northern Iowa.

Roles of these individuals within the emergency team may vary depending on various factors such as number of members of the team, the athletic venue itself, or the preference of the head athletic trainer. Roles within the emergency team include:  Immediate Care of the Athlete (by those with highest level of health training)  Emergency Equipment Retrieval  Activation of Emergency Medical Services  Directions to the Emergency Site (EMS)

A. Immediate Care of the Athlete The first and most important role is immediate care of the athlete. Acute care in an emergency situation should be provided by the most qualified individual on the scene. Individuals with lower credentials should yield to those with more appropriate training. This should be determined in advance of each training session.

B. Emergency Equipment Retrieval The second role, equipment retrieval, may be done by anyone on the emergency team who is familiar with the types and location of the specific equipment needed. Student athletic trainers, coaches and equipment personnel are good staff members for this role. Important emergency equipment is noted below.

C. Activation of Emergency Medical Services (EMS) The third role, EMS activation, should be done as soon as the situation is deemed an “emergency” or “life-threatening event”. Time is the most critical factor. Activating the EMS system may be done by anyone on the team. However, the person chosen for this duty should be someone who is calm under pressure, who communicates well, and who is familiar with the location of the sporting event. STEPS FOR ACTIVATION ARE NOTED BELOW.

D. Directions to the Emergency Site After EMS has been activated, one member of the team should be responsible for meeting the emergency medical personnel as they arrive at the site of the contest, if they are not already there. Depending on ease of access, this person should have keys to any locked gates or doors that may hinder the arrival of medical personnel. An athletic training student, manager or coach may be appropriate for this role

2) EMERGENCY COMMUNICATION

A. Activation of Emergency Medical System (EMS) In the event that an emergency occurs involving a student athlete, a member of the Emergency Team should promptly contact Emergency Medical Services (EMS). Phone numbers of emergency personnel should be posted by the phone or in the medical kit. If there isn’t a phone on the field, it is the responsibility of the certified athletic trainer or the coach (if an athletic trainer is not present) to bring a cellular phone to the field. A back up communication plan should be in effect if there should be failure of the primary communication system. It is important to note in advance the location of a workable telephone. Prearranged access to the phone should be established if it is not easily accessible. A cellular phone is preferred.

B. Contacting the Emergency Medical Services (EMS) 1. If EMT’s are at the event, then a signal discussed in advance (overhead circular signal) should be given to summon them forward.

2. If EMS is not on site, call UNI Police/Public Safety at 319-273-4000 or call 911.

3. The following information should be provided to the dispatcher:

a) Your name b) Exact location where the injury occurred and where you will meet them c) The number you are calling from d) Number of injured athletes e) The condition of the athlete(s) f) The care being provided g) Make sure that you hang up only after the dispatcher has hung up

4. Notify someone from the athletic training/sports medicine staff. Numbers are enclosed below.

5. As EMS is being dispatched, make sure someone is designated to retrieve any needed emergency equipment from the sidelines.

6. Have the coaches’ serve as crowd control and keep other athletes away from victim.

7. Send someone to meet the ambulance at the designated spot.

8. A member of the athletic training/sports medicine staff or coach will accompany the injured athlete to the hospital. The member of the athletic training/sports medicine staff should bring medical and/or insurance information with them to the hospital if accessible

UNI ATHLETIC TRAINING EMERGENCY COMMUNICATION HAND SIGNALS-

 “touch body part”- indicates the injured body part  “raised fist”- ATC / MD is needed;  “scuba OK” (pat top of head)- ATC / MD is not needed;  “overhead circular”- activate EMS immediately  “baseball safe signal”- spine board/stretcher is needed;  “hand pumping motion”- splints are needed;  “steering wheel motion”- cart/motorized transportation is needed;  “fist pound on heart”- automated external defibrillator (AED) is needed;

EMERGENCY PHONE NUMBERS-

Ambulance/Police/Fire 9-911 (on-campus phone)

911 (off-campus/pay phone)

Poison Control Center 1-800-222-1222

UNI Police / Public Safety (319) 273-4000

UNI Student Health Services (319) 273-2009

Staff Contact Information Athletic Training Staff Cell Phone Don Bishop 319-415-9337 Chelsea Lowe 303-241-9967 Travis Stueve 806-584-8473 Troy Garrett 319-415-4037 Melissa Stueve 319-239-3590 Katie Schulte 319-560-1215 Samantha Phillips 216-269-6070 Jacob Pszanka 641-485-5654 Carly Miller 319-541-1522 Brekahn Gasvoda 414-690-5533 Rachel Gallaway 734-672-2524 Devin Hasson 309-368-0420 Boone Tomlinson 712-240-2576

3) EMERGENCY EQUIPMENT

The majority of emergency equipment will be under the control of a member of the athletic training/sports medicine staff (ie: physician, ATC) or EMT’s. The highest trained provider at the event should be aware of what equipment is readily available at the venue or event. All necessary emergency equipment should be quickly accessible. Appropriate personnel should be familiar with the function and operation of available equipment. The equipment should be in good condition and checked regularly.

The highest trained member of the staff should determine in advance the type and manner in which any equipment is at or to be delivered to the site. Unless immediately adjacent to an athletic training room, non-sports medicine staff members should rely on emergency medical services for all equipment.

The following is a list of important available equipment and their location: 1. Anaphylaxis Kit / Epipen: Available in athletic training rooms and/or ATC kits. 66

2. Spine board: Spine boarding is the responsibility of the EMT, Physician, and/or ATC. Available in Athletic Training Rooms and EMS trucks.

3. Splints: Available in athletic training rooms or on site with ATC which will be Handled by ATC, athletic training student or physician.

4. Automatic Electronic Defibrillators (AED’s): Available in all EMS trucks and police vehicles, as well as the following locations:

 WRC: - mobile unit at the WRC front desk  HPC Weight Room: - mobile unit in the weight room  HPC Athletic Training Room: - (4) mobile units in the HPC athletic training room  UNI-Dome: - fixed unit on the south concourse wall  McLeod Center: - fixed unit on the event level entrance east wall  West Gym: - mobile unit in the West Gym athletic training room

IN CASE OF EMERGENCY, DO THE FOLLOWING:

I. PROVIDE EMERGENCY CARE (First Aid/CPR)

II. Contact Emergency Medical Services  Signal EMT (on site) or call (319) 273-4000 (on campus) or 911 (off campus)

III. Provide the following information:  Your name  Exact location where injured o Exact site locations  Where you will meet EMS  Number you are calling from  Number of injured individuals  Condition of the injured individuals  Care being provided  Wait for emergency person to end call

IV. Send someone to meet EMS

V. If appropriate, retrieve medical equipment per MD, ATC or EMT

VI. Notify the sports medicine staff (numbers on back)

VII. Control crowd to keep person safe

VIII. Staff member should accompany individual to emergency room

University of Northern Iowa Athletic Training Emergency Action Plan Football Outdoor Practice Fields

NW of UNI-Dome Emergency Personnel: A member ofEmergency the athletic training Action services staff Plan is on -site for practices. Additional Personnel may be available in the Human Performance Center Athletic Training Room.

Emergency Communication: Portable two-way radio during practice and by cellular phone.

Emergency Equipment: First aid supplies (athletic trainers' kit and body substance isolation (BSI) bag), AED, vacuum splints, spine board, and crutches are available on the sidelines.

Roles of Emergency Care Team Members

1. Immediate care of the injured/ill student-athlete: Follow appropriate first aid principles (See Injury/Illness Emergency Protocol sheet included with this Emergency Action Plan). 2. Emergency equipment retrieval: Appropriate to the emergency 3. Activation of emergency medical system (EMS) by calling 911. Provide them with the following information: a. Identify yourself and your role in the emergency b. Specify your location and telephone number (if calling by phone) c. Condition of victim(s) d. Time of the incident e. Care being provided f. Give specific directions to the scene of the emergency 4. Direction of EMS to the scene a. Assist University Public Safety with directing EMS to scene b. Clear a path for EMS (open appropriate doors, move cars, move other obstructions, etc.) c. Designate individual to "flag down" EMS and direct to scene d. Scene control: keep non-emergency medical team members away from the scene

Venue Directions: Practices for football outside will take place at the outdoor football practice fields north west of the corner of P E Center Drive and Panther Parkway, directly west of the “R” North Dome parking lot. Emergency access for the outdoor football practice fields is via North Panther Parkway through the “R” North Dome parking lot; north west of the UNI Dome. Approach campus via Hudson Road, turn west on PE Center Drive, turn north on Panther Parkway and turn west through the R Parking lot, the practice fields will be straight ahead on the west side.

Inclement Weather: Seek shelter in the69 WRC locker rooms.

University of Northern Iowa Athletic Training Emergency Action Plan UNI-Dome

Emergency Personnel: A member of the athletic training services staff is on-site for practices and competitive events taking place in the UNI-Dome. Possibly additional staff located in the Human Performance Center Athletic Training Room.

Emergency Communication: Portable two-way radio during football practices and games, access to a stationary telephone landline on the east sideline of the UNI-Dome, and by cellular phone.

Emergency Equipment: First aid supplies (athletic trainers' kit and body substance isolation (BSI) bag) available at sideline or medical area. AED is mounted on the South wall by the Hall of Fame pictures. Additional AED, breathing devices, vacuum splints, spine board, and crutches are also available in the Human Performance Center Athletic Training Room.

Roles of Emergency Care Team Members

Venue Directions: Practices, games and competitions for various sports take place in the UNI Dome. Emergency access for activities in UNI Dome is via “WRC” (Wellness and Recreation Center) Lot to the Northwest (NW) Loading Dock Entrance (Garage Door), which is on the ground floor on the Northwest side of the Dome. Approach the Northwest (WRC) Parking lot campus via PE Center Street off of Hudson Road and turn north into the WRC metered parking lot.

Inclement Weather: Seek shelter in the Football70 locker room and/or McLeod locker rooms.

University of Northern Iowa Athletic Training Emergency Action Plan

UNI Soccer & Rugby Practice Fields (West of UNI-Dome on West 27th Street)

Emergency Personnel: A member of the athletic training services staff is on-site for practices and competitive events for Women’s Soccer and Women’s Rugby. Additional Personnel may be available in the Human Performance Center Athletic Training Room.

Emergency Communication: Staff Athletic Trainer, Athletic Training Student, or Coaching Staff cellular phone.

Emergency Equipment: First aid supplies (athletic trainers' kit and body substance isolation (BSI) bag), AED, vacuum splints, and crutches are available on the sidelines.

Roles of Emergency Care Team Members

Venue Directions: Practices for Women’s Soccer and Rugby take place at the 27th Street practice fields. Emergency access for activities at the soccer practice fields is via 27th Street, which is West of the UNI Dome. Approach campus via Hudson Road, turn west on 27th Street, and the practice fields will be on the right (North).

Inclement Weather: Seek shelter in the McLeod Center, UNI Dome and/or WRC locker rooms.

University of Northern Iowa Athletic Training Emergency Action Plan McLeod Center Arena

Emergency Personnel: A member of the athletic training services staff is on-site for practices and competitive events for Volleyball, Women's Basketball, Men's Basketball, Indoor Track and Wrestling Matches. Additional Personnel may be available in the Human Performance Center Athletic Training Room.

Emergency Communication: Staff Athletic Trainer, Athletic Training Student, or Coaching Staff cellular phone. Portable two-way radio during competition events and access to a stationary telephone landline in the McLeod Center Athletic Training Room (ATR). Also, a landline stationary telephone is located inside the security ground floor check-in office next to the ground floor Hudson Road access to the arena.

Emergency Equipment: First aid supplies (athletic trainers' kit and body substance isolation (BSI) bag), AED, vacuum splints, and crutches are available in the McLeod Center ATR.

Roles of Emergency Care Team Members

Venue Directions: Practices, games and competitions take place in the McLeod Center Arena. Emergency access for activities in McLeod Center Arena is via the ground floor Hudson Road Loading Dock Entrance; which is on the Northeast side of the arena. Approach campus via southbound Hudson Road. Upon entering the arena at the security check point, go straight ahead and take an immediate left to enter the arena.

Inclement Weather: Seek shelter in the McLeod Center locker rooms. 72

University of Northern Iowa Athletic Training Emergency Action Plan Cedar Valley Soccer Complex

Emergency Personnel: Certified Athletic Trainer and Athletic Training Student(s) on site for practice and competition. Coaching staff as needed.

Emergency Communication: Staff athletic trainer, athletic training student, or coaching staff cellular phone.

Emergency Equipment: First aid supplies (athletic trainers' kit and body substance isolation (BSI) bag), AED, vacuum splints, and crutches are available on the sidelines.

Roles of Emergency Care Team Members

Venue Directions: Located on West Ridgeway Avenue 1 mile east of highway 58. Turn right onto DeWitt Road and then take an immediate left. An athletic training student or coach will be waiting at the gate to give further directions.

Inclement Weather: Seek shelter in the Concessions/Rest Room Building and/or personal vehicles. 73

University of Northern Iowa Athletic Training Emergency Action Plan Mark Messersmith

Outdoor Track & Field Complex Emergency Personnel: Certified Athletic Trainer and Athletic Training Student(s) on site for practice and competition. Coaching staff as needed.

Emergency Communication: Staff athletic trainer, athletic training student, or coaching staff cellular phone.

Emergency Equipment: First aid supplies (athletic trainers' kit and body substance isolation (BSI) bag), AED, vacuum splints, and crutches are available in the trailer/satellite athletic training facility at the complex.

Roles of Emergency Care Team Members

Venue Directions: Travel on Hudson Road, turn east on 19th Street and take first right possible into the Child Development Center “B” parking lot. Enter the complex through NE gate entrance.

Inclement Weather: Seek shelter in the main Mark Messersmith Complex Building (the “Bunker”) and Child Development Center.

University of Northern Iowa Athletic Training Emergency Action Plan

West Gym

Emergency Personnel: Certified Athletic Trainer and Student Athletic Trainer(s) on site for practice and competition; additional athletic training staff possibly available in the West Gym Athletic Training Room. Coaching staff if needed.

Emergency Communication: Staff athletic trainer, athletic training student, or coaching staff cellular phones. Possible land line in Wrestling, Softball, or Track offices.

Emergency Equipment: supplies (splint kit, spine board, cervical neck collars, AED, first aid kit) available in the West Gym.

Roles of Emergency Care Team Members

Venue Directions: When going Northbound on Hudson Road, turn right (east) onto West 23rd Street. Make the first right (south) and park EMS vehicle in the “Latham Field” parking lot, next to the West Gym.

Inclement Weather: Seek shelter in the West Gym locker rooms.

University of Northern Iowa Athletic Training Emergency Action Plan Outdoor Tennis Courts

Emergency Personnel: Head Coach Certified in ECSI CPR and AED; Certified Athletic available by phone: additional sports medicine staff located at the West Gym Athletic Training Room, or Human Performance Center Athletic Training Facility (2351 Hudson Road).

Emergency Communication: Staff Athletic Trainer, Coaching Staff, or Athlete Cellular Phone, Land line located in Bender Hall.

Emergency Equipment: first aid kit on site for practice and games.

Roles of Immediate Care Providers (Athletic Trainers, Coaches, and Athletes) 1. Immediate care of the injured or ill student-athlete 2. Activation of emergency medical system (EMS) a) Notify the emergency center at 911 b) Provide necessary information to EMS personnel:  name, address, telephone number of caller  number of victims; condition of victims  first-aid treatment initiated  specific directions as needed to locate scene  other information as requested by dispatcher 3. Emergency Equipment Retrieval 4. Direction of EMS to scene a) open appropriate gates b) designate individual to “flag down” EMS and direct to scene c) injury scene control: limit scene to first aid providers and move bystanders away from the area 5. Provide appropriate emergency care until arrival of EMS personnel: on arrival of EMS personnel, provide pertinent information (method of injury, vital signs, treatment rendered, medical history) and assist with emergency care as needed

Venue Directions: When going Southbound on Hudson Road, turn left (East) onto West 23rd Street. Turn left (north) onto Campus Street. Turn left and park EMS vehicle in “Campbell” CP parking lot.

23rd Street

Inclement Weather: Seek shelter in Bender Hall, Dancer Hall, or WRC locker rooms.

University of Northern Iowa Athletic Training Emergency Action Plan

Robinson-Dresser Sports Complex (Softball)

Emergency Personnel: Certified Athletic Trainer and Athletic Training Student(s) on site for practice and competition;

Emergency Communication: fixed telephone line in concession stand at the field; Staff Athletic Trainer, Athletic Training Student(s), or Coaching Staff Cellular Phone.

Emergency Equipment: First aid supplies (athletic trainers' kit and body substance isolation (BSI) bag), AED, vacuum splints, and crutches are available on the sidelines.

Roles of Emergency Care Team Members

Venue Directions: The address is 3626 West 12th Street. Traveling South on Hudson Road, turn West onto 12th Street and continue until the fields are on the Left (South). Turn South into the fields’ parking lot, turn into the left parking lot and proceed towards the gates that lead to the fields.

H u d s o n

R d

Inclement Weather: Seek shelter in the storm shelter at the complex.

University of Northern Iowa Athletic Training Emergency Action Plan Wellness Recreation Center

Upper Courts (PEC)

Emergency Personnel: Certified Athletic Trainer and Athletic Training Student(s) on site for practice. Coaching staff if necessary.

Emergency Communication: Staff Athletic Trainer, Athletic Training Student(s) or coaching staff cell phone, land line in the Human Performance Center Hydrotherapy Room, or Wellness and Recreation Center.

Emergency Equipment: Located in the Human Performance Center Athletic Training Room.

Roles of Emergency Care Team Members

Venue Directions: Instruct EMS to arrive at the “WRC Metered Lot” to the NW loading dock of the UNI-Dome. Approach the Northwest (WRC) Parking lot campus via PE Center Street off of Hudson Road and turn north into the WRC metered parking lot. Flag down EMS so they enter through the HPC West Doors near the medical clinics and to the Elevator to the 2nd Floor to the WRC/PEC.

Inclement Weather: Seek shelter in the WRC locker rooms.

University of Northern Iowa Athletic Training Emergency Action Plan Wellness Recreation Center

Natatorium

Emergency Personnel: Head Coach Certified in ECSI CPR and AED; Certified Athletic available by phone: additional sports medicine staff located in the Human Performance Center Athletic Training Facility.

Emergency Communication: Staff Athletic Trainer, Athletic Training Student(s) or coaching staff cell phone, land line in the Wellness and Recreation Center.

Emergency Equipment: Spine board with head and neck stabilization located poolside. AED located at WRC front desk. Other equipment located in the Human Performance Center Athletic Training Room.

Roles of Immediate Care Providers (ATs, Coaches, and Athletes): 1. Immediate care of the injured or ill student-athlete 2. Activation of emergency medical system (EMS) 1. Notify the emergency center at 911 2. Provide necessary information to EMS personnel:  name, address, telephone number of caller  number of victims; condition of victims  first-aid treatment initiated  specific directions as needed to locate scene  other information as requested by dispatcher 3. Emergency Equipment Retrieval 4. Direction of EMS to scene a) open appropriate gates b) designate individual to "flag down" EMS and direct to scene c) injury scene control: limit scene to first aid providers and move bystanders away from area 5. Provide appropriate emergency care until arrival of EMS personnel: on arrival of EMS personnel, provide pertinent information (method of injury, vital signs, treatment rendered, medical history) and assist with emergency care as needed

Venue Directions: Southbound on Hudson Road, turn Right on PE Center St. Instruct EMS to arrive at the Natatorium NE doors (Pool) that are on the same level as the pool deck.

Inclement Weather: Seek shelter in the WRC locker rooms.

University of Northern Iowa Athletic Training Emergency Action Plan Human Performance Center

Hydrotherapy Room

Emergency Personnel: Certified Athletic Trainers and Athletic Training Student(s) on site in the HPC athletic training room.

Emergency Communication: fixed telephone line in the Hydrotherapy Room (273-5288), fixed telephone lines at the Reception Desk (273-7479); Staff Athletic Trainer and Athletic Training Student cellular phones (usually poor reception).

Emergency Equipment: supplies (splint kit, spine board, cervical neck collars, AED, first aid kit) available in the in the adjacent HPC athletic training room.

Roles of Immediate Care Providers (Athletic Trainers, Coaches, and Athletes): 6. Immediate care of the injured or ill student-athlete 7. Activation of emergency medical system (EMS) 3. Notify the emergency center at 911 4. Provide necessary information to EMS personnel:  name, address, telephone number of caller  number of victims; condition of victims  first-aid treatment initiated  specific directions as needed to locate scene  other information as requested by dispatcher 8. Emergency Equipment Retrieval 9. Direction of EMS to scene d) open appropriate gates e) designate individual to "flag down" EMS and direct to scene f) injury scene control: limit scene to first aid providers and move bystanders away from area 10. Provide appropriate emergency care until arrival of EMS personnel: on arrival of EMS personnel, provide pertinent information (method of injury, vital signs, treatment rendered, medical history) and assist with emergency care as needed

Venue Directions: UNI HPC Athletic Training Room/Hydrotherapy Room is located at 2351 Hudson Road. Hudson Rd. heading South on Hudson Rd., then take a right on PE Center St., and then a left into the Metered WRC parking lot. The EMS should enter through the W entrance of the CVMS clinic on the south end of the parking lot.

Inclement Weather: Seek shelter in the HPC and WRC locker rooms.

University of Northern Iowa Athletic Training Emergency Action Plan Pheasant Ridge Golf Course

Emergency Personnel: Golf Coaches certified in CPR and First Aid, Director of Athletic Training Services Don Bishop on call (319) 415-9337 for golf. Staff Athletic Trainers and Athletic Training Students for Missouri Valley Conference Cross Country Meet.

Emergency Communication: fixed phone line in Pheasant Ridge Club House (266-8266); Staff Athletic Trainer, Athletic Training Student(s), Coaching Staff, or Athlete cellular phones.

Emergency Equipment: First Aid Kit with the coaching staff for golf. Splint bags, AED, and EMS on site for MVC CC Meet.

Roles of Immediate Care Providers (Athletic Trainers, Coaches, and Athletes): 1) Immediate care of the injured or ill student-athlete 2) Activation of emergency medical system (EMS) a) Notify the emergency center at 911 b) Provide necessary information to EMS personnel:  Name, address, telephone number of caller  Number of victims; condition of victims  First-aid treatment initiated  Specific directions as needed to locate scene  Other information as requested by dispatcher 3) Emergency Equipment Retrieval 4) Direction of EMS to scene a) Open appropriate gates b) Designate individual to "flag down" EMS and direct to scene c) Injury scene control: limit scene to first aid providers and move bystanders away from area 5) Provide appropriate emergency care until arrival of EMS personnel: on arrival of EMS personnel, provide pertinent information (method of injury, vital signs, treatment rendered, medical history) and assist with emergency care as needed

Venue Directions W 4th St heading west towards Hudson Rd, turn left at Hudson Rd, and turn right at W 12th St, at a right at 3205 W 12th St, the entrance to Pheasant Ridge Golf Course. There will be a staff member either from the golf team or club house to meet the ambulance at the entrance at the club house to escort the emergency personnel to the site.

Inclement Weather: Seek shelter in the Pheasant Ridge Club House.

University of Northern Iowa Athletic Training Emergency Action Plan UNI HPC Weight Room

Emergency Personnel: Strength and Conditioning Staff certified in CPR and First Aid, athletic training staff, athletic training students, and/or additional personnel possibly in the Human Performance Center Athletic Training Room.

Emergency Communication: fixed telephone line in the Weight Room; Staff Athletic Trainer, Athletic Training Student, Coaching Staff, or Athlete cellular phone.

Emergency Equipment: AED located in the Weight Room and First Aid Kit and splints located in the HPC Athletic Training Room

Roles of Immediate Care Providers (Athletic Trainers, Coaches, and Athletes): 1. Immediate care of the injured or ill student-athlete 2. Activation of emergency medical system (EMS) a) Notify the emergency center at 911 b) Provide necessary information to the EMS personnel:  Name, address, telephone number of the caller  Number of victims; condition of victims  First aid treatment initiated  Specific directions as needed to locate scene  Other information as requested by dispatcher 3. Emergency Equipment Retrieval 4. Direction of EMS to scene a) Open appropriate doors b) Designate individual to “flag down” EMS and direct to scene c) Injury scene control: limit scene to first aid providers and move bystanders away from area 5. Provide appropriate emergency care until arrival of EMS personnel: on arrival of EMS personnel, provide pertinent information (method of injury, vital signs, treatment rendered, medical history) and assist with emergency care as needed

Venue Directions: Hudson Rd. heading South on Hudson Rd., then take a right on PE Center St., and then a left into the Metered WRC parking lot. The EMS should enter through the NW entrance of the WRC on the Northwest end of the building (Park at the first over hang in the parking lot).

Inclement Weather: Seek shelter in the HPC and WRC locker rooms.

University of Northern Iowa Athletic Training Emergency Action Plan Black Hawk Tennis Center

Emergency Personnel: Head coach certified in American Red Cross CPR. Certified athletic trainer and athletic training student on site for competitions.

Emergency Communication: Fixed telephone in Black Hawk Tennis Center (319)-232-7512; Staff Athletic Trainer, Athletic Training Student, Coaching Staff or Athlete cellular phone.

Emergency Equipment: None

Roles of Immediate Care Providers (Athletic Trainers, Coaches, and Athletes):

1. Immediate care of the injured or ill student-athlete 2. Activation of emergency medical system (EMS) a) Notify the emergency center at 911 b) Provide necessary information to the EMS personnel:  Name, address, telephone number of the caller  Number of victims; condition of victims  First aid treatment initiated  Specific directions as needed to locate scene  Other information as requested by dispatcher 1. Emergency Equipment Retrieval 2. Direction of EMS to scene d) Open appropriate doors e) Designate individual to “flag down” EMS and direct to scene f) Injury scene control: limit scene to first aid providers and move bystanders away from area 3. Provide appropriate emergency care until arrival of EMS personnel: on arrival of EMS personnel, provide pertinent information (method of injury, vital signs, treatment rendered, medical history) and assist with emergency care as needed

Directions: Black Hawk Tennis Center is located at 1005 Black Hawk Road, Waterloo. The EMS vehicle should go south on Ansborough Ave., and turn onto Black Hawk Road, the Tennis Center will be on the South Side of the road. EMS should then enter through the North doors of the building.

Inclement Weather: Seek shelter in the Black Hawk Tennis Center locker rooms.

University of Northern Iowa Athletic Training Emergency Action Plan Byrnes Park Tennis Center

Emergency Personnel: Head coach certified in American Red Cross CPR. Certified athletic trainer and athletic training student on site for competitions.

Emergency Communication: Staff Athletic Trainer, Athletic Training Student, Coaching Staff or Athlete cellular phone.

Emergency Equipment: None

Roles of Immediate Care Providers (Athletic Trainers, Coaches, and Athletes):

1. Immediate care of the injured or ill student-athlete 2. Activation of emergency medical system (EMS) a) Notify the emergency center at 911 b) Provide necessary information to the EMS personnel:  Name, address, telephone number of the caller  Number of victims; condition of victims  First aid treatment initiated  Specific directions as needed to locate scene  Other information as requested by dispatcher 4. Emergency Equipment Retrieval 5. Direction of EMS to scene g) Open appropriate doors h) Designate individual to “flag down” EMS and direct to scene i) Injury scene control: limit scene to first aid providers and move bystanders away from area 6. Provide appropriate emergency care until arrival of EMS personnel: on arrival of EMS personnel, provide pertinent information (method of injury, vital signs, treatment rendered, medical history) and assist with emergency care as needed

Directions: Black Hawk Tennis Center is located at 1110 Campbell Ave, Waterloo. The EMS vehicle should take Sergeant Rd (63) to Fletcher Ave, turn east on Fletcher Ave., take Fletcher Ave to Campbell Ave and turn south, the Tennis Center will be on the end of Campbell Ave.

Inclement Weather: Seek shelter in the concessions building and pro-shop.

University of Northern Iowa Athletic Training Emergency Action Plan

Softball Hitting Facility 3219 Hudson Rd., Cedar Falls, IA 50614

Emergency Personnel: Coaching staff certified in ECSI CPR and AED. Certified athletic trainer and athletic training student on site for competitions.

Emergency Communication: Staff Athletic Trainer, Athletic Training Student, Coaching Staff or Athlete cellular phone.

Emergency Equipment: None

Roles of Immediate Care Providers (Athletic Trainers, Coaches, and Athletes):

1. Immediate care of the injured or ill student-athlete 2. Activation of emergency medical system (EMS) a) Notify the emergency center at 911 b) Provide necessary information to the EMS personnel:  Name, address, telephone number of the caller  Number of victims; condition of victims  First aid treatment initiated  Specific directions as needed to locate scene  Other information as requested by dispatcher 7. Emergency Equipment Retrieval 8. Direction of EMS to scene j) Open appropriate doors k) Designate individual to “flag down” EMS and direct to scene l) Injury scene control: limit scene to first aid providers and move bystanders away from area 9. Provide appropriate emergency care until arrival of EMS personnel: on arrival of EMS personnel, provide pertinent information (method of injury, vital signs, treatment rendered, medical history) and assist with emergency care as needed

Directions: The EMS vehicle should take Hudson Rd. south, turn west onto W 31st St. and turn immediately south onto Spring Valley Ln., facility/building will be on the end of Spring Valley Ln.

Inclement Weather: Seek shelter in an interior office in the facility.

