PEDDIE SCHOOL ATHLETIC DEPARTMENT
Athletic Training Policy & Procedure Manual
Peddie School 201 South Main Street Hightstown, New Jersey 08520 609-944-7500
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Table of Contents PEDDIE SCHOOL ATHLETIC DEPARTMENT ...... 1 Athletic Training Policy & Procedure Manual ...... 1 Introduction ...... 5 Mission Statement ...... 5 Job Description ...... 5 Peddie School Personnel ...... 6 Athletic Training Standing Orders ...... 7 Pre-Participation Physicals ...... 9 Athletic Training Room Rules ...... 9 Athletic Training Room Hours ...... 11 Coaches Information ...... 11 Basic Emergency Response Procedures ...... 12 Injury Evaluation & Treatment ...... 13 Emergency Action Plans (EAPs) ...... 15 Emergency Contact Information ...... 16 Components of Emergency Action Plan ...... 16 Response Personnel ...... 16 Role of Response Personnel ...... 17 Initiating EMS ...... 18 Emergency Communications ...... 18 Code Red Policy ...... 19 Emergency Equipment ...... 19 Automated External Defibrillator (AED) Policy ...... 20 Conclusion ...... 21 Traumatic Brain Injury (TBI)/Concussion Policy ...... 21 TBI/Concussion Severity Protocols ...... 21 Mild Concussion – Home Event...... 22 Severe Concussion – Home Event ...... 22 TBI/Concussion – Away Event ...... 23 TBI/Concussion Management Plan ...... 24 Accommodation Policy ...... 25
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Return to Activity...... 26 Exertion Testing Protocol ...... 27 Infection & Blood borne Pathogen Policy ...... 29 Precautions for Blood borne Pathogens...... 29 Universal Precautions ...... 29 Skin Infection Policy ...... 31 Common Skin Infections ...... 31 Prevention ...... 32 Skin Infection Suspected ...... 32 Return to Play Guidelines ...... 33 Severe Weather Policy ...... 33 Sudden Cardiac Arrest ...... 34 Commotio Cordis ...... 36 Heat Policy ...... 36 Practice Heat Index Guidelines ...... 37 Heat Illnesses ...... 38 Sickle Cell Trait ...... 39 Preseason Heat Acclimatization Policy...... 40 Cold Exposure Policy ...... 42 Practice Temperature Guidelines ...... 42 Prevention ...... 44 Cold Illnesses ...... 45 Fluid Replacement for Athletes ...... 48 Recommendations ...... 48 Dietary Supplements & Anabolic Androgenic Steroids ...... 48 Local Hospital Information ...... 49 Appendix A – Emergency Action Plans (EAP’s) ...... 50 Peddie Outdoor Track/ Football Game Field Emergency Action Plan ...... 50 Peddie Tennis Courts Emergency Action Plan ...... 51 Peddie Varsity Hub Fields / Softball/ Baseball Emergency Action Plan ...... 51 Peddie Outdoor Turf Emergency Action Plan ...... 52 Peddie Back Athletic Fields, in East Windsor, NJ Emergency Action Plan ...... 53 Peddie Golf Course Emergency Action Plan ...... 53 Von Center – Indoor Turf Facility Emergency Action Plan ...... 54
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Erik B. Hanson Field House Emergency Action Plan ...... 55 Fitness Center Emergency Action Plan ...... 56 Eckert Wrestling Room Emergency Action Plan ...... 56 Appendix B – Skin Infection Physician Consult Form ...... 58
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Introduction
This manual is a compilation of procedures, guidelines, policies, and action plans for the Peddie School Athletic Department. It is important to note that any Peddie School Student Handbook procedures, guidelines, policies, or action plans would supersede any information included in this manual. All athletic staff members; including coaches, athletic trainers, and administration, should familiarize themselves with these documents and all Peddie School policies and procedures, so they understand how certain situations and incidents will be addressed.
Mission Statement
It is the responsibility of the athletic trainers to provide the highest quality of medical care for the students at the Peddie School. The athletic trainers will provide medical care for the students in the following manner: injury prevention, emergency care, proper medical referral and treatment for illnesses, injuries, and/or conditions affecting the physical well-being of the student.
Job Description
Certified by the Board of Certification (BOC) and licensed through the New Jersey State Board of Medical Examiners, a certified athletic trainer (ATC) is a member of the allied health community whose role it is to care for and help prevent athletic and fitness related injuries. At the Peddie School, there are currently two certified athletic trainers on staff. The priority of the athletic trainers is to provide on-site care for all Peddie School students (particularly students participating in varsity, junior varsity, thirds sporting events and physical activity classes) and their respective sport related activities, including football, soccer, field hockey, tennis, cross country, wrestling, basketball, swimming, indoor and outdoor track & field, baseball, softball, lacrosse, crew and golf. The ATC shall be responsible for first aid and triage, evaluation of athletic or fitness related injuries, preventative taping and/or bracing, treatment and reconditioning of injuries, and appropriate referrals to physicians.
The ATC will also have responsibilities that include:
1. Being available for all home Peddie Athletic Department sanctioned events
2. Attending away contests as deemed necessary
3. Administering first-aid to injured students in any venue or setting, or in the athletic training room.
4. Record all injuries and treatments and maintain a record of these.
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5. In the absence of a physician be responsible for the determination of when an athlete should return to athletic participation.
6. Apply protective or injury preventative devices, such as adhesive strapping, bandaging, padding or braces.
7. Supply medical kits for each team.
8. Supervise and maintain the athletic training room.
9. Prepare an annual budget for medical supplies and equipment.
10. Maintain a standing and running inventory of supplies and equipment.
11. Counsel and advise athletes and coaches on matters pertaining to: conditioning, training, playing status, safety, diet and reconditioning of injured athletes.
Peddie School Personnel
Mr. Peter Quinn Head of School 609-490-7555
Mr. Jason Baseden Athletic Director 609-944-7654
Mr. William Sodano Assistant Athletic Director 609-944-7508
Ms. Ann Gartner Athletics Administrative Assistant 609-944-7507
Mr. Paul Miller Director of Peddie Security 609-944-7557
Mr. Jose Roca ATC Head Athletic Trainer 609-944-7634
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Ms. Robin Gerber MS, ATC Assistant Athletic Trainer 609-944-7655
Mr. Mike Volkmar CSCS Strength and Conditioning Coach 609-944-7673
Dr. John Drstvensek MD Director of Health Services 609-944-7806
Dr. Frederick Song MD Princeton Orthopedic Associates Consulting Orthopedic Surgeon 609-924-8131
Ashley Reckdenwald ATC, PA-C Princeton Orthopedic Associates Consulting Orthopedic Physician Assistant 609-924-8131
Athletic Training Standing Orders
The appointed Peddie School physician, Dr. John Drstvensek MD, will supervise all Peddie School certified athletic trainer(s) in matters concerning the prevention, evaluation, management, treatment, and rehabilitation of athletic injuries.
The Peddie School certified athletic trainer(s) shall be certified by the Board of Certification, Inc. (BOC) and licensed by the New Jersey State Board of Medical Examiners and practice within the Rules and Regulations.
The Peddie School certified athletic trainer(s) shall be certified in professional rescuer Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillation (AED).
The Peddie School certified athletic trainer(s) shall maintain his or her New Jersey license, BOC, CPR, and AED certifications by obtaining the required number of continuing education units.
The Peddie School certified athletic trainer(s) will follow general treatment orders set forth by the Peddie School physician for all athletic injuries:
A. Evaluate, provide first level care, and initiate treatment on all injuries presented to them. B. Carry out appropriate rehabilitative protocols, post injury, to increase range of motion, strength, proprioception, agility, and functional ability through use of various modalities. C. Based on student athletes’ progress, determine whether to clear the individual for full or partial participation.
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D. HEAD: All suspected concussions must be evaluated by a physician. E. NECK: All suspected fractures and dislocations are to be immobilized; EMS should be called immediately, based on the situation follow NATA recommendations for equipment removal. Brachial plexus injuries involving motor weakness must be evaluated by a physician. F. UPPER EXTREMITY: All suspected fractures and dislocations are to be immobilized and referred to a physician for evaluation. G. ABDOMEN: Evaluate, treat, and refer to physician as indicated. If internal organ injury is suspected, call EMS and refer to physician immediately. H. CHEST: Evaluate, treat, and refer to physician as indicated. I. PELVIS/BACK: Evaluate, treat, and refer to physician as indicated. J. LOWER EXTREMITY: Suspected fractures and dislocations are to be immobilized and referred to a physician for evaluation. If femur or tibia fracture is suspected, check distal neurological and arterial innervations before and after immobilization, DO NOT move or transport – Call for EMS and take steps to help prevent onset of shock. K. HEAT ILLNESS (Heat Exhaustion): Any student suspected of suffering from heat exhaustion should be removed from the sun, transported to a cooler environment, cooled with ice bags, and properly hydrated until signs and symptoms clear. L. HEAT STROKE (Exertional Heat Stroke): If any student is suspected of suffering from heat stroke; 911 should be called immediately, athlete should be moved into a cooler environment, it is recommended that a temperature be taken, athlete should be placed in a cold water immersion tank for rapid cooling of the body if core body temperature is above 103 degrees F, and vital signs should be monitored until EMS arrives.
The Peddie School certified athletic trainer(s) will initiate emergency care as indicated.
The Peddie School certified athletic trainer(s) may use treatment modalities and therapeutic exercise techniques as indicated within a certified athletic trainers’ ‘Scope of Practice’.
The Peddie School certified athletic trainer(s) may use bandaging, wrapping, taping, compression, padding, and splinting procedures for the prevention and management of injuries as soon as signs and symptoms indicate their use.
The Peddie School certified athletic trainer(s) use the ImPACT concussion software as an evaluation tool.
The Peddie School certified athletic trainer(s) shall instruct the athlete in crutch or cane use when symptoms indicate their use.
The Peddie School certified athletic trainer(s) may return a student athlete to competition at their discretion after a full physical evaluation is completed and documented unless the athlete is under the proximate care of a licensed physician. In that case, the Peddie School certified athletic trainer(s) must have written documentation from a licensed physician to return an athlete under their care to practice and competition.
Treatment records will be maintained on each student athlete who receives an evaluation, treatment, and/or is placed in a rehabilitation program. Progress notes physician orders/notes will be part of the record. Records may be destroyed 7 years after the last date of entry.
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The Peddie School certified athletic trainer(s) shall provide advice regarding nutrition, hygiene, and the fitting of protective equipment and padding.
The Peddie School certified athletic trainer(s) will not release any medical or injury information to college recruiters, professional scouts, or the media without the expressed written consent signed by an athlete and a parent or legal guardian.
The Peddie School certified athletic trainer(s) will communicate frequently and when necessary with the Peddie School Health Center regarding all students having seen or needing to see a physician for any reason.
The Peddie School certified athletic trainer(s) will NOT distribute prescribed or non-prescribed medication unless authorized by the treating physician. In the case of an emergency, use of an Epi- Pen, Glucagon injection, Asthma inhaler, or Benadryl due to an anaphylactic reaction, hypoglycemia, asthma attack, or allergic reaction will be administered in accordance with that particular individuals’ medication action plan or, if in good faith, the athletic trainer believes that any student is having an anaphylactic reaction.
The Peddie School certified athletic trainer(s) may recommend an athlete be evaluated at the Peddie School Health Center for use of anti-inflammatory or pain relieving medication.
The Peddie School certified athletic trainer(s) may administer oxygen in an emergency as indicated.
The Peddie School certified athletic trainer(s) may administer an Automated External Defibrillator (AED) in the event of a cardiac emergency.
Pre-Participation Physicals
All students are required to have a completed physical examination and medical history prior to participation in Peddie School Athletics each year ideally after July 1. This may include such tests as deemed necessary by the examining, consulting, or personal physician. This examination will be kept on file at the Peddie Health Center in the student-athlete’s permanent electronic medical record in the Magnus Health program.
The athletic director will inform each seasonal head coach when his/her athletes have been cleared to participate in athletic practices or games.
No student-athlete will be treated in the athletic training room or be given medical clearance without a complete physical examination performed by a physician and updated medical history questionnaire on file.
