Radford University Medicine Employee Manual 2018-2019 Sports Medicine 2018- Employee Manual 2019 Table of Contents

I. Signature and Acknowledgement Sheets a. Policy and Procedures Acknowledgement…………………………………………… 2 b. CPR and AED Class Acknowledgement…………………………………………….. 3 c. BBP and HBV Vaccination Acknowledgement……………………………………... 4 d. AED Training Acknowledgement…………………………………………………… 5 e. Epipen and Inhaler Training Acknowledgement…………………………………….. 6 f. Spineboard and Splinting Acknowledgement………………………………………... 7 g. Management Guidelines Acknowledgement…………………………… 8 h. Preventing Sudden Death Seminar Acknowledgement……………………………… 9 II. RUSM Operational Procedures Quick Guide………………………………………………….. 10 III. Staffing and Expectations a. Staffing Matrix………………………………………………………………………... 24 b. Expectations……………………………………………………………………. 25 c. Staff Meeting Schedule……………………………………………………………….. 26 d. ATR Survival 101…………………………………………………………………….. 27 IV. Operational Policies a. Athletic Training Room Policies……………………………………………………… 28 b. Dress Code……………………………………………………………………………... 29 c. Heat Illness Prevention Policies……………………………………………………… 30 d. Cold Weather Injury Prevention……………………………………………………….. 34 e. Lightning Policy………………………………………………………………………... 35 f. Infectious Disease Control………………………………………………………………39 g. Skin Infection Control…………………………………………………………………..41 h. Cleaning Procedures…………………………………………………………………… 49 i. Appropriate Medical Coverage Policy…………………………………………………. 54 j. Mental Health Concerns ………………………………………………………………. 58 k. Physical Examinations (PPE’s) …………………………………………………………63 V. Emergency Action Plans……………………………………………………………………….. 70 a. First Floor Locker Rooms…………………………….……………… 74 b. Dedmon Center Weight Room ……….……………………………………………….. 75 c. Dedmon Center Arena/VCOM Center…….…………………………………………… 76 d. Baseball Field…………………………………………………….……………………..77 e. Softball Field…………………………..………………………………………..……… 78 f. Tennis Courts ………………...………………………………………………………… 79 g. Lower Practice Fields ……...………………………………………………………….. 80 h. Dedmon Center (DC) Field…………………………………………………………….. 81 i. Cupp Stadium ATR and Locker Rooms………………..………………………………. 82 j. Cupp Stadium Soccer Field and Track…………………………………………………. 83 k. Track Throws Area …………………………………………………………………….. 84 l. Indoor Hitting/Throwing Facility.………...……………………………………………. 85 m. Intramural Facility/Turf Fields ………………………………………………………… 86 n. Peters Hall Gymnasium ……………………………………………………………… 87 VI. Medical Condition Policies and Protocols a. Independent Medical Care Model Policy ……………………………………………... 88 b. Sudden Cardiac Arrest/AED Policies and Procedures..……………………………….. 93 c. Anaphylactic Shock and Epi-Pen Policies and Procedures……………………………. 99 d. Asthma Management Protocol…………………………………………………………. 103 e. Emergency Airway Oxygen Protocol………………………………………………….. 106 f. Exertional Heat Illness Protocol……………………………………………………….. 108 g. Orthopedic Emergencies Protocol……………………………………………………... 111 h. Sickle Cell Screening and Policies…………………………………………………….. 114 i. Concussion Management Plan and Guidelines………………………………………… 124 j. Prescription and Over the Counter Medication Policies and Protocol………………… 138 Section I

Signature and Acknowledgement Sheets Radford University Sports Medicine Staff Acknowledgement of Policies and Procedures

Policies and procedures listed in this guide are to be followed by all active members of the Radford University Sports Medicine Staff. By signing this document, you acknowledge that you have read and understand the documents and agree to adhere to the guidelines set forth by this document. Furthermore, you acknowledge that you have viewed, are familiar with and will follow the guidelines set forth by the Sports Medicine Policies and Procedures contained on the Radford Athletics website. Any discrepancies or concerns should be addressed with the Head Team Physician/Medical Director and the Assistant AD for Sports Medicine.

Staff Member Name Staff Member Signature Date

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______Assistant AD for Sports Medicine Name Signature Date ______Head Team Physician/Medical Director Name Signature Date ______Team Physician Name Team Physician Signature Date ______Team Physician Name Team Physician Signature Date ______Team Physician Name Team Physician Signature Date ______Team Physician Name Team Physician Signature Date ______Team Physician Name Team Physician Signature Date

2 Radford University Sports Medicine Staff Basic Life Support for the Healthcare Provider

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By signing this document, you acknowledge that you have participated in this class and are comfortable with the information presented and are currently certified in CPR and AED for the Healthcare Provider. Any discrepancies or concerns should be addressed with the Head Team Physician/Medical Director and the Assistant AD for Sports Medicine.

Staff Member Name Staff Member Signature Date

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______Assistant AD for Sports Medicine Name Signature Date

______Head Team Physician/Medical Director Signature Date

3 Radford University Sports Medicine Staff Blood Borne Pathogens/Personal Protective Equipment Class

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By signing this document, you acknowledge that you have participated in this class and are comfortable with the information presented. You also acknowledge that you have been offered the Hepatitis B Vaccination at the expense of the Sports Medicine Department. Any discrepancies or concerns should be addressed with the Head Team Physician/Medical Director and the Assistant AD for Sports Medicine.

Staff Member Name Staff Member Signature Date HBV Vaccine Accept Decline

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______Assistant AD for Sports Medicine Signature Date

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Radford University Sports Medicine Staff Automated External Defibrillator Refresher Training

Date ______

By signing this document, you acknowledge that you have participated in this workshop and are comfortable with the information presented, know the location of all RUSM AED’s and have familiarized yourself with all components of the AED’s. Any discrepancies or concerns should be addressed with the Head Team Physician/Medical Dirrector and the Assistant AD for Sports Medicine.

Staff Member Name Staff Member Signature Date

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Radford University Sports Medicine Staff Epinephrine Pen and Albuterol Inhaler Refresher Training

Date ______

By signing this document, you acknowledge that you have participated in this workshop and are comfortable with the information presented and are comfortable using and or teaching a patient to use an epinephrine pen and rescue inhaler. Any discrepancies or concerns should be addressed with the Head Team Physician/Medical Director and the Assistant AD for Sports Medicine.

Staff Member Name Staff Member Signature Date

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______Assistant AD for Sports Medicine Name Signature Date

______Head Team Physician/Medical Director Name Signature Date

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Radford University Sports Medicine Staff Spineboard and Splinting Procedures and Workshop

Date ______

By signing this document, you acknowledge that you have participated in this workshop and are comfortable with the information presented, know the location of all RUSM spineboards and splint bags and are comfortable applying these pieces of equipment. Any discrepancies or concerns should be addressed with the Head Team Physician/Medical Director and the Assistant AD for Sports Medicine.

Staff Member Name Staff Member Signature Date

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______Assistant AD for Sports Medicine Name Signature Date

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7 Radford University Sports Medicine Staff Concussion Management Policy Acknowledgement

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By signing this document, I hereby acknowledge that I have received a copy of the Radford University Concussion Management Plan and have reviewed the plan in detail with the Assistant AD for Sports Medicine or his designee. I have also received a copy of and reviewed the NCAA Concussion Fact Sheet. I further acknowledge that all of my questions have been answered to my satisfaction regarding the concussion policy and the fact sheet. I agree to follow the steps set forth in the plan by notifying the Assistant AD for Sports Medicine as well as the team physician to seek further evaluation of any of my athletes that I suspect may have sustained a concussion. I also agree to comply fully with the recommendations by the team physician and those guidelines outlined in the Radford University Concussion Management Plan with regards to the return to play and learning status of my student-athletes.

Staff Member Name Staff Member Signature Date ______

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______Assistant AD for Sports Medicine Name Signature Date ______Head Team Physician/Medical Director Signature Date ______Team Physician Name Signature Date ______Team Physician Name Signature Date ______Team Physician Name Signature Date ______Team Physician Name Signature Date ______Team Physician Name Signature Date

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Radford University Sports Medicine Staff Seminar on Sudden Death in Athletics (Sudden Cardiac Arrest, Sickle Cell Collapse, Exertional Heat Illness, Asthma)

Date ______

By signing this document, you acknowledge that you have participated in this seminar and are comfortable with the information presented and familiar with the RUSM policies concerning these topics. Any discrepancies or concerns should be addressed with the Head Team Physician/Medical Director and the Assistant AD for Sports Medicine.