EMERGENCY ALGORITHMS

Cardiorespiratory#, Medical%, and/or Orthopedic$ Emergency occurring at a HOME PRACTICE session-

1. the UNI staff athletic trainer and/or the senior athletic training student will evaluate the athlete, administer basic life support (BLS), and stabilize the athlete until EMS arrives;  if the injury is a suspected cervical spine injury during a football practice, a certified athletic trainer will maintain in-line head and shoulder stabilization while another member of the UNI athletic training staff removes the facemask and/or helmet and shoulder pads as indicated;  if the injury is a suspected non-football cervical spine injury, the UNI certified athletic trainer will maintain in-line head and shoulder stabilization;  the athlete will be placed on the backboard using standard protocols  if the injury is a cardiorespiratory emergency, the UNI certified athletic trainer(s) and/or an athletic training student(s) will set up and use the automated external defibrillator as per standard protocol; 2. the senior athletic training student, the lower level athletic training student (if available), or a member of the coaching staff will use a cellular phone to call EMS and direct them to the site of the emergency;  if no cellular phone is available, the designated individual will proceed to the nearest campus phone or pay phone to access EMS; 3. after activating EMS, the designated individual should call the Director of Athletic Training Services (319-415-9337) and UNI Public Safety (3-4000 from a campus phone or 273-4000 from a non- campus phone) to notify them of the emergency situation;  ask someone to bring the automated external defibrillator (AED) to the emergency location; 4. a member of the coaching staff will proceed to the assigned field / court entrance and guide EMS onto the field / court; 5. the assistant student athletic trainer (if available) will assist the UNI staff athletic trainer and the senior athletic training student as necessary; 6. a member of the coaching staff will be responsible for crowd control and securing an unobstructed and safe passageway for EMS personnel; 7. the lower level athletic training student (if available) will accompany the injured athlete to the medical facility with the injured athlete’s emergency medical information card;  if the lower level athletic training student is not available, the senior athletic training student and/or an assistant coach will accompany the athlete to the medical facility; 8. the UNI staff athletic trainer will immediately call the team physician to notify him/her about the situation if applicable; 9. once at the medical facility, the athletic training student or assistant coach will call back to the Head Athletic Trainer (319-415-9337) with any medical updates; 10. if the AED unit is used- a) contact Troy Garrett (AED Liaison) at 319-415-4037 to notify him of the emergency situation and AED use. b) The AED may travel to the ER where the chip can be removed and analyzed. .

# = Cardiorespiratory emergency includes but is not limited to: cardiac arrest; respiratory arrest; foreign body airway obstruction (FBAO); pneumothorax; hemothorax; sucking chest wound; flail chest

% = Medical emergency includes but is not limited to: anaphylactic shock; hypovolemic shock; internal bleeding; head injury; diabetic emergencies (insulin shock; diabetic coma); seizure disorder; asthma

$ = Orthopedic emergency includes but is not limited to: cervical spine injury; flail chest; femur fracture; hip dislocation; knee/ankle dislocation

Cardiorespiratory#, Medical%, and/or Orthopedic$ Emergency occurring at a HOME GAME-

1. the UNI staff athletic trainer and the senior athletic training student will go onto the field to evaluate the athlete, administer basic life support (BLS), and stabilize the athlete until EMS arrives;  if the injury is a suspected non-football cervical spine injury, the UNI staff athletic trainer will maintain in-line head and shoulder stabilization;  the athlete will be placed on the backboard using standard protocols  if the injury is a cardiorespiratory emergency, the UNI staff athletic trainer and/or an athletic training student will set up and use the automated external defibrillator as per standard protocol; 2. the senior athletic training student will give the appropriate hand signals to the sidelines; 3. the senior athletic training student, the lower level athletic training student (if available), or a member of the coaching staff will use the cellular phone to call EMS and direct them to the site of the emergency;  if no cellular phone is available, the designated individual will proceed to the nearest pay phone and/or campus phone to access EMS;  if a UNI Game Management staff member is available, he/she may be notified and instructed to summons EMS; 4. after activating EMS, the Director of Athletic Training Services (319-415-9337) and UNI Public Safety (3-2712 from a campus phone or 273-2712 from a non-campus phone) should be contacted and notified of the emergency situation; 5. the team physician (if available) will evaluate the athlete and provide treatment / stabilization as needed and/or required; 6. a member of the coaching staff and/or UNI game management personnel will proceed to the field / court entrance and guide EMS onto the field / court; 7. the lower level athletic training student (if available) will assist the team physician (if available), the UNI staff athletic trainer, and the senior athletic training student as necessary; 8. a member of the coaching staff and/or UNI game management personnel will be responsible for crowd control and securing an unobstructed and safe passageway for EMS personnel; 9. the lower level athletic training student (if available) will accompany the injured athlete to the medical facility with the injured athlete’s emergency medical information card;  if the lower level athletic training student is not available, the senior athletic training student and/or an assistant coach will accompany the athlete to the medical facility; 10. the UNI staff athletic trainer will immediately call the team physician (if applicable) to notify him/her about the emergency situation; 11. once at the medical facility, the athletic training student or assistant coach will call back to the HPC Athletic Training Room (273-6369) with any medical updates; 12. if the AED unit is used-contact Troy Garrett (AED Liaison) at 319-415-4037 to notify him of the emergency situation and AED use.

# = Cardiorespiratory emergency includes but is not limited to: cardiac arrest; respiratory arrest; foreign body airway obstruction (FBAO); pneumothorax; hemothorax; sucking chest wound; flail chest

$ = Orthopedic emergency includes but is not limited to: cervical spine injury; flail chest; femur fracture; hip dislocation; knee/ankle dislocation

Cardiorespiratory#, Medical%, and/or Orthopedic$ Emergency occurring at an AWAY game and/or practice session-

1. The UNI staff athletic trainer and senior athletic training student (if available) will proceed onto the field / court, evaluate the athlete, administer basic life support (BLS), and stabilize the athlete until EMS arrives;  if the injury is a suspected cervical spine injury during a football game, the team physician or senior athletic training student will maintain in-line head and shoulder stabilization while the UNI staff athletic trainer removes the facemask and/or helmet and shoulder pads as indicated;  if the injury is a suspected non-football cervical spine injury, the team physician (if available), the UNI staff athletic trainer, or the athletic training student will maintain in-line head and shoulder stabilization;  the athlete will be placed on the backboard using standard protocols 2. the senior athletic training student will notify the host certified athletic trainer that an emergency exists and that EMS is needed; 3. the UNI staff athletic trainer, the senior athletic training student, and the host certified athletic trainer will continue to administer BLS and stabilize the athlete as best possible while following the host institution’s emergency protocols; 4. the senior athletic training student (if a UNI staff athletic trainer is present) or a member of the coaching staff (if no UNI staff athletic trainer is present) will accompany the injured athlete to the hospital with the injured athlete’s emergency medical information card; 5. once at the hospital, the athletic training student or member of the coaching staff will immediately call a UNI staff athletic trainer (if applicable) to notify him/her of the emergency situation; 6. the UNI staff athletic trainer will notify the Director of Athletic Training Services (319-415-9337).

# = Cardiorespiratory emergency includes but is not limited to: cardiac arrest; respiratory arrest; foreign body airway obstruction (FBAO); pneumothorax; hemothorax; sucking chest wound; flail chest

$ = Orthopedic emergency includes but is not limited to: cervical spine injury; flail chest; femur fracture; hip dislocation; knee/ankle dislocation

XLVI. EMERGENCY CARE & COVERAGE PROCEDURES FOR PRACTICES & EVENTS

HOME Practice / Workout Coverage-  At least one (1) member of the UNI Athletic Training Services/Sports Medicine Department (staff athletic trainer and/or athletic training student) will be in attendance at every practice or workout (including off season workouts);  The athletic trainer(s) will station himself / herself in a position where he / she can visualize the entire practice/workout;  In the event of a cardiorespiratory, medical, and/or orthopedic emergency, the following protocol should be followed: 1) the UNI staff athletic trainer will evaluate the athlete, administer basic life support (BLS), and stabilize the athlete until EMS arrives; 2) the athletic training student(s) or a member of the coaching staff will use a cellular phone to call EMS and direct them to the site of the emergency;  if no cellular phone is available, the designated individual will proceed to the nearest campus phone to access EMS; 3) after activating EMS, the designated individual should call the HPC Athletic Training Room (3-7479 from a campus phone or 273-7479 from a non-campus phone) and UNI Public Safety (3-2712 from a campus phone or 273-2712 from a non-campus phone) to notify them of the emergency situation; 4) a member of the coaching staff will proceed to the assigned field / court / facility entrance and guide EMS onto the field / court or into the facility; 5) the student athletic trainer(s) will assist the UNI staff athletic as necessary; 6) a member of the coaching staff will be responsible for crowd control and securing an unobstructed and safe passageway for EMS personnel; 7) a student athletic trainer (if available) will accompany the injured athlete to the medical facility with the injured athlete’s emergency medical information;  if an athletic training student is not available, an assistant coach will accompany the athlete to the medical facility; 8) the UNI staff athletic trainer will immediately call the team physician to notify him/her about the situation; 9) once at the medical facility, the athletic training student or assistant coach will call back to the treating staff athletic trainer with any medical updates.

HOME Game Coverage-  At least one (1) member of the UNI Athletic Training Services/Sports Medicine Department (staff athletic trainer) and at least one (1) athletic training student will be in attendance at every home game/competition that takes place on the UNI campus;  The athletic trainer(s) will station himself / herself in a position where he / she can visualize the entire field / court, typically on the team bench or sideline;  The team physician will use his/her discretion with regards to attendance at the event;  In the event of a cardiorespiratory, medical, and/or orthopedic emergency, the following protocol should be followed: 1. the UNI staff athletic trainer will evaluate the athlete, administer basic life support (BLS), and stabilize the athlete until EMS arrives; 2. the athletic training student(s) or a member of the coaching staff will use a cellular phone to call EMS and direct them to the site of the emergency;  if a UNI Game Management staff member is available, he/she may be notified and instructed to summons EMS;  if no cellular phone is available, the designated individual will proceed to the nearest campus phone to access EMS; 3. after activating EMS, the designated individual should call the HPC Athletic Training Room (3-7479 from a campus phone or 273-7479 from a non-campus phone) and UNI Public Safety (3-2712 from a campus phone or 273-2712 from a non-campus phone) to notify them of the emergency situation; 4. the team physician (if available), the UNI staff athletic trainer and the athletic training students will provide BLS and stabilize the athlete until EMS arrives; 89

5. a member of the coaching staff and/or UNI game management personnel will proceed to the field / court entrance and guide EMS onto the field / court; 6. the athletic training student(s) will assist the team physician (if available) and the UNI staff athletic trainer; 7. a member of the coaching staff and/or UNI game management personnel will be responsible for crowd control and securing an unobstructed and safe passageway for EMS personnel; 8. the athletic training student or an assistant coach will accompany the injured athlete to the medical facility with the injured athlete’s emergency medical information; 9. the UNI staff athletic trainer will immediately call the team physician (if applicable) to notify him/her about the emergency situation; 10. once at the medical facility, the athletic training student or assistant coach will call back to the treating staff athletic trainer with any medical updates.

AWAY Practice / Game Coverage-

 At least one (1) staff member of the Athletic Training Services/Sports Medicine Department will travel with the team at all times and be in attendance at every practice / game;  The athletic trainer(s) will station himself / herself in a position where he / she can visualize the entire field / court, typically on the team bench or sideline;  The team physician will use his/her discretion with regards to attendance at the event;  In the event of a non-emergency injury, the following protocol should be followed to avoid confusion and the appearance of disorganization: 1) the UNI staff athletic trainer will go onto the field / court; 2) the UNI staff athletic trainer will stabilize the athlete, evaluate the injury, and provide the appropriate care for the athlete; 3) if it is determined that the athlete’s injury is a cardiorespiratory, medical, and/or orthopedic emergency, the UNI staff athletic trainer will immediately notify the host certified athletic trainer that an emergency exists and that EMS is needed; the host institution’s emergency medical protocols will be followed; 4) if it is determined that the athlete’s injury is not a cardiorespiratory, medical, and/or orthopedic emergency, the UNI staff athletic trainer and host certified athletic trainer (if applicable) will determine the most appropriate means of transportation from the field / court. 5) if it is determined that the athlete needs to be seen by a physician during a game/ practice, the UNI staff athletic trainer will arrange for this with the host certified athletic trainer; a) an assistant coach will accompany the athlete and remain with that athlete at all times; (if a UNI staff athletic trainer AND an athletic training student are present, the athletic training student will accompany the athlete); b) immediately after the game/practice, the UNI staff athletic trainer should go to the hospital/doctor’s office; c) the UNI staff athletic trainer will bring copies of any physician’s instructions, x- rays, CT-scans, etc. back to campus with him/her; 6) if the athlete needs to be seen by a physician after a game/practice, the UNI staff athletic trainer will arrange for this with the host certified athletic trainer: a) the UNI staff athletic trainer will accompany the athlete and remain with him/her at all times; b) the UNI staff athletic trainer will bring copies of any physician’s instructions, x- rays, CT-scans, etc. back to campus with him/her; c) if the athlete needs additional medical attention when he/she arrives back on the UNI campus, a UNI staff athletic trainer will arrange this immediately.

 In the event of a cardiorespiratory, medical, and/or orthopedic emergency, the following protocol should be followed: 1) the UNI staff athletic trainer will proceed onto the field / court, evaluate the athlete, administer basic life support (BLS), and stabilize the athlete until EMS arrives;

2) the UNI staff athletic trainer will notify the host certified athletic trainer that an emergency exists and that EMS is needed; 3) the UNI staff athletic trainer, the athletic training student (if present), and the host certified athletic trainer will continue to administer BLS and stabilize the athlete as best possible while following the host institution’s emergency protocols; 4) the athletic training student or a member of the coaching staff (if no athletic training student is present) will accompany the injured athlete to the hospital with the injured athlete’s emergency medical information; 5) once at the hospital, the athletic training student or member of the coaching staff will immediately call the treating UNI staff athletic trainer to update him/her on the status of the injured athlete.

XLVII. CATASTROPHIC INCIDENT PLAN

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING UNI Athletics Catastrophic Incident Plan

I. INTRODUCTION AND DEFINITION OF CATASTROPHIC INCIDENT The University of Northern Iowa Athletic Department’s Catastrophic Incident Plan will be activated when the following catastrophic incidents (CI) occur:

1. Sudden death of a student-athlete, coach, or staff member during a UNI event or during official travel to / from a UNI event. Catastrophic Injuries that may befall a UNI Student- Athlete will be handled using this plan even for non-athletic injuries until otherwise notified by the Director of Athletics. • Death during competition, practice, or conditioning • Death during travel - All UNI Athletic Department official business • Non-athletic accidents (e.g. at home) - Personal (e.g. automobile, airline accidents) • Unknown medical anomalies (e.g. heart attack, stroke, illness) • Victim of a crime (e.g. homicide) • Suicide 2. Disability / Quality of life altering injuries or illness including but not limited to: • Either during UNI Athletic Department participation and/or travel, or during non-athletic activities • Spinal Cord Injury-resulting in partial or complete paralysis • Loss of Paired Organ • Severe Head Injury • Injuries resulting in severely diminished mental capacity or other neurological injury that results in inability to perform daily functions (e.g.-coma) • Irrecoverable loss of speech or hearing (both ears) or sight (both eyes) or both arms or both legs or one arm and one leg. 3. Other incidents as deemed appropriate.

II. CATASTROPHIC INCIDENT MANAGEMENT TEAM (CIMT) The following individuals are considered members of the Catastrophic Injury Management Team (CIMT) should be notified as described in this policy in the event of a Catastrophic Incident (See plan for order):  Director of Athletics  Senior Associate Athletic Director/Woman Administrator  Director of Athletic Training Services/Head Athletic Trainer  Head Team Physician

 Director of Counseling Center  Senior Vice President for Administrative and Financial Services  University Spokesperson  Director of Athletic Communications/Media Relations  Director of Risk Management or University Counsel  Additional personnel as deemed appropriate by CIMT

III. IMMEDIATE ACTION PLAN

The following action plan will appropriately apply steps to manage a catastrophic incident. While applying these steps, the UNI Athletic Department Personnel will keep in mind the following goals: • Get all pertinent facts regarding the incident accurately and expeditiously • Accurately document all events, especially list all participants and witnesses • Secure any or all available materials/equipment involved. If the equipment is something the student-athlete would wear or use, the medical staff will secure it • Respect the dignity of the individuals involved • Immediate communication within the catastrophic incident management team (CIMT) • Only members of the CIMT, or individuals they designate, are to speak on the incident to family members, media, other staff members, student-athletes or coaches- no one else has clearance to speak on the incident • Instruct student-athletes they are not to speak to anyone regarding the incident • The coaching staff, support staff and team members will be directed to refer all media inquiries to the UNI Athletics Communications office. This group will also be reminded that no comments regarding the incident be made to the public and/or media personnel • The team physician, the Head Athletic Trainer, the Director of Athletics and/or their designees along with other appropriate personnel will proceed to the medical facility as soon as possible • All statements regarding the incident will be coordinated by members of the CIMT and released as appropriate.

IV. CHAIN OF COMMAND AND AREAS OF ACTION: After being informed of a catastrophic incident, the following individuals should be notified to commence their responsibilities: • During UNI Athletic Department participation/travel: Head Athletic Trainer or Director of Athletics • Non UNI Athletic Department activities or individual is not a Student-Athlete or Coach: Director of Athletics and Head Athletic Trainer (if Student-Athlete)

DIRECTOR OF ATHLETICS • Notifies University President • Notifies Senior Vice President for Administration & Financial Services who in turn enacts any catastrophic incident procedures for the University • Notifies or is notified by Head Athletic Trainer of a catastrophic incident • Notifies or is notified by Director of Public Safety • Notifies Senior Associate Athletic Director/Senior Woman Administrator • Notifies Senor Associate Athletic Director for External Affairs • In the event the Catastrophic Incident is non-athletic, the Director of Athletics notifies or is notified by the Head Coach of sport • Directs statement to team at conclusion of event if appropriate with or without the Head Coach. SENIOR VICE PRESIDENT FOR ADMINISTRATION & FINANCIAL SERVICES 92

• Notifies UNI President • Notifies Vice-President for Student Affairs • Notifies Executive Vice-President & Provost • Notifies Risk Manager of UNI HEAD ATHLETIC TRAINER • Notifies Director of Athletics, Head Team Physician, all Senior and Associate Athletic Directors, Sports Medicine Staff, and Insurance Coordinator • Notifies Head Coach if incident occurs during non-practice participation, or when coach may not be present (e.g.-conditioning) • Coordinates, along with Head Team Physician, communication with any physicians involved in the Catastrophic incident medical care • Coordinates notification of Parents or Next of Kin and provides updates while they may be in route to site. * If possible, Parents or Next of Kin are notified first by the Athletic Director and/or the Vice President for Student Affairs, then updates or elaboration on student-athletes condition can be done by the Head Team Physician and/or Head Athletic Trainer. • Provides any insurance information and/or pertinent health history information • Communicates with Risk Manager and UNI legal counsel • Communicates with Director of Athletic Communications • Along with Insurance Coordinator, provides any insurance information • Notifies counseling services and makes immediate referrals or sets up eventual referrals for team/support staff • Notifies Student Health Center • Notifies NCAA Catastrophic Injury Service Insurance Carrier • Notifies International Student Services Program if S-A is International and translator is needed to contact parents/next of kin.

TEAM PHYSICIAN • Helps coordinate medical information regarding incident and care and/or possible transfer of student-athlete or their immediate care • Facilitate communication between caregivers and Head Athletic Trainer, Director of Athletics and Parents.

SENIOR ASSOCIATE ATHLETIC DIRECTOR/SENIOR WOMAN ADMINISTRATOR • Notifies Director of Compliance • Notifies Faculty Athletic Representative • Direct travel/lodging for Parents/Next of Kin • Direct establishing a meeting space at hospital facility if appropriate.

SENIOR ASSOCIATE ATHLETIC DIRECTOR EXTERNAL AFFAIRS • Notifies Director of Athletics Communications • Notifies University Communications Director • Coordinate eventual media release with appropriate CIMT personnel • No release will be made until Parents/Next of Kin are notified.

ASSISTANT ATHLETIC DIRECTOR FOR ATHLETICS COMMUNICATIONS • Establish “no publicity” protection for Student-Athlete with hospital facility • Responsible for keeping all media at a safe distance from the private meeting space and that they do not “harass” team or University personnel in or around the medical facility if applicable.

ASSISTANT ATHLETIC DIRECTOR FOR INTERNAL OPERATIONS • Notifies or is notified by Head Athletic Trainer • Notifies University Director of Risk Management 93

• Notifies Director of Public Safety DIRECTOR OF ATHLTEICS COMPLIANCE • Notifies professors of incident and impact on class/grades • Provide guidance regarding payment of incidental expenses and interpretive support relating to any NCAA regulations.

COACHING AND SUPPORT STAFF • Notify Director of Athletics and Head Athletic Trainer of Catastrophic Incident • Follow Immediate Action Plan • Direct Student-Athletes to not discuss incident with outside personnel • Support Student-Athletes and facilitate CI Immediate Action Plan.

RISK MANAGER • Notify UNI Insurance Carrier • Enact any Catastrophic incident procedures for UNI Administration • Work collaboratively with UNI Athletic Department to gather incident facts • Communicate with UNI Legal Counsel.

SENIOR VICE PRESIDENT FOR STUDENT AFFAIRS • Coordinate communication with Athletic Department and Student Affairs Activities • Help facilitate efforts of Athletic Department, parent’s office, counseling services and campus Catastrophic incident Stress Management Team (for counseling of team, coaches, staff)

UNI COUNSELING SERVICES • 319-273-2676 between the hours of 8:00 a.m. and 5:00 p.m. • For urgent situations outside of office hours, call UNI Public Safety at 319-273-2712 and they will contact a Counseling Center staff • Activate Catastrophic Incident Stress Management Team to provide immediate grief counseling to student-athletes, coaches, and staff • Provide any follow-up counseling post-incident to student-athletes, coaches, or staff members

UNI FACULTY REPRESENTATIVE • Serve as faculty liaison to campus for the Athletic Department

INSURANCE COORDINATOR • Communicate health insurance procedure information as needed

V. CRIMINAL CIRCUMSTANCES (ACCIDENT, ASSAULT, HOMICIDE, SUICIDE)

UNI PUBLIC SAFETY • Public Safety notified immediately of catastrophic incident involving possible criminal activity. Director of Athletics follows CI plan as necessary based on type of incident • Director of Public Safety notified • Public Safety communicates with Cedar Falls Police Department • Public Safety communicates information as appropriate to CIMT

VI. AWAY CONTESTS-COACHES, ADMINISTRATORS AND STAFF MEMBERS • Immediately notify Director of Athletics and Head Athletic Trainer of CI • Work with local hospital, Sports Medicine Staff, Athletic Department, or Police to assist in process and gather information to update the Director of Athletics and/or Head Athletic Trainer 94

• The Head Coach and/or Administrator remains on site after team departs to coordinate communication and arrangements with UNI Administration until relieved by a representative of UNI.

UNI Athletic Training personnel and/or a member of the UNI Department of Intercollegiate Athletics will accompany the injured student-athlete to the medical facility with the injured student-athlete’s emergency medical information. The athletic trainer will not leave the contest unattended unless there is another athletic trainer on-site to continue coverage of the student- athletes. The UNI athletic training staff member will initiate the Catastrophic Incident Plan. Once at the medical facility, the designated individual will call back to the UNI athletic trainer with updates until the athletic trainer arrives at the facility.

VII. POST CI SUMMARY A detailed written summary by each participating member of the CIMT will be prepared following any catastrophic incident which identifies and explains the activities of those who participated in and responded to the incident. This summary will be used to critique the process, its efficiency and effectiveness, and will be used as the basis for review of procedures by the CIMT.

UNI Catastrophic Incident Flow Chart

Head Athletic Trainer Administration Notified by Notified Athletic Director

XLVIII. LIGHTNING SAFETY

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING SERVICES Policy Statement On Thunder & Lightning {updated as of 07/25/18 }

Education

Lightning occurs due to a natural electrical discharge within the atmosphere. As a thunderstorm develops a region of positive and negative charges are separated into layers. This separation produces electrical potential that continues to build in strength until the air can no longer resist the attraction resulting in a flash. This flash is commonly categorized in one of two ways: a cloud discharge/in-cloud lightning, or cloud to ground lightning. Cloud to ground lightning is initiated by an electrical breakdown between the positive and negative charge regions. A faint luminous channel, known as the stepped leader, descends in a downward pattern toward the ground. As this stepped leader nears the ground an opposite discharge ascends from the ground or other object to meet the stepped leader. At this point of junction the cloud is short circuited to the ground, and a brilliant flash of high current is seen. A flash has a billion volts of energy with a peak current between 10,000 and 200,000 amperes.

Thunder is created when the air immediately around the lightning channel is superheated. This heated air expands rapidly producing the claps, rumbles and all other sounds of thunder. Thus, thunder is actually the result of lightning and always accompanies it. Thunder at a distance is heard beginning with a rumble while at nearer vicinities it is initiated as a clap followed by a long rumble. Since light travels much faster than sound, the amount of time between a lightning bolt and thunder clap allows the distance of the lightning to be calculated based on the sound traveling at a rate of one mile per five seconds. This method of calculation is known as the flash-to-bang system which will be discussed in more detail in the methods of gathering information section.

Cloud-to-ground lightning strikes are most prominent from late spring to early autumn with the number of positive flashes peaking in July. Strikes tend to occur most frequently during the afternoon and early evening, and the majority of fatalities have been reported to occur between 10 a.m. and 7 p.m. This puts athletics at an increased risk since practices traditionally take place during the periods of elevated lightning occurrence.

The goal of this policy is to minimize lightning casualties by emphasizing advanced planning and the recognition of a potential threat. However, it is also important to know what to do if caught by surprise. If you are caught in a dangerous situation too far from a safe shelter and you feel your hair stand on end or your skin tingle, you should immediately crouch down on the balls of your feet with your arms wrapped around your knees and your head down. Minimize your body’s surface area and minimize contact with the ground. Do not be the highest object or connected to anything taller than its surroundings, avoid metal objects, individual trees and standing pools of water.

Lightning-Safety Slogans

 NO Place Outside Is Safe When Thunderstorms Are in the Area.  When Thunder Roars, Go Indoors!  Half An Hour Since Thunder Roars, Now It’s Safe To Go Outdoors.

Treatment

In the event that a person is struck by lightning, do not hesitate to assist them; unlike electrical victims they do not carry a charge so they may be safely handled. If the victim is not breathing yet has a pulse, begin mouth-to-mouth resuscitation, once every five seconds for adults. If a pulse is absent as well, it is imperative to initiate and sustain cardiopulmonary resuscitation (CPR) as soon as possible. If there are multiple victims, aid should be administered to the apparently “dead” first. Keep in mind, for the safety of the rescuer, the possibility of a second strike within the immediate area. 97

Methods of Gathering Lightning Information

The decision to suspend a game or practice will be based on the following information systems.

Flash to Bang Method

To estimate the distance between your location and a lightning flash, use the "Flash to Bang" method: If you observe lightning, count the number of seconds until you hear thunder. Divide the number of seconds by five to obtain the distance in miles.

If Thunder is heard The Lightning is...

5 seconds after a Flash 1 mile away

10 seconds after a Flash 2 miles away

15 seconds after a Flash 3 miles away

20 seconds after a Flash 4 miles away

25 seconds after a Flash 5 miles away

30 seconds after a Flash 6 miles away

35 seconds after a Flash 7 miles away

40 seconds after a Flash 8 miles away

Because lightning can strike up to 10 miles from a storm, you should seek safe shelter as soon as you hear thunder or see lightning. Get to a safe location if the time between the lightning flash and the rumble of thunder is 30 seconds or less.

WeatherBug Online®

This is a satellite network provider that receives and disseminates information every 15 seconds to the subscribers of this service. The service can show the past movement of severe storms containing lightning. This service shows the distance and location of the last lightning strikes. The network cannot predict where the next strike will be. The information provided allows the user to determine existing lightning dangers and includes an all-clear notification of when it’s safe to resume activity. This program allows for lightning and other forecasted and observed weather notifications for UNI Athletics GPS position and fixed locations of concern. It provides interactive weather maps to see lightning and current weather storm tracks and “future radar”, a 90-minute projected radar animation.

The decision maker may consult the weather service web site to evaluate the lightning/storm tracker to evaluate current lightning locations and storm movement.

Available Meteorologist

A meteorologist should be consulted if there is one available. Time constraints in contacting him/her should be considered as well as the risk of lightning continuing to move into the area.

Decision Making

The decision to suspend a game or practice will be made by the following individuals.

Practice

The certified athletic trainer will make the final decision. All athletic staff must assess the dangers by the methods stated in this policy. If available, the staff grounds/facilities or game management administrators will help gather and disseminate lightning information. Coaches are required to follow the decisions made by the athletic training and game management administrative staff. Any individual, athlete or staff member who feels he or she is in danger of lightning has the right to leave the field and seek safe shelter.

Prior to Contest

The game administrator and/or host certified athletic trainer will make the final decision. These individuals must assess the dangers by the methods stated in this policy. If available, the staff grounds keepers will help gather and disseminate lightning information. The responsibility remains with the game administrator and/or athletic trainer hosting the activity to remove the teams or individuals from the field or event site. With the information presented in this policy, these individuals can make an informed, intelligent and safe decision regarding the risk of a lightning strike. Any individual, athlete or staff member who feels he or she is in danger of lightning has the right to leave the field and seek safe shelter.

During Contest

The head official will make the final decision. The game administrator and/or host head coach shall inform head official of the dangers associated with lightning and of the department lightning policy. These individuals must assess the dangers by the methods stated in this policy. Whenever possible, the staff certified athletic trainer(s) will advise the game administrator and/or host head coach of the danger of lightning. If available, the staff grounds keepers will help gather and disseminate lightning information. The responsibility remains with the head official supervising the activity to remove the teams or individuals from the field or event site. With the information presented in this policy, these individuals can make an 99 informed, intelligent and safe decision regarding the risk of a lightning strike. Any individual, athlete or staff member who feels he or she is in danger of lightning has the right to leave the field and seek safe shelter.

Safer Shelters

Know where the closest “safer structure or location” is to every outdoor venue and know how long it will take to evacuate everyone to that safer location. A safer structure or location is defined as any building normally occupied or used by people, i.e., a building with plumbing and/or electrical wiring that acts to electrically ground the structure. Avoid the shower, plumbing facilities, contact with electrical appliances and open windows and doorways during a thunderstorm.

In the absence of a sturdy, frequently inhabited building, any vehicle with a hard metal roof (neither a convertible, nor a golf cart) with the windows shut provides a measure of safety. The hard metal frame and roof, not the rubber tires, are what protects occupants by dissipating lightning current around the vehicle and not through the occupants. It is important not to touch the metal framework of the vehicle. Some athletics events rent school buses to provide safer locations around open courses or fields.