Athletic Training Room Rules
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The athletic training room (ATR) is a facility designed to aid in the evaluation, treatment, and rehabilitation of all the athletic injuries which occur to the students of the Peddie School while involved in an activity at the Peddie School. The Peddie School athletic trainers are not responsible for evaluating injuries that occur during activities not related to the Peddie School. Although, the Peddie athletic trainers will work with these students on treatment and rehabilitation after they have been seen by a physician.
1. Report all injuries that occur at Peddie, no-matter how minor, to a certified athletic trainer for early treatment. The longer you wait, the more damage you may do, resulting in possible loss of participation for an extended period of time. Allow the ATC’s to help keep you on the field – see us early in the injury phase!
2. Any student that utilizes the ATR for any service (including getting ice) MUST sign in the daily log sheet and record time of arrival and all pertinent information every time you visit.
3. No one is allowed to give themselves treatment without the direct consent of an athletic trainer. - Ask the athletic trainers for ice and/or hot packs. - Do not use athletic training room equipment, supplies (tape, band aids, etc.), or machines without permission.
4. Report to the athletic training room dressed for your practice, game, or ready for rehabilitation/workout.
5. Cell phones are not allowed in the athletic training room.
6. Spikes or cleats are not allowed to be worn in the athletic center or athletic training room.
7. Leave all athletic equipment, backpacks, or excess gear outside of the athletic training room.
8. Appropriate attire is expected in the athletic training room at all times. At the least, full tee- shirts and shorts should be worn by anyone entering the athletic training room!
9. Please be respectful of those other individuals that are around you in the ATR.
- Vulgar and offensive language will not be tolerated! This includes any obscenities, racial/discriminatory language, and anything that is deemed as being sexually harassing. - Failure to respect the rights of those around you will result in reporting to the athletic director/deans office.
10. No bottled or canned beverages (Gatorade, Powerade, Coke, etc.) are allowed in the ATR.
11. Help to keep the athletic training room clean at all times. Discard trash and used ice bags appropriately, and place used towels in the proper laundry bags hanging near the clean towels. ICE BAGS NEED TO BE EMPTIED BEFORE THROWING THEM IN THE TRASH!
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12. Student athletic trainers are acting on behalf of the certified athletic trainers. Treat them with respect.
12. To facilitate treatment of all athletes, we ask that you leave the athletic training room once you have received treatment. The athletic training room is not a hang-out! Visiting other athletes is not allowed during busy or crowded times.
Failure to follow these policies may result in you being asked to leave the athletic training room.
Athletic Training Room Hours
Monday 9:00am – 11:45am 2:00pm – 6:30pm
Tuesday 9:00am – 11:45am 2:00pm – 6:30pm
Wednesday 9:00am – 11:45am 1:00pm – End of Games/Practice Thursday 9:00am – 11:45am 2:00pm – 6:30pm
Friday 9:00am – 11:45am 2:00pm – 6:30pm
Saturday 11:45am - End of Games/Practice Sunday Closed
These times are subject to change depending on practice, home/away games, vacations, and winter sports schedules.
Morning treatment and rehabilitation hours are for students with free periods; appointments are recommended and should never interfere with classes or other school obligations.
Coaches Information
1. Every coach must be certified in CPR & AED and must complete an annual concussion awareness education program before the start of their season.
2. Every attempt will be made by the athletic trainers to supply the coaches with important medical information (diabetics, allergies, epilepsy, asthma, heart conditions, etc.) that may be of concern to them in terms of their players, managers, or film crew; once this information has been received from the health center staff. Although, we do encourage all coaches to speak with their teams and to ask for this information during their first meeting, with the understanding that privacy could be an issue.
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3. All injuries that require emergency transportation to a medical facility will utilize ‘Magnus 911’ by calling the health center (609-944-7545) and requesting the Magnus 911 number for the student needing transportation to a hospital. You will then give the Magnus 911 number to the triage nurse at the hospital so she can access the student’s parental permission to treat, pertinent medical information, and health insurance online at www.magnus911.com.
a. Teams traveling overnight in-season or for pre-season trips, must provide the health center staff with a list of all students traveling on the trip at least 1 week prior to the departure to allow the health center staff time to put together a list of the Magnus 911 #’s for each student attending the trip.
4. Medical Kits & Ice Coolers should always be picked up at the athletic training room for home/away games. They should always be returned to the athletic training room or left in front of the door if we are not there. Basic Emergency Response Procedures and Emergency Phone Numbers are listed inside the medical kits to assist coaches in the case of an emergency.
5. Emergency Action Plans (EAP’s) are in effect for all the different athletic facilities. It is the coach’s responsibility to know the EAP’s of each facility they use. Emergency radios will play a role in these EAP’s and will be given to various teams, placed at certain venues or fields depending on the layout of practices/games on campus. These radios are to be used to contact us for emergencies or acute injuries only and should be returned at the end of a practice/game directly to one of the athletic trainers. Please do not leave them outside the door of the athletic training room. Call us on the radio and we will pick them up from you if you can’t find us!
a. If injury is NOT life threatening, but an ambulance is needed, first responder should: o Call 911, then Peddie Security. o If the injury occurs during athletics, first responder should call athletic trainers first and allow the athletic trainers to determine the need for EMS. o First responder should always stay with the victim until help arrives. Basic Emergency Response Procedures
The Unconscious Person: Do not move or transport the person under any circumstances! 1. Have someone call the athletic trainers for help using the appropriate methods for your playing area as described above (radio/cell phone) 2. If the person is not breathing, perform CPR if your certification is current. 3. If the person is breathing, maintain observation until help arrives.
The Seizure Victim (Convulsions): 1. Call for help from the athletic training staff 2. If the person is convulsing, make sure that her/she does not injure himself/herself. 3. After the seizure, keep the person warm and calm. Convince him/her of the need for rest.
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The Person is Bleeding Excessively: 1. Call for help from the athletic training staff 2. Control the bleeding with direct pressure, using gauze pads, towel or clean shirt while awaiting help. 3. Always wear latex gloves when exposed to blood-borne pathogens.
General Technique for any Seriously Injured Person: Do not move or transport the person under any circumstances!
This is particularly important if you suspect any head, neck or spinal injury. In the case of football, baseball, softball or lacrosse, DO NOT remove a player's helmet.
1. Call for help from the athletic training staff. 2. Keep the patient warm and comfortable 3. Keep the patient under observation until assistance arrives.
General Technique for Basic Athletic Injuries: 1. Call for help from the athletic training staff 2. Apply ice to injured area. 3. Elevate and compress the injury. 4. Keep the patient warm and comfortable.
Injury Evaluation & Treatment
1. All injuries are to be reported to the ATC’s at the time of occurrence or as soon as possible afterwards. Emergencies/injuries that take place away from Peddie’s athletic fields or at an away competition are the only exceptions. In these instances, the Health Center should be informed as soon as possible and the student should be brought directly to the Health Center by a coach or faculty member if the athletic training room is closed. (If sport related the health center will contact the athletic trainers if they determine there is an immediate need for us to come in and evaluate the injury).
2. If an athlete is injured on the field, no matter what type, he/she should never be moved, especially, if a head or neck injury is suspected, unless it is essential to maintain airway, breathing, and circulation. If the injured athlete has a head or spinal injury and is moved, the vertebrae can shift and sever the spinal cord. A severed spinal cord can mean permanent paralysis or death for that athlete. Thus, you should never move an injured athlete! In the case of home football, wrestling, and varsity basketball, and lacrosse games, the ATC will almost always be present. At other sporting events, however, it will be necessary for the coach, being the first responder, to evaluate the situation and implement the emergency communication system deemed appropriate for the respective venue. If a life threatening emergency is suspected (unconscious/unresponsive person/student) dial 911 while also attempting to contact the athletic trainers.
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3. It is a coach’s responsibility to make sure an athlete reports to the athletic training room to have an injury evaluated if that injury occurs during practice or a game. Coach’s should not diagnose or give advice on how to treat or care for injuries; please allow the ATC’s to be the medical professionals.
4. All referrals to a physician for an athletic injury must be arranged through the ATR or health center for insurance purposes. Failure to do this could result in insurance complications, unnecessary loss of participation time, and possible accumulation of absences from our MED-X program for an athlete.
5. All medical notes from outside physicians must be handed in to the athletic trainers or the Health Center immediately on an athlete’s return to campus. They should not participate in any way until the medical note is in the hands of the H.C. or ATC’s. This applies even more importantly when an athlete returns with a note clearing them to participate.
6. Evaluation and treatment of injuries is on a first come, first serve basis – regardless of sport, level or class.
7. Athletes should report to the athletic training room early enough to get treatment and taped before practices and games. The athletic trainers will be available at least one hour before all games and practices. Some exceptions to this rule do exist.
8. Treatment and taping of athletes who will be participating in practice or games takes precedence over evaluations of new injuries, unless it is a serious injury or medical emergency.
9. Injured athletes are expected to complete all treatment/rehabilitation programs as assigned by the ATC’s. Failure to do so may result in that athlete not being allowed to practice or participate in a game.
10. Any athlete who is unable to practice due to an injury will be required to do sport specific cardiovascular conditioning in the athletic training room or fitness center as part of their rehabilitation program.
11. Anyone not able to participate in a full practice, without restrictions, the day before a game, WILL NOT be allowed to participate in that game. Any player injured in practice the day before a game must see the ATC’s immediately. In this instance, game participation (away contest) will be determined after initial evaluation of the injury, (home contest) decision can be made immediately after an initial evaluation or the following day during pre-game warm ups, by a Peddie ATC.
12. The ATC’s will always have the final word on when a player can or cannot participate and under what conditions they can participate in the case of an injury. This includes games and/or practices. If someone has a question about an athlete’s level of participation, please don’t hesitate to speak with the ATC’s in person privately.
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13. Coaches must speak and check with every athlete who is coming back from injury before allowing them back on the field to confirm they have been cleared by the ATC’s or if they have been given any restrictions.
14. Anyone getting taped or wrapped for an injury will be required to do rehabilitation for the injured body part on practice days. No rehab – No Taping!
15. If an athlete requires long term taping or wrapping, the ATC’s will require them to purchase a brace or a generic supportive device which will benefit the athlete overall.
16. Athletes are not allowed to tape or treat themselves at any time or under any circumstances in the athletic training room.
17. Use of electrical muscle stimulation, ultrasound, or other significant modality will only be administered to Peddie students, faculty, or staff. Taping, moist heat, and cryotherapy will be made available to visiting teams.
18. Athletes will be educated on stretching themselves or each other before practices. Manual stretching will be reserved for pre-game or game-time situations on the sidelines after an appropriate warm-up and at the discretion of the athletic trainers.
19. All equipment checked out or borrowed from the athletic training room must be returned once an injury is healed or at the end of the season. - Athletes are responsible for all equipment checked out to them. - Lost equipment is the financial responsibility of the athlete; a charge equal to the replacement cost of the item will be assessed to their debit account.
Emergency Action Plans (EAPs)
Emergency situations and other incidents may arise at any time during athletic events. In order to provide the best care possible, appropriate and quick action must be taken for the athlete during emergency situations and/or life threatening conditions. The creation and execution of an emergency plan will help ensure that the best management of the incident will be provided.
As athletic injuries may arise during practices and competition, the emergency management team must be prepared. Preparation for injuries and emergencies includes the formulation and complete understanding of an emergency plan, proper coverage of events, maintenance of appropriate emergency equipment and supplies, utilization of appropriate emergency medical personnel, and continuing education in the area of emergency medicine and planning. Hopefully, through careful pre-participation physical screenings, adequate medical coverage, safe practice and training techniques and other safety avenues, some potential emergencies may be averted. However, injuries and emergency situations are inherent with sports participation, and proper preparation on the part of the emergency management team should enable each emergency situation to be managed appropriately.