Staff Member Name Staff Member Signature Date

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______Assistant AD for Sports Medicine Name Signature Date ______Head Team Physician/Medical Director Name Signature Date ______Team Physician Name Signature Date ______Team Physician Name Signature Date ______Team Physician Name Signature Date ______Team Physician Name Signature Date ______Team Physician Name Signature Date

9 Section II

Operational Procedures Quick Guide Radford University Sports Medicine Employee Manual revised 6/5/2018

I. Introduction II. Mission Statement III. Vision Statement IV. Sports Medicine Staff V. Procedures 1. NATABOC Certification 2. Virginia State Licensure 3. Drug and Alcohol Policy 4. Emergency Medicine Skill Requirements 5. Emergency Plan 6. Health Center 7. VCOM and Dr. Delmas Bolin (Head Team Physician) 8. Dr. Catterson (Orthopedic Surgeon) 9. Dr. Kincaid (Associate Team Physician) 10. Dr. Logan Brooke (Team Chiropractor) 11. Hospitals 12. Imaging 13. Presagia (eMR) 14. Supplies 15. Injury Reports 16. HIPPA 17. Communication 18. Ethics and Professionalism 19. Treatment and Rehabilitation Philosophy 20. Physical Therapy 21. Work Hours

10 22. Team Practice and Workout Coverage 23. Athletic Training Room Coverage 24. Medical Documentation 25. Medication and OTC Log 26. General Medical 27. Environmental 28. Strength and Conditioning 29. Nutrition 30. Student Counseling 31. Transportation of Student Athletes 32. Dress Code 33. Campus Safety- Van Training and BBP Class 34. Continuing Education Allotment 35. CEU Presentations 36. Insurance Procedures

11 I. INTRODUCTION

Welcome to the Radford University Sports Medicine Team. We are excited that you have joined us and look forward to working together. This handbook hopefully will help you through the difficult first days on the job. Remember we have all been in your “shoes” and want to assist you in any way possible. With quite a large staff it will seem like everyone is going in a different direction at the same time, which at times may be true, but we have time for your questions and concerns. We want this to be an open and sharing environment to work and hope that many lifelong friends are made. Take your time to get settled and remember we are here to assist you in any of your needs.

II. Mission Statement

The Radford University Sports Medicine staff provides high quality, compassionate care to enhance the overall well-being and meet the medical needs of all Radford University Student-Athletes. Our goal is that every student- athlete will remain physically, mentally, and nutritionally healthy as they compete for championships and success on and off the field of play.

III. Vision Statement

The Sports Medicine staff, consisting of board-certified team physicians, Certified Athletic Trainers, orthopedic surgeons, cardiologists, chiropractors, physical therapists and registered dieticians, aims to provide an individualized plan of care for each Student-Athlete. Each plan will address preventing illness and injury, accurate and timely diagnosis, and evidence-based treatment and rehabilitation in a cutting-edge sports medicine facility.

IV. Sports Medicine Staff

Head Team Physician, Medical Director - Dr. Delmas Bolin, MD PhD FACSM Associate Team Physician: Orthopedic Surgeon -Dr. Chris Catterson, MD (Carilion Orthopedics) Associate Team Physician: General Medical and Sports Medicine -Dr. Scott Kincaid Associate Team Physician: Chiropractor -Dr. Logan Brooke Consulting Team Physician: Cardiology -Dr. Jose Rivero (Carilion Cardiology) Consulting Team Physician: Dentistry -Dr. Steve McCuin Consulting Team Physician: Neurosurgery -Dr. Raymond Harron Consulting Team Physician: Ophthalmology -Dr. Jay Ridgeway

Assistant Director of Athletics for Sports Medicine, Athletics Healthcare Administrator - Chad Hyatt MED, ATC, LAT

Associate Athletic Trainer, Insurance and Rehabilitation Coordinator - John Shifflett, MED, ATC, LAT

12 Staff Athletic Trainers - Jon Arvelo, MED, ATC, LAT - Nicole Segala, MED, ATC, LAT - Katherine Moreno, ATC, LAT Part-Time Assistant Certified Athletic Trainers - Joshua Haefner, ATC, LAT - Rachel Starner , ATC, LAT - Katherine Cook ATC, LAT - Brianna Spencer, ATC, LAT VCOM Sports Medicine Fellows - Dr. Brianna Beach - Dr. Matthew Chung - Dr. Natalie Hyppolite - Dr. David Woodson Team Physical Therapists - Nolan Stewart, DPT - Brittany Stewart, DPT

The Medical team is assisted by consultants in specialty areas that include:

Cardiology, Chiropractic Medicine, Family Medicine, General Surgery, Internal Medicine, Nutrition, Neurosurgery, Obstetrics and Gynecology, Orthopedic Surgery, Physical Therapy, Podiatry.

V. Procedures

1. NATABOC Certification

All athletic trainers employed by Radford University Athletics, whether staff or intern, must be NATABOC certified at the time of employment. This status will be confirmed with the NATABOC office. Furthermore, the athletic trainer should have or be eligible for athletic trainer licensure in the state of Virginia. This policy ensures that Radford University Athletics has established baseline standards to ensure that the athletic trainers have demonstrated competency in the profession. We will pay your NATABOC annual fees when they are due. A copy of your BOC Certification will be kept on file in the Director of Athletic Training’s office.

2. Virginia State Licensure

Hopefully, you have already applied for your Virginia State Licensure. If not, you are to apply for your Virginia State License within the first week that you are employed. You will be responsible for the payment for your state licensure. A copy of your Virginia State License will be kept on file in the Director of Athletic Training’s office.

3. Drug and Alcohol Policy

The Radford University Athletics Substance Abuse Education and Drug Testing Policy is available on- line at www.radfordathletics.com under the Athletic Training Section of the Athletic Department tab. Please remember that you are an employee of the athletic department and you should never use alcohol in the presence of student athletes or athletic training students. Please remember when your travel with a team it is a business trip and that you are on call 24 hours a day and the use of alcohol will interfere with your judgment as a medical professional. We expect you to conduct yourself as a professional.

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4. Emergency Medicine Skill Requirements

You are required to be certified in CPR for the professional rescuer and in the use of the AED. It is also imperative that you are completely comfortable with the emergency oxygen units and splint bags and all of the equipment in them. An in-service will be provided to help you achieve these requirements. CPR refresher courses will generally be offered in August of each year. Although certifications are good for 2 years, RUSM staff and interns are required to complete a refresher course yearly.

5. Emergency Plan

You are to become familiar with the emergency plan for your venues and are required to make any additions or changes as needed (just be sure to let Chad know of any updates). Please make sure you have it posted in all the correct spots and that all of your coaches, strength staff, athletic training students, facility crew and administrator for your sports are familiar with the plan. Please also make sure that there is an up to date RUSM Emergency Contact list attached to the EAP. A copy of the entire emergency plan is included in this packet. You need to ensure that you have emergency cards for yourself. There should already be a set of cards that include the emergency plans and lightening policy in your sports kit. The packet should include EAP’s, Heat Illness Card and a Concussion card. If not, please see John Shifflett and he will help you make a copy of the plan. You should also have an emergency card with a listing of any pertinent medical information on your student athlete recorded on it. These need to be completed by your first official team workout.

6. Health Center

We are fortunate to have access to the Radford University Health Center for our student athletes. It is located on campus and is accessible to the students throughout the day. Typically, we will schedule our athletes to be seen by our team physicians during their scheduled office hours, however, there are times when it is appropriate for them to be seen by the staff at the student health center. We will use the health center mainly for obtaining labwork that is prescribed by our physicians, for scheduling flu shot clinics for our athletes and for general illness examination. The health center is run by Carilion employees. Dr. Tom Knisely is the Director and Judy Collins-Cox is the Nurse Practitioner. They are more than willing to work with us to get our athletes in and out very quickly and efficiently, however, please do not try to bully them around just because we are sending athletes to them. The number to the health center is 540-831-5111 and the fax number is 540-831-6638. The clinic is open 8:30a to 5p during the school year and it is closed when school is out of session. It is best for you or the student- athlete to call and set an appointment, but in emergency cases, the best time for walk ins is 8:30am and 1pm.

7. Virginia College of Osteopathic Medicine (Dr. Delmas Bolin and Fellows)

We are very fortunate to have the Edward Via Virginia College of Osteopathic Medicine as our primary provider of Sports Medicine for our student athletes. Dr. Delmas Bolin is our Head Team Physician and he oversees the care of all of our student athletes and guides us in our medical practices. VCOM also provides us with fellow physicians who will assist Dr. Bolin in the care of our athletes. Dr. Bolin comes to the physician’s office on Tuesday and Thursday mornings during the school year from 9a to 12p to see student athletes. We need to make sure to schedule athletes that need to see him so that he is not overwhelmed when he gets to campus. Scheduling will be done on workflow. Dr. Bolin also runs a private practice at Performance Sports Medicine in Roanoke, VA. Dr. Bolin’s office number is 540-

14 772-1890 and his nurse is Tamara. His cell phone is 540-797-5197 and his email is [email protected]. The fax number to his office is 540-772-1893.

8. Dr. Chris Catterson, MD (Team Orthopedic Surgeon)

We are very fortunate to have one of the best sports medicine orthopedic surgeons in our area in Dr. Chris Catterson. We are also able to take our athletes to his office as needed. His office is located at The Carilion New River Valley Medical Center. The number to Catterson’s office is 540-731-2436. Usually Amy Davis and Brittany Stewart handle scheduling of appointments, insurance and office notes. Amy’s cell phone is 540-250-0395 and Brittany’s is 540-682-0384. Dr. Catterson’s cell phone number is 828-400-7031. The fax number to his office is 540-731-2439. Dr. Catterson will come to the Dedmon Physician Suite two times per month to see student-athletes, typically on Thursday mornings. These appointments will be used mostly for surgical follow ups and non-urgent consultation cases. All first time cases that are going to need surgery or any type of advanced work-up should be seen in his office.