Safer shelters at the University of Northern Iowa include, but are not limited to:

UNI VENUE Primary Safe Secondary Safe Unacceptable Location(s) Location(s) Location(s) Women’s Soccer McLeod Center, UNI Personal vehicles Convertible / “soft-top” Practice / Rugby / Dome, Wellness w/metal roof and/or vehicles, golf carts, Intramural Fields Recreation Center team bus storage sheds, canopy, awning, and/or tents IM Baseball / Softball UNI Dome, Wellness Personal vehicles Dugouts, convertible / Fields Recreation Center, HPC w/metal roof and/or “soft-top” vehicles, golf and/or PEC team bus carts, storage sheds, canopy, awning, and/or tents Football Practice Field UNI Dome, Wellness Personal vehicles Dugouts, convertible / Recreation Center, HPC w/metal roof and/or “soft-top” vehicles, golf and/or PEC team bus carts, storage sheds, canopy, awning, and/or tents Outdoor Track / WRC, HPC/PEC, Personal vehicles Convertible / “soft-top” Tennis Courts Bender / Dancer Hall, w/metal roof and/or vehicles, golf carts, and/or Towers Center team bus storage sheds, canopy, awning, and/or tents Cedar Valley Soccer Concessions/Rest Personal vehicles Convertible / “soft-top” Complex Room Building w/metal roof and/or vehicles, golf carts, team bus storage sheds, canopy, awning, and/or tents Robison Dresser Storm shelter, personal Dugouts, grandstand, Complex, Cedar vehicles w/metal roof convertible / “soft-top” Falls/UNI Softball and/or team bus vehicles, golf carts, Field storage sheds, canopy, awning, and/or tents Pheasant Ridge Golf Club House Personal vehicles Convertible / “soft-top” Course Cedar Falls w/metal roof and/or vehicles, golf carts, team bus storage sheds, canopy, awning, and/or tents Blackhawk Tennis Club House Personal vehicles Convertible / “soft-top” Club w/metal roof and/or vehicles, golf carts, team bus storage sheds, canopy, awning, and/or tents

100

Suspension of Activity

The average distance from one lightning strike to the next is approximately 2 to 3 miles, yet can be as much as 10 miles. Therefore, while a storm may still be several miles from your location, the very next strike could be on top of you. Based on NCAA Guidelines and the Texas A&M University Meteorology Department, all activity should be suspended and all persons should seek safe shelter when using the flash-to-bang method a 30 second count is made between lightning strike and thunder. This is equivalent to a distance of six miles or less. This rule is the called the 30-30 rule.

Return to Activity

To resume athletics activities, lightning safety experts recommend waiting 30 minutes after both the last sound of thunder and after the last flash of lightning is at least six miles away, and moving away from the venue. If lightning is seen without hearing thunder, lightning may be out of range and therefore less likely to be a significant threat. At night, be aware that lightning can be visible at a much greater distance than during the day as clouds are being lit from the inside by lightning. This greater distance may mean that the lightning is no longer a significant threat. At night, use both the sound of thunder and seeing the lightning channel itself to decide on when to reset the 30-minute return-to-play clock before resuming outdoor athletics activities.

XLIX. EXPOSURE CONTROL PLAN

UNI ATHLETIC TRAINING SERVICES Communicable Disease Policy/Blood-Borne Disease Control

The University of Northern Iowa (UNI), its Athletic Department, and its Athletic Training Services Department are committed to providing a safe and healthful work environment. In pursuit of this endeavor, the Exposure Control Plan (“ECP” or “Plan”) set forth below is aimed at eliminating or minimizing the risk of those employees, athletic training students*, and student managers, among others (“employees”), of the University of Northern Iowa Athletic Department (“Department”) and Health, Physical Education and Leisure Services Division of Athletic Training, whose job-related exposure to blood and other potentially infectious materials presents a measurable danger of exposure to blood-borne pathogens and other body fluids

The plan is based on provisions in the Occupational Safety and Health Association’s (OSHA) Occupational Exposure to Blood-borne Pathogens Standard, 29 C.F.R. § 1910.1030, and requires the Department to institute or provide universal precautions, engineering and work practice controls, personal protective equipment, sanitary housekeeping, employee training, hepatitis B vaccinations, post-exposure evaluations and follow-up, and certain recordkeeping practices. The Department has identified those employees whose job-related responsibilities fall within the scope of the OSHA standard. Those employees are covered by and must comply with the Plan.

*Although athletic training students are not employees of the University, they are expected to abide by the guidelines contained in this Plan.

A. Definitions-

Blood- includes human blood, human blood components (plasma, platelets, and serosanguineous fluids- e.g., exudates from wounds), and/or products made from human blood.

Blood-borne pathogens- Although HBV and HIV are widely recognized and specifically identified, the term includes any pathogenic microorganism that is present in human blood or OPIM and can infect and cause disease in persons who are exposed to blood containing the pathogen. Pathogenic microorganisms include, but are not limited to, hepatitis B virus (HBV), human immunodeficiency virus (HIV), hepatitis C virus (HCV), malaria, syphilis, and other diseases.

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Contaminated- means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

Contaminated Laundry- means laundry that has been soiled with blood or other potentially infectious materials or may contain sharps.

Contaminated Sharps- means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, razor blades, glass, broken tubes, and exposed ends of wires.

Decontamination- means the use of physical or chemical means to remove, inactivate, or destroy blood borne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

Exposure Incident- means specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.

Hand washing Facilities- means a facility providing an adequate supply of running potable water, soap, and single use towels and/or hot air drying materials.

Licensed Healthcare Professional- a person whose legally permitted scope of practice allows him/her to independently perform the activities required by paragraph (f) hepatitis B Vaccination and Post-exposure Evaluation and Follow-up of the OSHA Safety and Health Standards (Standard # 1910.1030)

HBV- means hepatitis B virus.

HCV- means hepatitis C virus. According to the Centers for Disease Control (CDC), hepatitis C virus is the most common chronic blood-borne infection in the US. The infection may lead to chronic liver disease. Currently, there is no vaccine effective against HCV.

HIV- means human immunodeficiency virus.

Occupational Exposure- means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties.

Other Potentially Infectious Materials (OPIM) - means (1) The following human body fluids:  Semen  Vaginal secretions  Cerebrospinal fluid  Synovial fluid  Pleural fluid  Pericardial fluid  Peritoneal fluid  Amniotic fluid  Saliva in dental procedures  Any body fluid that is visibly contaminated with blood  All body fluids in situations where it is difficult or impossible to differentiate between body fluids  Any unfixed tissue or organ (other than intact skin) from a human (living or dead); (2) HIV-containing cell or tissue cultures, organ cultures, and HIV-, HBV-, or HCV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV, HBV, or HCV.

Parenteral- means piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

Personal Protective Equipment (PPE) - is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts, or blouses) not 102

intended to function as protection against a hazard are not considered to be personal protective equipment.

Regulated Waste- means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.

Source Individual- means any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. Examples include, but are not limited to, student-athletes; hospital and clinic patients; trauma patients; human remains; and individuals who donate or sell blood or blood components.

Sterilize- means the use of a physical or chemical procedure to destroy all microbial life, including, but not limited to, highly resistant bacterial endospores.

Universal Precautions- is an approach to infection control where all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, HCV, and/or other blood-borne pathogens.

Work Practice / Engineering Controls- means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting the recapping of needles by a two- handed technique)

B. Program Administration-

 The University of Northern Iowa Athletic Training / Sports Medicine Department’s Exposure Control Plan has been in place since July 1, 2000.

 The Director of Athletic Training Services and/or designee is responsible for the implementation of the Exposure Control Plan.

 The Director of Athletic Training Services and/or designee will maintain, review, and update the ECP at least annually, and whenever necessary to include new or modified tasks and procedures.

 Questions, comments, and/or concerns regarding the UNI Athletic Training Services Department’s Exposure Control Plan should be directed to:

Don Bishop, Director of Athletic Training Services University of Northern Iowa Human Performance Complex 008 2351 Hudson Rd. (319) 273-6369 fax (319) 273-7023 email- [email protected];

 Those employees who are determined to have occupational exposure to blood or other potentially infectious materials (OPIM) must comply with the procedures and work practices outlined in this ECP.

 The Director of Athletic Training Services and/or designee will maintain and provide all necessary personal protective equipment, engineering / work practice controls, labels, and/or red bags as required by the standard.

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 The Director of Athletic Training Services and/or designee will ensure that adequate supplies of the aforementioned equipment are available in the appropriate sizes.

 The Director of Athletic Training Services and/or designee will be responsible for ensuring that all medical actions required are performed and that appropriate employee health and OSHA records are maintained.

 The Director of Athletic Training Services and/or designee will be responsible for training, documentation of training, and making the written ECP available to employees, OSHA, and National Institute for Occupational Safety and Health (NIOSH) representatives.

 Employees covered by the blood borne pathogens standard will receive an explanation of the Exposure Control Plan during their initial training and orientation session. It will also be reviewed in the annual “refresher” training session.

 All employees have an opportunity to review this plan at any time by contacting the Director of Athletic Training Services and/or designee.

 If requested, the Director of Athletic Training Services and/or designee will provide a copy of the Exposure Control Plan free of charge and within 15 business days of the request.

C. Employee Exposure Determination-

 All employees who, as a result of performing their job duties, must engage in activities where exposure to blood and/or other potentially infectious materials is reasonably anticipated are considered to have occupational exposure.

 Certain groups of tasks have been identified as those where occupational exposure could be reasonably anticipated. These include, but are not limited to: o Direct contact with body fluids; o Direct contact with needles, scalpels, and/or other instruments, equipment, or surfaces that are contaminated with blood or other potentially infectious materials. o Handling of contaminated laundry; o Handling of regulated waste products; o Performance of emergency Basic Life Support and/or First Aid procedures; o Other duties as determined.

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The following is a list of all job classifications within the UNI School of HPELS (Division of Athletic Training & Strength & Conditioning) in which all employees have occupational exposure:

JOB TITLE DEPARTMENT / LOCATION Certified Athletic Trainers Human Performance Complex Athletic Training Room; West Gymnasium Athletic Training Room; McLeod Center Athletic Training Room Athletic Training Students Human Performance Complex Athletic Training Room; West Gymnasium Athletic Training Room; McLeod Center Athletic Training Room Team Physicians / Medical Human Performance Complex Athletic Training Room; Consultants West Gymnasium Athletic Training Room; McLeod Center Athletic Training Room Strength & Conditioning Personnel Human Performance Complex Weight Room

 The following is a list of job classifications within the UNI Athletic Department in which some employees have occupational exposure. Included in a list of tasks and procedures, or groups of closely related tasks and procedures, in which occupational exposure may occur for these individuals:

JOB TITLE DEPARTMENT / LOCATION TASK / PROCEDURE Equipment Manager 163 Human Performance Handling contaminated Complex laundry; UNI Dome Game Management UNI Dome Emergency Basic Life Personnel Support and/or First Aid procedures; Housekeeper / Custodian Wellness Recreation Center; Handling regulated waste; Human Performance Complex; UNI Dome; McLeod Center; West Gymnasium;

 All employees should take necessary precautions to avoid direct contact with body fluids and should, except when absolutely necessary for the performance of duties, not participate in activities that will require them to come into contact with body fluids, needles, or other instruments, equipment, and/or surfaces that are contaminated with blood or other potentially infectious materials.

 In cases of occupational exposure, employees are to exercise extreme caution and utilize universal precautions and personal protective equipment at all times.

D. Universal Precautions-

The term “universal precautions” refers to a concept of blood-borne disease control which requires that ALL human blood and OPIM be treated as if known to be infectious for HIV, HBV, HCV, or other blood borne pathogens, regardless of the perceived “low risk” status of a patient or patient population. Universal Precautions should be observed by all personnel to prevent contact with blood or other potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids should be considered potentially infectious materials.

 ALL employees should routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any patient is anticipated.  Gloves should be worn for touching blood and body fluids, mucous membranes, or non-intact skin of all patients, for handling items or surfaces soiled with blood or body fluids, and for performing venipuncture and other vascular access procedures.  Gloves should be changed after contact with each patient.

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 Hands should be washed before and after patient contact, and immediately after gloves are removed.  Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids.  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 membranes of the mouth, nose, and eyes.  Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or other body fluids.  Surgical caps or hoods and/or shoe covers or boots shall be worn in instances when gross contamination can reasonably be anticipated;  In order to minimize the need for emergency mouth-to-mouth resuscitation, mouthpieces, resuscitation bags, or other ventilation devices should be available for use in areas and/or situations in which the need for resuscitation is predictable.  Persons who have exudative lesions or weeping dermatitis should refrain from all direct patient care and from handling patient-care equipment until the condition resolves.  All employees should take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices during procedures; when cleaning used instruments; during disposal of used needles; and when handling sharp instruments after procedures.  Disposable syringes and needles, scalpel blades, disposable scalpels, razor blades, and other sharp items should be placed in a puncture resistant “sharps” container for disposal.  Lab specimens should be transported in a manner to prevent leaking.  Soiled linen(s) should be bagged at the point of origin and should not be sorted or rinsed in patient care areas.  All procedures involving blood or OPIM shall be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances;  Mouth pipetting / suctioning of blood or OPIM is prohibited.

E. Universal Blood and Body Fluid Precaution Guidelines-

Procedures Wash Gloves Gown Mask Eyewear Hands Talking with patients, shaking hands, adjusting IV X fluid rate or noninvasive equipment;

Examining patients without touching blood, body X fluids, mucous membranes

Examining a patient with a significant cough X X

Examining a patient including contact with blood, X X body fluids, mucous membranes, drainage

Suctioning X X Use a gown, mask, and/or eyewear if bloody body fluid spattering is likely;

Handling soiled waste, linen, or other materials X X Use a gown, mask, and/or eyewear if waste or linen is extensively contaminated and spattering is likely;

Procedures that produce extensive spattering of X X X X X blood or body fluids & are likely to soil clothes

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F. Category-Specific Isolation System-

A. Strict Isolation-

 Designed to prevent the transmission of highly contagious or virulent infections that may be spread by both air and contact.

2. Specifications for Strict Isolation- a. Private room is indicated; door should be kept closed; b. Gloves, gowns, and masks are indicated for all persons entering the room; c. Hands must be washed after touching the patient or potentially contaminated articles and before taking care of another patient; d. Articles contaminated with infective material should be discarded or bagged and labeled before being sent for decontamination and reprocessing.

3. Diseases Requiring Strict Isolation- a. Diphtheria, pharyngeal b. Lassa fever and other viral hemorrhagic fevers, such as Marburg virus disease c. Plague, pneumonic d. Smallpox e. Chickenpox (varicella) f. Zoster, localized in immunocompromised patient or disseminated

4. Contact Isolation-

a. Designed to prevent the transmission of highly transmissible or epidemiologically important infections (or colonization) that do not warrant Strict Isolation; b. All diseases or conditions included in this category are spread primarily by close or direct contact.

5. Specifications for Contact Isolation- a. Private room is indicated; b. Masks are indicated for those who come close to patient; c. Gowns are indicated if soiling is likely; d. Gloves are indicated for touching infective material; e. Hands must be washed after touching the patient or potentially contaminated articles and before taking care of another patient; f. Articles contaminated with infective material should be discarded or bagged and labeled before being sent for decontamination and reprocessing.

6. Diseases Requiring Contact Isolation- a. Acute respiratory infections including croup, colds, bronchitis, bronchiolitis caused by respiratory syncytial virus, adenovirus, coronavirus, influenza viruses, parainfluenza viruses, and rhinovirus; b. Conjunctivitis; c. Diphtheria, cutaneous; d. Endometritis, group A Streptococcus; e. Furunculosis; f. Herpes simplex, disseminated, severe primary or neonatal; g. Impetigo; h. Influenza; i. Multiply-resistant bacteria, infection, or colonization with any of the following: i. Gram-negative bacilli resistant to all aminoglycosides that are tested; ii. Staphylococcus aureus resistant to methicillin, nafcillin, or oxacillin; iii. Pneumococcus resistant to penicillin; iv. Haemophilus influenzae resistant to ampicillin and chloramphenicol;

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v. Other resistant bacteria may be included if they are judged by the infection control team to be of special clinical and epidemiologic significance; j. Pediculosis; k. Pharyngitis, infectious l. Pneumonia, viral, Staphylococcus aureus or Group A Streptococcus m. Rabies; n. Rubella, congenital or other; o. Scabies; p. Scalded skin syndrome, staphylococcal (Ritter’s disease) q. Skin wound or burn infection, major (draining and not covered by dressing or dressing does not adequately contain the purulent material) including those infected with Staphylococcus aureus or Group A Streptococcus r. Vaccinia (generalized and progressive eczema vaccinatum)

G. Engineering and Work Practice Controls-

Engineering and work practice controls will be used as the primary means of eliminating or minimizing a person’s exposure to blood-borne pathogens. Engineering and work practice controls will be examined and maintained or replaced on a regular (bi-annual) basis and as needed. The Director of Athletic Training Services and/or designee will monitor on a daily basis or as needed specific engineering and work practice controls.

a. General Engineering and Work Practice Controls-  Clean” activities (medication administration, wound care, etc.) are to be performed in an area away from areas where “dirty” activities (handling soiled linen and contaminated equipment, etc.) are performed;  Supplies used are to be kept at least 8-10 inches off of the floor;  Supplies and medications are to be checked for integrity of the packaging, sterility (as indicated), and expiration dates before use and on a monthly basis by the Director of Athletic Training Services and/or designee;  Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure;  Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets, or on countertops or bench tops where blood or OPIM are present;  Spittoons should be made available for sports that establish a need (e.g. wrestling);  Tables, countertops, whirlpools, and any other stations that are used for medical purposes are to be disinfected on a daily basis, or as needed following every possible contamination.  Sterile and clean supplies (paper towels, cups, and soaps) are not to be stored under sinks or near water.

b. Personal Protective Equipment (PPE)-  All employees will be trained in the types, proper use, location, disposal, etc. of PPE;  PPE sufficient enough to prevent blood or OPIM from passing through to, or contact clothing, undergarments, skin, eyes, mouth, or other mucous membranes will be provided to all employees at no cost to the employee;  PPE can include, but is not limited to: gloves, gowns, aprons, lab coats, goggles, face shields, masks, protective eyewear, mouthpieces, ventilation/resuscitation devices, shoe covers, etc.;  PPE should be made of appropriate material and be of appropriate size for each employee;  Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided.  PPE should not be used if peeling, cracked, discolored, or have other evidence of deterioration.  Single-use (disposable) gloves should not be washed or disinfected for reuse. Utility gloves may be decontaminated for reuse if their integrity is not compromised.  PPE must be replaced as soon as practical and feasible when contaminated, and before leaving the work area;

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 Gowns should be made of, or lined with, impervious material and should protect all areas of exposed skin;  Resuscitator devices are to be readily available and accessible to employees who can reasonably be expected to perform resuscitation procedures.  Appropriate PPE should be used at all times by all employees. There are limited situations in which the use of PPE would prevent the proper delivery of healthcare or public safety services, or would pose an increased hazard to the personal safety of the worker or coworker. The decision not to use PPE is to be made on a case-by-case basis and must have been prompted by legitimate and truly extenuating circumstances.  Used and contaminated PPE must be disposed of in a biohazard (red-bag) container.  PPE that is not single-use (disposable) and is able to be decontaminated should be done so under appropriate measures.  Laundering of PPE is to be performed by the employer at no cost to the employee.  PPE will be repaired and/or replaced as needed to maintain its effectiveness.  All PPE shall be removed prior to leaving the work area.

H. “BLOOD KIT” CONTENTS-

The following supplies and/or equipment will be neatly arranged in the “blood kit” to be supplied to visiting teams:  Sterile gauze  Latex gloves  Assorted adhesive bandages  Sani-wipe disinfectant towelettes  Hydrogen peroxide spray bottle  Alcohol towelettes (5-8)  Biohazard bag(s)  Small “sharps” container

I. Hand washing-

 Hand washing facilities should be readily accessible to all employees and visiting athletic teams.  Employees are to wash hands and any other skin that has come in contact with blood or any other potentially infectious material with soap and at least tepid water, or flush mucous membranes with water immediately or as soon as feasible.  Employees shall wash their hands with soap and at least tepid water immediately following the removal of gloves or other PPE.  Employees should engage in appropriate hand washing practices upon leaving the work area if he/she has come in contact with blood or OPIM.  When the provisions of appropriate hand washing facilities are not feasible and/or readily accessible, an alcohol-based antiseptic hand cleanser in conjunction with clean cloth/paper towels and/or antiseptic towelette will be provided.  Antiseptic towelettes should be disposed of as would any other trash, except in the very rare circumstance where they become contaminated to the extent that they would be considered regulated waste. In such a case, the towelette(s) should be disposed of as per the “regulated waste” section of this plan.  Hands and/or other skin surfaces cleansed using antiseptic towelettes and/or alcohol-based antiseptic hand cleansers are to be washed in an appropriate fashion as soon as feasible.  If a possible infectious exposure occurs to the face and/or eyes, all surfaces are to be cleansed using running water and/or commercial eyewashes available in the athletic training room.  All student-athletes must shower, using liquid soap dispensers, before receiving treatment of any kind in the athletic training room.

J. Regulated Waste Management-

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 Biohazard waste cans and/or pails will be inspected, maintained, disinfected, decontaminated, and/or replaced by the Director of Athletic Training Services and/or designee every Monday or whenever necessary to prevent overfilling;  Biohazard (“red”) bags are to be sealed appropriately and set outside of the athletic training room when full for the custodial staff to properly dispose of;  Specimens of blood or other potentially infectious materials shall be placed in a container that will eliminate any leakage during the collection, handling, processing, storage, transport, and/or shipping of the specimen.  The container for storage, transport, or shipping shall be labeled or color-coded and closed to prevent spillage or protrusion of contents during handling, storage, transport, or shipping. o If outside contamination of the primary container occurs, the primary container should be placed within a second container which is closeable, prevents leakage during handling, processing, storage, transport, or shipping, and is labeled or color-coded appropriately.  If the specimen could puncture the primary container, the primary container should be placed within a secondary container, which is puncture-resistant in addition to the above characteristics.  Disposal of all regulated waste shall be in accordance with applicable regulations of the United States, State of Iowa, Black Hawk County, and the University of Northern Iowa.

K. Contaminated “Sharps”-

 “Sharps” / needles shall be disposed of in an appropriate, color-coded “sharps container” labeled as “biohazardous”. The container must be puncture resistant, closeable, and leak proof on the sides and bottom.  During use, containers for contaminated sharps should be: 1. Easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found; 2. Maintained upright throughout use; 3. Replaced routinely and not be allowed to overfill.  When moving containers of contaminated sharps from the area or use, the containers shall be: 1. Closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping; 2. Placed in a secondary container if leakage is possible. The secondary container shall be closeable, appropriately labeled or color-coded, and constructed to contain all contents and prevent leakage during handling, storage, transport, and shipping;  Shearing, breaking, bending, recapping, removing, and/or otherwise manipulating “sharps”/ needles by hand is prohibited.  Special circumstances may exist in which recapping, bending, or removing needles is necessary. However, recapping must be performed by some method other than the traditional “two-handed” procedure. Acceptable procedures include the use of a mechanical device or forceps and/or the “one-hand scoop” method;  Containers for reusable “sharps” must meet the same requirements as outlined above, with the exception that they are not required to be closable.  Employees are not to place their hand(s) into containers whose contents include reusable sharps contaminated with blood or OPIM.  Reusable containers shall not be opened, emptied, or cleaned manually or in any other manner, which would expose employees to the risk of percutaneous injury.  “Sharps” disposal containers will be inspected and maintained and/or replaced by the Director of Athletic Training Services and/or designee every month or whenever necessary to prevent overfilling.

L. Housekeeping / Cleaning of Facilities and Equipment -

 All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or OPIM.

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 Contaminated work surfaces shall be decontaminated with an appropriate disinfectant after completion of all procedures; immediately or as soon as feasible when surfaces are overtly contaminated or after any spill of blood or OPIM; and at the end of the day if the surface may have become contaminated since the last cleaning;  Protective coverings, such as plastic wrap, aluminum foil, or imperviously-backed absorbent paper used to cover equipment and environmental surfaces, should be removed and replaced as soon as feasible when they become overtly contaminated or at the end of the day if they may have become contaminated during the day;  All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable likelihood for becoming contaminated with blood or OPIM should be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination.  Broken glassware, which may be contaminated, should not be picked up directly with the hands. It shall be cleaned up using mechanical means, such as a brush and dustpan, tongs, or forceps.  Reusable sharps that are contaminated with blood or OPIM shall not be stored or processed in a manner that requires employees to reach by hand into the containers where these sharps have been placed.

1. Hard Surfaces (floors, etc.)-  The individual(s) responsible for cleaning and disinfecting the area will adhere to Universal Precautions and wear PPE as needed;  The individual(s) will use disposable products (e.g. paper towels, Sani-Wipe, etc.) to clean and disinfect the area;  If the individual(s) use a non-disposable product (e.g. towel, shirt, mop, broom, etc.) to clean and disinfect the area, the non-disposable product should be handled according to the guidelines set forth in the “contaminated laundry” section of this Plan;  The individual(s) will also utilize an appropriate hard-surface disinfectant (e.g. Dispatch, Sanicide, Sporicidin, End-Bac etc.), soap and water, and/or a 1:10 diluted bleach solution for disinfection and decontamination of the area;  Absorbent products (e.g. Isolyzer, Red-Z, etc.) should be used, as needed, to contain the spill.

2. Tabletops, Countertops, Stools, Benches, etc.  The individual(s) responsible for cleaning and disinfecting the area will adhere to Universal Precautions and wear PPE as needed;  Treatment tables, taping tables, countertops, stools, and applicable rehabilitation equipment should be cleaned on a daily basis, or as needed following every possible contamination.  Treatment Tables, taping tables, countertops, stools, and applicable rehabilitation equipment are to be cleaned using an appropriate hard-surface disinfectant (e.g. Dispatch, Sanicide, Sporicidin, End-Bac etc.)To prepare the diluted solution,- combine the appropriate amount of the cleaner with water in a generic spray bottle designated for cleaning solution. The ratio of cleaner to water should be determined with respect to the following: o Follow the manufacturer’s diluting instructions as indicated on the bottle of cleaner. Different cleaners require different diluting ratios. o The size of the cleaning bottles may differ. o Ensure that the cleaner being used requires diluting. (*Diluting a cleaner that is not supposed to be diluted can render the solution ineffective.)  Tables, countertops, etc. are to be cleaned / disinfected in the following manner:  Spray the “table cleaner” solution on the surface to be cleaned;  Allow the solution to sit for 1-2 minutes;  Wipe down the surface with a towel.  Isopropyl alcohol and/or a 1:10 diluted bleach solution can also be used to clean tables, countertops, etc.

3. Hydrocollator Units- 111

 Hydrocollator units are to be drained, appropriately cleaned, and refilled every Thursday or Friday evening, or as needed following every possible contamination;  Hydrocollator covers are to be laundered every Friday night, or as needed following every possible contamination;

4. Coolers-  Coolers are to be cleaned and disinfected every day following use, or as needed following every possible contamination;  Coolers are to be cleaned using the dishwasher in the McLeod Center Kitchen area.  Coolers are to be towel dried and then stored upright with the tops off to allow for further drying and ventilation.

5. Medical Instruments-  All instruments (including athletic trainer’s equipment such as scissors, tape cutters, callous shavers, etc.) shall be cleaned and decontaminated in an appropriate fashion after contact with blood or OPIM.  The individual(s) responsible for cleaning and disinfecting will adhere to Universal Precautions and wear PPE as needed;  Pre-clean instruments with soap and water and thoroughly rinse free of all soap before immersion;  Follow directions on germicidal instrument cleansing solution bottle (e.g. Cidex, Abocide, Omnicare-DQ, etc.) for disinfecting and decontaminating instruments;  When using a glass / manual oral thermometer, the use of a plastic “thermometer sheath” is highly recommended;  Glass / manual oral thermometers shall be sanitized following every use using the “Dial-a- Therm” germicidal treatment;  The individual(s) responsible for cleaning and disinfecting will adhere to Universal Precautions and wear PPE as needed;  Place the used / contaminated thermometers in the plastic container;  Fill the plastic container with the appropriate dilution of Dial-a-Therm germicidal solution and water (as stated on the bottle);  Allow the used / contaminated thermometer to soak for a minimum of five (5) minutes;  Rinse the thermometer with water before the next use;  Replace diluted germicidal solution when the color fades from its normal “dark amber” color, or as needed;  When using an electric / digital thermometer, a plastic “thermometer sheath” shall be utilized;  Electric / digital thermometers should be sanitized following every use through the use of an alcohol swab.

6. Blood or OPIM Spill-  All contaminated surfaces will be cleaned and disinfected immediately, or as soon as feasible;  If a blood or OPIM spill occurs:  The individual(s) responsible for cleaning and disinfecting the area will adhere to Universal Precautions and wear PPE as needed;  The individual(s) will use disposable products (e.g. paper towels, Sani Wipe, etc.) to clean and disinfect the area;  If the individual(s) use a non-disposable product (e.g. towel, shirt, mop, broom, etc.) to clean and disinfect the area, the non-disposable product should be handled according to the guidelines set forth in the “contaminated laundry” section of this Plan;  The individual(s) will also utilize an appropriate hard-surface disinfectant (e.g. Sanicide, Sporicidin, End-Bac, etc.), soap and water, and/or a 1:10 diluted bleach solution for disinfection and decontamination of the area;  Absorbent products (e.g. Isolyzer, Red-Z, etc.) should be used, as needed, to contain the spill;  The individual(s) should be careful not to splash or splatter the blood or OPIM;  All materials are to be disposed of properly.

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7. Contaminated Laundry-  All employees who have contact with contaminated laundry shall wear protective gloves and other appropriate PPE;  Contaminated laundry should be handled as little as possible with a minimum of agitation;  Contaminated laundry should be bagged or containerized at the location where it was used and should not be sorted or rinsed in the location of use;  Contaminated laundry shall be sorted and bagged separately from other dirty linens and uniforms;  Contaminated laundry shall be placed and transported in appropriately labeled biohazard (“red”) bags;  Whenever contaminated laundry is wet and presents a reasonable likelihood of soak-through or of leakage from the bag or container, the laundry shall be placed and transported in bags or containers which prevent soak-through and/or leakage of fluids to the exterior;  Water temperatures for washing contaminated laundry items should be 160 F (or 71 C) or chemicals for low-temperature sterilization should be used in water less than 158 F (7 C).