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See Appendix A for EAP’s for all Venues
Emergency Contact Information
Emergency Medical Services (EMS) 911 Police, Fire, BLS/ALS Hightstown Police Department 609-448-1234 Hightstown Fire Department 609-448-1245 East Windsor Police Department 609-448-5678 East Windsor Fire Department Company #1 609-448-5487 Athletic Office – Ann Gartner 609-944-7507 Athletic Director – Jason Baseden 609-944-7654 (Office) 609-250-5565 (Cell) Assistant Athletic Director – Will Sodano 609-944-7508 (Office) 908-910-8350 (Cell) Athletic Training Room 609-944-7634 609-944-7655 Head Athletic Trainer (Cell) – Jose Roca 609-575-6736 Assistant Athletic Trainer (Cell) – Robin Gerber 973-960-4479 Health Center 609-944-7545 Director of Health Center – Dr. John Drstvensek 609-944-7545
Components of Emergency Action Plan
1. Emergency Personnel 2. Role of athletic trainer (ATC), Peddie Security, Health Center nurses, coaches, and administrators 3. Emergency communication 4. Emergency equipment
Response Personnel
During athletic events, the first responder to an emergency situation is usually either a certified athletic trainer or a coach. The type and degree of coverage for an athletic event may vary widely, based on such factors as the sport or activity, the setting, and the type of training or competition. Certification in cardiopulmonary resuscitation (CPR), AED usage, prevention of disease transmission, and emergency action plan review is necessary for all athletics personnel.
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The development of an emergency action plan would not be complete without the formation of an emergency team. The emergency team may consist of a number of healthcare providers and first responders including physicians, certified athletic trainers, Health Center nurses, emergency medical technicians, Peddie Security, coaches, and administrators. Roles of these individuals within the emergency team may vary depending on various factors, such as the number of members of the team, the athletic venue itself, or the presence of an ATC.
Role of Response Personnel
1. Survey scene/area for safety 2. Immediate assessment and required care of injured student 3. Activate EMS & notify Peddie Security and Health Center nurses 4. Retrieve essential emergency equipment 5. Direction of EMS to the scene
There are five basic roles within the emergency team. The first and most important role is for the responders to ascertain scene safety and to identify any physical hazards that may be present. If present, the hazard should be removed if possible without endangering the rescuer. In the event that the scene cannot be made safe, the responders will focus on not allowing anyone else to become injured or harmed and wait for public safety agencies (Police, FD, EMS) to arrive. Once scene safety has been addressed, immediate assessment of the injured athlete should be performed. Acute care in an emergency situation should be provided by the most qualified individual on the scene. In most instances, this role will be assumed by the Certified Athletic Trainer.
The second role, 911 activation of EMS, may be necessary in situations where emergency transportation is not already present. Since time is the most critical factor in an emergency situation, EMS activation should be initiated as soon as the situation is deemed an emergency incident. Activating the EMS system may be done by anyone on the team who has the ability to remain calm under pressure and who communicates well over the telephone. This person also needs to be familiar with the location and/or address of the event. Typically, the certified athletic trainer, a coach, administrator, health center nurse, or Peddie Security is the best choice to fulfill this role.
The third role, notification of Peddie Security and Peddie Health Center nurses. Peddie Security will respond to the scene with AED and other essential equipment. They will also meet emergency responders and direct them to the scene. The health center will assist at the site of emergency if necessary, provide Magnus911 information if needed and contact parents when necessary.
The fourth 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, including an AED, splints, etc. Security, coaches, or administrators are good choices for this role.
The fifth role of the emergency team is that of directing EMS to the scene. A member of the Peddie Security is responsible for meeting emergency medical personnel as they arrive on campus directing them to the site of the emergency.
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When forming the emergency team, it is important to adapt the team to each situation or sport. Athletic trainers, Peddie Security, health center nurses, coaches, and administrators should be able to perform any task if needed. This allows the emergency team to function even though certain members may not always be present. Keep in mind that activation of EMS, notification of Peddie Security and Peddie Health Center and the retrieval of equipment should take place simultaneously if at all possible. Peddie Security should be waiting for Police and EMS as they arrive on campus.
Initiating EMS 1. Call 911 2. Provide necessary information a. Name & contact phone number b. Location c. Description of emergency d. Number of people involved e. Current condition of student f. Directions to scene of incident g. Do Not hang up until dispatch hangs up first!
3. Call Peddie Security a. Notify them of EMS call b. Provide location of incident c. Provide entrance where EMS will respond
4. Call Peddie Health Center a. Notify them of EMS call b. Provide nature of emergency c. Provide location of incident d. Provide them the name of injured student Emergency Communications
Communication is the key to quick emergency response. Emergency communication begins within the team. They should identify roles and responsibilities in the event that an injury does occur. Athletic teams assigned with emergency radios will contact the athletic trainers for all emergencies. The athletic trainers will initiate the Emergency Action Plan. Communication prior to the event is a good way to establish boundaries and to build rapport between both groups of professionals. If emergency medical transportation is not available on site during a particular sporting event, then direct communication with the emergency medical system at the time of injury or illness is necessary.
Access to a working telephone or other telecommunications device, whether fixed or mobile, should be assured. The communications system should be checked prior to each practice or competition to ensure proper working order. A back-up communication plan should be in effect should there be failure of the primary communication system. The most common method of communication is a cellular telephone. However, a public phone will do just fine if access to a cellular phone is unavailable. At any athletic venue, whether home or away, it is important to know the location of a workable telephone. Peddie School Policy & Procedure Manual 18
Code Red Policy Peddie Security – Health Center Nurses - Athletic Trainers
If there is a life threatening emergency on campus, the first responder should: 1. Call 911 or have someone else call 911. 2. Call Peddie Security (609-944-7557) and tell them: a. Your name b. You have a “CODE RED” c. Location of the emergency d. What the emergency is 3. Give appropriate care to the victim until help arrives
Peddie Security In the case of a “CODE RED” emergency: 1. Immediately call 911 if First Responder hasn’t already 2. Quickly bring your AED to the sight of the emergency 3. Provide care if necessary 4. If not providing care help EMS get to the scene as quickly as possible
Health Center In the case of a “CODE RED” emergency: 1. Make sure 911 has been called 2. Bring your AED to the sight of the emergency 3. The nurse on duty should remain available in person or by radio in case assistance is deemed necessary by the athletic trainers or Peddie Security. 4. Provide activation code for student so Magnus 911 can be activated by appropriate medical personnel.
Athletic Trainers During athletic events & practices, the athletic trainers are on duty and should be utilized in the case of a “CODE RED”. The first responder should: 1. Call 911 or have someone else call 911. 2. Then contact Jose Roca or Robin Gerber, establish communication via radio, cell phone, or in person. 3. Inform them of the “CODE RED”, the location of the emergency, and what the emergency is. 4. The athletic trainers will respond immediately to the scene with an AED, contact Peddie Security, and provide medical attention to the person in need of care.
It is considered a life threatening emergency if someone is unconscious, unresponsive, not breathing or having difficulty breathing, severely bleeding, in shock, or any other circumstance in which you feel someone’s life is in jeopardy. Emergency Equipment
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It is the responsibility of the emergency response team to assure that all necessary emergency equipment is at the site and quickly accessible. Personnel should be familiar with the function and operation of each type of emergency equipment that they have in their possession and are thus trained to use. Equipment should be in good operating condition, and personnel must be trained in advance to use it properly. Emergency equipment should be checked on a regular basis and use rehearsed by emergency personnel. The emergency equipment available should be appropriate for the level of training for the emergency medical providers. The schools’ certified athletic trainers should be trained and responsible for the care of the medical equipment. Automated External Defibrillator (AED) Policy
Purpose: To provide guidance in the management or administration of a school-based AED program. It is the responsibility of the person administering the AED to be in charge of the scene!
Authorized AED users: Employees including: administrators, faculty/staff, nurses, athletic trainers, security personnel, coaches, and office staff who have CPR/AED certification. Any trained volunteer responder who has successfully completed an approved CPR/AED training program within the last two years and has a current successful course completion card.
Volunteer Lay Responder Responsibilities: Anyone can, at their discretion, provide voluntary assistance to victims of medical emergencies. The extent to which these individuals respond shall be appropriate to their training and experience. These responders are encouraged to contribute to emergency situations only to the extent they are comfortable. The emergency medical response of these individuals may include CPR, AED or medical first aid, if appropriately trained. Anyone can and should call 911, even if they choose not to give medical care.
Equipment: The LIFEPAK CR Plus and LIFEPAK 1000 Automated External Defibrillators (AEDs) have been approved for this program. The AED will be brought to all medical emergencies. The AED should be used on any person who displays ALL the symptoms of cardiac arrest. o Victim is unconscious and unresponsive o Victim shows no signs of life
Note: The Infant/ Child reduced energy electrodes found in the pouch on the back of the AED’s should be used on victims below age 8 or 55 pounds. An AED should not be used on a child younger than 1yr old.
Location of AEDs: 1. Annenberg Hall – outside Head of School’s office 2. Caspersen Student Center – main lobby, to the right of the front doors 3. Geiger-Reaves Theatre – main lobby, to the left of main entrance doors Peddie School Policy & Procedure Manual 20
4. Peddie Health Center/Student Services Office – in hallway between both facilities 5. Peddie Golf Course – foyer between pro shop and dining area 6. Athletic Center (5 AED’s) a. Main lobby, on brick wall, to the right of the Athletic Dept. Offices b. Directly outside athletic training room (carried by ATC’s during athletics). c. In Athletic Training Room office and carried by assistant ATC during athletics. d. 2 AED’s for teams traveling off campus to non AED covered sites 7. Havnonian Fields (Back athletic fields) - located on the west side of the central storage shed 8. Aquatics Center – between pool bathroom doors in the pool lobby 9. Peddie Security - carried in Peddie Security Vehicle 10. Caspersen Rowing Center – near the main office (maintained by rowing center personnel) 11. Green Dorm 12. Kaye Dorm Conclusion
A great deal of emphasis must be placed on preparedness when athletic emergencies arise. An athlete’s survival may hinge on how properly trained and prepared all healthcare providers are. Each individual that is involved in athletics, security, and the health center must fully comprehend the emergency action plan and be able and willing to implement the necessary care. The emergency plan should be reviewed at least once a year with all emergency management personnel, along with CPR and AED refresher training. Through development and implementation of the emergency action plan, the Peddie School helps ensure that every student will have the best care provided in the event an emergency situation arises.
Traumatic Brain Injury (TBI)/Concussion Policy
These policies are consistent with NATA & NJSIAA guidelines
When a traumatic brain injury occurs on campus, an athletic trainer or Health Center nurse should evaluate the traumatic brain injury and determine the initial severity using the 5 categories listed below. If ‘loss of consciousness’ is determined, EMS will be summoned immediately and head, neck, and spine will be immobilized.
Subjective Questioning (most importantly - Reported Symptoms) Neurological functions Cranial Nerves Balance / Proprioception Motor Skills
New Jersey State Law mandates that any student/athlete with a suspected TBI/concussion must be evaluated by a physician educated in the diagnosis and management of concussions before returning to any physical activity. TBI/Concussion Severity Protocols
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Peddie School uses a combination of two grade classifications in determining the severity of a concussion in an effort to provide the safest management guidelines for Peddie students. (Mild Concussion & Severe Concussion) Mild Concussion – Home Event When the traumatic brain injury is deemed to be mild, based on the Peddie School Medical Teams evaluation, the Health Center and/or Athletic Trainers will notify the parents and inform them of the injury. The student, parents, School Physician, Director of Health Services, Assistant Head for Student Life, Athletic Director, Athletic Trainers, Dorm Faculty, Coach, Director of Academic Support, and Advisor will also be made aware of the individual’s injury and activity restriction via email.
Day students/local boarding students Student will remain in the Health Center for observation until parents arrive. Parents will be informed of the signs & symptoms associated with a traumatic brain injury and will be advised to monitor their child at home and take student to their primary care physician (PCP) as soon as possible. If the symptoms intensify while the child is in their custody, parents are advised to immediately transport their child for medical evaluation (to the hospital or call EMS.)
Boarding students Student will remain at the Health Center for observation overnight and will be seen by the Peddie School physician or their own PCP as soon as possible. If the symptoms intensify while the child is being observed by the health center staff; they will immediately be transported for medical evaluation (to the hospital or call EMS.) Parents/Guardians will be notified of their injury and ongoing plan of care. Severe Concussion – Home Event When the traumatic brain injury is deemed to be severe, based on the Peddie School Medical Teams evaluation, the student may be sent to the emergency department for further evaluation. If the injured student is transported by a Peddie staff/faculty member, the Health Center may activate Magnus 911. Health Center staff will be sure the parents are aware of which hospital the student is being treated at. The student, parents, the School Physician, Director of Health Services, Assistant Head for Student Life, Athletic Director, Athletic Trainers, Dorm Faculty, Coach, Director of Academic Support, and Advisor will also be made aware of the individual’s injury and activity restriction via email.