9. Carilion Family Physicians (Dr. Scott Kincaid)

We are very fortunate to have Dr. Scott Kincaid as a volunteer team physician for our student athletes. Dr. Kincaid’s office is in Radford at 701 Randolph Street, Suite 120. His office phone number is 540- 731-3200 extension 235 and his nurse is Barbara at extension 232. His Cell phone number is 540-577- 1455 and his fax is 639-1048. His email is [email protected]. Dr. Kincaid is happy to see athletes at his office for emergent visits as long as they can be worked in to the schedule. He will also be attending most of the home Women’s games as well as some of the home soccer matches.

10. Tuck Clinic (Dr. Logan Brooke)

We are very fortunate to have the voluntary services of Dr. Brooke (chiropractor) for our student athletes. Dr. Brooke sees athletes in our physician’s office one day per week (Day TBD) and he is sometimes available at other times. His office phone number is 540-731-4357. Please be sure that we are not using Dr. Brooke for athletes as a “feel good” treatment. Chiropractic manipulation should only be a small part of the overall prevention and rehab of sports injuries for our student athletes. Referrals should be made under the guidance and with a referral from our physicians. At times, he will see student-athletes in his office with an appointment. Please be sure to send a Physician Note with them when they go for Dr. Brooke to fill out.

11. Hospitals

We are very fortunate to have 2 quality hospitals within 15 miles of our campus. We have outstanding working relationships with both of them and we want to work hard to keep it that way. Keep in mind that anytime an athlete is referred to a hospital, be sure that they have an outside medical referral sheet and all of their insurance information to present to registration at the hospital. Please notify John anytime there is to be an outside referral that will require some form of payment. The number to the main line at Carilion New River Valley is 540-731-2000. The number to the main line of Montgomery Regional is 540-951-1111.

12. Imaging

There are times when we may send a student-athlete to one hospital rather than the other (insurance, international SA’s,etc.) Please consult Chad or John for guidance on where to obtain imaging due to

15 insurance purposes and timing of x-rays and other imaging. Many times, it may be more beneficial to just set up an appointment with Dr. Catterson and he can plain x-rays at his office and review them on site. Anytime a student-athlete goes for imaging, they should return to the ATR with a copy of their films. Please remember that for any advanced imaging (this means anything other than an x-ray) pre- authorization from the student-athlete’s insurance must be obtained and the study must be scheduled. Most of the time, Chad and/or John will be handling this procedure.

13. Presagia Injury Zone (eMR)

Radford University Sports Medicine has chosen to use Presagia Injury Zone as our means of keeping files on our athletes. Workflow is a completely web-based electronic medical record (eMR). All current student athletes should have a file on Presagia and all incoming student -athletes should have a file created for them with a minimum of name, sport and birthday before they arrive on campus. There are certain requirements that you will need in order to create an athlete file and there are many details to learn about using Presagia. Therefore, in addition to the brief introduction to Presagia that you will receive during orientation, there will be a tutorial session scheduled that you are required to attend so that you can learn how to correctly use the system. Please do not hesitate to ask about proper procedure regarding how to use this system. Nicole will be the in-house contact for Presagia. She will assist you with getting set-up and should be notified of any issues that are experienced with the system.

14. Supplies

With 9 certified athletic trainers and 250 student athletes supplies can go very quickly, if not monitored. Take and use what you need, but only what you need! Please do not hand out supplies to athletes and other staff. Use them in the athletic training room and only give the athlete enough for that evening. Most supplies will be stored in the VCOM Center for Sports Medicine storage area, “the Cage”. There is additional storage in the back of the ATR in Cupp Stadium. Powerade and Cups will be stored in the pool storage area in “the Cage” in the Dedmon Center. Please notify Katherine of any products that are running low, BEFORE THEY RUNOUT. This applies to all medical supplies and Powerade products. We especially need to know early when Powerade is running low. There should be a minimum of 4 boxes of Powerade Powder and 2 boxes of cups in the storage areas of both facilities at all times.

15. Injury Reports

All athletic trainers are required to make daily injury reports and email/hand a copy to their coaches. A lot of problems will be eliminated if coaches are kept up to date with their athlete’s status on a daily basis. Included on your injury report list serve should be 1) Coaches, 2) Physician, 3) Strength Coach, and 4) Academic Supervisor, 5) Head ATC. All intern athletic trainers are also required to e-mail a copy of the injury report to their athletic trainer supervisor. All athletic trainers will also be responsible for an End of the Year injury report by body part and time missed to be presented to 1) Head Coach, 2) Strength Coach and 3) Assistant AD for Sports Medicine. These can be created as a report on Presagia.

16. HIPPA

Remember that an athlete’s medical information is their own and it is private. Please keep it that way! The athletes will sign an NCAA and Radford University HIPPA form each year at their first team meeting. These forms will be kept in the athlete’s file in the compliance department. Each athlete should also sign a Release of Medical Information form at the beginning of each year that is kept in the athlete’s file on Presagia. Please remind your coaches that this information is private and should not be

16 released to the press other than the athlete that is injured and body part. If more information is needed by the press, then a release needs to be typed up and it needs to be read and agreed upon by the student athlete, athletic trainer, physician and head coach. The student athlete needs to consent with its release before it is given to the SID for your sport. Please remind your athletic training students and managers to keep this information private.

17. Communication

You will find that if you have problems here at RU with coaches, strength and conditioning staff, administration, physicians, athletes, parents or other athletic trainers, most of the time it can be traced back to lack of communication. Please give your coaches and strength staff a daily injury report, keep your physician updated in whatever means they choose, keep your supervising athletic trainer and Assistant AD for Sports Medicine updated on all areas of concern. Use all forms for doctors’ appointments and visits. Please record all injuries, daily treatments and weekly SOAP notes on each of your rehabilitation patients in Presagia. Communicate with parents of your injured athletes and keep them informed regarding the progress of the injury. Send out welcome letters to visiting athletic trainers (may be in the form of an e-mail) and treat them as you would like to be treated. A little communication now will stop a whole lot of grief later!

18. Ethics and Professionalism

You are expected to conduct yourself at all times with the utmost in professionalism and ethical standards. Remember you are a member of a medical profession and must be beyond reproach. You must not fraternize with student athletes or athletic training students. You are expected to come to work on time and to be properly attired. If you have some question on the attire you are to wear- dress up not down! You are required to comply with your teams grooming requirements. Do not wear Radford University Sports Medicine clothing in inappropriate places. You represent the athletic department, athletic training, your team and your family. We expect you to act and behave in a professional and ethical manner. The areas of emphasis for us are;

TRUSTWORTHINESS (Be honest, reliable and caring.), RESPECT (Live by the golden rule, respect the dignity, privacy and freedom of others. Be courteous and polite to all and tolerant and accepting of differences.), RESPONSIBILITY (Meet the demands, be accountable, exercise self control and pursue excellence.), FAIRNESS (Be fair and impartial and listen to different viewpoints.), CARING (Be considerate and compassionate to others.) CITIZENSHIP (Respect authority. Be a good citizen and contribute to the community.)

You will be held accountable to these standards at all times

19. Treatment and Rehabilitation Philosophy

The Radford University Athletic Department competes at the very highest level of collegiate athletics. It is important that you be as efficient and thorough with your treatments and rehabilitation as possible. It is expected that you have your injured athletes complete morning treatments (before 11:30am) and pre- practice treatments. Athletes that do not finish practice or conditioning should be required to complete rehab during the morning hours in the Dedmon Center Training Room, or in Cupp Stadium if your team is practicing there, and in the afternoon in their sport’s training room until they are participating full

17 speed (this includes conditioning and the weight room). Post practice should be reserved for new injury evaluation, ice bags and compression wraps.

Remember, if you cannot answer why with a sound, research based explanation for everything that you do, don’t do it! Modalities are an adjunct to movement. We expect all treatment sessions to include rehabilitation exercises. We will not treat the symptoms but strive to eliminate the cause with early, aggressive, research based treatment and rehabilitation. Do not allow the athletes and coaches to dictate treatment protocols. Ice and stim will do no good without a sound rehab protocol. We do not expect you to know everything about rehabilitation and modality use. We do expect questions and are here to assist you with your needs.

Also remember that we as athletic trainers are not personal stretchers and massagers. While sometimes we should incorporate these modalities into our athletes’ protocols, this is not the reason that we are here. Feel free to teach the athletes how to partner stretch with their teammates and how to stretch on their own (Precor Stretch, active warm-up, etc.). Most of the time, you will have too many responsibilities to worry about stretching each athlete that has a tight hamstring. Ultimately, it is the athlete’s responsibility take the initiative to warm up before practice.

Lastly, it should be a goal of yours that an athlete can complete their rehab even when you are not present. Obviously, for the first couple of sessions, you will want to spend some one on one time with them to teach them all of the correct exercises and techniques, however, you will not always be available to drop everything that you are doing to walk an athlete through a rehab that they have done 3 or 4 times already. A flow sheet for each student-athlete that is rehabilitating more than 2-3 days should have a flow sheet in the rehab file box so that each athlete can locate their sheet and complete their own rehab as needed. Also, we should all be willing and able to help out each others’ athletes. Training room coverage times will be assigned and you will be expected to be available to all athletes that come through the training room.