8. Labeling:

 Warning labels shall be affixed to containers of regulated waste, refrigerators and freezers containing blood or OPIM; and other containers used to store, transport, or ship blood or OPIM;  Warning labels shall be fluorescent orange or orange-red or predominantly so, with lettering and symbols in a contrasting color.  Labels should be affixed as close as feasible to the container by string, wire, adhesive, or other method that prevents their loss or unintentional removal.  Red bags or red containers may be substituted for labels;

ITEM BIOHAZARD RED LABEL CONTAINER Regulated Waste Container YES or YES

Reusable contaminated sharps container YES or YES

Refrigerator / freezer holding blood or OPIM YES or YES

Containers used for storage, transport, or YES or YES shipping of blood or OPIM

Blood products for clinical use NO NO

Individual specimen containers of blood or YES or YES OPIM remaining in the facility

Contaminated equipment needing service YES NO

Specimens and regulated waste shipped YES or YES from UNI to another facility for service or disposal

Contaminated laundry YES or YES

Contaminated laundry sent to another YES or YES facility that does not use Universal Precautions

M. Post-Exposure Evaluation and Follow-up-

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 An exposure incident is defined as “specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s (or student’s) duties”. Should an exposure incident occur, the following steps are to be taken: 1. Perform initial first aid and emergency care on the individual(s); 2. Carefully document the incident on the “Exposure Incident Form” (see Appendix), including identification of the “source individual”; 3. Immediately inform the Director of Athletic Training Services and/or designee of the exposure incident. . The Director of Athletic Training Services will then notify the Chair of the Division of Athletic Training and the Director of Athletics and/or designee of the incident. 4. Refer the individual(s) to the appropriate medical personnel for a confidential post- exposure medical evaluation and testing. The medical evaluation and follow-up should minimally include the following elements: a) Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred; b) Identification and documentation of the source individual (unless identification is infeasible or prohibited by state or local law); c) Collection and testing of blood for HBV and HIV serological status as soon as feasible after the exposure incident; . If the exposed individual(s) consents to baseline blood collection, but do not give consent for HIV serological testing during collection of blood for baseline testing, the health care professional must preserve the individual’s blood sample for a minimum of 90 days. . If the exposed individual(s) elects to have the baseline sample tested during the 90 day waiting period, it is to be done as soon as feasible. d) Post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service; e) Counseling; and f) Evaluation of reported illnesses; 5. If the exposed individual(s) refuse to consent to a post-exposure evaluation and follow- up, he/she must sign the “Informed Refusal of Post-Exposure Medical Evaluation” Form (see Appendix); 6. The UNI Athletic Training Services Department will provide the health care professional with the following: . A copy of OSHA’s blood-borne pathogens standard; . A description of the exposed individual’s job duties as they relate to the exposure incident; . Route(s) of exposure; . Circumstances of exposure; . Results of the source individual’s blood test (if available); and . Relevant medical records for the exposed individual(s), including vaccination status; 7. Follow the Director for Athletic Training Services for isolation, testing, and/or treatment of all individuals involved with the exposure. 8. Isolate and treat the “source individual” as directed by the Director for Athletic Training Services; 9. Obtain consent and make arrangements to have the source individual tested as soon as possible to determine HIV, HCV, and HBV infectivity; . If the source individual is already known to be HIV, HCV, and/or HBV positive, new testing need not be performed. . The exposed individual(s) should be provided with the source individual’s test results and with information about applicable disclosure laws and regulations concerning the identity and infectious status of the source individual.

10. The Director of Athletic Training Services and/or designee will be responsible for obtaining and providing the exposed individual(s) with a copy of the healthcare professional’s written opinion within 15 days after the completion of the evaluation. 114

11. The healthcare professional’s written opinion should be limited to a statement that the exposed individual has been informed of the results and told of the need, if any, for further evaluation and/or treatment;

 All aspects of the Post-Exposure Evaluation and Follow-Up will be performed under the strictest of confidentiality. Anyone who violates and/or breaches this confidentiality will be subject to disciplinary action from the University of Northern Iowa, its Athletic Department, and/or the UNI Athletic Training Services Department.  At no time is anyone besides the exposed individual or the healthcare professional responsible for the exposed individual’s evaluation, follow-up, and treatment allowed to disclose test results;  All evaluations, follow-up, and/or treatment should be made available at no cost to the exposed individual at a reasonable time and place.  A licensed physician or other licensed health care professional should perform all evaluations, follow-up, and/or treatment.  The healthcare professional responsible for the exposed individual’s evaluation, follow-up, and treatment and/or the Director of Athletics and/or designee are the only persons authorized to release a statement to the press/media concerning the exposure incident.  Following every exposure incident, the Director of Athletic Training Services and other individuals appointed by the Director of Athletic Training Services will review and evaluate the circumstances of the incident. This evaluation will include: 1. A review of the engineering and work practice controls used at the time; 2. A description of the device being used (if applicable); 3. A review of protective equipment or clothing that was used at the time of the exposure incident; 4. A review of the location of the incident; 5. A review of the procedure being performed when the incident occurred; 6. A review of the exposed individual’s continuing education and training; 7. A review of the Exposure Incident Report; 8. A review of post-exposure evaluation and follow-up process; 9. A review of any plan(s) to reduce the likelihood of a future similar exposure incident; If it is determined that revisions need to be made to the Exposure Control Plan, the Director of Athletic Training Services and/or designee will ensure that the appropriate changes are made.

N. Recordkeeping- Records are required to be kept for each student and employee covered by the OSHA standard for training, as well as for medical records.

Training Records-  Training records will be completed for each athletic training student upon the completion of the training session.  Training records for athletic training students will be located in the office of the Director of the Athletic Training Education Program (Office 3G, Human Performance Complex).  Training records should include: a) The dates of the training sessions; b) The contents or a summary of the training sessions; c) The names and qualifications of persons conducting the training; d) The names and job titles of all persons attending the training sessions;  Training records are not considered confidential and should be provided upon written request to an employee, an athletic training student, and/or an authorized representative of an employee and/or a athletic training student within 15 working days.  Written request for training records should be addressed to: Director of Athletic Training Services University of Northern Iowa 115

Human Performance Complex, 008 Cedar Falls, IA 50614-0244 (319) 273-6369 fax- (319) 273-7023

 Training records should be maintained for three (3) years from the date on which the training occurred;

Medical Records-  Medical records are maintained for each athletic training student and employee with occupational exposure in accordance with 29 CFR 1910.1020.  Medical records for athletic training students will be located in the office of the Director of the Athletic Training Education Program (Office 3G, Human Performance Complex).  The medical record should include: a) Student’s name and student ID number b) Copy of the student’s hepatitis B vaccination status, including the dates of all the hepatitis B vaccinations and any medical records relative to the employee’s ability to receive vaccination; c) Copy of all results of examinations, medical testing, and follow-up procedures; d) Copy of the healthcare professional’s written opinion; and e) Copy of the information provided to the healthcare professional.  The program director should ensure that student medical records are kept confidential and not disclosed or reported without the student’s express written consent to any person within or outside the athletic training education program, except as may be required by law;  Medical records should be maintained for at least the duration of employment plus 30 years in accordance with 29 CFR 1910.1020.

 If the Director of Athletic Training Services and/or the Athletic Training Education Program Director cease to be a part of the University of Northern Iowa’s Athletic Training Services Department, medical and training records will be transferred to the successor(s).

 If there is no successor, a member of the UNI Athletic Department and/or the University of Northern Iowa must notify the Director of the National Institute for Occupational Safety and Health, U.S. Department of Health and Human Services, for specific directions regarding the disposition of the records at least three (3) months prior to disposal.

 Upon request, both medical and training records must be made available to the Assistant Secretary of Labor for Occupational Safety and Health.

O. Review and Update Procedures-

 UNI Athletic Training Services Department personnel, in conjunction with other Athletic Department, University, and/or public health personnel, will review and update the Exposure Control Plan on an annual basis and/or whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure; and to reflect new or revised employee positions with occupational exposure.

 The reviewed and updated ECP will reflect changes in technology that eliminate or reduce exposure to blood-borne pathogens.

 The periodic review procedure will ensure that the ECP remains current with the latest information and scientific knowledge pertaining to blood-borne pathogens.

 The ECP will document consideration and implementation of appropriate commercially available and effective engineering and work practice controls designed to eliminate and/or minimize exposure.

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L. HEPATITIS B VACCINATIONS: A. Hepatitis B Vaccination Statement-  Athletic Trainers Employed by the University can receive the vaccination at no expense to themselves through the University Health Services.

 Athletic Trainers who initially decline the vaccine may request and obtain the vaccination at a later date at no cost.

 Athletic Training Students may obtain the vaccine and vaccination series at their own expense; . It is strongly recommended that all UNI athletic training students receive the hepatitis B vaccination series before beginning their clinical assignment(s);

 Vaccinations will be performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional;

 Vaccinations may be obtained at the UNI Student Health Services;

 Vaccination is encouraged unless: 1. Documentation exists that the employee has previously received the series; 2. Antibody testing reveals that the employee is immune; or 3. Medical evaluation shows that the vaccination is contraindicated;  Participation in a prescreening program is not a prerequisite for receiving the hepatitis B vaccination;

 If an athletic training student or employee chooses to decline vaccination, the student or employee must sign a declination form (a declination form is included at the end of this document);

 Documentation of the refusal of the vaccination will be kept in the student’s permanent file in the Human Performance Complex Athletic Training Education Program filing cabinet;

 Students who do not respond to the primary vaccination series must be revaccinated with a second three-dose vaccine series and retested. Non-responders must be medically evaluated;

 The aforementioned testing can be obtained at the UNI Student Health Services;

 Following hepatitis B vaccinations, the health care professional’s Written Opinion will be limited to whether the student requires the hepatitis vaccine, and whether the vaccine was administered. If a routine booster dose(s) of hepatitis B vaccine is recommended by the U.S. Public Health Service at a future date, such booster dose(s) should be made available to the student as outlined above;

University of Northern Iowa Athletic Training Services

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Hepatitis B Vaccine Information Sheet

The Disease:

Hepatitis B is a viral infection caused by hepatitis B virus (HBV), which causes death in 1-2% of patients. Most people with hepatitis B recover completely, but approximately 5-10% becomes chronic carriers of the virus. Most of these people have no symptoms, but can continue to transmit the disease to others. Some may develop chronic active hepatitis and cirrhosis. HBV also appears to be a causative factor in the development of liver cancer. Thus, immunization against hepatitis B can prevent acute hepatitis and also reduce sickness and death from chronic active hepatitis, cirrhosis, and liver cancer.

The Vaccine:

RECOMBIVAX HB (Hepatitis B Vaccine Recombinant) is a non-infectious subunit viral vaccine derived from hepatitis B surface antigen (HBsAG) produced in yeast cells. A portion of the hepatitis B virus gene, coding for HBsAG, is cloned into yeast, and the vaccine for hepatitis B is produced from cultures of this recombinant yeast strain according to methods developed in the Merck, Sharp, & Dohme Research Laboratories. The vaccine against hepatitis B, prepared from recombinant yeast cultures, is free of association with human blood or blood products. Each lot of hepatitis B vaccine is tested for safety, in mice and guinea pigs and for sterility.

A high percentage of healthy people who receive two doses of vaccine and a booster achieve high levels of surface antibody (anti-HBs) and protection against hepatitis B. Persons with immune-system abnormalities, such as dialysis patients, have less response to the vaccine, but over half of those receiving it do develop antibodies. Full immunization requires three (3) doses of vaccine over a six-month period although some persons may not develop immunity even after three (3) doses. There is no evidence that the vaccine has ever caused hepatitis B. However, persons who have been infected with HBV prior to receiving the vaccine may go on to develop clinical hepatitis in spite of immunization. The duration of immunity is unknown at this time.

Possible Vaccine Side Effects:

The incidence of side effects is very low. No serious side effects have been reported with the vaccine. A few persons experience tenderness and redness at the site of injection. Low-grade fever may also occur. Rash, nausea, joint pain, and mild fatigue have also been reported. The possibility exists that more serious side effects may be identified with more extensive use.

Due to the inherent nature and danger of the job, the University of Northern Iowa Division of Athletic Training and Athletic Training Services recommend that all staff athletic trainers and student athletic training students receive this vaccine.

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Hepatitis B Vaccine Declaration / Declination

Last Name First Name

COMPLETE AND SIGN SECTION A, B, or C BELOW:

Section A I have been informed about Hepatitis B Vaccination by reading the information provided with this waiver. I understand its role in providing protection for persons (i.e. healthcare personnel, etc.) who are at increased risk for Hepatitis B through clinical exposure. I understand the risks and benefits of being vaccinated and not being vaccinated. In addition, I understand that it is my responsibility to immediately report any adverse reaction to the vaccination.

YES, I choose to receive the Hepatitis B Vaccine (Recombivax).

Signature Date

Witness Signature Date

Section B I understand that due to my potential occupational exposure to blood or other infectious materials, I may be at risk of acquiring Hepatitis B (HBV) infection. I decline Hepatitis B vaccination at this time. I understand that by declining the vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease.

NO, I do not choose to receive the Hepatitis B Vaccine (Recombivax) at this time.

Signature Date

Witness Signature Date

Section C

I have already received the Hepatitis B immunization series.

______Date of dose 1 Date of dose 2 Date of dose 3

Signature Date

Witness Signature Date

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LI. HPC HYDROTHERAPY ROOM POLICIES:

The HPC Hydrotherapy Room contains three therapeutic pools: 1.) thermal plunge, 2.) cold plunge, and 3.) HydroWorx 2000. This room also has an ice machine, storage area for coolers, water bottles, and storage cabinet area for miscellaneous hydrotherapy equipment. The HPC Hydrotherapy Room should be kept neat and orderly and therefore has many daily and weekly tasks.

DAILY HPC Hydrotherapy Room Tasks:

1. Pool Water Levels Checked: a. Check water levels of all 3 pools. b. The water level should be at the mid point of each skimmer. c. Add water from the hose in the Hydrotherapy Room as needed if low.

2. Check Water Temperature of the pools: a. HydroWorx 2000 should be ~ 88 degrees b. Cold Plunge should be ~ 55 degrees c. Thermal Plunge should be ~ 102 degrees d. NOTE: Notify Travis Stueve or Troy Garrett if any pool temperature is off by three or more degrees

3. Pool Floors: a. Use the Spa-Vac to remove any debris/dirt at the bottom of cold and thermal plunge

4. Hydrotherapy Room Floor: a. Squeegee all excess water on the floor and empty it into the Hydrotherapy Room drain.

5. Pool Walls: a. Use a clean towel and scrub along water level of each pool to remove build-up. b. Make sure the towel is clean with no chemicals or cleaners added.

6. Counters: a. Counters should be clear and clean of ALL garbage, water bottles, equipment, chemicals, etc. b. Place items left on the counter in their correct places c. Disinfect and wipe down the counter top.

7. Changing Rooms: a. Squeegee any excess water into the drain in the changing room. b. Clear the room of any trash or towels left on the floor.

8. Coolers/Water Bottles: a. Assure the neatness of the cooler area. All 5 gallon coolers belong on the top shelf, 10 gallon coolers on the bottom shelf, and all ice chests should be neatly stacked under the bottom shelf along with any carts. b. All water bottles and carries should be neatly stacked in the water bottle shelving unit. This needs to be done in an organized fashion.

9. Chemical testing of pools:  There are three chemical levels that need to be checked daily. It is most beneficial to check chemical levels in the morning before the pools have experienced heavy use. a. Bromine: 1. Fill the tester with 25 ml of water 2. Put two level scoops of powder into the water 3. Begin adding R-0872* one drop at a time, counting the drops added, until the water turns clear 4. Divide the number of drops or R-0872* by 5 120

5. Total number of drops should be around 15-25. b. pH: 1. Fill the tester with 44 ml of water 2. Add 5 drops of R-0004 3. Place the cap on the tester, shake, and compare the color to the pH color chart located on the tester. 4. Normal pH levels are 7.2-7.4 c. Alkalinity: 1. Fill the tester with 25 ml of water. 2. Add 2 drops of R-007 3. Add 5 drops of R-008 4. Add R-009 one drop at a time until the water turns from green to red 5. Add a zero to the number of drops of R-009 added. 6. Total number of R-009 drops should be 8-12

END OF THE DAY Hydrotherapy Room Tasks:

1. Check to be sure all the jets are off in the plunge pools (both thermal and polar plunge tanks) 2. HydroWorx 2000 power is off. 3. All items in the room are neatly put away. 4. All counters and floors are clean.

WEEKLEY / MONTHLY Hydrotherapy Room Pool Cleaning:

Cleaning of the Thermal Plunge: This task needs to be done every TWO WEEKS during a time period that does not experience heavy use (Friday afternoon/night) and entails the following:

1. Drain the thermal plunge by shutting off the power and opening the drain valve underneath. 2. Clean the thermal plunge with diluted Simple Green or Lime-A-Way and a scrub sponge. 3. Refill the thermal plunge using the hose to a level just above the halfway point of the skimmer. 4. Turn the power back on.

NOTE: 2. The individual(s) responsible for cleaning and disinfecting will adhere to Universal Precautions and wear PPE as needed 3. The thermal plunge is not to be used by student-athletes with open or draining wounds

Cleaning the Polar Plunge:

This task needs to be done every TWO MONTHS during a time period that does not experience heavy use (Friday afternoon/night) and entails the following: 1. Drain the polar plunge by shutting off the power and opening the drain valve. 2. Clean with thermal plunge with diluted Simple Green or Lime-A-Way and a scrub sponge. 3. Refill the cold plunge using the hose in the Hydrotherapy Room to a level just above the halfway point of the skimmer

NOTE: 4. The individual(s) responsible for cleaning and disinfecting will adhere to Universal Precautions and wear PPE as needed 5. The cold plunge is not to be used by student-athletes with open or draining wounds a)

121 b) Cleaning the HydroWorx 2000:

 The Athletic Training Services Staff shall maintain general cleanliness of the HydroWorx 2000 Pool Walls and monitor water temperature and chemical levels daily. Any problems or concerns with the HydroWorx 2000 should be reported to the Director of Athletic Training Services/Head Athletic Trainer.

General Hydrotherapy Room Policies/Procedures:

 The phone located in the Hydrotherapy Room is to be used for emergency situations only. To contact local emergency/police dial 9-911.

 All posted pool/spa rules and regulations must be followed.

 Student-athletes are not allowed to be in the Hydrotherapy Room without a staff athletic trainer in the HPC Athletic Training Room.

 All patients and/or student athletes are to shower prior to using any of the pools.

 No jumping, splashing, horseplay in any of the pools.

 No excessive noise (yelling/screaming) in the Hydrotherapy Room.

 All patients and/or student athletes shall turn the jets off in the plunge pools (thermal plunge/hot tub and polar plunge/cold pool) after they are done using the plunge pool.

 No food or drink is allowed in the Hydrotherapy Room other than water bottles given to athletes by a staff athletic trainer.

 The stereo in the Hydrotherapy Rom is only to be adjusted by staff athletic trainers.

 All aqua equipment, water bottles, and coolers should be kept in their proper places, keeping the room looking neat and organized.

 Student-athletes should bring their own towels to use in the Hydrotherapy room.

 Used towels should be placed in the dirty laundry basket in the HPC Athletic Training Room.

 Staff members are expected to mop up any standing water/puddles on the hydrotherapy room floor after use in order of keeping the floor clean and sanitary.

General HydroWorx 2000 Policies and Procedures:

The following is a brief description of HydroWorx policies/procedures. Please refer to the HydroWorx 2000 Operating Manual located in the Hydrotherapy Room for a complete listing of operating procedures.

 The HydroWorx 2000 is only to be operated by a full time staff or staff graduate assistant athletic trainer. Athletic Training Students can be instructed by a staff athletic trainer on how the pool operates, but should never be allowed to operate it without direct supervision.

 The HydroWorx 2000 should have a maximum of four (4) student-athletes in it at one time.

 Jewelry and other accessory items should not be worn in the HydroWorx 2000.

 Athletes/patients undergoing a running type workout in the HydroWorx 2000 should be advised to wear aqua shoes, socks, or old running shoes in the pool to prevent blisters.

 The HydroWorx 2000 should not be operated by an individual who is in the pool.

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 All student-athletes using the HydroWorx 2000 must be signed up on the HydroWorx Daily Schedule Board located on the north wall of the Hydrotherapy Room by their staff athletic trainer prior to using the pool. o NOTE: Prior to reserving a time for a student-athlete, the staff athletic trainer shall check with the Physical Therapy Clinic to confirm there are no patients scheduled to use the pool during that time period.

 Any operating problems experienced while using the HydroWorx 2000 shall be immediately reported to either the Director of Athletic Training Services.

LII. STUDENT-ATHLETE ASSISTANCE PROGRAM (SAAP):

Purpose- The University of Northern Iowa’s Student-Athlete Assistance Program (SAAP) provides confidential, professional, and voluntary assistance and support to student-athletes regarding personal problems that are adversely affecting their academic and/or athletic performance. Educational programs are also offered to prevent problems and promote the general well being of student-athletes and athletic department coaches and administrative personnel.

The SAAP offers education and assistance regarding:  Substance use and/or abuse  Alcohol abuse  Mental / emotional problems  Nutritional concerns / eating disorders  Family difficulties  Health / physical problems  Financial and legal problems

Personnel- A group of UNI athletic department administrators and staff members will be designated to serve as SAAP resource contact persons known as the SAAP Core Committee. In no sense is the Core Committee member a counselor. The sole responsibility of members of the Core Committee is to make a referral to the appropriate campus, community, and/or professional agency for assistance.

Guidelines- To ensure the effectiveness of the SAAP and protect the student-athlete’s rights, the following guidelines govern the program: 1. The decision to utilize the SAAP must be voluntary. 2. The academic and/or athletic status of the student will not be jeopardized by the student- athlete seeking assistance. 3. If the student-athlete rejects a suggestion to seek assistance, it is the student-athlete’s responsibility to remedy the athletic and/or academic performance problem or face the appropriate action. 4. Every effort possible will be made to assure confidentiality and protect the privacy of the student-athlete within normal limits and General Statutes of the State of Iowa. Any details of communication between student-athletes and Core Committee members or Athletic Department personnel may not be disclosed to any source without the prior written consent of the student or when required by law. 5. Unless the student-athlete consents otherwise, the person making a referral to a source of assistance at a student-athlete’s request my disclose only the following information:  How the student was referred to the SAAP;  The reason for the referral;  The disposition of the referral;

6. Records are made of program referrals only with the student-athlete’s written consent. The student will not be denied assistance for refusing consent. Records are maintained solely for

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program evaluation and will be kept by the SAAP Program Coordinator in a centralized secure location. 7. The SAAP does not alter the Athletic Department coach’s and staff’s disciplinary and/or control measures. It is an alternative source of assistance to help ensure the successful academic and athletic development and well being of student-athletes. As an NCAA affiliate, the UNI athletic department falls under the rules and regulations of the NCAA, the Missouri Valley Conference (MVC), and the Missouri Valley Football Conference first and foremost. There is no protection from these rules and regulations.

Student-Athlete Procedures for Seeking Information and/or Assistance-

Contact a coach, athletic trainer, and/or other Athletic Department personnel for information and/or assistance. After discussion of your situation, this person will aid you in contacting a Core Committee member for further assistance.

Contact a Core Committee member directly for assistance.  The Core Committee member will discuss the situation with the student-athlete and the referral source (if any) to assess and evaluate the problem.  The student-athlete and the Core Committee member will then outline a plan in regard to the problem. This plan may include a referral to the appropriate source of assistance such as: substance abuse / alcohol treatment agencies, counseling centers, education & community programs, and/or UNI services.  The Core Committee member and referral sources will provide any necessary assistance and follow-up until completion of the recommended plan.

Family and/or Peer Procedures for Seeking Information and/or Assistance on Behalf of a Student-Athlete-

If a family member and/or peer is concerned about problems that may be interfering with a student- athlete’s academic and/or athletic performance, assistance may be sought on behalf of the student- athlete. Discuss the situation with the student-athlete and suggest the SAAP.

Contact a Core Committee member and allow him/her to confidentially contact the student- athlete.  The Core Committee member will discuss the situation with the student-athlete and the referral source (if any) to assess and evaluate the problem.  The student-athlete and the Core Committee member will then outline a plan in regard to the problem. This plan may include a referral to the appropriate source of assistance such as: substance abuse / alcohol treatment agencies, counseling centers, education & community programs, and/or UNI services.  The Core Committee member and referral sources will provide any necessary assistance and follow-up until completion of the recommended plan.

In any event, the family member and/or peer should maintain contact with the student-athlete throughout the program process to offer support and encouragement.

Coaching Staff, Sports Medicine Department Personnel, and/or Other Athletic Department Personnel Procedures for Seeking Information and/or Assistance on Behalf of a Student-Athlete-

If a member of the coaching staff, Sports Medicine Department, and/or other athletic department personnel is concerned about a student-athlete’s academic and/or athletic performance or inappropriate behavior, the staff member should carefully observe and document the situation and possible performance indicators.

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The staff member should then discuss the situation with the student if a problem is indicated. During this discussion, the athletic department staff member should:  Review the observed and documented performance deterioration and/or inappropriate behavior;  Explain the consequences if the situation does not improve;  Offer the help of the SAAP;  Assist in contacting a Core Committee member at the student-athlete’s request;

Contact a Core Committee member directly and present your observations and documentation. Then allow the Core Committee member to confidentially contact the student-athlete.  The Core Committee member will discuss the situation with the student-athlete and the referral source (if any) to assess and evaluate the problem.  The student-athlete and the Core Committee member will then outline a plan in regard to the problem. This plan may include a referral to the appropriate source of assistance such as: substance abuse / alcohol treatment agencies, counseling centers, education & community programs, and/or UNI services.  The Core Committee member and referral sources will provide any necessary assistance and follow-up until completion of the recommended plan.

In any event, the athletic department staff member should maintain contact with the student- athlete throughout the program process to offer support and encouragement.

Academic and Athletic Performance Indicators-

The following are indicators that may be used in the evaluation of a student-athlete’s athletic and/or academic performance. This list is not all-inclusive.

 Class attendance record;  Significant GPA changes  Athletic practice attendance record;  Performance at scheduled training sessions or competitions;  Physical appearance;  Health changes;  Motivation level regarding academic and/or athletic activities;

Student alcohol and illegal substance usage and behaviors that require action and intervention by the UNI Athletic Department include:  The sale of illegal drugs;  Possession and/or observed use of illegal drugs;  Possession and/or observed use of drug paraphernalia;  Identified alcohol abuse;

This list is not all-inclusive.

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LIII. MENSTRUAL-CYCLE DYSFUNCTION:

During the past few decades, increasing numbers of women of all ages have been participating in sports, at both recreational and competitive levels. Most girls and women derive significant health benefits from regular physical activity. They can achieve the same training effects as do men, such as decreased blood pressure, lowered heart rate, and improved aerobic capacity, as well as decreased percent body fat. These changes help protect against atherosclerosis and heart disease. In addition, weight-bearing exercise promotes strong and healthy bones. Earlier myths regarding detrimental effects of excessive exercise on the female reproductive system have been largely dispelled. However, athletes, coaches, staff athletic trainers and physicians should be aware that exercising women could potentially be subject to menstrual cycle dysfunction.

There are several important reasons to discuss the treatment of menstrual-cycle irregularities. One reason is infertility. Another medical consequence is skeletal demineralization, which occurs in hypoestrogenic women. Despite resumption of normal menses, the loss of bone mass during prolonged hypoestrogenemia is not completely reversible. Therefore, young women with low levels of circulating estrogen are at risk for low peak bone mass, which may increase the potential for osteoporotic fractures later in life. An increased incidence in stress fractures has also been observed in the long bones of the feet.

A student-athlete with menstrual irregularities will be referred for the following:

1. Full medical evaluation, including an endocrine work-up and bone mineral density test;

2. Nutritional counseling with specific emphasis on: a. Total caloric intake versus energy expenditure; b. Calcium intake of 1,200 to 1,500 milligrams per day; and

3. Routine monitoring of the diet, menstrual function, weight-training schedule and exercise habits.

If this treatment plan does not result in regular menstrual cycles, estrogen-progesterone supplementation should be considered. This should be coupled with appropriate counseling on hormone replacement and review of family history.

Other recommendations include:

 All sports medicine professionals, including athletic training staff and coaches, should learn to recognize the symptoms and risks associated with the female athlete triad.  Coaches and other should avoid pressuring female athletes to diet and lose weight and should be educated about the warning signs of eating disorders.  Female student-athletes should be educated about proper nutrition, safe training practices, and the risks and warning signs of the female athlete triad.

LIV. EATING DISORDER INTERVENTION PROTOCOL:

If a member of the UNI Athletics staff has a concern, or if an individual(s) express concern to a UNI Athletic staff member, that a student-athlete may be at risk because of disordered eating, the following procedural steps should be taken:

1. The staff member should meet confidentially with the concerned individual(s) and gather specific information regarding the behavior of the student-athlete suspected of disordered eating and then refer the concerned individual(s) to one of the UNI Staff Certified Athletic Trainers (ATC).

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2. The UNI Staff ATC will arrange to meet with the student-athlete to discuss the concerns raised regarding his/her disordered eating behavior. Based on the objective information gathered by the ATC the following steps may be taken:

a. No direct intervention will be taken, however monitoring may occur. b. Request that the student-athlete be evaluated by a University Health Services (UHS) Clinician (Medical Doctor, Physician’s Assistant, Nurse Practitioner, etc.) for further objective findings (i.e. significant weight loss, BMI, low % of body fat, blood testing, etc.). The UHS Clinician will facilitate a counseling and nutritional referral.

3. If step 2b above is chosen, the ATC will contact the UHS directly to arrange for examination of the student-athlete. All referrals made between the ATC and UHS will possess written consent from the student-athlete for release of pertinent medical information.