Day Student/local boarding Students and parents will be strongly advised to take their child for medical evaluation of Traumatic Brain Injury/Concussion immediately. The written diagnosis should be shared with the Health Center as soon as possible.
Boarding Students Student will remain in the Health Center for observation and inpatient care. The student will be seen by the Peddie School physician or their own PCP as soon as possible. They will be transported to an emergency department (hospital) for further evaluation if recommended by the school physician/school nurse/athletic trainer. If a Peddie parent or Peddie faculty/staff are not available Peddie School Policy & Procedure Manual 22
to drive the student for further medical evaluation within 1 hour of the recommendation, EMS will be called.
Parents will be advised to keep their child home for 48 hours after diagnosis of Traumatic Brain Injury, Closed Head Injury, or Concussion determined to be severe. Boarding students who are unable to return home will be inpatient at the Health Center for a minimum of 48 hours after diagnosis.
Returning to Campus Upon return to campus, student and parent must immediately report to Health Center for evaluation with all hospital discharge instructions, imaging reports (CT Scan/MRI, Xray), and visit summary from Primary Care MD and/or specialists, if seen. The student will take his/her first post- injury ImPACT test no sooner than 48 hours after injury. Students and parent should request academic accommodations from the office of Academic Support, if medically appropriate/necessary.
TBI/Concussion – Away Event
If a Peddie student suffers a traumatic brain injury or appears to have suffered a traumatic brain injury while participating at an away contest.
Coaching staff should immediately remove athlete from competition. Summon help from an athletic trainer or other medical professional at the event and follow all recommendations. If ‘loss of consciousness’ is determined, EMS should be called. o Student should not be moved or allowed to get up until ATC or EMS has arrived. The Health Center will provide activation code for student so Magnus 911 can be activated by appropriate medical personnel. Call them at 609-944-7545 and advise nurse of situation.
NO PEDDIE ATHLETE SHOULD RETURN TO THE FIELD OF PLAY IF THEY HAVE ANY SYMPTOMS RELATED TO A TRAUMATIC BRAIN INJURY! (EVEN IF THE SYMPTOMS SUBSIDE WITHIN A SHORT PERIOD OF TIME.)
If an injured athlete is cleared by a medical professional to travel back to Peddie with the team, the Coach or Faculty/staff must do the following:
Frequently monitor the student while traveling back to campus. Call the Health Center to inform them of injury and give approximate time of arrival. Adult will escort the student directly to the Health Center upon their return to campus for further evaluation. Peddie traumatic brain injury guidelines take effect and will be followed until the athlete is cleared for unrestricted activity by the Peddie School Physician.
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If an injured athlete is deemed to have a severe TBI/Concussion and is required to go to the hospital by EMS, the Coach or Faculty/staff must do the following:
Travel with student unless parent is present. Call the Health Center, 609-944-7545. Give the RN the student’s name, injury, and name of hospital where they are being transported to. Health Center nurse provide activation code for student so Magnus 911 can be activated by appropriate medical personnel and notify parents, administrator on call, Assistant Head for Student Life, Athletic Director, Dorm Faculty, and Advisor. Upon conclusion of the game, the team will pick up the coach at the hospital unless other arrangements are made. If parent is present, they will be strongly encouraged to take child home for a minimum of 48 hours. If student must return to Peddie, coach must escort student to Health Center on arrival with the discharge documents from hospital. Student will remain in the Health Center for a minimum of 48 hours or until parents arrive to take the student home for a period of time specified by the Health Center. Peddie traumatic brain injury guidelines take effect and will be followed until the athlete is cleared for unrestricted activity by the Peddie School Physician.
Important Phone Numbers
Health Center 609-944-7545 Athletic Training Room 609-944-7634 Jason Baseden 609-250-5565 Will Sodano 908-910-8350 Jose Roca 609-575-6736 Robin Gerber 973-960-4479 Dr. John Drstvensek 614-361-9793
TBI/Concussion Management Plan
Step 1 – Baseline Testing & Education Educate Students, Parents, Coaches, Teachers, School Nurses on Concussions Take ImPACT Training Webinar/Workshop to learn about baseline test administration Have Concussion Management protocol that has key professionals ready to treat student; specific roles/duties established for: o ATC o Coach o School Nurse o Concussion Specialist o Dorm Supervisor/Advisor Have Parent/Guardian read TBI policy AND sign ImPACT permission form Schedule supervised Baseline Testing while on campus
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Test Administrator confirms ALL Baseline tests are valid – If invalid, retest Student
Step 2 – TBI/Concussion Suspected If concussion is suspected – Immediate REMOVAL from play/activity Evaluation done by ATC or School RN per Peddie TBI/Concussion Protocol. Complete restriction from physical activity initiated ATC or School RN to set up referral to Physician/ Concussion Specialist Ongoing monitoring by School Nurse/parent until evaluated by Physician At the discretion of the trained medical personnel….Optional brain imaging, if needed
Step 3 – Post Injury Testing & Treatment Plan Student to take supervised post injury ImPACT Test in HC 48 hours after injury DAILY check at HC to monitor symptoms required when student is on campus Complete restriction from physical activity continued HC/ATC continues to coordinate care with Physician/ Concussion Specialist HC communicates plan of care with Student, Parent, Advisor, Dorm Staff, Coach, Dean’s Office, and Athletic Dept. Repeat post injury ImPACT testing if abnormal. Refer to Neuropsychologist if more extensive testing needed
Step 4 – Is Student Ready for Non-Contact Activity CRITERIA: o Symptom free at rest with cognitive exertion o Post injury ImPACT Test: within normal range of baseline o Written clearance for progression to activity by supervising Physician WITH approval from School Physician Progressed through a graduated exertion testing protocol under the supervision of the ATC ONLY
Step 5 – Determining Safe Return to Activity Return to activity decision made by Physician/ Concussion Specialist/ School Physician After return to activity, student’s final ImPACT score is set as their new Baseline ImPACT Student is expected to meet all obligations when cleared for unrestricted activity
Accommodation Policy Managed by Academic Support and Student Services
Overview The Peddie School is committed to providing equal opportunity to qualified students with disabilities in accordance with the law. Peddie will make reasonable accommodations to policies, practices and procedures that deny equal access to individuals with disabilities, unless the alteration would fundamentally alter the course, program or service provided or result in an undue burden to Peddie.
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Some qualified students with disabilities may require reasonable accommodations to allow them equal access to classes, programs, and coursework. An accommodation is the removal of a barrier to full participation and learning. The emphasis is on access, not on outcome. This is done by providing the student with a disability reasonable equal access to the content and activities of a course, but not necessarily assuring their success.
Documentation Any request for accommodations must be made by or on behalf of students and supported by a formal evaluation certified by a medical or otherwise qualified profession in the field of psychology/neurology. All requested accommodations must be supported in the evaluation with a rationale that describes the functional limitations of the student, the impact these limitations would have on academic success, and the recommended accommodations to address these limitations. Peddie will review all documentation to confirm accommodation requests, and in some cases will have outside professionals in specific fields review evaluations as well. All evaluations are confidential and will be maintained as such at the school’s office of student services.
Reasonable Accommodations A request for a reasonable accommodation must be made on behalf of a student to the director of academic support. If an accommodation can be made which would not result in an undue burden to the Peddie School, and which would not fundamentally alter the course or program, the director of academic support will create an accommodation recommendation plan, with the assistance of the student and his/her health care provider. The plan will document specific accommodations recommended for the student with the disability. These recommendations will be shared with the faculty who work with the student. It is the student’s responsibility to fulfill the academic requirements of the course. The office of academic support will review accommodations periodically with the student and the faculty to assess effectiveness and adjust to changing needs.
It is important to note that not all requested accommodations are “reasonable.” For example, an accommodation is not reasonable if: making the accommodation or having the individual involved in the activity poses a direct threat to the health or safety of others; making the accommodation means making a substantial change in an essential element of the curriculum; making the accommodation would require a substantial alteration in the manner in which educational opportunities are provided, such as the course objectives being altered; or making the accommodation would impose an undue financial or administrative burden to the institution.
Return to Activity
The Peddie School Physician will then determine the student’s activity level and treatment plan based on the following:
Neurological exam and post-concussion symptoms ImPACT test results Diagnosis from hospital Diagnosis from primary care Physician/Specialists Imaging reports Peddie School Policy & Procedure Manual 26
No student will be allowed to participate in activities unless approved by the Peddie School Physician. Should there be a discrepancy between the recommendations made by the student’s Primary Care Physician/Specialist and the Peddie School Physician, the more restrictive plan of care will be followed. The Health Center staff or athletic training staff will inform parents, student, Director of Health Services, Assistant Head for Student Life, Athletic Director, Athletic Trainers, Dorm Faculty, Coach, Director of Academic Support, and Advisor of status or changes in status throughout the progression.
Graduated return-to-activity program set forth by Peddie’s School Physician will include the following steps:
Complete restriction (NO activity) until symptom free (Peddie Physician’s discretion), Post injury ImPACT test within normal range of baseline Written clearance for progression by supervising Physician. Exertion testing – under the supervision of our Certified Athletic Trainers Return-to-activity protocol (level of participation determined by athletic trainer) ** Cleared – No restriction (expected to participate in all academic/athletic commitments)
**Return-to-activity protocols will differ based on individual activity, sport (contact vs. non- contact), and past medical history. Progressions will be determined by the athletic trainer from day to day.
The athletic trainer will oversee the graduated return-to-activity program once the student has progressed to supervised exertion testing and continue to monitor student through the ‘Cleared – No restriction’ step. Any symptoms that arise during the individual’s return-to-activity program will be immediately reported to the athletic trainer, health center staff, and school physician. Modifications to the graduated return-to-activity program or removal from physical activity may occur at any time during the progression.
When the student has gone through the return-to-activity protocols under the supervision of the athletic trainer and is cleared for unrestricted activity by the School Physician; the athletic training staff or Health Center staff will inform, parents, student, Director of Health Services, Assistant Head for Student Life, Athletic Director, Dorm Faculty, Coach, and Director of Academic Support, and the Advisor.
Exertion Testing Protocol
Step 1: If Asymptomatic at rest with cognitive exertion; a. Cleared by Peddie School Physician – Dr. John Drstvensek MD b. ImPACT within normal limits of baseline level
Step 2: Low Level Physical Activity - Stationary Bike: a. 10 min at Zone 1 (Aerobic – Active Recovery) b. 10 min at Zone 2 (Aerobic – Endurance) Peddie School Policy & Procedure Manual 27
Step 3: If Asymptomatic after Step 2 proceed to Moderate Level Physical Activity with body/head movement – Stairmaster/Arc Trainer/Treadmill (No Equipment) a. 15 min on Stairmaster at Zone 2 / Zone 3 (Aerobic/Anaerobic) Zone 2 for first 5 minutes then Zone 3 for next 10 minutes b. 9 min on Treadmill at Zone 2/Zone 4 (Intervals 2:1 ratio) Zone 2 for 2 min then Zone 4 for 1 min alternating for 9 min
Step 4: If Asymptomatic after Step 3 proceed to Heavy Non-Contact Physical Activity Conditioning/Skill Drills (Full Equipment/Non-Contact)
Step 5: If Asymptomatic after Step 4 proceed to Full Activity/Full Contact in a controlled practice.
Step 6: If Asymptomatic after Step 5 proceed to Full Return to Activity/Contact in game play with Peddie School Physician Clearance.