20. Physical Therapy We will utilize physical therapy services of Nolan Stewart, DPT and Brittany Stewart, DPT for post- operative athletes. Generally, student athletes should be referred for physical therapy services 2 days per week for 4 to 12 weeks. PT visits will then be scaled back to 1 time per week until the ATC, Physician and PT determine that PT services are no longer warranted. During this time, the athlete should continue to participate in rehab and treatment in the training room on the days that they do not have PT. Physical Therapy services are to be used as part of the overall rehabilitation of the student athlete and not as their only form of rehabilitation. We should assist our athletes in setting up their physical therapy appointments, but it is their responsibility to make it to their scheduled appointments on time. Physical therapy hours are TBD and are conducted in the VCOM Center for Sports Medicine unless otherwise specified. Athletes are to call their therapist if they know they are going to be late or unable to attend a therapy session. The SA’s first evaluation and first couple of sessions are to be scheduled at Professional Rehab Associates. ATC’s are expected to create a PT Chart before their S-A’s first appointment in the Dedmon Center (include PT Order, operative report, exercise flow sheet and progress note sheet)ATC’s are also expected to attend the first physical therapy session with their student-athlete and have regular communication with the PT throughout the process.

18 21. Work Hours

6:00am to 8:30am Dedmon Center Open for WR/Conditioning Sessions and early treatment (as needed) and rehab when needed(1-2 ATC(s), students) Cupp Stadium Open for Practices Only

8:30am to 12:00pm* Dedmon Center Morning Rehab Time Staff in Respective ATR Cupp Stadium Open for preparation and practice *Athletes that do not finish practice are required to report to the training room during this time.

12:00pm to 1:00pm Dedmon Center Lunch Coverage (1 ATC) Cupp Stadium open for practices only

1pm to 5:30pm (Cupp 6pm) Both Training Rooms open for pre-practice treatments and Or end of practices preparation. (Use your own discretion for your times)

*Please be clear with your athletes what time they are to report for rehab and pre-practice preparation.

*Be smart with your time (eg if you don’t have practice until 5pm, don’t hang around all day if you don’t have training room coverage!)

*We will do our best to get a morning off for all staff and allow staff to take as much of their off day off as possible.

22. Team Practice and Workout Coverage

You will be expected to cover your team during all required athletic activities. The exception to the rule is when your team is only working out in the weight room and someone else has training room coverage. You may cover Individual/Skill workouts from the ATR. If your team is participating in conditioning activities outside of the weight room then you will need to be there or make sure that you have someone to cover for you. Always have water and an AED (O2 for intense activities if you have a sickle cell athlete). Please make sure that we communicate with each other if our team is working out and we will not be there. Also, be sure to communicate with the respective ATC for each team if you deal with one of their athletes in their absence. Everyone should check in with the weight room staff daily regarding the workout plans for their teams. Please refer to the Appropriate Medical Coverage Policy listed later in this manual.

23. Athletic Training Room Coverage

Whenever the weight room is open, we will have someone in the Dedmon Center Training Room. When you have ATR coverage, you are there for ANY and ALL athletes that need care. Please make yourself readily available to the athletes that come through. Also, please make sure to communicate to the weight room staff when you are covering the training room during lifting times and make sure that you know of any conditioning sessions that they will be conducting so that someone is there for coverage. Once again, please make sure that we communicate with the respective ATC for each team if you deal with one of their athletes in their absence and be sure that all student-athletes sign into Presagia under their Athletic Trainer so that their treatment note can be entered into the system.

19 24. Medical Documentation

Sound medical documentation is paramount to an efficiently functioning sports medicine department. I will expect each of you to write an injury evaluation for each student-athlete that takes the time to come to you with an injury or illness. The evaluation will be created and completed in Presagia. Treatment notes should be entered daily for each session. For those student-athletes who have long term injuries requiring extensive rehabilitation, I want to see a SOAP note on them at least once per week. Rehab sheets should be kept up to date and scanned into Presagia when the patient is discharged. A note should be made each time there is a change in condition or play/practice status as well. Each time a student-athlete goes to a physician or other medical specialists office, then the office not should be obtained and scanned into Presagia. The same goes for any and all diagnostic imaging reports. As a brief outline, each SA who suffers an injury or illness should have at least the following: a. Initial Injury Evaluation in Presagia b. Rehab Sheet in file cabinet and then scanned into Presagia when discharged c. Daily treatment and rehabilitation note d. Weekly SOAP/Progress Note e. Discharge Note- either from physician or ATC

These notes are especially important when John and Chad are working with insurance companies to pre- authorize studies and to complete billing and payment for services. Each of you will be expected to be very diligent about these processes.

25. Medication and OTC Log

Our OTC medication policies are available from the Assistant AD for Sports Medicine. You are to log all OTC medications and keep that log available. The OTC logs are located in the OTC cabinets in the VCOM Center for Sports Medicine (including physician’s office) and Cupp Stadium. Please double check your athletes for allergies and other medications before administering any OTC medications. You should only give the athletes enough medication to last them until the next time you will see them. On occasion, you may give them up to three days worth of medications for weekends, etc. At no time, is an athletic training student or non-certified intern to administer OTC medications. Also, as part of a cost saving effort, often times it is better to obtain a prescription for generic medications from one of our team physicians for the athletes that they can take and fill at CVS, Kroger or Wal-Mart Pharmacies.

26. General Medical

Make sure that you are comfortable using the vital sign equipment in the doctors’ offices and that you always record vital signs and symptoms on your referral sheets. We will be glad to assist you in learning any of the equipment we have available. You will encounter as many general medical problems as orthopedic while here at RU. Be prepared to deal with those problems and know the right way to refer them to a physician.

27. Environmental

Please review the NATA lightning and Exertional Heat Illness position statements. Heat illness is preventable, however, especially in the late summer, this condition can progress very quickly. Be prepared each time a team is practicing or conditioning for heat illness. Our heat illness policy can be obtained from the Assistant AD for Sports Medicine and includes weighing in of athletes participating in outdoor activities for the month of August. Please also use a digital psychrometer or contact the

20 National Weather Center at 552-0084 to determine the Wet Bulb Globe Temperature and the Heat Index and follow the precautions laid out in our heat policy with regards to recommendations for breaks during practice. Be sure to discuss these recommendations with your coaches ahead of time, rather than waiting until the first really hot day to make recommendations.

All staff, intern and student athletic trainers, strength and conditioning staff, coaches and anyone else involved with practice and conditioning should be aware of any student athletes with sickle cell trait, asthma, allergies or any other pertinent medical condition for their student athletes. Student athletes with sickle cell trait will not be allowed to participate in any timed sprints or other conditioning tests before completing a 14 day acclimatization period. At that point, those student athletes should be given extra recovery time in between sprints. At no time should a student athlete with sickle cell trait be allowed to perform timed track workouts. They should be allowed to perform these conditioning sessions at their own pace.

Follow the NATA lightning guidelines for participation and safety. All staff and interns will be included on the DTN Weather Sentry lightening warning system. This system will send you a text when there is a lightning strike within 20 miles of our athletic facilities. This will serve as a warning that a storm is coming. You will get an additional warning when there is a strike within 8 miles. At the receipt of this 8 mile notification, all outdoor and pool activities are to be halted immediately and all athletes are to seek shelter in the Dedmon Center, inside Cupp Stadium or in their vehicles. Activities may be resumed upon receipt of a text that there have been no detected lightning strikes within 8 miles for the last 30 minutes. Remember, this may be 30 minutes from your first warning and it may be 3 hours. Also, check the DTN radar for impending weather while your team will be participating outside and also in the event of a lightning delay. The DTN website is loaded on the computer in the rehab room in Dedmon and the desktop computer in Cupp Stadium. Please also use the National Weather Center to get an idea of how close impending storms and lightning strikes are and how long it will be before they get to you.

28. Strength and Conditioning

Develop a relationship with the strength coach for your team and communicate with them in regards to injuries and preexisting injuries. Make sure they get a copy of your injury report for the safety of the athlete. Include sickle cell status, asthma, allergies, etc. Anytime the strength and conditioning coach is outside conditioning your athletes or performing intense indoor activities you need to be present and prepared for emergencies. The ATR will be open whenever the weight room is open.

29. Nutrition

We are fortunate to be able to offer the services of a Sports Nutritionist/Registered Dietician to our student athletes. The nutritionist is available by email and phone throughout the week and will schedule individual meeting times with athletes. First meetings will be in person and subsequent meetings may be conducted over the phone or through Skype. The nutritionist will also be available for team style nutritional meetings, grocery store tours, socials, cooking classes and a number of other opportunities. Anytime that you are concerned that an athlete may have an eating disorder, please make the Assistant AD for Sports Medicine and the Team Physician aware of this and we will help facilitate care for the athlete with the newly formed Sports Performance and Nutrition Committee which consists of members from the AT staff, Strength and Conditioning staff, Sports Nutritionist, Counseling Center and Team Physician. Alex Bechard is our Sports Nutritionist and his email is [email protected]. Alex will have office hours on Thursdays from 5:30-7:30p one day per week after school starts. We will also have

21 nutrition coaches that are masters level students at Virginia Tech that will be working with our student- athletes under the Guidance of Michelle Rockwell, another registered dietician and Sports Nutritionist. The general email to set up a nutrition consultation or other program is [email protected].