4. Based on the results of the evaluations, the UHS Clinician will determine one of the following:

a. The student-athlete is not in any immediate risk. If medical clearance is recommended for the student-athlete the UHS Physician will notify the ATC immediately via telephone and in writing. b. The student-athlete may be at risk physically or emotionally. Temporary suspension from participation in intercollegiate athletics may be instituted pending further medical intervention. The UHS Physician in consultation with the ATC will make the final decision regarding athletic participation. The ATC will communicate all decisions to the student- athlete directly. It must be made clear to all parties concerned that the UHS Clinician and the ATC shall act in the best interest and personal safety of the student-athlete.

5. If the student-athlete has not been cleared or if further intervention is necessary, the Eating Disorders Intervention Team (EDIT) will be assembled as soon as possible to develop a formal healthcare plan and written compliance contract with the student-athlete. EDIT may consist of the following members:

a. Student-athlete b. Student-athlete's chosen representative c. UHS Clinician d. ATC e. Nutritional support personnel f. Counseling clinician g. Other medical professional, if desired

6. The healthcare plan and compliance contract developed by EDIT will include a process for determining the student-athlete's compliance with the contract and the consequences of non- compliance.

7. The student-athlete may or may not be cleared for athletic participation following review by EDIT.

The health and welfare of the student-athlete will be the primary consideration throughout the consultation and intervention process. Furthermore, medical confidentiality applies to all information shared with the ATC and the UNI Student Health Clinic, which includes the UNI Student Health Center Counseling Services and members of EDIT.

Support Services Available at UNI

The Wellness and Recreation Services Center provides nutritional information programs for all UNI students. These programs may include eating disorder screening, nutrition information, and support, weight management education, and referral when indicated. Appointments can be made by referral through the team certified athletic trainer. Teams may also schedule an appointment for the nutritionist to meet with the team through the team’s certified athletic trainer.

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The University of Northern Iowa Athletic Training Services can also coordinate a multi-disciplinary treatment approach to eating disorders. This program involves the screening of athletes for eating disorders, educational programs, and comprehensive medical care of the athlete. Our team includes physicians, mental health professionals, nutritionists and other allied health care providers who are qualified and experienced in the evaluation and treatment of eating disorders in athletes. Student athletes should feel free to contact their team certified athletic trainer to discuss any case in private.

LV. SEXUAL HARASSMENT POLICY:

It is the policy of the University of Northern Iowa to provide a campus environment for students, faculty, and staff that is free from sexual harassment; to provide appropriate institutional appeal process to ensure thorough and prompt investigation of allegations of sexual harassment; and to apply appropriate disciplinary sanctions to those who engage in sexual harassment.

The University of Northern Iowa is committed to maintaining a humane atmosphere in which individuals treat each other with respect. The University will not tolerate any form of sexual harassment and will not condone any actions words that constitute sexual harassment in any situation under the jurisdiction of, sponsored by, or associated with the University, including academic, employment, residential, or social situations.

In the event that any individual has a grievance against faculty, staff, clinical supervisor(s), fellow athletic training student(s), or athlete(s) the following guidelines should be followed:

1. Confront the individual with the grievance so that you can assure that there is not some form of miscommunication.

2. Try to work out the grievance with the individual.

3. If the problem cannot be worked out, inform the individual that you are planning on filing a grievance.

4. Fill out a UNI Grievance Form and submit it to the Chair of the Division of Athletic Training or the Director of Athletic Training Services.

5. The Chair of the Division of Athletic Training or the Director of Athletic Training Services will then contact the Office of Compliance and Equity Management (OCEM). Complaints are handled as confidentially as possible to protect the rights of both the complainant and the person accused.

 The goal is to seek resolution. If a complainant chooses or if a problem cannot be resolved informally an official investigation will follow with the assistance of the OCEM. If harassment has occurred, disciplinary actions will result as mandated by the OCEM.

LVI. SEXUAL ASSAULT / RAPE REFERRAL & TREATMENT PROGRAM-

Entrance into program-

1. Through the UNI Student-Athlete Assistance Program (SAAP)  Student-athlete seeks assistance;  Family and/or peers seek assistance on behalf of the student-athlete; and/or Coaching staff, Athletic Training Services Department personnel, and/or other athletic department personnel seek assistance on behalf of the student-athlete;

2. Report the incident to the UNI Department of Public Safety (273-2712 / 4000) // Cedar Falls Police Department (273-8611 or 911 Emergency) // Waterloo Police Department (291-4345 or 911 Emergency)  To report sexual abuse that occurred on the UNI campus and/or in Cedar Falls or Waterloo;  Reporting is not the same as filing charges, but would initiate an investigation of the assault. 128

3. Contact the UNI Counseling Center (273-2676 // 233-8484- 24-hour hotline)

AND / OR

4. Contact the UNI Sexual Abuse Services Center (273-2137), Coordinator- Julie Thompson (email- [email protected] )

LVII. MENTAL HEALTH REFERRAL & TREATMENT PROGRAM-

The University of Northern Iowa has a shared commitment to developing and supporting mental health and wellbeing. Coaches, athletic trainers, team physicians, strength and conditioning staff, academic support staff, equipment managers and administrators are in position to observe and interact with student-athletes on a daily basis. In most cases, athletic department personnel have the trust of the student-athlete and are someone that the student-athletes turns to in difficult times or personal crisis.

1. Referral Pattern- a) Entrance into program through the UNI Student-Athlete Assistance Program (SAAP)  Student-athlete seeks assistance;  Family and/or peers seek assistance on behalf of the student-athlete; and/or  personnel seek assistance on behalf of the student-athlete;

b) On-Campus referral to the UNI Counseling Center-  213 Student Services Center (273-2676)  24-hour Crisis Hotline (233-8484)  Website- www.uni.edu/counseling  If indicated and appropriate, the student-athlete will be asked to sign a consent form so that there can be a line of communication between all parties involved with regards to- - Attendance; - Assessment and treatment; - Recommendations; - Return to play;

c) Off-Campus Referrals-  Call the UNI Counseling Center (273-2676 or 233-8484- 24-hour crisis hotline) and inform them of the specific problem and/or need and the appropriate place of referral will be given;

2. Treatment Considerations- a) Group intervention may be needed-  Certified athletic trainer assigned to the sport;  Team Physician;  Head Coach and/or his/her designee;  Julie Thompson and/or other medical personnel (as needed)  Other personnel (family, teammates, friends, etc.)

b) Behavior contracts for treatment compliance and participation; c) Student-athlete may be asked to sign a consent form so that his/her parent(s)/guardian(s) can be notified in severe cases of non-compliance and/or hospitalization;

3. Fees / Funding-  First 10 individual sessions are offered free of charge;

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 If there is a need for additional services, a fee will be discussed and established on a case-by-case basis;  No person will be denied services because of financial hardships;  Off-campus referrals will involve fees for service on a sliding fee scale;

4. Parental Involvement- a) Minor Student-Athlete-  Team physician and/or medical personnel, if applicable, is obligated to inform the parent(s) / guardian(s);  Others involved in the case should not independently discuss the case with the parent(s) / guardian(s);

b) Student-Athlete > 18 years of age-  Should strongly encourage the student-athlete to communicate with his/her parent(s) / guardian(s)  Student-athlete is protected by the Family Educational Rights & Privacy Act (Buckley Amendment) - Must obtain permission from the student-athlete; - Interference by without permission from the student-athlete violates the student- athlete’s rights and opens up liability concerns; - Medical and/or University personnel can only communicate with the parent(s) / guardian(s) without permission if the student-athlete is in immediate and serious danger;  Team physician and/or medical personnel, if applicable, should be the person to inform the parent(s) / guardian(s);  Others involved in the case should not independently discuss the case with the parent(s) / guardian(s);  Other persons (i.e. athletic trainer, coach, etc.) can be involved in the parental notification process only if the student-athlete and physician agree that this is acceptable and appropriate;

LVIII. SUBSTANCE ABUSE POLICIES AND PROCEDURES-

The following is the official UNI Intercollegiate Athletics Department Substance Abuse Policies Procedures:

UNIVERSITY OF NORTHERN IOWA Intercollegiate Athletics Department Substance Abuse Policies and Procedures

The University of Northern Iowa Intercollegiate Athletics and Sports Medicine Department is committed to the physical and mental health and well being of its student-athletes. UNI recognizes that the use of certain drugs, legal or illegal, is not in the best interests of the student athlete or UNI Intercollegiate Athletics. In an effort to combat the use of illicit drugs, the UNI Intercollegiate Athletics has implemented a comprehensive substance abuse education and testing program to promote healthy and responsible lifestyles for student athletes.

I. Introduction and Overview:

A. Purpose

The purpose of the UNI Substance Abuse Education and Testing Program is multifaceted. The program focuses on the following objectives: 1) Deterring the use of drugs and alcohol; 2) Identifying substance-abuse users; 3) Providing substance-abuse rehabilitation and educational services;

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4) Promoting the role of UNI student-athletes as representatives of the University and positive role models for the youth in the community; 5) Counseling student-athletes who do not adhere to the requirements of the program.

B. Department of Athletics Drug and Alcohol Committee

The Department of Athletics Drug and Alcohol Committee shall consist of the following staff members: 1) Athletic Director or designee 2) Senior Women’s Administrator 3) Assistant Athletic Director, Compliance 4) Member of Intercollegiate Athletics Academic Services 5) Head Athletic Trainer 6) Appropriate Sports Supervisor

C. Program Compliance / Eligibility:

Participation within UNI Intercollegiate Athletics is a privilege, not a right. To become and remain a participant at UNI, including receiving athletics grant-in-aid after a student-athlete has exhausted his/her eligibility; a student-athlete must comply with the terms of this program that encompasses substance- abuse education, screening, and counseling. By signing the UNI Sports Medicine Department’s Medical Examination and Authorization Waiver and Substance Abuse Testing Authorization Waiver, the student-athlete agrees to submit to any and all tests ordered by the UNI Intercollegiate Athletic Department in order to detect unauthorized substance use. This document must be completed in order to practice and/or compete. The form is required of all student-athletes as a part of their annual pre- participation physical examination.

D. What is Being Tested For / Banned Substances:

The UNI Intercollegiate Athletics and Sports Medicine Department utilizes the most current NCAA List of Banned Drug Classes (NCAA Bylaw 31.2.3.1) for its substance abuse testing program. This list may be obtained through:

a) A member of the UNI Sports Medicine and Strength and Conditioning Departments; b) A member of the UNI Compliance Office; or c) The NCAA Sports Sciences internet site (www.ncaa.org/sports_sciences/drugtesting).

No substance belonging to the prohibited class(es) may be used, regardless of whether it is specifically listed as an example. A complete listing of banned substances is found in Appendix C of this document.

II. Testing Selection and Frequency:

A. Random Drug Testing

All UNI student-athletes are subject to substance abuse testing. Selection for the testing will occur randomly, by UNI-assigned student identification number, throughout a student-athlete’s association with UNI. The Director of Athletics, and/or his/her designee will determine the date, time, and site for testing. UNI Intercollegiate Athletics will conduct random testing a minimum of one (1) time every eight (8) weeks, up to a maximum of once every 24 hours.

All student-athletes are eligible for each test. Therefore, someone may be tested more than once per year.

B. “Reasonable Suspicion” Drug Testing:

In addition to random testing, the UNI Intercollegiate Athletics reserves the right to screen a student- athlete anytime there is reasonable suspicion that he/she may be engaged in the use of banned substances. The term “reasonable suspicion” means that information has been given to a member of the coaching staff, Sports Medicine Department, and/or athletics administrator, regarding a student-athlete’s possible use of banned substances. Other events or conduct may rise to the level of reasonable suspicion, including but not limited to: (a) a student-athlete’s possession or use of a prohibited substance; 131

(b) a student-athlete’s arrest or conviction related to the possession of, use or trafficking of banned substances; or (c) abnormal conduct interpretable as being caused by the use of banned substances. Reasonable suspicion drug testing may be done in one of two ways, at the election of the authorized Athletics Department personnel: urinalysis as described in Section IV below; or contact screening with a rapid drug screening test as described in Section V below.

(See Iowa State’s definition of suspicion--“Reasonable suspicion” shall not mean a mere “hunch” or “intuition.” It shall be based upon a specific event or occurrence, which leads to the belief based on reasonable circumstances that a student-athlete has used a banned substance. a. Such belief may be engendered by direct observation, a physical or mental deficiency, medically indicated symptomology of banned substance use, suspicious conduct, or unexplained absence. b. Such belief may also be engendered by information supplied by reliable third parties corroborated by objective facts. c. Such belief may also be engendered by common-sense conclusions about observed or reliably described human behavior upon which practical people ordinarily rely.

C Postseason/Championship Testing Any participant or team likely to advance to post-season championship competition may be subject to additional testing. Testing may be required of all team members or individual student-athletes at any time within thirty (30) days prior to the post-season competition. If a student-athlete tests positive, he/she will not be allowed to compete at the post-season event until the student-athlete has completed the appropriate sanction as outlined in this policy, until the student-athlete subsequently tests negative prior to departure for the event, and until the student-athlete receives permission from the Director of Athletics or his/her designee to participate.

D. NCAA Year Round Drug Testing Program

The NCAA reserves the right to test all sports in accordance with the Year Round Drug Testing Program. All UNI student-athletes are subject to the NCAA Year Round Drug Testing Program. Selection for the testing will occur randomly throughout a student-athlete’s association with UNI and the NCAA. The Center for Drug Free Sport (NCAA) will determine the date, time, and sports to be tested. The NCAA will conduct random testing a minimum of one (1) time every year.

All student-athletes are eligible for each test. Therefore, someone may be tested more than once per year.

E. NCAA Championship Drug Testing Program

In the event of an individual or team qualifying for NCAA Championship competition, the individual or team is subject to drug testing prior to, during, or post event by the NCAA. All UNI student-athletes participating in NCAA Championship competition are subject to the NCAA Championship Drug Testing Program. Selection for the testing will occur randomly by the NCAA. The Center for Drug Free Sport (NCAA) will randomly determine individuals to be tested.

III. Notification Process:

A. Random Drug Testing and “Reasonable Suspicion” Drug Testing by Urinalysis

1) Upon selection, student-athletes will be notified prior to testing by a member of the UNI Sports Medicine Department, the student-athlete’s coach, and/or a member of the UNI athletics administration (“personnel”). a. Personnel will call all available phone numbers; attend student-athlete’s classes, etc. in an effort to notify the student-athlete. Personnel may notify a student-athlete in person if possible, such as when the student-athlete is present in UNI athletic facilities. b. Personnel WILL NOT leave a phone message on the student-athlete’s voice mail or with anyone answering the phone besides the student-athlete.

2) Notification will take place no more than four (4) hours before the scheduled test. 132

3) Upon notification, the student-athlete will be asked to read and sign a UNI Substance Abuse Testing Notification Form, notifying him/her of the date, time, and site of the testing, as well as any other special instructions pertinent to the test. 1) The student-athlete will be instructed to immediately report to the test site or location with a picture ID. 2) b. The student-athlete will not be allowed to practice or otherwise participate in team activities until he/she has reported to the testing site/location and supplied a viable sample.

4) It is the UNI Test Site Coordinator’s responsibility to notify the Director of Athletics and/or his/her designee of those individuals who do not report for their test within the scheduled time periods. The scheduled time period for a random drug test is normally two hours from the start of the testing period until its conclusion.

5) If a student-athlete does not report at the scheduled time for his/her test, he/she will be sanctioned appropriately for his/her action. A "no show" will be interpreted as a positive test result, and the student-athlete will enter the UNI Intercollegiate Athletics Department Substance Abuse Program at the appropriate level.

IV. Urinalysis Collection Procedures:

Every possible step will be taken to ensure and maintain the confidentiality of the test results and to ensure the identity and integrity of the sample throughout the collection and testing process.

1) Only those persons authorized by the UNI Director of Athletics and/or his/her designee and/or the UNI Test Site Coordinator will be allowed in the specimen collection and processing area. 2) The UNI Director of Athletics and/or his/her designee and/or the UNI Test Site Coordinator may release a sick or injured student-athlete from the collection area or may release a student-athlete to return to meet academic obligations only after appropriate arrangements for having the student-athlete tested have been made and documented on the UNI Substance Abuse Testing Notification Form. 3) Upon entering the collection station, the student-athlete will show his/her picture ID and will be identified by the UNI Test Site Coordinator and/or his/her designee. The student-athlete will record the time of arrival and print his/her name on the UNI Drug Testing Roster Form. 4) When ready to urinate, the student-athlete will be asked to remove any unnecessary outer clothing, and to leave his/her briefcase, purse, book bag, gym bag, and/or other personal belongings that he/she may be carrying outside of the collection station. 5) The student-athlete will select a sealed collection container from a supply of such, will unwrap the container in the presence of a member of the substance abuse testing crew, and will record his/her initials on the beaker’s lid. 6) A crew member will accompany the student-athlete to the restroom, and will monitor the furnishing of the specimen by observation in order to assure the integrity of the specimen. a. A minimum specimen of at least 80 ml is required. b. If a student-athlete has difficulty voiding, he/she may drink fluids and/or eat foods approved by the UNI Site Coordinator. Such fluids and food items must be caffeine and alcohol-free and free of any other banned substances. c. If the specimen is incomplete, the student-athlete must remain in the collection station with the sample until the sample is complete. During this period, the student-athlete is responsible for keeping the collection beaker closed and controlled. d. If the specimen is incomplete and the student-athlete must leave the collection station for a reason approved by the UNI Site Coordinator, the specimen must be discarded. Upon return to the collection station, the student-athlete will be required to begin the collection procedure again. 7) Once the specimen (at least 80 ml) has been provided, the student-athlete is responsible for keeping the collection beaker closed and controlled. 8) The collector, in the presence of the student-athlete, will immediately assure that the collection beaker is securely closed. 9) The collector, in the presence of the student-athlete, will then apply tamper-evident label/seals to the beaker and write the student-athlete’s identification number on the tamper-evident label/seal 133

(usually the student-athlete’s social security number or last six digits of the social security number). 10) The student-athlete will initial the tamper-evident label/seal. 11) The student-athlete will witness the collector placing the sealed specimen in a shipping case for express shipment to a testing laboratory. 12) The student-athlete, the collector, and a witness (if present) will sign the Student-Athlete Notification Form, certifying that the procedures were followed as described in the protocol. 13) Any deviation from the procedures outlined must be described and recorded on the Student- Athlete Notification Form at that time. 14) The student-athlete will then sign-out on the Testing Roster, collect his/her belongings, and immediately vacate the collection area. 15) After the collection has been completed, the specimens will be forwarded to the designated laboratory. 16) The specimens become the property of the UNI Intercollegiate Athletics Department. 17) Failure to sign the UNI Drug Testing Notification Form, UNI Drug Testing Roster Form, arrive at the collection station at the designated time without justification, or provide a urine specimen according to the aforementioned protocol is cause for the same action(s) as evidence of use of a banned substance. The UNI Drug Testing Site Coordinator will inform the student-athlete of these implications (in the presence of witnesses) and will record such on the Drug Testing Notification Form.

V. Rapid Drug Screen Procedures-

Every possible step will be taken to ensure and maintain the confidentiality of the test results and to ensure the identity and integrity of the sample throughout the collection and testing process.

1) Notification procedures will be followed as outlined previously in section IV. 2) Only those persons authorized by the UNI Director of Athletics and/or his/her designee will be permitted to administer and process the rapid drug screen 3) The UNI Director of Athletics and/or his/her designee and/or the UNI Test Site Coordinator may release a sick or injured student-athlete from the collection area only after appropriate arrangements for having the student-athlete tested have been made and documented on the UNI Substance Abuse Testing Notification Form. 4) Upon entering collection station, the student-athlete will show his/her picture ID and will be identified by the UNI Test Site Coordinator and/or his/her designee. The student-athlete will record the time of arrival and print his/her name on the UNI Drug Testing Roster Form. 5) The student-athlete, in the presence of the collector, will verify the expiration date on the rapid drug screen test package and verify that there is no damage to the package. 6) The collector, in the presence of the student-athlete, will tear open the foil packet at the cut and remove the rapid drug screen test. 7) The student-athlete will write his/her name and test date on the back of the body of the rapid drug screen test. 8) The collector will lift the blue rapid drug screen test cover off of the white body, taking care not to touch the test pad and/or remove the cap. 9) The collector will wet the test pad with tap water (sterile saline and/or distilled water may be substituted for tap water) and shake off any excess water. 10) The collector will wipe the test pad gently over the student-athlete’s body surface (e.g. forehead, arm, back, chest, leg, etc.) 4 to 6 times, taking care to dab rough surfaces, tablets, and powders. 11) The collector will replace the blue cover onto the white body gently and close firmly with a “double click”. 12) The collector will remove the clear end cap and fill the end cap to the mark with tap water (sterile saline and/or distilled water may be substituted for tap water). 13) The collector will dip the rapid drug screen test into the cap of water for ten (10) seconds, taking care not to immerse the white plastic body. 14) The collector will remove the rapid drug screen test from the cap of water and hold the rapid drug screen test horizontal for 3 – 5 minutes. 15) After 3 – 5 minutes, the collector will read and interpret the rapid drug screen test as directed by the manufacturer’s directions.

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16) After interpretation of the rapid drug screen test ,the student-athlete, in the presence of the collector, will place the used rapid drug screen test in an envelope, label the front of the envelope with his/her name and date of test. 17) The student-athlete, in the presence of the collector, will seal the envelope. 18) The student-athlete and the collector will sign and date the sealed envelope over the seal. 19) The student-athlete, the collector, and a witness (if present) will sign the Student-Athlete Drug Testing Notification Form, certifying that the procedures were followed as described in the protocol. 20) Any deviation from the procedures outlined must be described and recorded on the Student- Athlete Drug Testing Notification Form at that time. 21) The student-athlete will then sign-out on the Drug Testing Roster, collect his/her belongings, and immediately vacate the collection area. 22) The rapid drug screen test becomes the property of the UNI Intercollegiate Athletics Department and will be filed as per the UNI Director of Athletics and/or his/her designee. 23) Failure to sign the UNI Drug Testing Notification Form, UNI Drug Testing Roster Form, arrive at the collection station at the designated time without justification, or allow the collection of a sample according to the aforementioned protocol is cause for the same action(s) as evidence of use of a banned substance. The UNI Drug Testing Site Coordinator will inform the student-athlete of these implications (in the presence of witnesses) and will record such on the Drug Testing Notification Form.

In the Event of a Positive Rapid Drug Screen Test Result, the Following Procedure Applies:

In the event that a student-athlete tests positive for the presence of a banned substance using the rapid drug screen test, the following procedures will be followed- 1) The student-athlete will be verbally notified by the collector of the presence of a banned substance as detected by the rapid drug screen test system and will record such on the Drug Testing Notification Form. 2) The student-athlete will be immediately referred for follow-up urinalysis testing as described in the aforementioned section. 3) The student may not participate in team activities (e.g. team meetings, strength and conditioning sessions, individual workouts, practices, and competition) until the urinalysis has been conducted. 4) Failure to allow the collection of a urine specimen according to the aforementioned protocol will be considered a positive test result and will be cause for the same action(s) as evidence of a use of a banned substance. The UNI Drug Testing Site Coordinator will inform the student-athlete of these implications (in the presence of witnesses) and will record such on the Drug Testing Notification Form.

VI. Self Referral: 1) Any student-athlete may refer himself/herself for evaluation or counseling by contacting a member of the coaching staff, UNI Sports Medicine Department, and/or an UNI administrator. o A student-athlete may not initiate self-referral after he/she has been informed of their participation in an impending drug test. 2) This self-referral will be held strictly confidential and no team and/or administrative sanctions will be imposed upon the student-athlete who has made a personal decision to seek professional assistance. 3) A treatment plan will be put into place and the student-athlete will not be sanctioned for entry. 4) A student-athlete testing positive (during random and/or reasonable suspicion testing) after entering this program will be subject to the applicable sanctions.

VII. Notification of Results:

A. Urinalysis Results 1) The designated laboratory will use a portion of the specimen (“specimen A”) for its initial analysis, consisting of sample preparation, instrument analysis, and data interpretation. o If the initial analysis of the specimen shows the presence of a banned substance and/or a masking device, the designated laboratory will immediately arrange for an analysis of the remainder of “specimen A”. o Preparation and analysis of the remainder of “specimen A” will be conducted by a

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o laboratory staff member other than the individual who prepared and analyzed the student- athlete’s initial specimen. The designated laboratory reserves the right to send the remainder of “specimen A” to another certified laboratory for preparation, analysis, and interpretation. 2) Upon verification of “specimen A”, the designated Medical Review Officer (MRO) / laboratory will notify the Director of Athletics and/or his/her designee of the test results. 3) Upon notification of a positive test result, the UNI Director of Athletics and/or his/her designee will verbally notify the student-athlete, the student-athlete’s head coach, and the Head Athletic Trainer and/or his/her designee. A representative of the UNI Student Health Center Counseling Center and/or the team physician may be present at this meeting and/or verbally notified as per the Director of Athletics and/or his/her designee. Do we want to notify parents? o At this time, the student-athlete may request to appeal the test results. o The student-athlete will have 48 hours from the time of his/her verbal notification to begin the appeals process. o The student-athlete may request that the remainder of his/her initial specimen (“specimen B”) be sent to the certified laboratory of his/her choosing for preparation, analysis, and interpretation. o All costs associated with the appeals process, including shipping, preparation, analysis, and interpretation of the specimen will be the responsibility of the student-athlete. o The interpretation of Specimen B will be final. 4) The student-athlete will also be notified in writing within 48 hours, with carbon copies being sent to the UNI Director of Athletics and/or his/her designee, Head Athletic Trainer and/or his/her designee, the student-athlete’s head coach, a representative of UNI Student Health Center Counseling Center, and the team physician (if necessary). The UNI Drug Testing Administrator is responsible for this written notification.

B. Rapid Drug Screen Test Results

In the event that a student-athlete tests positive for the presence of a banned substance using the rapid drug screen test, the following procedures will be followed- 1) The student-athlete will be verbally notified by the collector of the presence of a banned substance as detected by the rapid drug screen test system and will record such on the Substance Abuse Testing Notification Form. 2) The student-athlete will be immediately referred for follow-up urinalysis testing as described in the aforementioned section. 3) The student may not participate in team activities (e.g. team meetings, strength and conditioning sessions, individual workouts, practices, and competition) until the urinalysis has been conducted. 4) Failure to allow the collection of a urine specimen according to the aforementioned protocol will be considered a positive test result and will be cause for the same action(s) as evidence of a use of a banned substance. The UNI Drug Testing Site Coordinator will inform the student-athlete of these implications (in the presence of witnesses) and will record such on the Drug Testing Notification Form.

VII. Sanctions for Positive Test Results: (Need approval)

There are three ways in which a student-athlete can test positive under this program: 1) Any legal conviction of a student-athlete for underage possession of alcohol, DUI, public intoxication, and/or the purchase or possession of banned substances; 2) Any on-campus conviction of a student-athlete for violating the University of Northern Iowa's Drug and Alcohol Policy. The UNI Department of Intercollegiate Athletics has requested that the University notify the Director of Athletics and/or his/her designee of any such infractions; and 3) The presence of one or more of the banned substances in the student-athlete's urine during any UNI and/or NCAA substance abuse test, as confirmed through the collection testing methods outlined above.

A positive test result does not include detection of a banned substance where the banned substance use or presence is part of, or the result of, documented medical treatment prescribed and supervised by a qualified physician.

A. FIRST POSITIVE TEST

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1) The student-athlete will be required to have a confidential meeting with the Director of Athletics and/or his/her designee, the head coach, the Head Athletic Trainer and/or his/her designee, and the Director of Compliance (if available) within one (1) week of the positive test notification. a. The student-athlete has the option to request that one (1) person of his/her choosing to accompany him/her to this meeting. 2) The student-athlete will be referred to the UNI Student Health Center Counseling Center, or an outside designated agency of his/her choice, for evaluation, education, and mandatory counseling sessions. a. The student-athlete will be required to sign a waiver to release information regarding his/her attendance at the mandatory counseling services. b. The UNI Student Health Center Counseling Center (or the outside agency) will determine the appropriate duration of counseling required. 3) The student-athlete will be required to contact his/her parent or guardian in the presence of the Director of Athletics and/or his/her designee and the student-athlete’s head coach. 4) The student-athlete will be randomly tested at the discretion of the Director of Athletics and/or his/her designee for one (1) calendar year after the date of the first positive test. 5) An unexcused absence from, and/or failure or refusal to participate in the conditions set forth and those provided by the UNI Department of Intercollegiate Athletics and the UNI Student Health Center Counseling Center will be treated as a second positive test result. 6) The student-athlete’s head coach has the option to impose additional sanctions, including, but not limited to, indefinite suspension, revoking team privileges and/or travel, and/or termination of some or all athletics financial aid, as outlined in written team policies.

B. SECOND POSITIVE TEST 1) The student-athlete will be required to have a confidential meeting with the Director of Athletics and/or his/her designee, the head coach, the Head Athletic Trainer and/or his/her designee, a member of the UNI Student Health Center Counseling Center, and the Director of Compliance (if available) within one (1) week of his/her notification of the second positive test result. a. The student-athlete has the option to request that one (1) person of his/her choice, accompany him/her to this meeting. b. The student-athlete will be suspended from competition for a minimum of 10% of their total competitive season from the date of his/her notification of a second positive test result. i. Football – 1 game ii. Soccer – 2 dates of competition iii. Volleyball – 3 dates of competition iv. Cross-Country – 1 date of competition v. Basketball – 3 dates of competition vi. Baseball – 5 dates of competition vii. Softball – 6 dates of competition viii. Golf – 2 dates of competition ix. Tennis - 2 dates of competition x. Track and Field - 1 date of competition xi. Swimming - 2 dates of competition xii. Wrestling - 3 dates of competition

* If a team completes its competition schedule while a student-athlete is under a second positive sanction, the student-athlete’s suspension will be carried over into next season’s competition. If an individual is positive during a red shirt year, the student’s suspension will begin during the next season of competition.

c. The student-athlete’s head coach has the option to impose additional sanctions, including, but not limited to, indefinite suspension, revoking team privileges and/or travel, and/or termination of some or all athletics financial aid, as outlined in written team policies.

2) The student-athlete will be referred to the UNI Student Health Center Counseling Center, or an outside designated agency of his/her choice, for evaluation, education, and mandatory counseling sessions. 3) Counseling Center for evaluation, education, and mandatory counseling sessions. 4) The UNI Student Health Center Counseling Center (or the outside agency) will determine the appropriate duration of counseling required.