**If any symptoms occur the athlete will rest for a 24 hour asymptomatic period and return to the previous step**
Training Heart Description Zone Rate Zone 1 144 Over-Distance/Active Recovery - This is a low intensity zone used to establish a strong cardiovascular 154 base. Zone 1 training promotes increased oxygen absorption, fat-burning capacity, capillary, and mitochondrial density. This zone is also used for active recovery after intense training. Zone 2 154 Endurance - This is a moderate intensity zone used to improve overall conditioning 165 and endurance. Most exercise time should be spent in this zone. Zone 2 is an excellent calorie-burning zone because you can exercise here comfortably for an extended period of time Zone 3 165 Lactic Acid Tolerance/Tempo (Race Pace) Training - This is a higher intensity zone used to improve aerobic conditioning 177 while introducing an anaerobic component. Lactic acid is produced but not in sufficient quantities to immediately degrade performance. Training in this zone increases tolerance to lactic acid and raises the anaerobic threshold. Well-conditioned athletes will spend most of their time in this zone during a race of 30-60 min. Zone 4 177 Interval Training - This is a high intensity zone used for speed work and interval training. 187 Training in this zone improves sports performance but must be used carefully with rest to avoid over training.
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Infection & Blood borne Pathogen Policy Precautions for Blood borne Pathogens
In any circumstance where there is a possibility for contact with human blood or other bodily fluids such as saliva or mucous membranes all staff are required to wear protective gloves before touching the injured athlete.
When done take gloves off by peeling one off from top to bottom and hold it in the gloved hand. With the exposed hand peel the second glove off from the inside, tucking the first glove inside the second. The gloves along with any blood soaked materials must be disposed in a specially marked biohazard container*. The individual who treated the injury must was their hands with soap and hot water whether or not protective gloves were worn.
When dealing with any surface that has blood or other bodily fluids present clean the area with a bleach solution (10 parts water to 1 part bleach) or any comparable product. The individual cleaning the surface must wear protective gloves. Any towels with blood or any other bodily fluids will be washed in hot soapy water with a bleach detergent.
Any used sharps will be placed in a specially mark biohazard container*. When the container is full it will be brought to the health center for pick-up and proper disposal.
*Biohazard containers are located in the athletic training room and the health center.
Universal Precautions
Universal Precautions is the name used to describe a prevention strategy in which all blood and potentially infectious materials are treated as if they are actually infectious, regardless of the perceived status of the source individual. In other words, whether or not you think the blood/body fluid is infected with blood borne pathogens, you treat it as if it is. This approach is used in all situations where exposure to blood or potentially infectious materials is possible. In addition, it means that certain engineering and work practice controls shall always be utilized in situations where exposure may occur.
The Blood borne Pathogen Standard allows for healthcare facilities to use acceptable alternatives to Universal Precautions. Alternative concepts in infection control are called Body Substance Isolation (BSI) and Standard Precautions. These methods define all body fluids and substances as infectious. These methods incorporate not only the fluids and materials covered by the Blood borne Pathogens Standard but expand coverage to include all body fluids and substances. (OSHA, 2008).
Healthcare workers should learn and follow scientifically accepted infection prevention techniques appropriate to their profession for the cleaning and sterilization or disinfection of instruments, devices, materials, and work surfaces, utilization of protective garb, use of covers for Peddie School Policy & Procedure Manual 29
contamination-prone equipment, and the handling of sharp instruments. Such techniques include but are not limited to the following:
1. Wearing of appropriate protective gloves at all times when touching blood, saliva, other body fluids or secretions, mucous membranes, non-intact skin, blood-soiled items or bodily fluid–soiled items, contaminated surfaces, and sterile body areas, and during instrument cleaning and decontamination procedures;
2. Discarding gloves used following treatment of a patient and changing to new gloves if torn or damaged during treatment of a patient and washing hands prior to performing services for another patient; and washing hands and other skin surfaces immediately if contaminated with blood or other body fluids;
3. Wearing of appropriate masks, gowns or aprons, and protective eyewear or chin-length plastic face shields whenever splashing or spattering of blood or other body fluids is likely to occur;
4. Sterilizing equipment and devices that enter the patient’s vascular system or other normally sterile areas of the body;
5. Sterilizing equipment and devices that touch intact mucous membranes but do not penetrate the patient’s body, or using high-level disinfection for equipment and devices that cannot be sterilized prior to use for a patient;
6. Using appropriate agents, including but not limited to detergents for cleaning all equipment and devices prior to sterilization or disinfection;
7. Cleaning, by use of appropriate agents, including but not limited to detergents, equipment and devices that do not touch the patient or that only touch the intact skin of the patient;
8. Maintaining equipment and devices used for sterilization according to the manufacturer’s instructions;
9. Adequately monitoring the performance of all personnel, licensed or unlicensed, for whom the licensee is responsible regarding infection control techniques;
10. Placing disposable used syringes, needles, scalpel blades, and other sharp instruments in appropriate puncture-resistant containers for disposal; and placing reusable needles, scalpel blades, and other sharp instruments in appropriate puncture-resistant containers until appropriately cleaned and sterilized;
11. Maintaining appropriate ventilation devices to minimize the need for emergency mouth-to- mouth resuscitation;
12. Refraining from all direct patient care and handling of patient care equipment when the healthcare professional has exudative lesions or weeping dermatitis and the condition has not been medically evaluated and determined to be safe, or capable of being safely protected against, in providing direct patient care or in handling patient care equipment; Peddie School Policy & Procedure Manual 30
13. Placing all specimens of blood and body fluids in well-constructed containers with secure lids to prevent leaking; and cleaning any spill of blood or other body fluid with an appropriate detergent and appropriate chemical germicide.
Failing to use these techniques not only jeopardizes the health and safety of patients and other healthcare colleagues, but may constitute unprofessional conduct and/or be in violation of in-house policies and local, state, or federal regulations.
In order to quell the fear that often arises out of ignorance, student-athletes should be informed that although there is a theoretical risk of contracting HIV through casual contact or collisions on the playing field, no case of HIV transmission through this method has ever been documented. The risk of contracting HIV through sports is rather small. Normally situations where a student-athlete is bleeding should be handled by game officials in the following manner:
1. Upon observing a student-athlete with an open wound or a blood-stained uniform, the official should stop the contest as soon as is feasibly possible and call the athletic trainer onto the field or court to examine the student-athlete. If the athletic trainer is absent or head coach shall be summoned.
2. All open wounds or breaks in the skin should be bandaged before allowing the student- athlete to return to the contest. The athletic trainer shall determine the feasibility of dressing the wound on the field. If this is not feasible, the athlete shall be removed to the sidelines.
3. The athletic trainer shall determine whether a student-athletes uniform is grossly soiled with blood or other body fluids. If the uniform is grossly soiled, the student-athlete shall be removed from the competition until the uniform can be changed.
4. Teams shall not be charged with a time-out in the event that a player must leave the field in order to dress a wound or change a uniform. Players will be allowed immediate reentry once the wound is dressed or the uniform changed. No penalty shall be assessed if a player is forced to change numbered uniforms. The scorekeeper and the opposing coach shall be made aware of the number change.
Skin Infection Policy Adapted from NATA Position Statement: Skin Diseases Common Skin Infections
Fungal Infections 1. Tinea Capitis – presents as gray, scaly patches accompanied with mild hair loss
2. Tinea Corporis – presents with a well-defined, round, erythematous, scaly plaque with raised borders
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Viral Infections 1. Herpes Simplex – lesion typically found on head, face, neck, upper extremities and present as clustered, tense vesicles on an erythematous base
2. Molluscum Contagiosum – typically presents as umbilicated or delled, flesh colored to light- pink pearly papules measuring 1-10mm in diameter
Bacterial Infections 1. Impetigo – bullous impetigo presents on the trunk or the extremities with raised blisters that rupture easily, resulting in moist erosions surrounded by a scaly rim. Nonbullous impetigo presents with thin walled vesicles that rupture into a honey-colored crust
2. Folliculitis – presents as papules and pustules at the base of hair follicles, especially in areas that have been shaved, taped, or abrade 3. Furuncles or Carbuncles – Furuncles present as tender areas that, over several days, develop a reddened nodular swelling; carbuncles present as the coalescence of multiple furuncles in a deep, communicating, purulent mass
4. MRSA – CA-MRSA initially presents similarly to other bacterial infections. Furuncles, carbuncles, and abscesses are the most frequent clinical manifestations. Often CA-MRSA lesions are confused with spider bites. Lesions may begin as small pustules that develop into larger pustules or abscesses with areas of erythema and some tissue necrosis
Prevention Wash hands on a regular basis. Shower immediately after sports with antibacterial soap. Avoid whirlpools, saunas or common tubs. Individuals with open wounds, scrapes or scratches can easily infect others in this environment. Avoid sharing towels, razors, and daily athletic gear. Properly wash athletic gear and towels after each use – clothes must be given to cage for proper washing. Care for & cover cuts, abrasions & other lesions immediately after activity. Do not play a sport unless lesions are covered. Clean athletic equipment regularly. If equipment cannot be cleaned, it should be stored so that air can circulate & dry it. Do not store shin guards & other equipment in gym bags. Inform nurse or athletic trainer about any skin lesion which does not begin to heal immediately. Skin Infection Suspected 1. Athletic trainer made aware immediately 2. Athletic trainer evaluates possible skin infection 3. If further evaluation is needed a. Athletic trainer notifies Health Center b. Health Center evaluates possible infection c. Dr. Drstvensek evaluates possible infection and provides appropriate treatment Peddie School Policy & Procedure Manual 32
d. Dr. Drstvensek informs athletic trainers and health center of return to play date Return to Play Guidelines
Fungal Infections 1. Tinia Capitis – minimum 14 days antifungal therapy
2. Tinia Corporis – oral or topical fungicide for 72 hours and lesion must be adequately covered
Viral Infections 1. Herpes Simplex a. Asymptomatic b. No new blisters for 72 hours c. Lesions must be crusted d. Minimum of 120 hours of antiviral therapy
2. Molluscum Contagiosum – 24 hours after curetted and covered
Bacterial Infections 1. Impetigo a. No new lesions for 48 hours b. 72 hours antibiotics therapy c. No further drainage or exudate
2. Folliculitis/Furuncles/Carbuncles a. No new lesions for 48 hours b. 72 hours antibiotic therapy c. No further drainage or exudate
3. Methicillin-resistant Staphylococcus aureus (MRSA) a. No new lesions for 48 hours b. 72 hours antibiotic therapy c. No further drainage or exudates
See Appendix B – Physician Consult Form
Severe Weather Policy
“If you hear it ‘clear it’, if you see it ‘flee it”
Outdoor Practices: At first clear sound of thunder or flash of lightening any and all practices will end and all fields must be cleared immediately Peddie School Policy & Procedure Manual 33
It is the responsibility of Peddie Coaches to ensure students are moved directly into the closest secure building or onto the bus as quickly as possible. o Back Athletic Fields – Athletic Center or von Center o Outdoor Turf – Athletic Center or von Center o Varsity Hub Fields – Athletic Center or History House (closest building) o Softball Field – Athletic Center o Baseball Field –History House or Annenberg Hall o Football Field/Track – Athletic Center o Tennis Courts – Health Center o Golf Course – Club House o Cross Country Team – Nearest secure building/facility or school bus if not near a secure building o Crew Team – Boathouse as soon as possible
Once the field is cleared students are not to re-enter area until 30 minutes following the last sound of thunder or sight of lightening.
Games: Officials have the responsibility of insuring that playing conditions are safe If you are involved in a contest and there is a clear sound of thunder or flash of lightening students are to be removed from the field into the closest building or onto the bus, even if officials are unwilling to suspend play. o This could result in forfeit of contest if the officials are unwilling to recognize the danger of severe weather. o Athletic Director will notify and discuss situation with head of officials.
Peddie Aquatic Center: At first clear sound of thunder or flash of lightening everyone in the water must clear the pool, pool deck, and showers. Swimmers are allowed to enter the locker rooms, although no-one will be allowed in the showers until the severe weather has passed Everyone should exit the pool area/deck and may congregate in the glass hallway outside pool entrances. No-one should re-enter the pool or exit the building until it is deemed safe as per the ’30 minute rule’ listed above. The Athletic Directors, Athletic Trainers, Aquatics Director or appropriate person in charge will make the final ‘All-Clear’ decision for everyone to re-enter the pool or exit the building.