30. Student Counseling

Counseling is available through student services and athletes you may help athletes facilitate these services. The number for Student Counseling is 831-5226 and the Director is Kelly Rubin. Remember that counseling is completely confidential and please be sure to respect this. Please familiarize yourself with the RU Athletics Mental Health Concerns Policy for guidance in referrals.

31. Transportation of Student Athletes

ATC’s should accompany their student athletes to physician appointments whenever possible to insure that nothing gets lost in translation when it comes to continuation of care. However, this will not always be possible with practice times, treatments, etc. In these cases, please be sure to follow up with the treating physician or medical professional in a timely manner to ensure that all of their instructions for the student athlete are followed. In no circumstances should an athletic training student be allowed to transport a student athlete to and from medical appointments per the instructions of the Athletic Training Education Program. Try to utilize fellow student athletes to assist in transportation of student athletes who cannot provide their own. With that being said, do not allow the student athlete to become dependent on you as their main mode of transportation. Keep these trips strictly to medically related appointments.

32. Dress Code Always remember that you are a representative of the Radford University Athletics Department and are expected to dress appropriately at all times. Please refer to the Dress Code for details on appropriate practice and match attire.

33. Campus Safety- Van Training and Blood Borne Pathogens Training The Athletic Department has 4-16 passenger vans available for travel. When they are available, we can also use these vans to transport student-athletes to and from medical appointments. In order to be able to drive the vans, you must complete a course through the RU safety department. Please contact Grady Devilbiss at ext 6696 or [email protected] to get a schedule of available van training dates and times. I will probably schedule one for everyone in July or August.

The RU Safety Department will also be conducting a Blood Borne Pathogens class for us during our orientation week so that we are up to date on Universal Precautions, etc. The Athletic Department will pay for anyone’s Hepatitis B vaccinations if you are not up to date.

33. Continuing Education Allotment Each staff athletic trainer is allotted $600 per year for CEU’s. Please let Chad know at least 2 weeks before the event if you would like to utilize this money. Requests for reimbursement for intern athletic trainers will be evaluated on a case by case basis, but reimbursement will not exceed $200 per year.

22 34. CEU Presentations Throughout the school year, we will have various opportunities to gain CEU’s. Hopefully we will have a schedule of 4-6 - 1 hour events for the year. If you have a topic that you would like to present, you can earn 10 CEU’s for an hour presentation with a PPT and all of the required paperwork.

35. Insurance Procedures If care of a student-athlete is outsourced to another facility and/or physician, the following steps MUST be completed. 1. Notify John immediately of the referral. 2. A claim form for AG administrators must be completed and emailed or hand delivered to John. The AG claim form can be found in Workflow. 3. If the student-athlete is an international student, then an international claim form will also need to be filled out. You can get these from John. These may also be found on Workflow. 4. When scheduling any advanced imaging studies, pre-authorization will need to be obtained PRIOR to the date of service. Chad or John will perform the pre-authorization process. 5. If you have questions or are uncertain what the procedure is, just ask!

23 Section III

Staffing and Expectations 2018-19 RU Sports Medicine Staffing Sport Assignment Staff/GA Fall Winter Spring Areas of Responsibility Cleaning Delmas Bolin, MD Supervisoion and direction of program, Medical Director Medical Supervision of Program Liason with Medical Providers Scott Kincaid, MD Associate Physician Medical Supervision of Program SA Care, Liason with Medical Providers Chris Catterson, MD Orthopedic Consults and Surgeries for all Team Orthopedic student-athletes Administration of Program, Liason with Chad Hyatt EMS, Physicians and other healthcare Assistant AD for SM MWG, MBB MBB MBB, M/WG providers, Athleitc Health Admin Insurance Coordinator, Prehab and John Shifflett, screening Coordinator, Policies and Rehab Coordinator Baseball (SB), Insurance Insurance Baseball, Insurance Proecedures

Jon Arvelo MSC, (TR, Lax) T&F (indoor) Lax, T/F (MSC) Drug Testing, AED's Cupp Storage Ordering/Inventory, Physician Office, DC Treatment Katherine Moreno VB/WBB, TN WBB WBB, TN (VB) ATEP Liason and Rehab EMR Liason, Sport Nutrition and Nicole Segala WSC, (SB) SB, (WSC) Performance Committee Cupp Rehab

Josh Haefner (PT) CC, TR/F TR/F, Lax Cupp Inventory, Biohazard Cupp Hydro Physician's Brianna Spencer (PT) VB/WBB VB, Tennis Dedmon Inventory, Physician Office Office Cupp Rehab Rachel Starner (PT) Fall Lax, Track MSC, Track Cupp Rehab and Taping and taping DC Treatment Katherine Cook (PT) Fall SB WSC Dedmon Rehab area and Wet Area and Rehab Stocking and cleaning ATR's, Scanning Abby Arrington (WS) Administrative, Lax, CH Adminstrative, CH Administrative, VB and filing

Red = In Season ( ) = Supervisor VCOM Center for Sports Medicine (Dedmon)- 831-6128 Cupp Stadium Training Room- 831-7831 Chad's Office/Physician Clinic- 831-5877

24 Radford University Sports Medicine Coverage Expectations (updated June 2018)

The Radford University Sports Medicine Department strives to provide comprehensive care to all NCAA Varsity Sponsored sports.

It is our goal as Athletic Trainers at Radford University Sports Medicine to ensure the best potential care can be given to all student athletes and supporting staff in any given situation. This policy will help insure proper flow and communication for each patient and their respective care givers.

ENTITIES TO WHOM THIS POLICY APPLIES: All events/practices covered by Radford Sports Medicine

Staff: 1 ATC, Athletic Training Students

The staff/intern athletic trainer is responsible for the following:

Visiting Team Letter Construction and Dissemination (email is acceptable and recommended)

Detailed Athlete History Summary including Diagnostic Reports Surgical notes Pertinent Conditions

Evaluation, Treatment and Rehabilitation of athletic injuries and conditions Documentation of Athletic Injuries, Rehab and Progress

Completion of Excess Insurance Accident Claim forms for assigned sports

Daily Injury Report: E-mailed or hand delivered Head Coach, Strength Coach, Supervising ATC (when applicable) Academic Counseling, Team Physician

Weekly schedule presented every Monday during staff meeting.

Emergency plan updated and signed off on by all covering staff.

Coaches should be given a tutorial on EAP as well and assigned roles if necessary.

Organizational Forms that include: Team Demographic Sheets including: Name Phone E-mail Parents information RUID #

Emergency Plan including: Emergency numbers Directions to emergency locations Procedures for an incident Phone Locations Types of communication

Pertinent Medical Conditions/Allergies Cards

Practice/game set ups:

Practice/match attire:

Year End Report to all involved parties

25 SAMPLE Sports Medicine Staff Meeting Sport Updates: Cases: Date Date Date Date Date Date Date MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY A.M. 1 Staff or GA 1 Staff or GA 1 Staff or GA 1 Staff or GA 1 Staff or GA Dedmon (6-8:30a) ATR's 8:30-12:00a Lunch (12:00-1:00) 1 Staff or GA 1 Staff or GA 1 Staff or GA 1 Staff or GA 1 Staff or GA Dedmon By Practices By Practices By Practices By Practices By Practices P.M. 1 Staff or GA 1 Staff or GA 1 Staff or GA 1 Staff or GA 1 Staff or GA Cupp (1-5:30) Dedmon (1-5:30) Physician Clinic (T,Th 9a-12p) Ortho Clinic (Thursday 7:30a) Meetings/Classes Sporting Events

Physician Clinics

Event Debriefing: Drug Testing Update (Katlyn): PACS Update (Chad): Workflow Update (Amy): Student Update (Jamie) : Supplies/Inventory Update (Aya) : Carts (Jamie): Insurance Update (Amy): Intern Recruitment Update (Chad): Scheduling: Document Reason: I/Illness, F/U Ortho, etc… Injury/Illness Total Sheet (MRSA, Staph, ACL, High Ankle, , etc…) Discussion: Future Items: Cleaning: Everyone Medical Red Shirts (Notify Chad): Didactics:

26

Radford University Sports Medicine Athletic Training Facility Survival 101

1) We’re here for you 2) We want to keep you active and participating in your sport 3) COMMUNICATE all injuries and illnesses to your ATC ASAP (before 9am) 4) Be Respectful of staff and students 5) Don’t use the athletic training room as an excuse 6) Rehab in the AM 7) Focus on what you CAN do and not what you CAN’T do

8) Training Room Hours Dedmon Center Athletic Training Facility opens at 7:00a for morning rehab Cupp Athletic Training Room is open for AM practices Weekend times dictated by practice schedules Holiday times will be posted

9) Rehab and Treatment Times Please complete all rehabilitation sessions before 11:30am in your respective Athletic Training room or as directed as your ATC.

10) PM is for Practice prep and coverage You may complete maintenance rehabs on your own at this time.