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5) The student-athlete will be required to contact his/her parent or guardian in the presence of the Director of Athletics and/or his/her designee and the student-athlete’s head coach. 6) The student-athlete will be randomly tested at the discretion of the Director of Athletics and/or his/her designee for one (1) calendar year after the date of the first positive test. 7) An unexcused absence from, and/or failure or refusal to participate in the conditions set forth and those provided by the UNI Student Health Center Counseling Center will be treated as a third positive test result.

C. THIRD POSITIVE TEST 1) Upon a third positive test result, the student-athlete will be immediately dismissed from the UNI Intercollegiate Athletics Program indefinitely or permanently?? a. All existing athletics financial aid will be terminated at the first permissible opportunity. b. Further sanctions by the University of Northern Iowa may be imposed, including but not limited to suspension or expulsion.

IX. Confidentiality: All members of the UNI Intercollegiate Athletics are expected to respect a student-athlete’s right to privacy. It is essential that anything seen, heard, read, and/or otherwise obtained remain confidential by all parties involved. It is illegal for any unauthorized personnel to gain access to patient information, through any and all means, unless the information is needed in order to treat the patient, or because their job would require such access.

All UNI Intercollegiate Athletics personnel are expected to adhere to the Confidentiality Policy at all times. Violation of the policy may incur disciplinary action at the discretion of the Director of Athletics.

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APPENDIX A UNI Dietary Supplement Disclosure Form

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UNI Dietary Supplement Disclosure Form

I, ______would like to disclose the following substance for which I consume as a dietary supplement other than those prescribed by a medical doctor. I understand that labeling on these products can be misleading and inaccurate, and that advice of sales personnel may be inaccurate. Terms such as “healthy” or “naturally occurring” do not necessarily imply safety nor does it imply that the NCAA or the University of Northern Iowa approves these substances. Ultimately, I am responsible for knowing what is contained in any supplement that I may take.

1. Brand Name:______

Description:______

2. Brand Name:______

Description:______

3. Brand Name:______

Description:______

4 Brand Name:______

Description:______

5. Brand Name:______

Description:______

______Student-Athlete / Date UNI Sports Medicine Staff / Date

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APPENDIX B UNI ATHLETICS DRUG TESTING REASONABLE SUSPICION NOTIFICATION FORM

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UNIVERSITY DEPARTMENT OF INTERCOLLEGIATE ATHLETICS DRUG TESTING REASONABLE SUSPICION NOTIFICATION FORM

I, ______, under the reasonable suspicion clause University of Northern Iowa Athletic Dept. Staff Member outlined in the UNI Intercollegiate Athletics Drug and Alcohol Policy, report the following objective sign(s), symptom(s) or behavior(s) that I reasonably believe warrant ______be referred Name of Student-Athlete to the UNI Department of Intercollegiate Athletics Drug and Alcohol Committee Chair or his/her designate for possible drug testing. The following sign(s), symptom(s) or behavior(s) were observed by me over the past _____ hours and/or ______days.

Please check below all that apply:

The Student-Athlete has shown: _____ irritability _____ loss of temper _____ poor motivation _____ failure to follow directions _____ verbal outburst (e.g. to faculty, staff, teammates) _____ physical outburst (e.g. throwing equipment) _____ emotional outburst (e.g. crying) _____ weight gain _____ weight loss _____ sloppy hygiene and/or appearance

The Student-Athlete has been: _____ late for practice _____ late for class _____ not attending class _____ receiving poor grades _____ staying up too late _____ missing appointments _____ missing/skipping meals

The Student-Athlete has demonstrated the following: _____ dilated pupils _____ constricted pupils _____ red eyes _____ smell of alcohol on the breath _____ smell of marijuana _____ staggering or difficulty walking _____ constantly running and/or red nose _____ recurrent bouts with a cold or the flu (give dates ______) _____ over stimulated or “hyper” _____ excessive talking _____ withdrawn and/or less communicative _____ periods of memory loss _____ slurred speech _____ recurrent motor vehicle accidents and/or violations (give dates ______) _____ recurrent violations of University of Northern Iowa Student Code of Conduct

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Other specific objective findings include: ______

Signatures

______Print Name of Athletic Department Staff Signature of Athletic Department Staff Date

Reviewed by: ______Department of Athletics Drug and Alcohol Committee Chair/Designee Date

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APPENDIX C NCAA Banned Substance List

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2018-19 NCAA Banned Drugs

It is your responsibility to check with the appropriate or designated athletics staff before using any substance

The NCAA Bans the Following Classes of Drugs:

1. Stimulants; 2. Anabolic Agents; 3. Alcohol and Beta Blockers (banned for rifle only); 4. Diuretics and Other Masking Agents; 5. Street Drugs; 6. Peptide Hormones and Analogues; 7. Anti-estrogens; and 8. Beta-2 Agonists.

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

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

Drugs and Procedures Subject to Restrictions: 1. Blood Doping; 2. Gene Doping; 3. Local Anesthetics (under some conditions); 4. Manipulation of Urine Samples. 5. Beta-2 Agonists permitted only by prescription and inhalation.

NCAA Nutritional/Dietary Supplements Warning:

Before consuming any nutritional/dietary supplement product, review the product with the appropriate or designated athletics department staff. There are no NCAA approved supplement products.

1. Dietary supplements, including vitamins and minerals, are not well regulated and may cause a positive drug test result. 2. Student-athletes have tested positive and lost their eligibility using dietary supplements. 3. Many dietary supplements are contaminated with banned drugs not listed on the label. 4. Any product containing a dietary supplement ingredient is taken at your own risk.

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Examples of NCAA Banned Substances in Each Drug Class Note to Student-Athletes: There is NO complete list of banned substances. Do not rely on this list to rule out any supplement ingredient.

1. Stimulants: Amphetamine (Adderall); caffeine (guarana); cocaine; ephedrine; fenfluramine (Fen); methamphetamine; methylphenidate (Ritalin); phentermine (Phen); synephrine (bitter orange); methylhexaneamine, “bath salts” (mephedrone) etc. Exceptions: phenylephrine and pseudoephedrine are not banned.

2. Anabolic Agents (sometimes listed as a chemical formula, such as 3,6,17-androstenetrione): Androstenedione; boldenone; clenbuterol; DHEA (7-Keto); epi-trenbolone; etiocholanolone; methasterone; methandienone; nandrolone; norandrostenedione; stanozolol; stenbolone; testosterone; trenbolone; etc.

3. Alcohol and Beta Blockers (banned for rifle only): Alcohol; atenolol; metoprolol; nadolol; pindolol; propranolol; timolol; etc.

4. Diuretics (water pills) and Other Masking Agents: Bumetanide; chlorothiazide; furosemide; hydrochlorothiazide; probenecid; spironolactone (canrenone); triameterene; trichlormethiazide; etc.

5. Street Drugs: Heroin; marijuana; tetrahydrocannabinol (THC); synthetic cannabinoids (e.g., spice, K2, JWH-018, JWH-073)

6. Peptide Hormones and Analogues: Growth hormone (hGH); human chorionic gonadotropin (hCG); erythropoietin (EPO); etc.

7. Anti-Estrogens: Anastrozole; tamoxifen; formestane; 3,17-dioxo-etiochol-1,4,6- triene(ATD), etc.

8. Beta-2 Agonists: Bambuterol; formoterol; salbutamol; salmeterol; higenamine, norcoclaurine; etc.

Additional examples of banned drugs can be found at www.ncaa.org/drugtesting.

Any substance that is chemically related to the class, even if it is not listed as an example, is also banned!

Information about ingredients in medications and nutritional/dietary supplements can be obtained by contacting the Resource Exchange Center, REC, 877-202-0769 or www.drugfreesport.com/rec password ncaa1

It is your responsibility to check with the appropriate or designated athletics staff before using any substance. intra.ncaa.org/sites /ama/OperationsTeam/6.TechnologyTeam/07.ComplianceForms/2016-17/DivisionI/2016-17BannedDrugsEducationalDocument/LRZ_kh_dks_053116

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APPENDIX D UNI Alcohol and Drug Testing Policy Notification of Positive Test Result

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UNI Alcohol and Drug Testing Policy Notification of Positive Test Result

Student-Athlete: ______Date: ______

● Violation: 1 ______2 ______3 ______

● Consequences of Positive Results Confidential Meeting ______Notification of Parents ______Medical Examination ______Suspension of Athletic Participation ______Follow-up Testing ______

● Appeal Notification Form (Appendix F) Yes / No ______

Comments: ______

______Student-Athlete Date

______UNI Administrator Date

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APPENDIX E UNI Alcohol and Drug Testing Positive Test Notification of Appeals Form

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UNI Notification of Positive Drug Test Appeals Form

This form is to be submitted to the Director of Athletics or his/her designee within 72 hours of being notified of a positive drug test. This form will be forwarded to the Drug Testing Appeals Committee chair for notification of a pending meeting (within 72 hours of requesting the appeal) with the student-athlete and those deemed necessary for clarification.

Student-Athlete Name:______

Phone Number:______

Date of Drug Test:______

Date of Notification of Results:______

Date of Notification of Appeal:______

Reason for Appeal:______

______

______Student-Athlete Signature / Date Director of Athletics / Date

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APPENDIX F University of Northern Iowa Department of Athletics Drug and Alcohol Policy Consent Form

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University of Northern Iowa Department of Athletics Drug and Alcohol Policy Consent Form

I ______, certify that I agree that I have read and understand the forgoing University of Northern Iowa Department of Athletics Substance Abuse Policy and I understand that I must abide by the requirements set forth therein. I understand this serves as my notice to be tested at any time from here forward as long as I am a student-athlete at the University of Northern Iowa. I also understand that by signing below, my parents and/or guardians may be notified of any violation of the Drug and Alcohol Policy.

This the ______day of ______, 20______.

______Signature of Student-Athlete Print Full Name

______UNI Student ID #

______Signature of Parent / Guardian (If student-athlete is under 18)

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APPENDIX G Catastrophic Injury Forms

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University of Northern Iowa Athletic Training Catastrophic Injury and Emergency Reporting Form

Nature of Emergency (details about how, when, where, who, what happened) ______

Outcome/Follow up:

______

Signature:______Print: ______Date:______

Athletic Director

Signature:______Print: ______Date:______

Senior Women’s Administrator

Signature:______Print: ______Date:______

Head Athletic Trainer

Signature:______Print: ______Date:______

Legal Counsel

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University of Northern Iowa Catastrophic Injury and Emergency Notification Contact Form

Date:______Time:______Place:______

Athletic Director contacted by: ______Time of contact: ______

Parent/Legal Guardian contacted by: ______Name of Parent/Legal Guardian: ______Time of Contact: ______Notes on Conversation:______

Team Addressed by: ______, ______, ______, ______, ______

Time of Meeting: ______Location of Meeting ______

Contents of Meeting: ______

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APPENDIX H Graduate Assistant & Intern Assistant Job Descriptions

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UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING Graduate Assistant Athletic Trainer Position Description

Reports To: Director of Athletic Training Services / Head Athletic Trainer Assistant Athletic Trainers

Supervises: Athletic Training Students

Primary Function: To assist with the supervision and coordination of the University’s overall sports medicine program, including, but not limited to: injury prevention, evaluation, management, and treatment of athletic injuries, short-term and long-term rehabilitation of athletic injuries, education and counseling of student-athletes, and athletics related health care administration in consultation with and under the supervision of the Director of Sports Medicine / Head Athletic Trainer, Team Physician(s) and other qualified medical personnel.

Background Requirements: 1. Must be certified by the National Athletic Trainers’ Association Board of Certification (NATABOC) 2. Must possess or be eligible for Athletic Training Licensure in the State of Iowa;

Major Duties and Responsibilities: 1. Advise and seek direction from the Director of Athletic Training Services / Head Athletic Trainer and Assistant Athletic Trainers with regard to any and all duties; 2. Advise and direct the athletic training students with regard to any and all duties; 3. Provide athletic training services for the University’s athletic department as directed by the Director of Sports Medicine / Head Athletic Trainer and/or Team Physician(s), including attendance at scheduled team practices and home and away competitions as necessary; 4. Assist with the coordination and scheduling of student-athletes for physical examinations, and medical referrals, and determine a student-athlete’s ability to practice and/or compete in consultation with the Team Physician(s); 5. Consult with the Team Physician(s) for guidance on the treatment of injured student-athletes, and report on their progress; 6. Report the status of injured student-athletes to coaching staffs and periodically meet to identify and discuss problem areas; 7. Assist with the compilation, input, organization, and maintenance of all medical records on University student-athletes, and share in the responsibility of maintaining and organizing the athletic training room file system; 8. Assist with the establishment and enforcement of codes of conduct and rules of use for the athletic training facilities and equipment; 9. Share in the responsibility of athletic training room maintenance and upkeep; 10. Assist with the organization and administration of the NCAA drug testing program and the athletic department’s substance abuse education and testing program; 11. Serve as a Field Experience Supervisor within the Athletic Training Education Program; 12. Assist in the preparation of student athletic trainers for the National Athletic Trainers’ Association Board of Certification (NATABOC) Examination; 13. Cooperate with the Media Relations Department with regards to the status of injured student- athletes for dissemination to media outlets;

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14. Assist with the organization and administration of an Exposure Control Plan for Blood borne Pathogens as dictated by the State of Iowa and the Occupational Safety and Health Administration (OSHA); 15. Work in conjunction with the strength and conditioning staff with regard to the strength, conditioning, and flexibility of student-athletes, nutritional issues, supplements / ergogenic aids, injury prevention, exercise technique, and rehabilitation of injured student-athletes; 16. Work in conjunction with the University dietician, University dining services, Team Physician(s), and various coaching staffs and other personnel regarding student-athlete nutritional issues, including but not limited to the prevention and treatment of eating disorders, weight gain and weight reduction techniques, and training table and travel menus; 17. Work in conjunction with the equipment room staff regarding the safety of the athletic equipment, testing new equipment, to aid in the purchase of shoes and protective equipment, and to facilitate proper methods of fitting athletic equipment; 18. Maintain a good working relationship with the athletics facilities manager, physical plant and grounds department regarding the safety of practice and competition surfaces and general field/court conditions; 19. Assume the duties and responsibilities of the Assistant Athletic Trainer(s) in his/her absence; 20. Maintains certification and license requirements of the National Athletic Trainers’ Association Board of Certification (NATABOC) and the State of Iowa; 21. Other duties as assigned by the Director of Athletic Training Services / Head Athletic Trainer.

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UNIVERSITY OF NORTHERN IOWA Professional & Scientific Position Description

Working Title: INTERN ASSISTANT ATHLETIC TRAINER Reports To: Director of Athletic Training Services / Head Athletic Trainer

Supervises: Graduate Assistant Athletic Trainers Athletic Training Students (as determined by the UNI ATEP)

Primary Function: To assist with the supervision and coordination of the University’s overall sports medicine and athletic training services and education program, including, but not limited to: injury prevention, evaluation, management, and treatment of athletic injuries, short-term and long-term rehabilitation of athletic injuries, education and counseling of student-athletes, and athletics related health care administration in consultation with and under the supervision of the Director of Athletic Training Services / Head Athletic Trainer, Team Physician(s) and other qualified medical personnel.

Background Requirements: 1. Must be eligible to take the National Athletic Trainers’ Association Board of Certification (NATABOC) examination or certified by the NATABOC; 2. Must possess a minimum of a Bachelors’ Degree in a related field; 3. Must possess or be eligible for Athletic Training Licensure in the State of Iowa;

Major Duties and Responsibilities: 1. Advise and seek direction from the Director of Athletic Training Services / Head Athletic Trainer with regard to any and all duties; 2. Advise and direct the Graduate Assistant Athletic Trainers and athletic training students with regard to any and all duties; 3. Provide athletic training services for the University’s athletic department as directed by the Director of Sports Medicine / Head Athletic Trainer and/or Team Physician(s), including attendance at scheduled team practices and home and away competitions as necessary; 4. Assist with the coordination and scheduling of student-athletes for physical examinations, and medical referrals, and determine a student-athlete’s ability to practice and/or compete in consultation with the Team Physician(s); 5. Consult with the Team Physician(s) for guidance on the treatment of injured student-athletes, and report on their progress; 6. Report the status of injured student-athletes to coaching staffs and periodically meet to identify and discuss problem areas; 7. Assist with the compilation, input, organization, and maintenance of all medical records on University student-athletes, and share in the responsibility of maintaining and organizing the athletic training room file system; 8. Assist with the establishment and enforcement of codes of conduct and rules of use for the athletic training facilities and equipment; 9. Share in the responsibility of athletic training room maintenance and upkeep; 10. Assist with the organization and administration of the NCAA drug testing program and the athletic department’s substance abuse education and testing program; 11. Serve as a Field Experience Supervisor within the Athletic Training Education Program as directed by the Athletic Training Education Program Director; 12. Assist in the preparation of student athletic trainers for the National Athletic Trainers’ Association Board of Certification (NATABOC) Examination;

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13. Cooperate with the Media Relations Department with regards to the status of injured student- athletes for dissemination to media outlets; 14. Work in conjunction with the strength and conditioning staff with regard to the strength, conditioning, and flexibility of student-athletes, nutritional issues, supplements / ergogenic aids, injury prevention, exercise technique, and rehabilitation of injured student-athletes; 15. Work in conjunction with the University dietician, University dining services, Team Physician(s), and various coaching staffs and other personnel regarding student-athlete nutritional issues, including but not limited to the prevention and treatment of eating disorders, weight gain and weight reduction techniques, and training table and travel menus; 16. Work in conjunction with the equipment room staff regarding the safety of the athletic equipment, testing new equipment, to aid in the purchase of shoes and protective equipment, and to facilitate proper methods of fitting athletic equipment; 17. Maintain a good working relationship with the athletics facilities manager, physical plant and grounds department regarding the safety of practice and competition surfaces and general field/court conditions; 18. Assume the duties and responsibilities of the Director of Athletic Training Services / Head Athletic Trainer in his/her absence; 19. Maintains certification and license requirements of the National Athletic Trainers’ Association Board of Certification (NATABOC) and the State of Iowa; 20. Other duties as assigned by the Director of Athletic Training / Head Athletic Trainer.

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APPENDIX I Athletic Training Room Administrative Forms

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UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING Primary Health Insurance Information / Authorization (PLEASE TYPE OR PRINT IN INK!)

Athlete’s Name Social Security No. Sex Male Female Date of Birth Sport Home Address City State Zip Phone # Medications currently taking? Allergies/Asthma? FATHER’S INFORMATION MOTHER’S INFORMATION

Name ______Name ______SS No. ______DOB ______SS No. ______DOB ______Home Address ______Home Address ______Home Phone ______Home Phone ______Employer ______Employer ______Work Phone ______Work Phone ______Insurance Company ______Insurance Company ______Policy / ID # ______Policy / ID # ______Insurance Company Phone # ______Insurance Company Phone # ______Type of Insurance- Type of Insurance- HMO PPO Indemnity HMO PPO Indemnity Other ______Other ______Primary Care Physician ______Primary Care Physician ______Physician Phone # ______Physician Phone # ______Is preauthorization necessary for medical/diagnostic services? Is preauthorization necessary for medical/diagnostic services? Yes No Phone # ______Yes No Phone # ______Is your son/daughter covered under this policy? Yes No Is your son/daughter covered under this policy? Yes No

PLEASE READ CAREFULLY!  University of Northern Iowa’s (UNI) Department of Athletics’ accident policy provides insurance for student-athletes with injuries occurring only when participating in the play or practice of intercollegiate athletics. UNI’s accident policy is considered “EXCESS” or “SECONDARY” to any other collectible group insurance benefits. Therefore, any claims for benefits must first be filed with the group insurance company providing coverage. Only after all available benefits have been exhausted will the University of Northern Iowa’s insurance carrier consider payment for any remaining balances.  I hereby authorize UNI, hospitals, & physicians connected with or provided, to furnish information to insurance carriers concerning any illness, injury, & treatments & I hereby assign to the party all payments for medical services rendered to the student-athlete.  I agree to supply any & all information requested by my primary insurance, UNI & their excess insurance company in a timely manner.  I hereby authorize UNI and their excess insurance company to secure & inspect copies of case history records, lab reports, diagnoses, x- rays, & any other data pertaining to the injury/illness I am receiving care for or previous confinements of disabilities relevant to the care of the injury/illness.  I hereby authorize the UNI Athletic Training Services Staff and/or my coach to hospitalize & secure treatment for me for any athletic injury/illness. (must be cosigned by parent/guardian if student-athlete is under 18 years of age)  A photostatic copy of this authorization shall be deemed as effective & valid as the original.  I will notify the UNI Athletic Training Services Staff immediately upon any change in the above health insurance information.  I hereby certify that I have read & understand the above statements, that any & all questions have been answered to my satisfaction, & that the answers provided are true, complete, & correct to the best of my knowledge.

Policy Holder’s Signature Date

Student-Athlete’s Signature Date

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UNIVERSITY OF NOTHERN IOWA STUDENT ATHLETE AUTHORIZATION/CONSENT FORM FOR DISCLOSURE OF PROTECTED HEALTH & MEDICAL INFORMATION (HIPAA)

I hereby authorize all members of the University of Northern Iowa Sports Medicine/Athletic Training Staff, all University of Northern Iowa Team Physicians, or any other physicians or health care professional to disclose and release information, records, and reports regarding my medical history, medical status, record of injury and/or surgery, prognosis, diagnosis, record of serious illness, rehabilitation, and related personally identifiable health information to the following:

 the media, including specifically the University of Northern Iowa Media Relations Department, to advise the print, radio, television and other media of the nature, diagnosis, prognosis or treatment concerning my medical condition and any injuries or illnesses for the purpose of reporting on it while I am a student-athlete  professional athletic teams, their scouts, athletic trainers, physicians, servants, or employees for the purpose of making decisions regarding my prospect as a professional athlete  my parents/guardian and/or spouse for the purpose of assisting me in making healthcare decisions while I am a student-athlete  the coaches, assistant coaches, and other athletic staff so that they may make decisions regarding my athletic ability and suitability to compete while I am a student-athlete  my teammates so that they may be aware of my limitations that I may be under while I am a student-athlete  the student athletic trainers and other students who are participating in the provision of sports medicine healthcare to assist and participate in the provision of healthcare to me while I am a student-athlete  amateur athletic organizations for the purpose of making decisions regarding my prospect as an athletic participant  academic departments including specifically the University of Northern Iowa Athletic Student Compliance and Student Life Office for the purpose of making decisions regarding my ability and suitability to perform academically while I am a student-athlete  the Missouri Valley Conference/Gateway Football Conference and the National Collegiate Athletic Association for the purpose of making determination regarding my eligibility status while I am a student-athlete  applicable insurance providers for the purpose of processing insurance claims while I am a student-athlete

The information includes injuries or illnesses relevant to past, present, or future participation in athletics at the University of University of Northern Iowa.

I understand that my injury/illness information is protected by federal regulations under either the Health Information Portability and Accountability Act (HIPAA) or the Family Educational Rights and Privacy Act of 1974 (the Buckley Amendment) and may not be disclosed without either my authorization under HIPAA or my consent under the Buckley Amendment. I understand that my signing of this authorization/consent is voluntary and that my institution will not condition any health care treatment or payment, enrollment in a health plan or receipt of any benefits (if applicable) on whether I provide the consent or authorization requested for this disclosure. The reason for this disclosure is to advise any of the above individuals of the nature, diagnosis, prognosis, or other treatment concerning my medical condition and injuries/illnesses sustained while I am a student-athlete. I understand that not all of the entities receiving the information are health care providers or health plans covered by federal privacy regulations, and that the information described above may be disclosed publicly.

I understand that the University of Northern Iowa will not receive compensation for its use/disclosure of the information. I also understand that entities listed above are not covered by the Buckley Amendment or HIPAA and that these regulations will not apply to the entities use or disclosure of my injury/illness information. I may inspect or copy any information used/disclosed under this authorization.

I understand that once I have signed this authorization, the University of Northern Iowa can rely on it until you revoke it or, if you do not revoked it, until it expires. I understand that I may revoke this authorization at any time by notifying in writing the Director of Sports Medicine/Athletic Training Services, but if I do, it will not have any effect on actions the university took in reliance on this authorization prior to receiving the revocation. This authorization/consent expires 380 days from the date it is signed.

A photocopy of this authorization shall be considered as valid as the original.

NAME______DATE______

SPORT______DATE OF BIRTH______

SIGNATURE______

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Department of Athletics Sports Medicine / Athletic Training Services ADHD MEDICAL EXCEPTIONS NOTIFICATION FORM

I ______, affirm that I have been informed by University of Student-Athlete Print Name Northern Iowa Sports Medicine/Athletic Training Services personnel on ______Date about the NCAA Banned Substances List and NCAA Medical Exceptions Policy as it specifically pertains to the use of banned stimulant medications (e.g. Ritalin, Stattera, Adderall, Concerta, etc.) that are used to treat Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Disorder (ADD), or like conditions. I attest that:

I AM NOT presently taking and/or have taken within the last 12 months any Initial banned stimulant medications (e.g. Ritalin, Stattera, Adderall, Concerta, etc.) that are used to treat Attention Deficit Hyperactivity Disorder (ADHD), Attention ______Deficit Disorder (ADD), or like conditions.

I AM presently taking and/or have taken within the last 12 months any banned stimulant medications (e.g. Ritalin, Stattera, Adderall, Concerta, etc.) that are used to treat Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Initial Disorder (ADD), or like conditions. ______

Medication______

I, the undersigned, do hereby affirm that I understand that I am to immediately notify a member of the University of Northern Iowa Sports Medicine Department / Athletic Training Services should I ever be prescribed the aforementioned stimulant medications and that I must obtain and submit appropriate documentation from the prescribing physician.

I further attest that I have had any and all questions regarding the NCAA ADHD Medical Exceptions Policy answered to my satisfaction.

______Student-Athlete Signature Date

______Athletic Trainer Signature Date

______Athletic Trainer Print Name 164

UNIVERSITY OF NORTHERN IOWA SPORTS MEDICINE Questions & Answers Regarding the Use of Banned Stimulants for Treatment of ADHD, ADD, and/or like Conditions

Background- The NCAA bans classes of drugs that can be harmful to student-athletes and that can create unfair advantages during competition (NCAA Bylaw 31.2.3). Some medications that student-athletes are prescribed for legitimate medical reasons contain NCAA banned substances. The NCAA, through the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS) has a Medical Exceptions Procedure to review and approve the use of medications that contain NCAA banned substances. Effective August 1, 2009, with respect to the use of banned stimulant medications used to treat Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Disorder (ADD), and/or like conditions, (e.g. Ritalin, Stattera, Adderall, Concerta, etc.), the NCAA now requires documentation of a comprehensive clinical evaluation to support treatment with NCAA banned stimulants and a current prescription.

What should student-athletes who are prescribed stimulant medications for ADHD, ADD, and/or like conditions do? Student-athletes who have been prescribed stimulant medications for the treatment of ADHD, ADD, and/or like conditions should immediately notify a member of the Sports Medicine Department/Athletic Training Services to ensure that they have the necessary documentation on file.

What documentation must the student-athlete obtain from his/her prescribing physician? At a minimum, student-athletes prescribed NCAA banned stimulants for the treatment of ADHD, ADD, and/or like conditions must provide the following documentation from the prescribing physician- 1. Evidence of comprehensive clinical evaluation (recording observations and results from standardized rating scales and/or neuropsychological testing), a physical exam and any lab work (attaching all documentation);  A simple statement from a prescribing physician that he/she is treating the student- athlete for ADHD, ADD, and/or like conditions with the prescribed stimulant IS NOT adequate documentation 2. Statement of diagnosis, including when diagnosis was confirmed; 3. History of ADHD, ADD, and/or like conditions treatment (previous and ongoing); 4. Recommended treatment (attaching current prescription); 5. Statement that a non-banned ADHD alternative has been considered and why banned stimulant was prescribed; and 6. Annual follow-up with prescribing physician and updated letter or copy of medical record is required in each year of eligibility.

When and where should documentation be sent?  The aforementioned documentation must be on file with the University of Northern Iowa Sports Medicine Department/Athletic Training Services in order for the student-athlete to participate in intercollegiate athletics at the University of Northern Iowa.

 All documentation should be sent to the following address:

University of Northern Iowa Sports Medicine / Athletic Training Services Attn: Don Bishop 008 Human Performance Center Cedar Falls, IA 50614-0244 Fax- (319) 273-7023 {secure fax} Email- [email protected]

Who can student-athletes, parents, coaches, etc. contact with questions regarding issues surrounding ADHD medications and the NCAA Medical Exceptions Policy? Student-athletes and/or parents with questions regarding the use of prescribed stimulants to treat ADHD, ADD, and/or like conditions should start by directing questions to the physician who initially conducted the evaluation and diagnosis. Individuals with specific questions regarding the NCAA Bylaws related to banned substances, drug testing, and/or medical exceptions can view the NCAA website (www.ncaa.org/health- safety) and/or contact Don Bishop (319-273-6369 or [email protected]).

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UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING SERVICES Student-Athlete Health History Questionnaire Form

The information contained in this medical history form will only be used by the Athletic Training Services / Sports Medicine Department of the University of Northern Iowa for purposes of determining if you pose a health threat/risk to yourself on the athletic field. This information will be discussed with you in detail later in your physical examination. This information will remain CONFIDENTIAL at all times.

(please print clearly)

Name Date Social Security # Date of Birth Race: Caucasian Afro-American Hispanic Asian/Pacific Alaskan/Indian Sport(s) Position(s) Height Weight Right Handed Left Handed

PERMANENT ADDRESS:

STREET

CITY STATE ZIP CODE

PHONE 1 PHONE 2

Father’s Name Age If Deceased, Cause of Death Age Father’s Occupation Address (if different from permanent address):

STREET

CITY STATE ZIP CODE

HOME PHONE WORK PHONE

Mother’s Name Age If Deceased, Cause of Death Age Mother’s Occupation Address (if different from permanent address):

STREET

CITY STATE ZIP CODE

HOME PHONE WORK PHONE

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I. Concussions/Head Injuries: History of Injury? YES NO  List Dates/Time Missed

 Please Describe

Were Any Diagnostic Tests Performed? (check all that apply) MRI CT-Scan Neuropsychological Testing Other Have You Ever Been Hospitalized For A Concussion/Head Injury? YES NO  When? Where?