Sudden Cardiac Arrest Adapted from the Journal of Athletic Training & NJ State Department of Education
Sudden cardiac arrest (SCA) is the leading cause of death in young athletes usually caused by an underlying structural abnormality. Hypertrophic cardiomyopathy, coronary artery anomalies, and commotio cordis are some common causes of SCA. In about 55-80% of all sudden cardiac deaths (SCD) the athlete is asymptomatic until the sudden cardiac arrest. SCD is the result of an
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unexpected failure of proper heart function that about 60% of the time occurs during or immediately after exercise without any trauma.
Warning Signs In more than a third of SCD warning signs were not reported or taken seriously, they include: Fainting, a seizure or convulsion during physical activity Fainting or seizure from emotional excitement, distress, or being startled Dizziness or lightheadedness, especially during exertion Chest pain at rest or with exertion Palpitations – heart beating unusually (skipping, irregular, or extra beats) during exertion or during cool down periods Fatigue or tiring more quickly than peers Being unable to keep up with friends due to shortness of breath
All New Jersey secondary school athletes must be examined by their primary care physician at least once a year. The New Jersey Department of Education requires a specific pre-participation physical exam form be filled out.
The pre-participation physical exam begins with the parent and student athlete completing questions about symptoms while exercising and about a family health history. The primary care physician needs to know if any family member died suddenly during physical activity or during a seizure. They also need to know if anyone in the family under the age of 50 had an unexplained sudden death such as drowning or car accident. This information must be provided annually for each exam because it is so essential to identify those at risk for sudden cardiac death. The required physical exam includes measurement of blood pressure and a careful listening examination of the heart, especially for murmurs and rhythm abnormalities. If there are no warning signs reported on the health history and no abnormalities discovered on exam; no further evaluation or testing is recommended.
Treatment The only effective treatment for ventricular fibrillation is immediate use of an automated external defibrillator (AED). An AED can restore the heart back into a normal rhythm. An AED is also life-saving for ventricular fibrillation caused by a blow to the chest over the heart.
Effective September 1, 2014; the New Jersey Department of Education requires that all public and nonpublic schools grades K through 12 shall (Janet’s Law): Have an AED accessible to every sports event on Peddie’s campus Have adequate personnel who are trained in the use of an AED at practices/games Have coaches and athletic trainers trained in basic life support techniques (CPR/AED) Call 911 immediately while someone is retrieving the AED
Emergency Preparedness Emergency Action Plans (EAP) for all venues Emergency personnel aware of procedures Peddie School Policy & Procedure Manual 35
Rapid communication between emergency personnel Emergency transport – EMS & ALS Review of EAP’s & equipment annually Certification of CPR & AED for first responders – athletic trainers, nurses, security, coaches Access to early defibrillation within 3-5 min of collapse – survival rate decreases 7-10% per minute for every minute defibrillation is delayed
Management Early Activation o EMS o CPR o AED o Advanced Life Support (ALS) SCA should be expected in collapsed unresponsive athlete – until clearly ruled out Witnessed vs Unwitnessed Response – based on CPR training Early AED application Continued CPR before and after AED use
Wet & Metal Surfaces Rescuer is safe in a wet or ice environment during AED use Suspected person in SCA should NOT be moved out of puddles to avoid delays as there is no significant risk of electric shock Suspected person in SCA immersed in pool or body of water should be removed from water before defibrillation Suspected person in SCA should be moved to a nonmetal surface or onto a spine board before defibrillation Commotio Cordis
Commotio cordis occurs with a blunt non-penetrating blow to the chest during a vulnerable phase of ventricular repolarization leading to an arrhythmia or cardiac contusion. Survival for this injury relies primarily on the time to defibrillation. Students must be wearing properly fitted sport specific chest protectors during practices and games.
Heat Policy
1. An athletic trainer will be available for all Peddie Athletic Department sanctioned events to evaluate and examine any athlete who displays signs and symptoms of heat illness 2. All preseason athletes will complete a heat acclimatization period. 3. Athletes and coaches will be educated in prevention and recognition of heat illnesses 4. Athletes will be educated on fluid intake for proper hydration and to eat a well-balanced diet 5. An athletic trainer will use guidelines based on temperature and humidity (heat index) related to safety of practices/games/indoor facility activities. 6. Adequate amounts of fluids will be placed at venues for practices/games/indoor facility activities by Peddie equipment manager Peddie School Policy & Procedure Manual 36
7. An athletic trainer will maintain proper supplies to deal with heat illnesses a. Cool water and sports drinks b. Cold water immersion tub and ice to cool water c. Rectal thermometer d. Cell phone or radio to call for EMS
Practice Heat Index Guidelines
80- 90 degree heat index is safe to practice, workout, and play, however athletes should be given multiple water breaks. 90- 104 degree heat index is safe to practice, workout, or play, however practice and workouts will require modifications. o Frequent water breaks o Limit practice/workout duration o Limit conditioning time o Equipment intensive sports should practice without helmets or limit the time the helmets are on. 105- 129 degree heat index practice and workouts should be changed to early in the morning, late in the evening or moved indoors to a facility within the proper heat index guidelines. 130 + degree heat index practice and workouts must be canceled or indoor facility closed until proper heat index guidelines are met.
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Heat Illnesses
Heat Cramps Heat cramps are caused by people who sweat a lot during strenuous activity. This sweating depletes the body’s salt and moisture. The low salt level in the muscles causes painful cramps. Heat cramps may also be a symptom of heat exhaustion
Signs and Symptoms: Abdominal Cramps Thirst Fatigue Muscle Spasms Leg Cramps
First Aid: Move victim to a cool location Replace fluids – sports drinks containing sodium Mild Stretching
Heat exhaustion Heat exhaustion is a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids. Heat exhaustion is caused by fluid loss which, in turn, causes blood flow to decrease to vital organs, resulting in a form of shock. As a result of dehydration, victims often complain of flu like symptoms hours after exposure.
Signs and Symptoms: Cool, Moist, Pale Skin Headache Dizziness and/or Weakness Nausea Skin may feel warm Excessive Sweating
First Aid: Move victim to a cool location Assess cognitive function Measure core-body temp If temperature is elevated remove excess clothing Replace fluids slowly if possible
Exertional Heat stroke Heat stroke occurs when the body’s heat regulating mechanisms fail. Body temperature rises so high that brain damage and death may result unless the body is cooled quickly
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Signs and Symptoms: Skin may be hot, red, and dry Weak rapid pulse Rapid, shallow breathing Vomiting Decreased level of consciousness
First Aid: Move athlete to a cool, shaded location Assess cognitive function Call 911-Heat stoke is a life threatening condition Measure core body temp – with rectal thermometer if possible o Possible heat stroke if greater than 104 degrees Remove excess clothing Place athlete in cold water immersion tub to lower core body temp o Remove when temperature is less than 102 degrees Use icepacks in the armpits, neck, wrists, and ankles to cool the major blood vessels – if cold water immersion is not accessible Monitor vital signs Do not give any fluid by mouth
Sickle Cell Trait Adapted from NATA Consensus Statement
Sickle cell trait is a genetic condition in which there is one sickle cell hemoglobin and one normal hemoglobin cell. Under intensive exercise the sickle cell hemoglobin changes from its normal round shape to a half moon shape; causing the sickled red blood cells to collect together in blood vessels leading to collapse. The collapse is caused by what is known as ischemic rhabdomyolysis which is the rapid breakdown of muscle from lack of blood caused by the sickling of the cells and can be life threatening. Factors that increase risk of sickling include; heat, altitude, asthma, and dehydration.
Sickle cell trait status should be known for all students and reviewed for ability to participate in athletics. This will enable athletes to perform in an optimal and safe environment. Coaches, nurses, and athletic trainers should all be educated about the life threatening situation of sickle cell trait.
Sickling VS Heat Cramps Collapse within first ½ hour or when beginning sprints VS later in activity No muscle spasm VS intense muscle spasm Less painful VS extremely painful muscle spasm
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Slump to ground with weak muscle VS ‘locked up’ muscles Normal look and feel to muscle VS rock hard contracted muscle When caught early: faster recovery VS longer with muscle cramps
Guidelines for the Sickle Cell Athlete Slowly build up training Preseason strength and condition programs Stopping activity with onset of symptoms Set their own pace Year round strength and conditioning programs designed for specific athlete Alter workout depending on conditions: heat, dehydration, asthma, altitude Educate athletes, coaches, nurses, and athletic trainers of signs and symptoms and importance to report them honestly
In the case of a Sickling Collapse: Monitor vitals Administer oxygen Cool athlete If vital decline, call 911 & retrieve AED Explain possible rhabdomyolysis to EMT’s/Paramedics
Preseason Heat Acclimatization Policy Adapted from National Athletic Trainers’ Association Pre-Season Heat Acclimatization Guidelines for Secondary School Athletics
Before participating in the preseason practice period, all student-athletes should undergo a pre- participation medical examination administered by a physician (MD or DO) or as required/approved by state law. The examination can identify predisposing factors related to a number of safety concerns, including the identification of youths at particular risk for exertional heat illness.
The heat-acclimatization period is defined as the initial 14 consecutive days of preseason practice for all student-athletes. The goal of the acclimatization period is to enhance exercise heat tolerance and the ability to exercise safely and effectively in warm to hot conditions. This period should begin on the first day of practice or conditioning before the regular season. Any practices or conditioning conducted before this time should not be considered a part of the heat acclimatization period. Regardless of the conditioning program and conditioning status leading up to the first formal practice, all student-athletes (including those who arrive at preseason practice after the first day of practice) should follow the 14-day heat-acclimatization plan. During the preseason heat acclimatization period, if practice occurs on 6 consecutive days, student-athletes should have 1 day of complete rest (no conditioning, walk-through, practice, etc). Days on which athletes do not practice due to a scheduled rest day, injury, or illness do not count toward the heat-acclimatization period. For example, an athlete who sits out the third and fourth days of practice during this time; will resume practice as if on day 3 of the heat-acclimatization period when returning to play.
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A practice is defined as the period of time a participant engages in a coach-supervised, school approved, sport or conditioning-related physical activity. Each individual practice should last no more than 3 hours. Warm-up, stretching, and cool-down activities are included as part of the 3-hour practice time. Regardless of ambient temperature conditions, all conditioning and weight room activities should be considered part of practice.
A walk-through is defined as a teaching opportunity with the athletes not wearing protective equipment (helmets, shoulder pads, catcher’s gear, shin guards) or using other sport-related equipment (footballs, lacrosse sticks, blocking sleds, pitching machines, soccer balls, marker cones). The walk-through is not part of the 3-hour practice period which can last no more than 1 hour per day and does not include conditioning or weight-room activities.
A recovery period is defined as the time between the end of 1 practice or walk-through and the beginning of the next practice or walk-through. During this time, athletes should rest in a cool environment with no sport or conditioning-related activity permitted (speed or agility drills, strength training, conditioning, or walk-through). Treatment with the athletic trainer is permissible.
THE 14-DAY HEAT ACCLIMATIZATION PERIOD
1. Days 1 through 5 of the heat-acclimatization period consist of the first 5 days of formal practice. During this time, athletes may not participate in more than 1 practice per day.
2. If a practice is interrupted by inclement weather or heat restrictions, the practice should recommence once conditions are deemed safe. Total practice time should not exceed 3 hours in any 1 day.
3. A 1-hour maximum walk-through is permitted during days 1–5 of the heat-acclimatization period. However, a 3-hour recovery period should be inserted between the practice and walk-through.
4. During days 1–2 of the heat-acclimatization period, in sports requiring helmets or shoulder pads, a helmet should be the only protective equipment permitted (goalies, as in the case of field hockey and related sports, should not wear full protective gear or perform activities that would require protective equipment). During days 3–5, only helmets and shoulder pads should be worn. Beginning on day 6, all protective equipment may be worn and full contact may begin.
A. Football only: On days 3–5, contact with blocking sleds and tackling dummies may be initiated. B. Full-contact sports: 100% live contact drills should begin no earlier than day 6.
5. Beginning no earlier than day 6 and continuing through day 14, double-practice days must be followed by a single-practice day. On single-practice days, 1 walk-through is permitted,
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separated from the practice by at least 3 hours of continuous rest. When a double practice day is followed by a rest day, another double practice day is permitted after the rest day.