11) Do not use the training rooms as a cut through to locker rooms

12) You must be clean before all treatments (including whirlpools)

13) Hygeine- Please do not share towels, razors, soap, wash cloths, etc., Report all skin lesions immediately and cover them for practice, No mouths on water bottles!

14) ATC will go over specific training room policies

15) Medical Referrals and Insurance Policies - must be referred by ATC for athletic injuries - get bills and documents from Ins company in immediately (14 days) - get John Shifflett any old bills immediately

27 Section IV

Operational Policies Radford University Sports Medicine 2018 Policies and Procedures Athletic Training Facility Policies

POLICIES 1. VCOM Center for Sports Medicine

M-F 7:00am – 12:00pm 1:00pm – 5:30pm (coverage remains for weight room and practice) Sat As required for sport coverage only Sun As required for sport coverage only

2. All injured or ill student-athletes who do not complete practice or conditioning must complete their treatment and rehabilitation before 11:30am, and/ or as determined by Staff ATC. Any athlete who is injured, but still participating in full must complete their treatment and rehabilitation as directed by Staff ATC. 3. Holiday hours and exam week will vary and are dependent on sport coverage. All final decisions regarding these times shall be made by the staff ATC covering the sport. 4. The athletic training room is a co-educational facility; appropriate dress and behavior is required at all times. 5. Treatments and taping will cease fifteen minutes before practice or meetings. 6. The athletes must shower before all post-practice treatments. 7. No smoking or chewing tobacco allowed in the athletic training room. 8. No food or drink allowed in the athletic training room. 9. The athletic training room is for those seeking medical attention. Please do not loiter. 10. No one is allowed in the athletic training room offices without the permission of a Staff Certified Athletic Trainer. 11. Student-athletes are not allowed to use the telephone or computer in the athletic training room offices without the permission of a Staff Certified Athletic Trainer. 12. Medical referrals are to be made by Staff Certified Athletic Trainers only. 13. No shoes on the treatment tables. 14. No cleats or other athletic equipment in the athletic training room. 15. Student Athletes should refrain from using cell phones in the Athletic Training Room 16. Abusive or offensive behavior and/or language towards another individual will not be tolerated. 17. The athletic training room is not to be used as a cut through to the locker rooms.

Hygiene Please be sure to cover all wounds with the proper bandage, dressing, etc. Do not share towels, razors, washcloths or any other items that come into contact with skin Report All Suspicious Skin lesions to your medical team Do not put your mouth on the water bottles- learn how to squirt them

28 Radford University Sports Medicine 2018 Policies and Procedures Athletic Training Staff and Student Dress Code

Dress Code Athletic Training staff and students are expected to adhere to the following dress code. If an athletic training student is not properly dressed, that student will be excused from the clinical setting or practice area for that day. Repeatedly dressing inappropriately will result in decreased evaluation scores and may result in a decreased grade in the practicum.

Game/Competition or Weekday Practice Coverage 1. Khaki or Black business casual shorts or pants must be worn at all times and should be of an appropriate length with no visible holes, patches or frayed bottoms. Jeans, mesh shorts, wind pants/warm-ups, and sweat pants are not acceptable. 2. Polo or button down shirts (no other school’s logos) and business casual clothing are the only acceptable attire in the clinical setting (ATR, Physician Office). During intercollegiate competition, RED Radford University polos or button downs are the requirement. Shirts are to be clean, neat, and tucked all the way in. Formal wear may be required if covering IN-DOOR competitions. Exception: Some lenience will be given for PRACTICE COVERAGE. Radford University t-shirts and sweatshirts (no holes, fading or fraying) and jackets will be acceptable for PRACTICE COVERAGE. Please see a staff athletic trainer prior to appointment for approval on appropriate practice attire. Also, RED Radford University sweatshirts and pullovers are acceptable attire for OUTDOOR GAME COVERAGE.

Preseason, Holiday and Weekend Practice Coverage 1. Game/Competition or Weekday Practice attire is always acceptable. 2. RU shorts, T-shirts, wind pants/warm-ups, sweatshirts and sweatpants (no holes and/or fraying) will be acceptable for practice coverage during preseason, holiday and weekends.

General 1. Please practice good hygiene as we are working in a medical facility providing health care. Use appropriate discretion in applying make-up, perfume, cologne, hair, jewelry, etc. Also no hats are to be worn indoors, no visible facial jewelry, and no bandanas are allowed. One set of earrings maximum is allowed. Please keep tattoos covered. 2. Footwear may include neat and clean athletic shoes or dress shoes. No sandals, clogs, or other non-functional footwear. 3. Male facial hair and sideburns should be kept neat and groomed. Keep hairstyles professional. 4. Please remember that you are representing Radford University Athletics, the Athletic Training Program in which you are a part of and most importantly yourself as you begin your professional career.

If you ever have a question on what is acceptable attire please check with your Staff ATC. Thank you, Chad Hyatt, ATC Assistant AD for Sports Medicine

29 Radford University Sports Medicine 2018 Policies and Procedures Exercising in the Heat and Heat Illness Prevention

The following policy has been developed in accordance with the recommended guidelines of the NATA Position Statements: Fluid Replacement and Exertional Heat Illnesses. Most exertional heat illnesses are preventable with proper awareness and execution of the preventive measures explained below. The following policy defines the different types, signs and symptoms, and guidelines for preventing and treating heat illness at Radford University. This is to provide a safe environment and the best quality care to all Radford University student athletes.

POLICY

Prevention of Heat Illnesses Strategies In an effort to prevent heat related injuries and illnesses all student-athletes: . will complete a physician-supervised pre-participation medical screening before the start of the season to identify those with factors for heat illness or a history of heat illness. . who participate in outdoor sports will be acclimatized to the heat gradually over 7 to 14 days. . who are sick with viral infections, have a fever, serious skin rash, or other illness will not participate in any physical activity until the condition is resolved. . will be encouraged to sleep at least 7 hours per night; eat a balanced diet; and properly hydrate before, during, and after exercise. . will be educated NOT to use dietary supplements and other substances that have a dehydrating effect, increase metabolism, or affect body temperature and thermoregulation. . will be subject to a pre-season discussion with their athletic trainer on the prevention techniques for heat illness and heat related problems

Certified Athletic Trainers: . will be onsite at all appropriate practices and competitions to insure appropriate fluid replacement, and provide access to further cooling supplies. Players will have free access to readily available fluids at all times. . will educate relevant personnel (ie, coaches, administrators, emergency medical services [EMS] staff, athletic training students, and athletes) on preventing/recognizing Exertional Heat Illnesses and signs and symptoms of a medical emergency. Review and rehearsal of the emergency action plan will be completed before the start of every academic year. . will have available when environmental conditions warrant, fans, ice towels, popsicles and other means of cooling. . will have available a cold-water or ice tub and ice towels to immerse or soak a patient with a suspected heat illness. . will obtain a rectal temperature assessment under all circumstances in which Exertional Heat Stroke (EHS) is possible. Note the assessment of rectal temperature is the clinical gold standard for obtaining core body temperature of patients with EHS and the medical standard of practice and accepted protocol. . will identify and closely monitor individuals who are susceptible to EHI during stressful environmental conditions, and take preventive steps.

30 Radford University Sports Medicine 2018 Policies and Procedures Exercising in the Heat and Heat Illness Prevention

Fluid Replacement & Rehydration Guidelines . All student- athletes participating in sports associated with high risk of heat illness, will be required to record body weight before and after activity during the preseason and on subsequent days when the WBGT exceeds 82 F. This will determine proper amounts needed for rehydration before the next practice or competition. Certified athletic trainers will monitor athletes between 2-a-day practices and practice days to ensure⁰ athletes are maintaining less than a 2% change in body weight. . Proper hydration, including the use of electrolyte drinks (ex. Powerade) is recommended before, during and after practice. Specifically: . A minimum of 20oz of water or a electrolyte drink is recommended 2-3 hours before activity . A minimum of 10oz is again recommended 10-20 minutes prior to activity . A minimum of 10oz is recommended every 10-15 minutes during exercise . At least 20oz of electrolyte drink and/ or water should be ingested per pound of weight loss following activity . An unlimited access to water will be provided . Student athletes will be encouraged to drink 16 to 20 ounces of water or sports drink for every pound lost during activity. Rest Breaks . Rest breaks will be planned and the work-to-rest ratio modified to match the environmental conditions and intensity of the activity. Shade or a predetermined cooling zone will be available for breaks to allow enough time for all athletes to consume fluids. . To anticipate potential problems, sports medicine staff will frequently monitor environmental conditions using a Wet Bulb Globe Temperature (WBGT) device and make practice modifications in compliance with the following:

ALERT LEVEL WBGT CAT 3 (⁰F) EVENT CONDITIONS RECOMMENDED WORK TO REST RATIOS No Outdoor Training, delay training until 92.0 Extreme Conditions BLACK cooler, or cancel training. Maximum of 1 hour of training with 4 by High Risk for Heat 90.1-91.9 4 minute breaks within the hour. No RED Related Illness additional conditioning allowed Maximum of 2 hours of training with 4 by Moderate Risk for 4 minute breaks each hour, or a 10 87.1-90 ORANGE Heat Related Illness minute break every 30 minutes of training. 3 separate 4 minute breaks each hour, or Less than Ideal 82.2-87.0 a 12 minute break every 40 minutes of YELLOW Conditions training Normal Activities. 3 Separate 3 minute GREEN 82.1 Good Conditions breaks each hour of training, or a 10 minute break every 40 minutes