 Please Describe

Do You Suffer From Headaches? YES NO  When? Every Day 1-2 Times/Week 1-2 Times/Month  Where Are Your Headaches Located? Left Side of Head Right Side of Head Front of Head Back of Head All Over Your Head Have You Had Headaches For More Than Three (3) Months? YES NO  If yes, please explain

ORTHOPEDIC HISTORY: II. Cervical Spine/Neck: History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Been Hospitalized For A Cervical Spine/Neck Injury? YES NO  When? Where?  Please Describe Have You Ever Had “Burners”, “Stingers”, or Any Brachial Plexus Injury? YES NO  How Many? Date(s)/Time Missed? Have You Ever Had Surgery of Any Kind on Your Cervical Spine/Neck? YES NO  When? Surgeon?  Please Describe Do You Presently Wear A Neck Roll or Neck Collar? YES NO Do You Presently Wear A “Cowboy Collar”? YES NO Have You Ever Worn or Been Advised To Wear a Neck Roll, Neck Collar, and/or “Cowboy Collar”? YES NO  If yes, please explain

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III. Shoulder: History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Been Hospitalized For A Shoulder Injury? YES NO  When? Where?  Please Describe Have You Ever Had Surgery of Any Kind on Your Shoulder? YES NO  When? Surgeon?  Please Describe Have You Ever Experienced Numbness and/or Tingling in Your Arms/Fingers? YES NO  Date(s)?  Please Describe? IV. Elbow / Arm: History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Been Hospitalized For An Elbow/Arm Injury? YES NO  When? Where?  Please Describe Have You Ever Had Surgery of Any Kind on Your Elbow/Arm? YES NO  When? Surgeon?  Please Describe V. Wrist, Hand, & Fingers: History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Been Hospitalized For A Wrist, Hand, and/or Finger Injury? YES NO  When? Where?  Please Describe Have You Ever Had Surgery of Any Kind on Your Wrist, Hand, and/or Finger(s)? YES NO  When? Surgeon?  Please Describe 168

VII. Spine / Low Back: History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Been Hospitalized For A Spine/Low Back Injury? YES NO  When? Where?  Please Describe Have You Ever Had Surgery of Any Kind on Your Spine/Low Back? YES NO  When? Surgeon?  Please Describe Have You Ever Had Numbness/Tingling Down One (1) or Both Legs? YES NO  Date(s)/Time Missed?  Please Describe? VIII. Ribs / Thorax: History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Had Surgery For A Rib/Thorax Injury? YES NO  When? Where?  Please Describe IV. Hip / Groin: History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Had Surgery For A Hip/Groin Injury? YES NO  When? Where?  Please Describe

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X. Thigh (including Quadriceps & Hamstrings): History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Been Hospitalized For A Thigh Injury? YES NO  When? Where?  Please Describe Have You Ever Had Surgery For A Thigh Injury? YES NO  When? Surgeon?  Please Describe XII. Knee: History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Been Hospitalized For A Knee Injury? YES NO  When? Where?  Please Describe Have You Ever Had Surgery For A Knee Injury? YES NO  When? Surgeon?  Please Describe Have You Ever/Do You Presently Wear A Knee Brace? YES NO  Which Knee? Brand of Brace? XIII. Ankle / Lower Leg: History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Been Hospitalized For An Ankle/Lower Leg Injury? YES NO  When? Where?  Please Describe Have You Ever Had Surgery For An Ankle/Lower Leg Injury? YES NO  When? Surgeon?  Please Describe Do You Presently Tape Your Ankle(s) Use Ankle Brace(s) Other  Please Describe 170

XIV. Foot / Toes: History of Injury? YES NO  List Dates/Time Missed  Please Describe Were Any Diagnostic Tests Performed? (check all that apply) X-Rays Bone Scan MRI CT-Scan Other Have You Ever Had Surgery For A Foot/Toe Injury? YES NO  When? Surgeon?  Please Describe

Prescription Medications: Please List ALL Prescription Medications That You Are CURRENTLY Taking or Have Taken In The PAST, & For What Purpose: MEDICATION DOSAGE DATE(S)

Medical Testing: Have you ever been tested for HIV/AIDS that you are aware of? YES NO  Date(s) of Test(s)? Location(s) of Test(s) Have you ever contracted any type of Hepatitis? YES NO  Date(s)? Treatment? Have you ever received a Hepatitis B (HBV) Vaccination? YES NO  Date?

Heat Related Problems: Have You Ever Experienced (check all that apply):  Heat Cramps- Date(s)?  Heat Exhaustion- Date(s)?  Heat Stroke- Date(s)? Have You Ever Received Intravenous Fluids (IV) For A Heat Related Problem? YES NO  Date(s)? Have You Ever Been Hospitalized For a Heat-Related Problem? YES NO  Date(s)? Where?

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Allergies: Have You Ever Been Diagnosed With Any Allergies? YES NO  Date(s)?  Please Describe Are You Presently Taking/Have You Previously Taken Any Allergy Medications? YES NO  Date(s)?  Please Describe

Diabetic History: Have You Ever Been Diagnosed With Diabetes? YES NO  Date? Are You Presently Taking or Have You Taken Any Diabetic Medications? YES NO Medication Form Dosage Frequency

Do You Daily Monitor Your Blood Sugar Level? YES NO  Please Describe Please List Any Precautions That You Take and/or Additional Information Not Mentioned Above:

Eyes: Do you routinely wear glasses? YES NO Do you routinely wear contact lenses? YES NO  What Type?

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Please Answer: {All questions are strictly CONFIDENTIAL & will not be shared with parents or coaches!}

YES NO Have you ever had any injury or illness other than those already noted? YES NO Do you have any ongoing or chronic illnesses? YES NO Have you ever been told by a physician to restrict your sports activity or not to participate in a sport? YES NO Are you currently under a physician’s care for any medical conditions? YES NO Have you ever been under the care of a psychiatrist/psychologist? YES NO Have you consulted and/or been under the care of a chiropractor, hypnotist, acupuncturist, massage therapist, healer, and/or other such practitioner in the past five (5) years? YES NO Do you take any vitamins or supplements? YES NO Have you ever had a rash or hives develop during exercise? YES NO Do you have any skin problems? (itching, rashes, acne, herpes, eczema, warts, fungus, or blisters) YES NO Have you ever been told you have asthma? YES NO Do you cough, wheeze, or have trouble breathing during or after exercise? YES NO Have you ever experienced excessive fatigue associated with exercise? YES NO Do you know of any family members who have died of premature cardiac death? YES NO Do you know of any relatives under 50 who have been diagnosed with cardiovascular disease or have significant disability from cardiovascular disease? YES NO Have you ever felt dizzy, passed out, or had chest pain during or after exercise? YES NO Have you ever had the feeling of your heart racing or skipped beats during or after exercise? YES NO Have you ever been told you had high blood pressure or high cholesterol in your blood? YES NO Have you ever been told that you have a heart murmur? YES NO Have you ever had an electrocardiogram (EKG) of your heart? YES NO Has a physician ever denied or restricted your participation in sports due to any heart problems? YES NO Have you ever had seizures of convulsions? YES NO Do you have recurrent or frequent headaches? YES NO Do you have ringing in your ears or trouble hearing? YES NO Do you have frequent ear infections or nosebleeds? YES NO Do you require any special equipment (braces, neck rolls, dental, orthotics, hearing aids, etc.) YES NO Have you had a tetanus booster within the last 10 years? If yes, when? YES NO Have you received your measles booster shot? If yes, when? YES NO Have you received the hepatitis immunization series (all 3 shots)? YES NO Do you or anyone in your family have sickle cell trait or disease? YES NO Are you missing any paired organs (kidneys, testicles, eyes)? YES NO Do you have any body piercing or tattoos? YES NO Are you aware of any reasons why you should not participate in intercollegiate athletics at this time?

YES NO Do you smoke cigarettes, use smokeless tobacco, or use tobacco in any form? YES NO Do you use alcohol? If yes, how often? YES NO Have you ever used marijuana, cocaine, or any other illicit “street” drugs? YES NO Do you have any questions regarding drugs, tobacco, or alcohol? YES NO Do you feel stressed out? If yes, do you feel as though you get the necessary support to deal with your stress?

YES NO Have you had a weight change (loss or gain) of greater than 10 pounds in the past year? YES NO Are you a vegetarian? YES NO Do you regularly lose weight to participate in your sport? YES NO Do you want to weigh more or less than you presently do? YES NO Have you restricted you food intake due to concerns about your weight and/or body size? YES NO Have you had a history of anorexia, bulimia (forced vomiting), and/or any other eating disorders? YES NO Would you like to meet with a dietitian to discuss your nutritional needs or eating habits?

For Females Only- YES NO Have you had menstrual periods within the past 12 months? If yes, how many? YES NO Do you have painful or heavy menstrual periods? YES NO Do you take any medications during your menstrual periods? If yes, what? YES NO Do you take birth control pills? If yes, what brand? YES NO Have you ever had any problems with your breasts? YES NO Have you had a pelvic examination within the last year? YES NO Would you like an appointment with a gynecologist?

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If you have answered YES to any of the above, please explain:

I hereby affirm that all statements on pages one (1) through nine (9) are true and correct to the best of my knowledge; and that no answers or information has been withheld pertaining to my past and present physical, mental, and injury status. If any information is false or omitted in reference to my medical and orthopedic history, I fully understand that the University of Northern Iowa is not responsible for any unknown injury.

Student-Athlete Signature Date

Student-Athlete Print Name

Parent/Guardian Signature (if under 18 years of age) Date

Parent/Guardian Print Name

Witness Date

Please describe below any further injury information or medical condition, which is knowledgeable to you and not required on this form.

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UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING SERVICES Medical Examination & Authorization Waiver

I, the undersigned, hereby acknowledge, affirm, and represent the following:

A. PRESENT PHYSICAL CONDITION: I have previously warranted and represented to University of Northern Iowa (UNI) that I am in excellent physical condition. Upon reporting to the University of Northern Iowa, I completed a “Health History Questionnaire” form and was examined by an UNI team and/or consulting physician and/or his/her designee. Recognizing that my true physical condition is dependent upon an accurate medical history and a full disclosure of any symptoms, complaints, prior injuries, ailments, and/or disabilities experienced, I hereby affirm that I have fully disclosed in writing my prior medical history; that my Health History Questionnaire Form was fully and accurately completed; that all of my present symptoms, complaints, ailments, disabilities, and/or prior injuries have been disclosed in writing to and discussed with an UNI team and/or consulting physician and/or his/her designee; and that I am not suffering from any complaints, prior injuries, ailments, disabilities, conditions, or problems not so disclosed and discussed. Furthermore, I consent to laboratory analysis, urine screen, blood chemistry, orthopedic, internal, and any other examination deemed necessary to determine my physical/mental condition.

B. FUTURE COMPLAINTS: I acknowledge and agree that all future injuries, medical/dental/mental problems, ailments, complaints, re-injuries, and aggravations of old injuries must be immediately reported to the University’s Team Physician, Head Athletic Trainer, and/or his/her designee, no matter how minor or insignificant I may deem them to be.

C. MEDICAL RECORDS: I hereby authorize and empower the University of Northern Iowa and its representatives to examine, copy, and/or obtain copies of any and all medical records relating to my prior health history, complaints, illnesses, injuries, examinations, tests, findings, and treatments. I also hereby authorize all physicians, hospitals, clinics, schools, colleges/universities, and all other organizations and/or entities that may possess such records, to make them freely available to representatives of the University of Northern Iowa Athletic Training Services Staff. I do hereby release and discharge all such persons and institutions from any and all claims by reason thereof.

D. ANABOLIC/ANDROGENIC STEROIDS: It is to be noted that the University of Northern Iowa DOES NOT accept or condone the use of anabolic / androgenic steroids. I, as the student-athlete signed below, acknowledge the aforementioned statements and policies and have been made aware of the University of Northern Iowa, Missouri Valley Conference (MVC), Gateway Football Conference, National Collegiate Athletic Association (NCAA), and United States Olympic Committee (USOC) Policies with regards to anabolic / androgenic steroid use. Also, I fully understand the detrimental and possibly permanent defects caused by the use of anabolic / androgenic steroids. Furthermore, anabolic / androgenic steroid use can cause injury as well as aggravation or delayed healing of a present injury. I accept any and all liability if I have in the past used, continue to use, or use at anytime in the future, anabolic / androgenic steroids. The University of Northern Iowa, its agents, servants, trustees, and employees disclaim liability and will not be held liable for any detrimental and possibly permanent defects caused by past, present, and/or future use of anabolic / androgenic steroids. I further release the University of Northern Iowa and all personnel of any and all responsibility and liability.

E. TOBACCO: It is to be noted that the University of Northern Iowa does not condone the use of tobacco in any form, including smoking and smokeless (i.e. “dipping”, “chewing”, etc.). Research has shown that the use of tobacco can lead to lung cancer, oral cancer, leukoplakia, emphysema, heart disease, heart attacks, etc. I, as the student-athlete signed below, acknowledge the aforementioned statements and policies and fully accept the detrimental and possibly permanent defects caused by the use of tobacco in any form. I accept any and all liability if I have in the past used, continue to use, or use at anytime in the future, tobacco in any form. The University of Northern Iowa, its agents, servants, trustees, and employees disclaim liability and will not be held liable for any detrimental and possibly permanent defects caused by past, present, and/or future use of tobacco products of any kind. I further release the University of Northern Iowa and all personnel of any and all responsibility and liability.

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F. ALCOHOL: It is to be noted that the University of Northern Iowa does not condone the use and/or abuse of alcohol in any form, nor does it condone operating a motor vehicle while under the influence of alcohol. Research has shown the alcohol acts as a central nervous system depressant and a diuretic. Research has also shown that alcohol can lead to dehydration, decreased motor awareness, and kidney and liver dysfunction. The unlawful manufacture, distribution, dispensation, possession, or use of alcohol by students on property owned or leased by the University of Northern Iowa or in conjunction with a University-sponsored activity is prohibited. I, as the student-athlete signed below, acknowledge the aforementioned statements and policies and fully accept the detrimental and possibly permanent defects caused by the abuse of alcohol. I accept any and all liability if I have in the past abused, continue to abuse, or abuse at anytime in the future, alcohol in any form. The University of Northern Iowa, its agents, servants, trustees, and employees disclaim liability and will not be held liable for any detrimental and possibly permanent defects caused by past, present, and/or future use and/or abuse of alcohol in any form. I further release the University of Northern Iowa and all personnel of any and all responsibility and liability.

G. ILLICIT (“STREET”) DRUGS: It is to be noted that the University of Northern Iowa does not condone the use of illicit “street” drugs in any form, including, but not limited to: marijuana, cocaine, “crack”, barbiturates, LSD, amphetamines, PCP, heroin, hashish, mescaline, DMT, mushrooms, and inhalants. Research has shown that the use of illicit “street” drugs in any form is addictive, and can lead to: cardiac arrhythmia’s, impaired physical abilities, impaired judgment, mood alterations, hallucinations, circulatory problems, and possibly death. It is the policy of the University of Northern Iowa and the Iowa Board of Regents to provide for a drug free workplace and learning environment for students and employees. The unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance by students on property owned or leased by the University of Northern Iowa or in conjunction with a University-sponsored activity is prohibited. I, as the student-athlete signed below, acknowledge the aforementioned statements and policies and have been made aware of the University of Northern Iowa, Missouri Valley Conference (MVC), Gateway Football Conference, National Collegiate Athletic Association (NCAA), and United States Olympic Committee (USOC) policies with regards to the use of illicit (“street”) drugs; and I acknowledge this and fully accept the detrimental and possibly permanent defects caused by the use of illicit (“street”) drugs. I accept any and all liability if I have in the past used, continue to use, or use at anytime in the future, illicit (“street”) drugs in any form. The University of Northern Iowa, its agents, servants, trustees, and employees disclaim liability and will not be held liable for any detrimental and possibly permanent defects caused by past, present, and/or future use of illicit (“street”) drugs in any form. I further release the University of Northern Iowa and all personnel of any and all responsibility and liability.

H. ERGOGENIC AIDS: The University of Northern Iowa does not condone the use of ergogenic aids, creatine powder, protein supplements, amino acids, etc. 1) Supplements do not undergo the same quality controls as do medications. These are considered food supplements and do not require the same strict control as medications. 2) The claims, which are made, have not been based on scientific evidence in most cases, and many of these substances have had no research performed to substantiate their claims. 3) The potential adverse and/or harmful effects of these substances have not been studied, but serious adverse effects have been reported in some instances. 4) These substances are sometimes mislabeled. There have been instances of substances not listed on the label being contained in the product. It is truly a “BUYER BEWARE” market. It is important for you to remember that YOU WILL BE HELD RESPONSIBLE FOR EACH AND EVERY SUBSTANCE THAT ENTERS YOUR BODY!!

I understand that I am to list all supplements on the Chain of Custody Forms at the time of any drug test which I take. I, as the student-athlete signed below, acknowledge the aforementioned statements and policies and fully accept the detrimental and possibly permanent defects caused by the use of ergogenic aids. I accept any and all liability if I have in the past used, continue to use, or use at anytime in the future, ergogenic aids in any form. The University of Northern Iowa, its agents, servants, trustees, and employees disclaim liability and will not be held liable for any detrimental and possibly permanent defects caused by past, present, and/or future use of ergogenic aids and/or nutritional supplements in any form. I further release the University of Northern Iowa and all personnel of any and all responsibility and liability.

I. DIURETICS: Diuretics or “water pills” have been used in the past by some student-athletes to lose weight so that an assigned weight might be reached. The use of diuretics or “water pills” for weight loss is not considered medically safe, and is not permissible under National Collegiate Athletic Association (NCAA) and United States Olympic Committee (USOC) Drug Testing Guidelines. I, as the student-athlete signed below, acknowledge the aforementioned statements and policies and fully accept the detrimental and possibly permanent defects caused by the use of diuretics. I accept any and all liability if I have in the past used, continue to use, or use at anytime in the future, diuretics in any form. The University of Northern 176

Iowa, its agents, servants, trustees, and employees disclaim liability and will not be held liable for any detrimental and possibly permanent defects caused by past, present, and/or future use of diuretics. I further release the University of Northern Iowa and all personnel of any and all responsibility and liability.

J. PIERCED EARS, EARRINGS & BODY PIERCINGS: The University of Northern Iowa does not condone the puncturing of body parts (i.e. earlobe, nose, tongue, belly button, eyebrow, nipple, etc.), or the use or wearing of earrings and/or pierced body ornaments during athletic competition. I, as the student athlete signed below, acknowledge the aforementioned statements and policies, and accept any liability if I have in the past, or at any time in the future pierce or puncture any part of my body for the purpose of wearing earrings and/or pierced body ornaments. In the event of injury to any body part and/or nerve(s) due to the wearing of earrings and/or pierced body ornaments, the University of Northern Iowa, its agents, servants, trustees, and employees disclaim liability and will not be held liable. I further release the University of Northern Iowa and all personnel of any and all responsibility.

K. MEDICAL TREATMENT: I hereby authorize the University of Northern Iowa team physicians, athletic trainers, and designated medical staff to examine and treat any injuries, which may occur, while participating in intercollegiate athletics for the University of Northern Iowa. I authorize the team physicians, athletic trainers, and designated medical staff to communicate with athletic department officials and coaching staff regarding their findings and recommendations. I further understand that the team physician and/or his/her designee have the authority to eliminate me from participation as a student-athlete due to an injury/illness, and/or due to undue liability risk of the University of Northern Iowa.

L. DRUG TESTING: I understand that as a student-athlete at the University of Northern Iowa, I am eligible to be drug tested by the National Collegiate Athletic Association (NCAA) and by the UNI Athletic Department. I agree to submit to drug testing for the banned drugs listed in NCAA Bylaw 31.2.3.1. I attest that I have read and fully understand the drug testing procedure to be utilized and the penalties in accordance with NCAA Bylaw 31.2.3.1 and the University of Northern Iowa’s Drug and Alcohol Policy. I further accept that any and all questions and/or concerns that I may have regarding drug testing have been answered to my satisfaction by the appropriate personnel.

M. RELEASE OF MEDICAL RECORDS: I give authorization to the University of Northern Iowa Team Physician, Head Athletic Trainer, and/or his/her designee to release and make available complete copies of my medical records including physical examinations, athletic training records, diagnosis, treatment, history, prognosis of any and all injuries and ailments, to any professional sport teams, athletic trainers, physicians, and/or other medical personnel.

N. AUTHORIZATION: I fully understand that this authorization shall be effective and valid for one year (52 weeks) after the termination of my playing and/or academic career at the University of Northern Iowa.

O. AGREEMENT TO PARTICIPATE: I am aware that playing, practicing, training, and/or other involvement in any sport can be a dangerous activity involving MANY RISKS OF INJURY, including, but not limited to the potential for catastrophic injury. I understand that the dangers and risks of playing, practicing, or training in any athletic activity include, but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis or brain damage, serious injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the muscular-skeletal system, and serious injury or impairment to other aspects of my body, general health and well-being. Because of the aforementioned dangers of participating in any athletic activity, I recognize the importance of following all instructions of the coaching staff and/or Athletic Training Services Department. Furthermore, I understand that the possibility of injury, including catastrophic injury, does exist even though proper rules and techniques are followed to the fullest. I also understand that there are risks involved with traveling in connection with intercollegiate athletics.

In consideration of the University of Northern Iowa (UNI) permitting me to participate in intercollegiate athletics and to engage in all activities related to my sport, I hereby voluntarily assume all risks associated with participation and agree to exonerate, save harmless and release UNI, its agents, servants, trustees, and employees from any and all liability, any medical expenses not covered by the University of Northern Iowa’s athletic medical insurance coverage, and all claims, causes of action or demands of any kind and nature whatsoever which may arise by or in connection with my participation in any activities related to intercollegiate athletics.

The terms hereof shall serve as release and assumption of risk for my heirs, estate, executor, administrator, assignees, and all members of my family. 177

University of Northern Iowa Athletic Training Services

I, the undersigned, do hereby attest that I have read and fully understand the University of Northern Iowa Athletic Training Services Department’s Medical Examination and Authorization Waiver. Further, I agree to abide by all regulations set forth, and I understand that failure to abide by the statements could result in serious health consequences.

Student-Athlete Signature Date

Student-Athlete Print Name

Parent/Guardian Signature (if under 18 years of age) Date

Parent/Guardian Print Name

Witness Date

178

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING SERVICES Student-Athlete Physical Examination

Name Social Security # Date of Birth Sport(s)

Since your last physical examination on , have you? DATE Yes No 1. Had a serious injury? Yes No 21. Had an unfavorable / allergic reaction to a drug, antibiotic, and/or medicine? Yes No 2. Had a fracture? Yes No 22. Do you have only one of two paired, functioning organs (eye, kidney, ovary, etc.)? Yes No 3. Had a concussion and/or head injury? Yes No 23. Do you have any allergies? Yes No 4. Been unconscious for any other reason other than Yes No 24. Do you require daily medications? anesthesia? Yes No 5. Had a neck injury? Yes No 25. Been diagnosed with asthma? Yes No 6. Had a back injury or back pain? Yes No 26. Experienced wheezing? Yes No 7. Had a history of burners, stingers, numbness in neck, Yes No 27. Been diagnosed with diabetes? shoulder, and/or hand? Yes No 8. Had a shoulder, elbow, and/or hand/wrist injury? Yes No 28. Been diagnosed with kidney disease? Yes No 9. Had a hip and/or knee injury? Yes No 29. Been diagnosed with a hernia? Yes No 10. Had a lower leg, ankle, and/or foot injury? Yes No 30. Experienced seizures or convulsions; and/or been diagnosed with epilepsy? Yes No 11. Had an operation? Yes No 31. Been diagnosed with high blood pressure? Yes No 12. Are you currently undergoing physical therapy or Yes No 32. Do you require any special equipment to participate in rehabilitation for an injury? athletics? Yes No 13. Do you have any medical problems about which we should Yes No 33. Have you been hospitalized OR had a major illness? be aware? Yes No 14. Do you wear contact lenses, glasses, and/or safety Yes No 34. Are you currently taking any short course medication for glasses? any illnesses? Yes No 15. Had frequent headaches? Yes No 35. Do you have any concerns regarding drugs, tobacco, and/or alcohol? Yes No 16. Had a heat related illness (heat cramps, heat exhaustion, Yes No 36. Have you had a history of anorexia, bulimia (forced and/or heat stroke)? vomiting), and/or any other eating disorder? Yes No 17. While exercising, has your heart ever “skipped” a beat, Yes No 37. Do you take vitamins, amino acids, creatine, and/or any have you suffered from a “racing heart”, severe chest pain, other dietary supplement? lightheadedness, or fainted? Yes No 18. Had a dental injury? Yes No 38. Do you know of, or do you believe there is any health reason why you should not participate in intercollegiate athletics at the University of Northern Iowa? Yes No 19. Do you wear a removable dental appliance? Yes No 39. Had trouble with coughing, wheezing, or breathing during or after exercise? Yes No 20. Been recently diagnosed with infectious mononucleosis Yes No 40. Have you ever felt dizzy or passed out during or after (“mono”), hepatitis B or C, and/or HIV/AIDS? exercise

FEMALES ONLY! When did your last menstrual period begin? How long does your menstrual period usually last? How many menstrual periods have you had in the last 12 months? Do you take birth control pills? If so, which one(s)? Do you take pain medication? If so, which one(s)?

If you answered “YES” to any of the above questions and/or have any further information, which is knowledgeable to you and not required on this form, please explain in detail-

I hereby affirm that all of the above statements are true and correct to the best of my knowledge; and that no answers or information has been withheld pertaining to my past and present physical, mental, and injury status since my last physical examination. If any information is false or omitted in reference to my medical and orthopedic history, I fully understand that the University of Northern Iowa is not responsible for any unknown injury.

Student-Athlete Signature Date 179

UNI HEALTH EXAMINATION FORM (to be completed by the examining physician) Vital Information: Height Weight Blood Pressure / Pulse Vision: right- 20 / ___ left- 20 / ___ Corrected- YES NO

Marfan’s Screen: Positive History YES NO Arm Span Thumb Opposition Test YES NO Wrist Circumference Test YES NO Palate

Physical Exam:

NORMAL ABNORMAL FINDINGS Skin Eyes Ears Nose Mouth / Throat Lymph Nodes Heart / Cardiovascular Pulmonary / Lungs Femoral Artery Pulses Abdomen / Gastrointestinal Genitalia (Hernia/Testicles) Genitourinary Neurological Orthopedic (spine) Orthopedic (upper extremity) Orthopedic (lower extremity)

Recommendations / Comments:

Status: Pass without restrictions Pass with restrictions Further Evaluation Needed- Appt. with Appt. Date

Examiner’s Signature Date

Examiner Print Name

180

EXIT PHYSICAL EXAMINATION

Name Sport

Findings:

Recommendations / Comments:

Status:

Pass without restrictions Pass with restrictions Further Evaluation Needed- Appt. with

I, the undersigned, do hereby affirm that the information contained on this page and any attached pages is true and correct to the best of my knowledge; and that no information has been withheld pertaining to my past and present physical, mental, and injury status. I further attest that any physical findings and/or recommendations have been discussed with me by a member of the University of Northern Iowa Sports Medicine Department; and that I fully understand the recommendations and have had any questions answered to my satisfaction. If any information is false or omitted in reference to my medical history, I fully understand that University of Northern Iowa, its Athletic Department, and its Sports Medicine Department are not responsible for any unknown injuries or conditions.

Student-Athlete Signature Date

Examining Physician / Athletic Trainer’s Signature Date

Examining Physician / Athletic Trainer Print Name

181

UNI Sickle Cell Trait Disclosure Form

I, ______affirm that I have been informed by my family physician as to my Sickle Cell Trait Status, and/or have undergone the sickle cell trait screening, in the form of a blood test, at the ______Clinic.

1. Sickle Cell Trait Positive Initial ______

2. Sickle Cell Trait Negative Initial ______

About Sickle Cell Trait-  Sickle cell trait is an inherited condition of the oxygen-carrying protein, hemoglobin, in the red blood cells.  Although Sickle cell trait is most predominant in African-Americans and those of Mediterranean, Middle Eastern, Indian, Caribbean, and South and Central American ancestry, persons of all races and ancestry may test positive for sickle cell trait.  Sickle cell trait is usually benign, but during intense, sustained exercise, hypoxia (lack of oxygen) in the muscles may cause sickling of red blood cells (red blood cells changing from a normal disc shape to a crescent or “sickle” shape), which can accumulate in the bloodstream and “logjam” blood vessels, leading to collapse from the rapid breakdown of muscles starved of blood.  Likely sickling settings include timed runs, all out exertion of any type for 2 – 3 continuous minutes without a rest period, intense drills and other spurts of exercise after prolonged conditioning exercises, and other extreme conditioning sessions.  Common signs and symptoms of a sickle cell emergency include, but are not limited to: increased pain and weakness in the working muscles (especially the legs, buttocks, and/or low back); cramping type pain of muscles; soft, flaccid muscle tone; and/or immediate symptoms with no early warning signs.

I, the undersigned, do hereby affirm that I have been informed of my sickle cell trait status by my family physician and/or one of the clinician at the ______Clinic. If my sickle cell trait status is positive I understand that I am required to undergo educational sessions around the topic of sickle cell and understand that specific precautions that need to be undertaken due to the serious nature of the condition. The educational sessions will be administered by a University of Northern Iowa Team Physician and/or a member of the UNI Sports Medicine Department / Athletic Training Services. I also affirm that I have read through and University of Northern Iowa Sickle Cell Position Statement.

______Student-Athlete Signature (If under 18, include parent/guardian signature) Date

______Examining Physician Signature Date

______Examining Physician Print Name Date

______Athletic Trainer Signature Date

______Athletic Trainer Print Name Date

182

UNI Sickle Cell Trait Waiver Form

About Sickle Cell Trait-  Sickle cell trait is an inherited condition of the oxygen-carrying protein, hemoglobin, in the red blood cells.  Sickle cell trait is a common condition (> three million Americans)  Although Sickle cell trait is most predominant in African-Americans and those of Mediterranean, Middle Eastern, Indian, Caribbean, and South and Central American ancestry, persons of all races and ancestry may test positive for sickle cell trait.  Sickle cell trait is usually benign, but during intense, sustained exercise, hypoxia (lack of oxygen) in the muscles may cause sickling of red blood cells (red blood cells changing from a normal disc shape to a crescent or “sickle” shape), which can accumulate in the bloodstream and “logjam” blood vessels, leading to collapse from the rapid breakdown of muscles starved of blood.