6. On a double-practice day, practices should not exceed 3 hours in duration and student- athletes should not participate in more than 5 total hours of practice. Warm-up, stretching, cool-down, walk-through, conditioning, and weight-room activities are included as part of the practice time. The 2 practices should be separated by at least 3 continuous hours in a cool environment.
7. Because the risk of exertional heat illnesses during the preseason heat-acclimatization period is high, we strongly recommend that an athletic trainer be on site before, during, and after all practices.
Cold Exposure Policy Adapted from NCAA Sports Medicine Handbook & NATA Position Statement: Environmental Cold Injuries
Cold injury is dependent on a combination of two factors. These factors are low air or water temperatures and the influence of wind on the body’s ability to maintain a normothermic core temperature due to the exposure of cold air or surfaces.
Cold injury varies in signs and symptoms depending on environmental and non-environmental factors. They can include, previous cold weather injury, race, origin, temperature, use of medications, clothing, fatigue, hydration, fitness level, and caloric intake.
1. An athletic trainer will be available for all Peddie Athletic Department sanctioned events to evaluate and examine any athlete who displays signs and symptoms of cold exposure. 2. Athletes and coaches will be educated in prevention and recognition of cold exposure. 3. Athletes will be educated on fluid intake for proper hydration and to eat a well-balanced diet. 4. An athletic trainer will use guidelines based on temperature and wind related to safety of practices/games. 5. Adequate amounts of fluids will be placed at fields for practices/games by Peddie equipment manager 6. An athletic trainer will maintain proper supplies to deal with cold exposure a. Water and sports drinks b. Heat packs and blankets c. Rectal thermometer d. Cell phone or radio to call for EMS
Practice Temperature Guidelines
Conditions should be constantly re-evaluated for change in risk:
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30 degrees Fahrenheit & below – based on temperature and wind chill o Limit 60 minutes outside practice time o Be aware of potential for cold injury o Use of additional protective clothing o Cover as much exposed skin as possible . It is the coaches responsibility to ensure all student athletes are dressed appropriately o Provide facilities & opportunities for re-warming
25 degrees Fahrenheit & below – based on temperature and wind chill o Limit only 30 minutes outside practice time o Protective clothing must be worn o Covering as much exposed skin as possible . It is the coaches responsibility to ensure all student athletes are dressed appropriately o Provide facilities & opportunities for re-warming
20 degrees Fahrenheit & below – based on temperature and wind chill o Termination of outside practice time
*The ability to play a game/practice in cold weather will be based on temperature and wind chill. This decision will be made by the Director of Athletics in collaboration with athletic trainers and assistant athletic director along with the officials for that particular game.*
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Prevention
1. Pre-season physical evaluation a. History of cold injury 2. Identify student athletes with known risk factors a. Lean body composition b. Females c. Older age d. Black race e. Low fitness levels f. Comorbidity i. Cardiac disease ii. Anorexia iii. Raynaud syndrome iv. Exercise induced bronchospasm 3. Ensure appropriately trained personnel are available onsite 4. Education of coaches and athletes 5. Education of proper hydration and nutrition 6. Develop practice guidelines 7. Provide opportunity for rewarming
Clothing Peddie School Policy & Procedure Manual 44
Coaches are responsible for making sure each player is properly dressed for cold weather practices. Clothing is used to reduce the amount of heat lost to the environment by keeping warm air in.
1. Several layers around the core a. Inner wicking fabric next to the skin i. Keeps body warm and dry ii. Eliminates moisture retention iii. Polyester, polypropylene and wool b. Middle insulation layer i. Fleece or wool c. Outer wind blocking garment i. Avoid wind chill 2. Head and ear coverage a. Can account for 40% heat loss b. Hats or earmuffs c. Face protection 3. Hands should be covered as needed a. Gloves 4. Feet should utilize wicking fabric or wool socks 5. Remove wet clothing as soon as practical 6. Student athletes should be able to adjust layering as needed to their specific responses and comfort level while still following guidelines. Cold Illnesses
Frost Bite Frost bite is the freezing of body tissues. It is broke up into stages depending on depth of freezing tissue. It occurs when blood is shunted to the core from peripheral tissues. For tissue to freeze it must be below 28 degrees Fahrenheit.
Frost nip is the mildest form of cold injury and can occur with exposure to very cold temperatures and windy conditions. The superficial tissues are frozen and the tissue is not permanently damaged.
Mild frost bite involves superficial tissue freezing as well as adjacent subcutaneous tissue.
Severe frost bite is freezing of the tissue below the skin and adjacent tissues. This can include muscles, tendons, and bones.
Signs and Symptoms: Dry, waxy skin Edema Erythema Transient tingling or burning Skin with white or gray patches Skin is hard and cold Poor circulation Peddie School Policy & Procedure Manual 45
Blistering
First Aid:
Frost nip Firm, sustained pressure Blowing hot breath Placing hands in armpits
Mild Frostbite Immersion in warm water o Do not rub area – may cause blisters
Severe Frostbite Immediate hospitalization Rapid rewarming o Hot drinks o Heating pads o Hot water bottles
Chilblain Chilblain is a nonfreezing cold injury associated with long (1-5 hour) exposure to cold and wet conditions. It is an exaggerated inflammatory response. It is most common in the hands and feet.
Signs and Symptoms: Swelling Tenderness Red or cyanotic lesions Itching, numbness, burning, or tingling
First Aid: Gradual rewarming Do not massage or rub area
Immersion (Trench) Foot Immersion foot occurs with prolonged exposure (12 hours to 4 days) to wet and cold temperatures. Soft tissue including nerves and blood vessels are typically affected due to an inflammatory response. A common mechanism is wearing wet socks or footwear.
Signs and Symptoms: Burning, tingling, itching Loss of sensation Swelling Pain/sensitivity Blisters Peddie School Policy & Procedure Manual 46
Skin fissures
Hypothermia Hypothermia is defined as a significant drop in core body temperature below 95 degrees Fahrenheit. It occurs when the body is unable to maintain a normal core temperature due to the body’s heat loss exceeding its production.
Mild hypothermia is determined at core body temperature 95 degrees F to 98.6 degrees F.
Moderated hypothermia is determined at core body temperature 90 degrees F to 94 degrees F.
Severe hypothermia is determined at core body temperature below 90 degrees F.
Signs and Symptoms: Changes in motor function o Clumsiness o Loss of dexterity o Slurred speech Changes in cognition o Confusion o Memory loss Loss of consciousness Hyperventilation Shivering
First Aid:
Mild Hypothermia Rectal temperature reading for accurate core body temp Remove wet or damp clothing – insulate athlete with warm dry clothing/blankets Move athlete to warm environment with shelter Apply heat to trunk, axilla, chest, groin – avoid warming extremities due to afterdrop Provide warm fluids contains carbohydrates Avoid massaging tissues
Moderate/Severe Hypothermia Move gently to a warm , dry environment Complete primary survey Call 911 Remove wet or damp clothing – insulate athlete with warm dry clothing/blankets Apply heat to trunk, axilla, chest, groin – avoid warming extremities due to afterdrop Continually monitor vitals signs
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Fluid Replacement for Athletes Adapted from NATA Position Statement & Sports Safety International EBP Course
Dehydration of 1% to 2% of body weight begins to compromise physiologic function and negatively influence performance Dehydration of greater than 3% of body weight further disturbs physiologic function (increased HR and increase body temperature) and increases an athlete’s risk of developing an exertional heat illness o Heat cramps o Heat exhaustion o Heat stroke Recommendations 1. Proper hydration – frequent small volume fluid consumption or less frequent large volume fluid consumption based on sport 2. Easily accessible fluid containers/water bottles 3. Assess hydration through body weight measurements – before & after practice 4. Assess hydration through urine color and volume 5. Consume 17-20 fl oz (about 2.5 cups) fluid 2-3 hours before exercise 6. Consume 7-10 fl oz (about 1 cup) 10-20 min before exercise 7. Generally, consume 7-10 fl oz (about 1 cup) every 10-20 min during exercise – maintain less than 2% body weight reduction 8. Post exercise hydration should aim to correct fluid loss – should include water, carbohydrates, and electrolytes which helps return physiological function. 9. Wet Blub Globe Temperature (WBGT) should be monitored – higher the humidity less sweat is evaporated into the environment – increases core body temperature 10. Consuming fluids with carbohydrates before, during, and after are beneficial. The fluid should not contain greater than 8% as it compromising rate of fluid emptying and absorbed 11. Athletic trainers or others supervising athletes should be aware of all sign/symptoms of dehydrations: thirst, headache, dizziness, cramps, vomiting, nausea, weakness, etc. 12. Inclusion of sodium chloride (salt) should be done to help maintain electrolyte balance 13. Complete heat acclimatization period 14. Educate athletes and coaches about proper rehydration and sign/symptoms of dehydration and effects to performance 15. Maintain proper water supply at all venues during practice/games 16. Encourage modifications to practices/games due to excessive heat
Dietary Supplements & Anabolic Androgenic Steroids (Adapted from Journal of Athletic Training Position Statements)
Use of both dietary supplements and anabolic steroids is strongly discouraged. At Peddie, use of anabolic steroids without a prescription is illegal and can lead to disciplinary action.
A dietary supplement is a product intended to supplement the diet that contains one or more of the following dietary ingredients: vitamin; mineral, herb or other botanical; amino acid, dietary Peddie School Policy & Procedure Manual 48
substance to supplement the diet by increasing the total dietary intake; concentrate, metabolic, constituent, extract or combination of any of the aforementioned ingredients. Dietary supplements do not require third-party verification, are not well regulated, and may contain banned substances. Under current federal law manufacturers are not required to provide evidence of purity, safety, or efficacy before being sold. Dietary supplements DO NOT require FDA approval if all ingredients are not considered new and fit the criteria of DSHEA (Dietary Supplement Health and Education ACT).
Use of anabolic androgenic steroids for non-therapeutic roles can lead to abuse and cause negative health effects to a variety of body systems. Adverse effects can possibly occur to the central nervous system, cardiovascular, hepatic, reproductive, musculoskeletal, immune, integumentary, nephritic, with the possibility of other systems as well.
The best way to a healthy and successful athletic career is a nutritionally sound, balanced diet and well-designed training program.
Local Hospital Information
University Medical Center of Princeton at Plainsboro One Plainsboro Road Plainsboro, New Jersey 08536
Main Number: 609-853-7000 Information Desk: 609-853-6006
Robert Wood Johnson University Hospital Hamilton One Hamilton Health Place Hamilton, New Jersey 08690
Main Number: 609-586-7900 Emergency Department: 609-584-6666
CentraState Medical Center 901 West Main Street Freehold, New Jersey 07728
Main Number: 732-431-2000 Patient Information: 732-294-2600
Robert Wood Johnson University Hospital New Brunswick One Robert Wood Johnson Place New Brunswick, New Jersey 08901
Level I Trauma Center
Main Number: 732-828-3000
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Capital Health System – Fuld Campus – Trenton 750 Brunswick Ave Trenton, New Jersey 08638
Level II Trauma Center
Main Number: 609-394-6000
Appendix A – Emergency Action Plans (EAP’s)
Peddie Outdoor Track/ Football Game Field Emergency Action Plan
*** Call the athletic trainers over the emergency radio if available or by cell phone if the injury is related to a Peddie School practice or game.***
***Nearest AED is located in the Peddie Health Center while school is in session***
Call 911 with cell phone. Tell the dispatcher 1. Your location- outdoor track, Peddie School, access via Ward St, main entrance. Tell them Peddie Security will meet them at the main campus entrance. 2. The situation or injury 3. Who are the people injured 4. Give them a phone number they can call back
*Wait to hang up, until the dispatcher hangs up first.
Call Peddie School Security 609-944-7557 1. Inform them of your location, situation, and that an ambulance has been called. 2. Tell them to meet ambulance at main campus entrance. 3. Give emergency care as qualified.
***If life threatening emergency, inform Peddie Security that you have a CODE RED situation and to bring the AED to the site before they meet EMS at the main campus entrance. Assign coach to acquire athlete’s medical information from health center if student involved. Assign different person to control the crowd. Stay calm, keep patient calm, until EMS arrives. When EMS arrives, let them take over all care of patient.