31 Radford University Sports Medicine 2018 Policies and Procedures Exercising in the Heat and Heat Illness Prevention

Signs and Symptoms of Heat Illnesses Exercise – Associated Muscle Cramps (EAMC) Exercise – Associated Muscle Cramps (EAMC) are sudden or sometimes progressively and noticeably evolving, involuntary, painful contractions of skeletal muscle during or after exercise. Signs and Symptoms: . Muscle cramping . Localized pain . Dehydration . Fatigue

Heat Syncope Heat Syncope, or orthostatic dizziness, often occurs in unfit or heat un-acclimatized persons who stand for a long period of time in the heat or during sudden changes in posture in the heat. Signs and Symptoms: . Brief episode of fainting . Tunnel vision . Decreased pulse rate . Dizziness . Pale skin

** Responsiveness, breathing, and pulse must be assessed to rule out a cardiac event.

Exertional Heat Exhaustion Heat Exhaustion is the inability to effectively exercise in the heat, secondary to a combination of factors, including cardiovascular insufficiency, hypotension, energy depletion, and central fatigue. This condition is manifested by elevated core body temperature usually less than 104 F and is often associated with a high rate or volume of skin blood flow. ⁰ Signs and Symptoms: . Excessive Fatigue . Disorientation . Low blood pressure . Fainting . Dizziness . Impaired muscle . Hallucination . Headache coordination . Altered mental status . Nausea or Vomiting . Confusion . Lightheadedness

Exertional Heat Stroke (Medical Emergency) Exertional Heat Stroke is the most severe heat illness. It is characterized by neuropsychiatric impairment and a high core body temperature, typically a rectal temperature above 104 F. This condition is a product of both metabolic heat production and environmental heat load. ⁰ Signs and Symptoms: Core Body Temperature greater than 104 F

. Collapse . ⁰Hypotension . Hysteria . Loss of consciousness . Altered mental status . Aggressivenes . Tachycardia . Irritability

32 Radford University Sports Medicine 2018 Policies and Procedures Exercising in the Heat and Heat Illness Prevention

Protocol Treatment of Exercise – Associated Muscle Cramps EAMC The immediate treatment for acute EAMCs related to muscle overload or fatigue is rest and passive static stretching of the affected muscle until cramps abate. Icing, massage, or both may also help relieve some of the discomfort. EAMCs related to excessive sweating and a suspected whole-body sodium deficit, the patient must ingest sodium-containing fluids or foods to help return the body to normal fluid, electrolyte, and energy distribution. Heat Syncope, Heat Exhaustion . Assess cognitive function and vital signs . Move the patient to an air conditioned or shaded area . Use ice towels and/or ice packs on head, neck, groin, axilla and other thin skinned areas of the body . Administer cool fluids/electrolytes and encourage rehydration . Monitor vital signs . If heat exhaustion is suspected and patient is not rapidly improving with prescribed treatment activate EMS and Heat Stroke Protocol Exertional Heat Stroke . This is a medical emergency! . Activate EMS and prepare hospital for heat related emergency . Assess cognitive function, vital signs, rectal temperature if Heat Stroke is suspected Heat Stroke: more than 104 F (Activate EMS)

. Lower body-core temperature as quickly⁰ as possible by: a. Removing excess clothing b. Transporting athlete to air conditioned or shaded area c. Placing ice bags, cold towels (replace towels frequently), or ice over as much of the body as possible d. Immersing the patient’s trunk and extremities into body of cool water 35 F to 54 F

***Remove patient from water if temperature reaches 102 F or after 15 minutes if rectal⁰ ⁰ temperature is not obtained. ⁰ DO NOT transport the patient to a medical facility until the core body temperature is at 102 F or below . Maintain and monitor airway for breathing and circulation at all times

33 Radford University Sports Medicine 2018 Policies and Procedures Cold Weather Injury Prevention/Exercising in the Cold

POLICY

1. If the temperature or wind chill is above 25˚F practice is allowed outside with appropriate clothing.

2. If the air temperature or wind chill is 25˚F-20˚F then teams may practice outside but must come inside to warm up every 60 minutes for 10 minutes or as needed.

3. If the air temperature or wind chill is 20˚F-15˚F then teams may practice outside but must come inside to warm up every 45 minutes for 10 minutes.

4. If the air temperature or wind chill is 15˚F-5˚F then teams may practice outside but must come inside to warm up every 30 minutes for 10 minutes.

5. If the air temperature or wind chill is less than 5˚F no outside practices are permitted.

The temperature, wind speed and wind chill will be monitored by the Athletic Trainer on duty through the National Weather Service or Weather.com,

Information derived from Springfield College Athletic Training Cold Weather Guidelines, Endicott College Athletic Training Cold Weather Guidelines, Western New England College Athletic Training Cold Weather Guidelines, NCAA Sports Medicine Handbook, and the National Oceanic and Atmospheric Administration (NOAA) and the U.S. Department of Commerce.

34 Radford University Sports Medicine 2018 Policies and Procedures Lightning Policy

POLICY Due to the significant and possibility of fatal injury from lightning strikes, it is imperative the Radford University Department of Athletics have a clear policy on how to deal with lightning in and around the areas of practice and / or competition. This policy will help to clearly state the department's position on this issue and help to define roles of certain individuals during the decision making process. The coaching and support staff’s primary responsibility is for the safety and concern of the student-athletes.

PROCEDURE The following plan will be in effect for all Radford University athletic events, including practices:

Depending on the event being played the Athletic Trainer, Game Manager or Coach will monitor the weather. This will be done through the use of the DTN Weather Sentry Lightning and Storm detector or when lightning is seen or thunder is heard.

In the event of threatening or inclement weather the Athletic Trainer, Game manager or Coach will inform the participants and spectators either through the public address system or any other means available of impending severe weather. A warning will be given when a storm is within 20 miles and tracking toward the area.

1. GENERAL POLICY: A member of the Radford University Athletics Training Staff, if on site will monitor the weather and make the decision to notify the Game Manager (during a game) or Head Coach (during practice) of dangerous situations and recommend the suspension of activity in the event of lightning. Exceptions will be made for any activity where an Athletic Trainer or Game Manager is not in attendance, whereby the supervising coach will have the ability to suspend activity. The decision to suspend activity will be based on:

• Any reading on the DTN Weather Sentry Lightning/Storm Detector within the 8 mile range regardless of the presence of visible lightning. (This device is portable and will be in the possession of the Athletic Trainer, and/or Game Manager and/or • If at any time there has been no warning given regarding lightning in the area but lightning is seen or thunder is heard then the activity is to be suspended and everyone should seek shelter immediately.

2. ANNOUNCEMENT OF SUSPENSION OF ACTIVITY: Once it is determined that there is a danger of inclement weather, the Athletic Trainer will notify the Event Manager (during a game) or Head Coach (during practice) and immediately request the removal of all players, coaches, and support staff from the playing field.

3. EVACUATION OF THE PLAYING FIELD AND STANDS: Immediately following the public address announcement (if available) of suspension of play, all players, coaches, officials, support personnel and spectators are to evacuate the facility to their vehicles, buses, nearest entrance of the Dedmon Center Arena, Cupp Stadium Locker room/Offices or the Indoor Hitting Facility. Participants and spectators should be advised that we do not consider the areas under the stands, pavilion or dugouts to be safe in the case of lightning. All parties will be urged to remain in a safe location within the Athletic Sports Complex until conditions improve unless otherwise notified by appropriate representatives.

4. RETURN TO PLAY: Play will be resumed 30 minutes following the last lightning strike. The last lightning strike will be determined by either the detection system or visual confirmation. The 30 minute time frame will immediately start over with each additional lightning strike.

35 Radford University Sports Medicine 2018 Policies and Procedures Lightning Policy

5. TREATMENT IN THE EVENT OF A LIGHTNING STRIKE: In the event that a person is struck by lightning, do not hesitate to assist them; unlike electrical victims they do not carry a charge so they may be safely handled. 1. Activate EMS (call 911; 9-911 on campus) 2. Administer rescue breathing or CPR as needed 3. If available, retrieve and utilize an AED. 4. If there are multiple victims, aid should be administered to the apparently “dead” first. Keep in mind, for the safety of the rescuer, the possibility of a second strike within the immediate area. 5. It is recommended that all Radford University Athletic staff be certified in CPR.

36 Radford University Sports Medicine 2018 Policies and Procedures Lightning Policy

In the Event of a Thunder and Lightning Storm

 Listen for announcement over PA (Public Address System)

 Find Safe Location in a vehicle or Dedmon or Cupp stadiums.

 Wait for announcement to return to play over PA system, listen to WVRU radio station for update of inclement weather and game play.

37 Radford University Sports Medicine 2018 Policies and Procedures Lightning Policy

Lightning Procedure Insertion for Athletic Programs

In the event of a thunder/lightning storm the following precautions should be taken. The PA will make an announcement and instruct everyone within the vicinity where a safe location will be. Play will be postponed until thirty minutes after the last lightning strike.