Sickle Cell Trait Testing-  The NCAA and the University of Northern Iowa Sports Medicine Department mandates that all NCAA student-athletes have knowledge of their sickle cell trait status, show proof of a prior test or sign a waiver before the student-athlete participates in any intercollegiate athletics event, including strength and conditioning sessions, practices, competitions, etc.  The University of Northern Iowa Student Health Center and Cedar Valley Medical Specialists located in the UNI Human Performance Complex offers sickle cell trait screening in the form of a blood test to all students for al fee. Results will be reported to the University of Northern Iowa team physicians and a member of the University of Northern Iowa Sports Medicine Department / Athletic Training Services.  Athletes should read through the University of Northern Iowa Sickle Cell Position Statement.

SICKLE CELL TRAIT TESTING WAIVER

I, ______, understand and acknowledge that the NCAA and the University of Northern Iowa Sports Medicine Department / Athletic Training Services mandate that all student-athletes have knowledge of their sickle cell trait status. Additionally, I have read and fully understand the aforementioned facts about sickle cell trait and sickle cell trait testing.

Recognizing that my true physical condition is dependent upon an accurate medical history and a full disclosure of any symptoms, complaints, prior injuries, ailments, and/or disabilities experienced, I hereby affirm that I have fully disclosed in writing any prior medical history and/or knowledge of sickle cell trait status to University of Northern Iowa Sports Medicine Department / Athletic Training Services personnel.

I do not wish to undergo sickle cell trait testing and I voluntarily agree to release, discharge, indemnify and hold harmless the State of Iowa, the University of Northern Iowa, its officers, employees and agents from any and all costs, liabilities, expenses, claims, demands, or causes of action on account of any loss or personal injury that might result from my non-compliance with the mandate of the NCAA and the University of Northern Iowa Sports Medicine Department / Athletic Training Services.

I have read and signed this document with full knowledge of its significance. I further state that I am at least 18 years of age and competent to sign this waiver.

______Student-Athlete Signature Date

______Parent/Guardian Signature (if under 18 years of age) UNI ID #

______Parent/Guardian Print Name Date

______Witness Date 183

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING Patient Initial Evaluation Form

NAME SPORT INJURED BODY PART- Right Left INJURY DATE

SUBJECTIVE INFORMATION HISTORY/MECHANISM

OBJECTIVE EXAMINATION PHYSICAL INSPECTION

GAIT PALPATION

AROM PROM MMT

NEUROVASCULAR/SENSORY EXAM

STRESS TESTS

SPECIAL TESTS

ASSESSMENT Short Term Goals Long Term Goals TREATMENT PLAN

ATHLETIC TRAINER DATE

184

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING

Initial SOAP Note

Name: ______Sport: ______Date: ______

Onset Date: ______Area Injured: ______Practice / Game / Other

S: (Hx, C.C., Mechanism)

O: Visual Inspection:

Palpation:

A/PROM:

Strength Tests / MME:

Special Tests:

Other:

A: L / R / NA:

P: (Short & Long-term goals / plans)

Examiner: ______Date: ______

ATC Signature: ______Date: ______

185

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING REFERRAL FOR MEDICAL SERVICES

Provider:

UNI Student Health CVMS – Ortho CVMS – Physical Therapy Dr. Shah/ Neurology Chiropractic ______(List Provider) Pharmacy ______(List location) Other: ______Physician Name: ______

======

Name: ______Student ID#: ______Date of Birth: ______Athletic Trainer Making Referral: ______Sport: ______Injury/ Illness Evaluation/ Prescription: ______

Condition Occurred During: Practice Competition Other Athletic Non-Athletic Athletic Trainers Remarks (be specific): ______

I hereby give permission to the provider of medical services listed above to release copies of all medical records, documentation, and test results to the University of Northern Iowa Athletic Trainers. Copies of notes should be forwarded to the UNI Athletic Training Room, Cedar Falls, IA 50613 Confidential Fax # 319-273-7023. Signed: ______Date: ______

======Provider Billing Instructions: Please bill student-athlete primary insurance first. If ‘Athletic Related’ box is checked, the below secondary insurance information can be added to patient’s billings for any services related to only the above injury/illness.

Athletic Related: Yes (See below for Secondary Insurance Information) No (Do not bill Secondary)

ID: _

All provider insurance billing/ referral questions can be directed to Chelsea Lowe (UNI Insurance Coordinator) 319-273-6108.

186

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING Rehabilitation Exercise Log Sheet

Name Sport Injury Date Injury Right Left

DATE

187

UNIVERSITY OF NORTHERN IOWA ATHLETIC TRAINING SERVICES Student-Athlete Referral / Consultation Form

Name SS# Sport Date of Birth Date of Injury Date of Referral Injured Body Part- Right Left History / Reason for Referral:

Referred To: Dr. Jeff Clark IHP Urgent Care Center Dr. Brian Burnett Northeast Iowa Family Practice Dr. Roswell Johnston UNI Student Health Services CV Podiatry (Cervetti / Morreale) Family Foot Health Care (Lantz / Weires) Dr. Anne Hennessey, DDS Hy-Vee Pharmacy Allen Hospital Covenant Medical Center // Sartori Hospital Other

Referred By: Name Title

Sport Related Injury / Illness: Primary insurance information is attached. The University of Northern Iowa and its athletic department is the SECONDARY insurance carrier for this referral. All claims and charges should be submitted directly to the patient’s primary insurance company. Remaining or unpaid charges should then be submitted to:

University of Northern Iowa Sports Medicine Department Attn: Insurance Coordinator UNI Human Performance Center 008 Cedar Falls, IA 50614-0244 (319) 273-6476 // fax (319) 273-7023

Non-Sport Related Injury / Illness: Injury / Illness is NOT the direct result of intercollegiate athletic participation at the University of Northern Iowa. Submit all charges directly to the aforementioned student-athlete. The University of Northern Iowa’s Athletic Department cannot, per NCAA regulations, remit payment for these charges.

UNI Athletic Trainer Signature Date

188

Athletic Training Services

IV Fluid Treatment Record

Name: DOB:

Date:

Reason for IV administration:

Allergies: Rx Meds: OTC Meds:

Type of IV Fluid:. ( ) 9% Sodium Chloride______( ) D5 Dextrose______( ) Lactated Ringers______

Flow Rate: “Wide Open” ( ) 500 cc/hr ( )

Site: ______

Pre-IV Vitals: Pulse:

Blood Pressure:

Body Weight:

Start time of IV fluids: ______

Time of IV removal: ______

Post-IV Vitals: Pulse:

Blood Pressure:

Body Weight:

Additional comments or concerns:

Clinician Signature Date

189

University of Northern Iowa Coaches Concussion Statement

□ I have read and understand the UNI Concussion Management Protocol.

□ I have read and understand the NCAA Concussion Fact Sheet

After reading the NCAA Concussion fact sheet and reviewing the UNI Concussion Management Protocol, I am aware of the following information:

______A concussion is a brain injury which athletes should report to the medical Initial staff.

______A concussion can affect the athlete’s ability to perform everyday activities, Initial and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury.

______I will not knowingly allow the athlete to return to play in a game or practice Initial If he/she has received a blow to the head or body that results in concussion- related symptoms.

______Athletes shall not return to play in a game or practice on the same day that Initial they are suspected of having a concussion.

______If I suspect one of my athletes has a concussion, it is my responsibility to Initial have that athlete see the medical staff.

______I will encourage my athletes to report any suspected injuries and illnesses to Initial the medical staff, including signs and symptoms of concussions.

______Following concussion the brain needs time to heal. Concussed athletes are Initial much more likely to have a repeat concussion if they return to play before their symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage, and even death.

______I am aware that every first-year student-athlete participating on specified Initial UNI teams must be baseline tested prior to participation in sport. These tests allow for comparison of symptoms, neurocognition, and balance if the athlete were to become injured.

______I am aware that athletes diagnosed with a concussion will be assessed at Initial regular time intervals following a concussion . Athletes will begin a graduated return to play protocol following full recovery of neurocognition and balance determined by baseline concussion testing and symptoms.

______Signature of Coach Date Printed name of Coach

190

University of Northern Iowa Student-Athlete Concussion Statement

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

□ I have read and understand the NCAA Concussion Fact Sheet.

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 Initial team physician or athletic trainer.

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

______You cannot see a concussion, but you might notice some of the symptoms Initial right away. Other symptoms can show up hours or days after the injury.

______If I suspect a teammate has a concussion, I am responsible for reporting the Initial injury to my team’s Athletic Trainer.

______I will not return to play in a game or practice if I have received a blow to Initial the head or body that results in concussion-related symptoms.

______Following concussion the brain needs time to heal. You are much more likely Initial to have a repeat concussion if you return to play before your symptoms resolve.

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

______Signature of Student-Athlete Date

______Printed name of Student-Athlete

191

University of Northern Iowa Athletic Training Services Post-Concussion Home Instruction Sheet

Name:______Date:______You have recently sustained a concussion and will need to be observed carefully over the next 24 hours. It is OK to: There is no need to: DO NOT:

 Use Tylenol  Stay awake  Drive (Acetaminophen)  Wake up every hour  Consume alcohol  Eat a light meal  Perform exercise  Go to sleep  Consume: o Ibuprofen o Advil o Any NSAID product

Special Recommendations: ______***Watch for any of the following*** Worsening Headache Stumbling/Loss of Balance Vomiting Weakness In One Arm/Leg Decreased Level of Consciousness Blurred Vision Dilated Pupils Increased Irritability Increased Confusion

If any of these problems develop call your athletic trainer immediately: Athletic Trainer:______Phone:______You need to be seen for a follow-up exam at ______AM / PM at:______

192

UNI Athletic Training – Concussion Home Care Instructions Card (Front Side)  Remain under the observation or a roommate or close friend for the first 24 hours. It is important that you get plenty of sleep. Being awaken in the night is not necessary unless: o You experienced a loss of consciousness or significant amnesia. o You are still experiencing significant symptoms at bedtime.  Do not drink alcohol.  Do not take any over-the-counter drugs (especially Advil/ibuprofen and aspirin) or prescription drugs without permission from your athletic trainer or physician.  Refrain from physical activity. Complete bed rest is not necessary – resume activities of daily living as tolerated.  Eat a well-balanced diet and drink plenty of water and other liquids.  Avoid anything that increases your symptoms. Limit time spent watching television, on the computer, and texting. Avoid bright or flashing lights and loud noises.  Check in with the athletic training staff right away tomorrow morning.

UNI Athletic Training – Concussion Home Care Instructions Card (Back Side) Go to the emergency room if you experience the following symptoms:  Headache of increasing severity  Unusual drowsiness or can’t be awakened  Seizure  Repeated vomiting  Slurred speech  Can’t recognize people or places  Increasing confusion or irritability  Weakness or numbness in arms or legs  Neck pain

Sartori Hospital Emergency Room: 515 College Street, 319-268-3090 Local “Nurse-On-Call” Line: 319-272-2600 For an immediate emergency, call 911.

193

APPENDIX J Medical Consultant List

194

UNIVERSITY of NORTHERN IOWA SPORTS MEDICINE DEPARTMENT Consultant List {updated as of 7/14/18}

Orthopedics (General)-

Dr. Jeffrey Clark, DO (all sports) ** Dr. Robert Bartlet (all sports) Cedar Valley Medical Specialists Cedar Valley Medical Specialists 2351 Hudson Road, Suite 001 164 West Dale Street Cedar Falls, IA 50614-0244 Waterloo, IA 50703 (319) 273-5275 (319) 833-5381 fax- (319) 273-5295

Dr. Todd Johnston (all sports) Dr. Richard Naylor, DO Dr. Benjamin Torrez Dr. Gary Knudson, MD Cedar Valley Medical Specialists Covenant Professional Building 1753 W Ridgeway Ave. Ste. 103B 2710 St. Francis Drive, Suite 419 Waterloo, IA 50701 Waterloo, IA 50702 (319) 833-5922 (319) 272-5000 fax (319) 833-5923 fax (319) 272-5788

Dr. David Tearse, MD (consultant) Univ. of Iowa (consultants) Mercy Medical Center Brian Wolf, MD 825 5th Ave SE Matthew Bollier, MD (319-855-3881 cell) Cedar Rapids, IA 52403 University of Iowa Sports Medicine Center Main Phone: 319-366-5633 2701 Prairie Meadow Drive Fax: 319-366-2142 Iowa City, Iowa 52242 Lynda- nurse Phone: 319-384-7070 Denise / Nebby- receptionists

Dr. William Jacobson, MD (consultant) Dr. Peter Buck, MD and (consultant) Central Iowa Orthopedics Dr. Thomas Greenwald, MD 1601 NW 114th St., Suite 142 McFarland Clinic Des Moines, IA 50325 1215 Duff Ave. (515) 222-3151 (515)-239-4475 fax (515) 222-3155

Dr. Michael Stuart, M.D., Ph.D. (consultant)

Mayo Clinic 201 West Center St. Rochester, MN 55902 (507) 266-7890

Orthopedics (Foot/Ankle)-

Dr. Michael S. Lee, DPM, MS, FACFAS Dr. J. Chris Coetzee, MD Mb ChB Central Iowa Orthopedics 4010 W 65th Street 1601 NW 114th St., Suite 142 Edina, MN 55435 Des Moines, IA 50325 (952) 456-7000 (Office) (515) 222-3151 / fax (515) 222-3155 (952) 456 - 7000 (Fax) Lisa Long – Admin. Assistant [email protected] Orthopedics (Hand/Wrist)-

Dr. Timothy S. Loth, MD Physicians Clinic of Iowa 202 10th St SE Suite 140 Cedar Rapids, IA 52403 (319) 398-1545 (Office) (319) 399-2039 (Fax) 195

Orthopedics (Elbow)-

Dr. James Andrews Dr. Shawn O’Driscoll, M.D., Ph.D. Nurse: Pat Jones Mayo Clinic Receptionist: Melissa Meadows 201 West Center St. 205-939-3000 Rochester, MN 55902 Fax: 205-918-0848 (507) 266-7890

Family Practice / General Practitioner-

Northeast Iowa Family Practice ** Integra Health / Urgent Care Center Attn: Jan Palmer – Residency Program 1717 W. Ridgeway Ave. 2055 Kimball Ave. Waterloo, IA 50701 Waterloo, IA 50702 (319) 833-5888 (319) 272-2112 fax- (319) 833-5891 fax- (319) 272-2107

Dr. Brian Burnett, MD (Wrestling) ** UNI Student Health Services 226 Bluebell Road Cedar Falls, IA 50614 Cedar Falls, IA 50613 (319) 273-2009 Office: 319-575-5800 fax- (319) 273-3155 fax- (319)-575-5855

Dr. Dan Glascock, MD (MBB) ** Dr. Sharon Duclos, MD (VB & WBBl) ** Dr. Kyle Christiason, MD Peoples Community Health Clinic Dr. Monica Burgett, MD 905 Franklin St. IHP Cedarloo Family Practice & Pediatrics Waterloo, IA 50703 2624 Orchard Drive (319) 272-4300 Cedar Falls, IA 50613 fax- (319) 272-4473 (319) 277-1990 pager- (319) 274-6245 fax- (319) 277-0572 pager- (319) 235-4571

Dr. Nicholas Goetsch, D.O. (Soccer) ** United Medical Park – Family Practice Integra Health / Urgent Care Center 1717 W. Ridgeway 4612 Prairie Parkway Waterloo, IA 50701 Cedar Falls, IA 50613 Phone: (319) 833-6200 / Cell 319-231-9215 (319) 553-0828 Fax: (319) 833-5740

UNI Student Health Clinic (General Illness issues, Eating Disorder Team, Mental Health Services) 1600 W 23rd Street Cedar Falls, IA 50614 Phone: (319) 273-2009 Fax: (319) 273-5101

Pain Clinic:

Center for Pain Medicine Ashar Afzal, MD Frank E. Hawkins, MD UnityPoint Health – Allen Hospital 3630 West 4th Street Waterloo, IA 50701 (319) 235-7246 when you call ask for Kaleena to schedule ASAP fax (319) 235-3017 196

Neurology: Neuropsychology:

Dr. Marc Hines and Dr. Sangeeta Shah Karla Brennscheidt, Psy.D. Iowa Spine and Brain Institute Cedar Valley Neuropsychology Covenant Professional Office Building 8120 Jennings Dr., Suite 13 2710 St. Francis Dr. Cedar Falls, IA 50614 Waterloo, IA 50702 (319) 273-8049 (319) 272-5000 fax- (319) 273-8054 fax- (319) 272-5445 www.CedarValley.Neuro.org Dr. Ivo Bekavac, MD, PhD Cedar Valley Medical Specialists United Medical Park, Suite 112 1753 West Ridgeway Ave. Waterloo, IA 50701 (319) 833-5954 fax (319) 833-5955

Neuro Surgeon:

Dr. Chad Abernathey Dr. Russell Buchanan 701 10th St SE Heartland Neurosurgery Cedar Rapids, IA 52403 227 E. San Marnan Ste. #1 (319) 221-8570 Waterloo, IA 50702 (319) 226-9888 / fax (319) 226-9889 Allergy / Immunology:

Dr. David Redfern, MD Cedar Valley Medical Specialists United Medical Park, Suite 106 1753 West Ridgeway Ave. Waterloo, IA 50701 (319) 833-5982 fax (319) 833-5983

Plastic Surgery:

Renaissance Plastic Surgery Center Dr. David Congdon Covenant Professional Building Cedar Valley Medical Specialists 2710 St. Francis Drive, Suite 419 United Medical Park, Suite 108B Waterloo, IA 50702 1753 West Ridgeway Ave. (319) 272-8550 Waterloo, IA 50701 1-800-942-1344 (319) 833-5970 fax (319) 272-8558 fax (319) 833-5971

General Surgery:

Dr. Paul Burgett, MD Dr. Steve Davis, MD Dr. Douglas Duven, MD Cedar Valley Medical Specialists United Medical Park, Suite 107 1753 West Ridgeway Ave. Waterloo, IA 50701 (319) 833-5907 fax (319) 833-5908

197

Pulmonary Medicine:

Dr. James Cafaro, MD Dr. Hasan Shakoor, MD Cedar Valley Medical Specialists Cedar Valley Medical Specialists 212 West Dale Street 212 West Dale Street Waterloo, IA 50703 Waterloo, IA 50703 (319) 235-3518 (319) 235-3518 fax- (319) 235-3157 fax- (319) 235-3157

Cardiology:

Cedar Valley Cardiovascular Center Dr. Kalyana Sundaram, MD 419 E. Donald Street Cedar Valley Medical Specialists Waterloo, IA 50703 148 West Dale Street (319) 236-1911 Waterloo, IA 50703 (319) 236-1911 319-287-5832 FAX fax- (319) 274-7722

Gastroenterology:

Allen Digestive Health Center 125 E Tower Park Dr., Waterloo, IA 50701 319-234-5990Phone 877-858-4741Toll-Free 319-234-5994FAX

Otolaryngology:

Dr. Joseph Hart, MD Cedar Valley Medical Specialists United Medical Park, Suite 108 1753 West Ridgeway Ave. Waterloo, IA 50701 (319) 833-5972 fax (319) 833-5973

Podiatry-

Dr. Ronald Cervetti / Dr. Phillip Morreale ** Dr. Greg Lantz / Dr. Patrick Weires ** Dr. Cibula Dr. Christopher Considine Cedar Valley Foot & Ankle Center Family Foot Health Care 4508 Chadwick Rd. 927 North 4th Street Cedar Falls, IA 50613 Waterloo, IA 50702 (319) 277-4508 (319) 233-6107 fax- (319) 277-8908 fax- (319) 233-9138

Orthotics / Prostetics: Clark & Associates Dean Sturch, Dennis Clark, Andrew Steele, John Costello 127 East Tower Park Drive Waterloo, IA 50702 (319) 234-4010 // (319) 233-8911 fax- 319-287-5350

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Ophthalmology:

Dr. Norman Woodlief, MD Dr. Gary Phelps, MD Wolfe Clinic Dr. Michael Puk, MD 516 S. Division St. Cedar Valley Eye Clinic Cedar Falls, IA 50613 2710 St. Francis Drive, Suite 110 (319) 277-0103 Waterloo, IA 50702 fax (319) 277-8019 (319) 234-2616 / fax (319) 234-1939

Dr. Richard Mauer, MD Eye Care Associates** (in season only GIK) Mauer Eye Center 622 Progress Ave. Waterloo 3410 Kimball Ave. 999 Home Plaza Waterloo Waterloo, IA 50702 or Sartori Prof. Bldg Cedar Falls (319) 234-6749 // 1-888-628-3739 Waterloo Office 319-236-0815 fax (319) 274-8343 Cedar Falls office 319-266-0345

Dr. Thomas Petrie, DO Cedar Valley Eye Clinic 1409 W. 1st St. Cedar Falls, IA 50613 (319) 233-2020 www.cedarvalleyeyecare.com

Optometry:

Eye Care Associates** (in season only GIK) Cedar Valley Eye Clinic 622 Progress Ave. Waterloo 909 E. San Marnan Drive 999 Home Plaza Waterloo Waterloo, IA 50702 or Sartori Prof. Bldg Cedar Falls (319) 233-2020 Waterloo Office 319-236-0815 fax (319) 234-1939 Cedar Falls office 319-266-0345

Dr. Anthony Bailey, O.D. 4521 Chadwick Road, Suite 1 Cedar Falls, IA 50613 (319) 266-1136 fax (319) 277-2326

Dentist-

Dr. Anne Hennessey, DDS ** (mouth guards) Dr. Jamie Petrie 924 West 22nd Street Nemmers & Petrie Family Dental Cedar Falls, IA 50613 409 Washington Street (319) 266-1906 Cedar Falls, IA 50613 (319) 277-4040 Dr. Spencer Walker, DDS ** (mouth guards) Midwest Dental Dr. Mark Schreiner, DDS ** (mouth guards) 907 Rainbow Drive 1709 University Ave. Cedar Falls, IA 50613 Waterloo, IA 50701 (319) 277-7441 (319) 236-1742

Kimball & Beecher ** (mouth guards) 3217 Cedar Heights Drive Cedar Falls, IA 50613 (319) 277-6921

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Oral Surgeon-

Dr. Edwin King, MD 516 S. Division St. Cedar Falls, IA 50613 (319) 277-2165 // (319) 235-9385 (W’loo) fax (319) 236-7991

Orthodontist-

Dr. David Zwaninger, DDS Dr. Michael Crall, DDS 516 Division St. 1504 Main St. Cedar Falls, IA 50613 Cedar Falls, IA 50613 (319) 277-6976 (319) 266-4029 fax (319) 277-4790

Dermatology:

Dr. Martin Sands, MD // Dr. Bryan Sands, MD Dermatology Associates 220 Southbrooke Drive Waterloo, IA 50702 (319) 236-3444 fax- (319) 236-0257

Bone Health:

Dr. Jay Ginther Cedar Valley Bone Health Institute ADI 4006 Johnathan St., Waterloo, IA 50701 319-233-2663 Phone 800-786-6499 Toll-Free 319-287-8094 FAX

Urology:

Daniel K. Lee, MD / Eric J. Askeland, MD / Mark Newton, MD 2413 W Ridgeway Ave., Waterloo, IA 50701 319-233-0340 Phone 319-233-0666 FAX

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Physical Therapy:

Northeast Iowa Physical Therapy ** Agape Physical Therapy Katherine (Katie) Niebuhr, DPT, ATC 211 W 6th St 2351 Hudson Road, Suite 164 Cedar Falls, IA 50613-2859 Cedar Falls, IA 50614-0244 (319) 273-5265 fax- (319) 273-5266

Cedar Valley Medical Specialists PT United Medical Park Athletico Physical Therapy 1731 W. Ridgeway Ave. 1710 W 1st Street Waterloo, IA 50701 Cedar Falls, IA 50613 (319) 833-5900 (319) 273-8988 fax- (319) 833-5901

Massage Therapy:

Elements Massage Studio Steve Zimmerly, LMT 1001 Hudson Rd. Wayson Family Chiropractic Cedar Falls, IA 50613 4521 Chadwick Rd., Suite 2 (319) 277-1392 Cedar Falls, IA 50613 (319) 266-1119 Jane Toerner, MA, LMT 529 Bonita Blvd. fax- (319) 266-5275 Cedar Falls, IA 50613 LisLisa Gillespie (former UNI ATS) 319-390-4171 (319) 277-8190

Chiropractor:

Dr. John Schofield, DC ** Dr. Aaron Knutson, DC ** Dr. Michele Green, DC ** Knutson Chiropractic Cedar Schofield Chiropractic 622 Main Street 1001 Hudson Road, Suite A Cedar Falls, IA 50613 Cedar Falls, IA 50613 (319) 266-1838 (319) 277-5616 fax- (319) 268-1460 fax- (319) 277-0355

Dr. Lance Vanderloo, DC ** Dr. Derrick Benner, DC ** Vanderloo Chiropractic Elite Chiropractic 3812 Pheasant Lane 226 Brandilynn Blvd, Suite D Waterloo, IA 50701 Cedar Falls, IA 50613 (319) 232-1143 (319) 277-1819 fax- (319) 232-3279

Dr. Jennifer Rasmussen, D.C. ** Dr. Blake Wayson, DC **/ Dr. Thad Fever ** Cedar Valley Chiropractic Wayson Family Chiropractic 4614 University Ave, 4521Chadwick Rd., Suite 2 Cedar Falls, IA 50613-6222 Cedar Falls, IA 50613 (319) 268-9009 | [email protected] (319) 266-1119 fax- (319) 266-5275

Dr. Adam Hoogestraat, DC ** Dr. Jeremy Meyer 2807 Univeristy Ave Waterloo, Iowa 50701 (319) 233-6363 fax- (319) 233-6262

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Audiology/Hearing:

Deborah Rieks, AuD Cedar Valley Hearing Aid Center 1753 W Ridgeway Ave. Ste. 110 Waterloo, IA 50701 319-833-5970 Phone

Stacy Wolf, AuD Cedar Valley Hearing Care 1753 W Ridgeway Ave. Ste. 108 Waterloo, IA 50701 319-232-1400 Phone

Counseling / Psychology / Psychiatry:

Dr. David Towle, PhD Mark Rowe Counseling Director- UNI Substance Abuse & Violence Intervention UHS Counseling Center Services Coordinator Student Services Center, Room 213 WRC 101H Cedar Falls, IA 50614 University of Northern Iowa (319) 273-2676 E-mail: [email protected] 24 hr Crisis Hotline- (319) 233-8484 Phone: (319) 273-3423 fax- (319) 273-6884 Fax: (319) 273-7130 email- [email protected] http://www.uni.edu/subabuse

Dr. Kent Opheim, MD Dr. Raja Akbar, MD Choices Eating Disorders Program Psychiatric Associates of NE Iowa Covenant Medical Center 148 W. Dale St. 3421 West Ninth St. Waterloo, IA 50703 (319) 272-8031 (319) 233-3351 fax- (319) 272-8597 fax-

Debra Rainey, MD Covenant Clinic Psychiatry Black Hawk / Grundy Mental Health Center 2750 St. Francis Dr. 3251 W. 9th St. Waterloo, IA 50702 Waterloo, IA 50703 (319) 234-2671 (319) 234-2893 fax-

Pharmacy:

Dave Hansen Rex McKee, RPh - NuCara Pharmacy Hyvee Pharmacy 209 E. San Marnan Drive College Square Shopping Center Waterloo, IA 50702 (319) 266-9874 (319) 236-8891 / 9664 fax- (319) 266-4254 1-800-759-1641 fax- (319) 236-9665 Nutritionist:

Mary Stephensmeyer, RD Joan Thompson (319) 272-2265 Health Aid Coordinator fax- (319) 272-2923 Wellness Recreation Center, Room 101G Cedar Falls, IA 50614 (319) 273-2198 email- [email protected]

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Ambulance:

Paramedics Manager Sartori Memorial Hospital 515 College St. Cedar Falls, IA 50613 (319) 268-3169 pager- (319) 274-4755 fax- (319) 268-3280

David Wedeking, [email protected]

Hospital:

Sartori Memorial Hospital Allen Memorial Hospital 515 College Street 1854 Logan Ave. Cedar Falls, IA 50613 Waterloo, IA 50703 General information- (319) 266-3584 General information- (319) 235-3941 Emergency room- (319) 268-3090 Emergency room- (319) 235-3697 Emergency room fax- (319) 268-3280 Emergency room fax- (319) 235-3844 Radiology- (319) 268-3060 Radiology- (319) 235-3716 Ambulatory surgery- (319) 235-3747

Covenent Medical Center 3421 West 9th Street Waterloo, IA 50702 General information- (319) 272-8000 Emergency room- (319) 272-7050 Radiology- (319)

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UNIVERSITY OF NORTHERN IOWA SPORTS MEDICINE DEPARTMENT Insurance Claims / Billing Contacts / Administrative Contacts

Cedar Valley Medical Specialists- Verlene, Insurance Claims / Billing Contact 235.5395 ext. 227 fax- (319) 235-5607

Mary Greenley Accounts Receivable Manager (319) 235-5390 [email protected]

Covenant Medical Center / Sartori Memorial Hospital Peggy (319) 272-1572 fax (319) 272-1600

Covenant Clinic Judy (319) 272-1511 fax- (319) 272-1535

Allen Memorial Hospital Brenda Van Brocklin (319) 235-3928 fax- (319) 235-5010

UNI Student Health Services Margaret or Shelley Matthews (UNI Student Health Clinic Director) (319) 273-7289 273-7224 fax- (319) 273-7030 fax- 273-7030

Cedar Valley Medical Specialists Administration: Gil Irey, CEO Cedar Valley Medical Specialists 4150 Kimball Ave. P.O. Box 2758 Waterloo, IA 50704 (319) 235-5390

Jeff Kramer, CFO Cedar Valley Medical Specialists 4150 Kimball Ave. P.O. Box 2758 Waterloo, IA 50704 (319) 235-5390

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