Peddie Security – 609-944-7557 Athletic Training Room – 609-944-7634 Peddie Health Center – 609-944-7545
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Peddie Tennis Courts Emergency Action Plan
*** Call the athletic trainers over the emergency radio if available or by cell phone if the injury is related to a Peddie School practice or game.***
***Nearest AED is located in the Peddie Health Center while school is in session***
Call 911 with cell phone. Tell the dispatcher 1. Your location- Tennis courts, Peddie School, access via Ward St, deliveries entrance. Tell them Peddie Security will meet them at deliveries entrance off Ward St. 2. The situation or injury 3. Who are the people injured 4. Give them a phone number they can call back
*Wait to hang up, until the dispatcher hangs up first.
Call Peddie School Security 609-944-7557 1. Inform them of your location, situation, and that an ambulance has been called. 2. Tell them to meet ambulance at deliveries entrance off Ward St. 3. Give emergency care as qualified.
***If life threatening emergency, inform Peddie Security that you have a CODE RED situation and to bring the AED to the site before they meet EMS at deliveries entrance of Ward St. Assign coach to acquire athlete’s medical information from health center if Peddie student involved. Assign different person to control the crowd. Stay calm, keep patient calm, until EMS arrives. When EMS arrives, let them take over all care of patient.
Peddie Security – 609-944-7557 Athletic Training Room – 609-944-7634 Peddie Health Center – 609-944-7545
Peddie Varsity Hub Fields / Softball/ Baseball Emergency Action Plan
*** Call the athletic trainers over the emergency radio if available or by cell phone if the injury is related to a Peddie School practice or game.***
***Nearest AED is located in Pool Facility or Annenberg Hall depending on your location on those fields***
Call 911 with cell phone. Tell the dispatcher 1. Your location- Etra Road Fields, Peddie School, access via Etra Rd. athletic center entrance. Tell them Peddie Security will meet them at entrance of athletic center parking lot. 2. The situation or injury Peddie School Policy & Procedure Manual 51
3. Who are the people injured 4. Give them a phone number they can call back
*Wait to hang up, until the dispatcher hangs up first.
Call Peddie School Security 609-944-7557 1. Inform them of your location, situation, and that an ambulance has been called. 2. Tell them to meet ambulance at entrance of athletic center parking lot. 3. Give emergency care as qualified.
***If life threatening emergency, inform Peddie Security that you have a CODE RED situation and to bring the AED to the site before they meet EMS at entrance of athletic center parking lot. Assign coach to acquire athlete’s medical information from health center if Peddie student involved. Assign different person to control the crowd. Stay calm, keep patient calm, until EMS arrives. When EMS arrives, let them take over all care of patient.
Peddie Security – 609-944-7557 Athletic Training Room – 609-944-7634 Peddie Health Center – 609-944-7545
Peddie Outdoor Turf Emergency Action Plan
*** Call the athletic trainers over the emergency radio if available or by cell phone if the injury is related to a Peddie School practice or game.***
***Nearest AED is located in Pool Facility***
Call 911 with cell phone. Tell the dispatcher 1. Your location- Outdoor turf, Peddie School, access via Etra Rd. athletic center entrance. Ambulance does not drive vehicle onto the turf. Tell them Peddie Security will meet them at entrance of athletic center parking lot. 2. The situation or injury 3. Who are the people injured 4. Give them a phone number they can call back
*Wait to hang up, until the dispatcher hangs up first.
Call Peddie School Security 609-944-7557 1. Inform them of your location, situation, and that an ambulance has been called. 2. Tell them to meet ambulance at entrance of athletic center parking lot. 3. Give emergency care as qualified.
***If life threatening emergency, inform Peddie Security that you have a CODE RED situation and to bring the AED to the site before they meet EMS at entrance of athletic center
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parking lot. Assign coach to acquire athlete’s medical information from health center if Peddie student involved. Assign different person to control the crowd. Stay calm, keep patient calm, until EMS arrives. When EMS arrives, let them take over all care of patient.
Peddie Security – 609-944-7557 Athletic Training Room – 609-944-7634 Peddie Health Center – 609-944-7545
Peddie Back Athletic Fields, in East Windsor, NJ Emergency Action Plan
*** Call the athletic trainers over the emergency radio if available or by cell phone if the injury is related to a Peddie School practice or game.***
***Nearest AED is located on the side of storage shed centered between all the fields***
Call 911 with cell phone. Tell the dispatcher: 1. Your location- Peddie School Ward Street athletic Fields in East Windsor, access via Ward St. entrance across from the East Windsor public works building. Tell them Security will meet them at the entrance in the fence on Ward St. 2. The situation or injury 3. Who are the people injured 4. Give them a phone number they can call back
*Wait to hang up, until the dispatcher hangs up first.
Call Peddie School Security 609-944-7557 1. Inform them of your location, situation, and that an ambulance has been called. 2. Tell them to meet ambulance at the entrance in the fence on Ward St . 3. Give emergency care as qualified.
***If life threatening emergency, inform Peddie Security that you have a CODE RED situation and to bring the AED to the site before they meet EMS at entrance of fence on Ward St. Assign coach to acquire athlete’s medical information from health center if Peddie student involved. Assign different person to control the crowd. Stay calm, keep patient calm, until EMS arrives. When EMS arrives, let them take over all care of patient.
Peddie Security – 609-944-7557 Athletic Training Room – 609-944-7634 Peddie Health Center – 609-944-7545
Peddie Golf Course Emergency Action Plan
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*** Call the athletic trainers over the emergency radio if available or by cell phone if the injury is related to a Peddie School practice or game.***
***Nearest AED is located in the club house, in the lobby leading to the downstairs locker rooms***
Call 911 with cell phone. Tell the dispatcher: 1. Your location- Peddie School Golf Course in East Windsor. 2. The situation or injury 3. Who are the people injured 4. Give them a phone number they can call back (Peddie Golf Course 609-944-7542)
*Wait to hang up, until the dispatcher hangs up first.
Call Golf Pro (Golf Shop 609-490-7542) or person on duty in club house, inform him/her of emergency situation and location. Phone Peddie Security (at 609-944-7557) to inform them of your location, the emergency, and have Peddie Security meet ambulance in Golf Course parking lot. Give emergency care as qualified.
***If life threatening emergency, instruct Golf Pro or person on duty in club house to bring the AED to the site of emergency. Inform Peddie Security that you have a CODE RED situation at the golf course and to meet EMS at golf course entrance. Assign coach to acquire athlete’s medical information from health center if Peddie student involved. Assign different person to control the crowd. Stay calm, keep patient calm, until EMS arrives. When EMS arrives, let them take over all care of patient.
Peddie Security – 609-944-7557 Athletic Training Room – 609-944-7634 Peddie Health Center – 609-944-7545
Von Center – Indoor Turf Facility Emergency Action Plan
*** Call the athletic trainers over the emergency radio if available or by cell phone if the injury is related to Peddie School practice or game.***
***Nearest AED is located upstairs in the lobby of the athletic center, on the wall to the right of the athletic department office doors.***
***For rentals or activities not sanctioned by athletic department – call Peddie Security if an AED is needed.***
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Call 911 with cell phone. Tell the dispatcher 1. Your location- Peddie School indoor turf facility, access via Etra Rd. athletic center entrance. Tell them Peddie Security will meet them at entrance of athletic center parking lot. 2. The situation or injury 3. How many people are injured 4. Give them a phone number they can call back
*Don’t hang up until the dispatcher hangs up first.
Call Peddie School Security 609-944-7557 1. Inform them of your location, situation, and that an ambulance has been called. 2. Tell them to meet ambulance at entrance of athletic center parking lot. 3. Give emergency care as qualified.
***If life threatening emergency, inform Peddie Security that you have a CODE RED situation and to bring the AED to the site before they meet EMS at the athletic center entrance. Assign coach to acquire athlete’s medical information from health center if student involved. Assign different person to control the crowd. Stay calm, keep patient calm, until EMS arrives. When EMS arrives, let them take over all care of patient.
Peddie Security – 609-944-7557 Athletic Training Room – 609-944-7634 Peddie Health Center – 609-944-7545
Erik B. Hanson Field House Emergency Action Plan
*** Call the athletic trainers over the emergency radio if available or by cell phone if the injury is related to a Peddie School practice or game.***
***Nearest AED is located in the athletic center lobby, on the wall, to the right of the athletic department office doors***
Call 911 with cell phone. Tell the dispatcher 1. Your location- Peddie School Field House, access via Etra Rd. athletic center entrance. Tell them Peddie Security will meet them at entrance of athletic center parking lot. 2. The situation or injury 3. How many people are injured 4. Give them a phone number they can call back
*Don’t hang up until the dispatcher hangs up first.
Call Peddie School Security 609-944-7557 1. Inform them of your location, situation, and that an ambulance has been called. 2. Tell them to meet ambulance at entrance of athletic center parking lot. 3. Give emergency care as qualified. Peddie School Policy & Procedure Manual 55
***If life threatening emergency, inform Peddie Security that you have a CODE RED situation and to bring the AED to the site before they meet EMS at entrance of athletic center parking lot. Assign coach to acquire athlete’s medical information from health center if Peddie student involved. Assign different person to control the crowd. Stay calm, keep patient calm, until EMS arrives. When EMS arrives, let them take over all care of patient.
Peddie Security – 609-944-7557 Athletic Training Room – 609-944-7634 Peddie Health Center – 609-944-7545
Fitness Center Emergency Action Plan
*** Call the athletic trainers over the emergency radio if available or by cell phone if the injury is related to a Peddie School activity.***
***Nearest AED is located upstairs in the lobby of the athletic center, on the wall to the right of the athletic department offices.***
Call 911 with cell phone. Tell the dispatcher 1. Your location- Peddie School fitness center, access via Etra Rd. athletic center entrance. Tell them Peddie Security will meet them at entrance of athletic center parking lot. 2. The situation or injury 3. How many people are injured 4. Give them a phone number they can call back
*Don’t hang up until the dispatcher hangs up first.
Call Peddie School Security 609-944-7557 1. Inform them of your location, situation, and that an ambulance has been called. 2. Tell them to meet ambulance at entrance of athletic center parking lot. 3. Give emergency care as qualified.
***If life threatening emergency, inform Peddie Security that you have a CODE RED situation and to bring the AED to the site before they meet EMS at entrance of athletic center parking lot. Assign coach to acquire athlete’s medical information from health center if Peddie student involved. Assign different person to control the crowd. Stay calm, keep patient calm, until EMS arrives. When EMS arrives, let them take over all care of patient.
Peddie Security – 609-944-7557 Athletic Training Room – 609-944-7634 Peddie Health Center – 609-944-7545
Eckert Wrestling Room Emergency Action Plan
Peddie School Policy & Procedure Manual 56
*** Call the athletic trainers over the emergency radio if available or by cell phone if the injury is related to a Peddie School practice or match.***
***Nearest AED is located in the hallway, on the wall across from the entrance of the athletic training room.***
Call 911 with cell phone. Tell the dispatcher 1. Your location- Peddie School wrestling room, access via Etra Rd. athletic center entrance. Tell them Peddie Security will meet them at entrance of athletic center parking lot. 2. The situation or injury 3. How many people are injured 4. Give them a phone number they can call back
*Don’t hang up until the dispatcher hangs up first.
Call Peddie School Security 609-944-7557 1. Inform them of your location, situation, and that an ambulance has been called. 2. Tell them to meet ambulance at entrance of athletic center parking lot. 3. Give emergency care as qualified.
***If life threatening emergency, inform Peddie Security that you have a CODE RED situation and to bring the AED to the site before they meet EMS at entrance of athletic center parking lot. Assign coach to acquire athlete’s medical information from health center if Peddie student involved. Assign different person to control the crowd. Stay calm, keep patient calm, until EMS arrives. When EMS arrives, let them take over all care of patient. Peddie Security – 609-944-7557 Athletic Training Room – 609-944-7634 Peddie Health Center – 609-944-7545
Peddie School Policy & Procedure Manual 57
Appendix B – Skin Infection Physician Consult Form
Peddie School Policy & Procedure Manual 58
Peddie School Policy & Procedure Manual 59
Peddie School Policy & Procedure Manual 60