Safe Locations . A Safe location is a frequently used building with four walls, with grounded electrical and plumbing. . The following areas are considered safe when watching athletic events at RU: o Dedmon Center Arena o Cupp Stadium locker rooms and office complex o Indoor Hitting Facility behind the Softball stadium o Vehicles with hard roofs. Once inside a vehicle do not make contact with any metal parts. Use of Phones . Cell phones and cordless phones are able to be used in a safe location. Avoid using land line phones. What to do if you can’t get to a safe location: • Find a dry ditch or a large grouping of shrubs and small trees. Find these areas and take shelter. • Make your body as small as possible minimizing surface area for lightening strike. Crouch on the balls of your feet, DO NOT lie flat on the ground. • Stay away from small tress and large metal objects such as flagpoles and light poles. • Stay away from any other metal objects such as bleachers and metal fences. • Don’t stand in an open field • Stay away from standing bodies of water such as a pool, lake, or pond. Possible Sensations that a lightning strike may be eminent (assume a crouched position): • Hair standing on end • Skin tingling • A crackling sensation

38 Radford University Sports Medicine 2018 Policies and Procedures Infectious Disease Control

POLICY

It is the policy of the Radford University Sports Medicine Department to adhere to all recommendations by OSHA regarding universal precautions.

PROCEDURES 1. Education: A. At the beginning of each year, all staff and interns will be required to complete a blood-borne pathogens education class either in person or on-line. B. Topics will include, but not be limited to the use of universal precautions, disposal of biohazard, immunizations, workplace and a variety of other topics. C. A record verifying that all staff and interns have completed the requirement each year will be kept by the Director of Athletic Training.

2. Engineering and Work Practice Controls: A. Hand washing facilities are available in all athletic training room facilities. Staff members will be instructed on the importance of hand washing practices. B. Sharps containers are available in the physician's office for all used needles and disposable sharps. C. Eating, drinking, smoking, and the application of cosmetics are prohibited in the treatment areas of the athletic training room. Food may be stored only in the main refrigerator located in the hydrotherapy area.

3. Personal Protective Equipment: A. Gloves are readily available in all treatment areas of the athletic training room and in all medical kits. Gloves are required to be worn by all athletic training staff whenever there is reasonable risk of contact with contaminants. Gloves will be disposed of in the proper containers after use. B. Masks, eye goggles, and gowns are available for cases where there is a splash risk. Masks are disposable; goggles and gowns are disinfected after each use. C. CPR micro-shields and pocket masks are available to all athletic trainers.

4. Housekeeping: A. All treatment tables and equipment coming in direct contact with student-athletes are disinfected daily. Any items contaminated with bodily fluids are disinfected immediately. Whirlpools are cleaned daily with a disinfectant. i. No open skin lesions are allowed in the whirlpools. B. Biohazard waste bags will be disposed of as needed. Please call 1-800-662-0088 for collection. 5. Waste Disposal: A. Approved sharps containers are in use and are disposed of in accordance with OSHA guidelines.

39 Radford University Sports Medicine 2018 Policies and Procedures Infectious Disease Control

B. Biohazard bags and waste containers are disposed of in accordance with the above guidelines. All contaminated materials other than sharps and laundry are placed in these bags. D. Contaminated laundry should be placed in a sealed, red, biohazard bag and placed in the laundry container. All contaminated laundry is sent to the athletic equipment room, where it will be disinfected and washed separately.

6. Vaccines: A. The following vaccines and boosters are available to all Staff Certified Athletic Trainers and Certified Athletic Training Interns. The inoculations are available through the Radford University Student Health Service and will be paid for by the Athletic Department. i. Hepatitis B ii. Tetanus (tDap) iii. Influenza

7. Post Exposure Evaluations: A. Reported exposure incidents will be referred to the Radford University Human Resources for the appropriate protocol on testing, treatment, and counseling. Documentation will be done in accordance with OSHA guidelines. The Department of Public Safety and Office of Research Safety will also be informed. If for any reason, Radford University Student Health Services is unable to treat an exposure case, that person will be referred to the Radford Hospital Emergency Department.

8. Risk Communication, Labels: A. All containers for contaminated materials will be labeled with the biohazard symbol and identified as hazardous material, which includes laundry bins, sharps containers, and refuse containers.

9. Risk Communication, Information: Training sessions, which comply with OSHA requirements, will be given to the entire athletic training staff. Documentation will be made in accordance with OSHA standards.

40 Radford University Sports Medicine 2018 Policies and Procedures Skin Infection Control

POLICY

The Radford University Sports Medicine Department strives to prevent and protect all staff and participants from skin infections with special emphasis toward community-acquired methicillin- resistant Staphylococcus aureus (MRSA).

All staff members will adhere to the standards set forth by the Radford University and Safety Services as well as the procedures outlined in this document.

PURPOSE: Protect all participants and clinicians associated with Radford University Athletics.

MRSA Overview The organism Staphylococcus aureus is found on many individuals’ skin and generally causes no major problems. However if inoculated (e.g. under the skin or into the lungs), it can cause significant infections such as boils or pneumonia. Individuals who carry this organism are usually healthy, and are considered asymptomatic carriers of the organism.

The term MRSA or methicillin resistant Staphylococcus aureus is used to describe those examples of this organism that are resistant to this commonly used class of antibiotics. Methicillin was an antibiotic used many years ago to treat patients with Staphylococcus aureus infections. It is now no longer used except as a means of identifying this particular type of antibiotic resistance. Individuals can become carriers of MRSA in the same way that they can become a carrier of ordinary Staphylococcus aureus, which is by physical contact with the organism. If the organism is on the skin then it can be transmitted around by physical contact. If the organism is in the nose or is associated with the lungs rather than the skin then it may be transmitted by droplet spread from the mouth and nose. We can find out if and where Staphylococcus aureus is localized on a patient by culturing the suspected site, sending them to the laboratory and growing the organism. Tests done on any Staphylococcus aureus grown from such specimens can then be tested to determine the sensitivity of the organisms to various antibiotics. The test results are usually available in 2-3 days.

According to the Center for Disease Control (CDC) 1% of the population is colonized with MRSA. MRSA is one type of skin infection among several that are of concern in competitive sports. “Staph” and/or MRSA infections usually first presents as some type of skin or soft tissue infection such as pimples, abscesses, pustules, and/or boils. Some can be red, swollen, painful, and/or have pus or other drainage. The pustules may be confused with insect bites intiatally, and may also be associated with existing turf burns and/or abrasions. If an athlete or staff member has what appears to be “staph” and/or MRSA or has any of the related signs, please contact your staff athletic trainer immediately.

41 Radford University Sports Medicine 2018 Policies and Procedures Skin Infection Control

Prevention Measures: Measures to prevent the spread of organisms from one person to another are called isolation or infection controls. The specific type of infection control or isolation procedure required for a patient depends on the organism, where the organisms is found and its virulence. The most important type of isolation required for MRSA is called Contact Isolation. This type of isolation requires everyone in contact with the patient to observe proper hand washing protocols after touching either the patient or anything in contact with the patient.. Because dust and surfaces can become contaminated with the organism, cleaning of surfaces are also important. If a number of patients are infected with the same organism it may be necessary to move carriers of MRSA to an isolation unit/area.

PROCEDURES

Prevention Although treatable, complications can be associated with “staph” and/or MRSA infections, making prevention the best measure to combat these infections. The Centers for Disease Control suggest the following measures for preventing staphylococcal skin infections, including MRSA:

1. Practice good hand hygiene by washing hands frequently and in a thorough fashion with soap and warm water or using an alcohol-based hand sanitizer. 2. Take a shower with hot water and wash with soap (liquid antibacterial soap, not bar soap) following all activities (e.g. strength & conditioning sessions, practices, and competitions). 3. Avoid sharing towels, equipment, razors, soap (use liquid soap instead of bar soap), etc. 4. Use a barrier (e.g. clothing or a towel) between your skin and shared equipment. 5. Wipe surfaces of equipment before and after use with an approved disinfectant. 6. Clean and properly cover any open wounds such as turf burns, abrasions, lacerations, etc. with an appropriate bandage at all times. 7. Avoid whirlpools, hydrotherapy pools, cold tubs, swimming pools, and other common tubs if you have an open wound. 8. Maintain clean facilities and equipment. 9. Do not ignore skin infections, pimples, pustules, abscesses, etc. Report these to a Sports Medicine staff member and/or physician immediately.

Cleaning Procedures. All individuals participating in cleaning will adhere to EHSS Guidelines and Universal Precautions.

Potential Skin Infection Care 1. Initial evaluation by certified athletic trainer followed by a referral to one of the team physicians. 2. If evidence of pus-like discharge exists, incise, drain and culture the wound for laboratory testing. 3. Begin appropriate antibiotic therapy based on current guidelines (Bactrim DS 2 po bid x 10 days) BEWARE OF ALLERGIES

42 Radford University Sports Medicine 2018 Policies and Procedures Skin Infection Control

4. Hibiclens Irrigation bid. 5. Home intructions and individual Hibiclens packets for showering bid. 6. Daily application of an appropriate topical antimicrobial (Bactroban) with Telfa Antimicrobial Non-Adherent Dressing.

Hard Surfaces 1. Treatment tables, taping tables, weight room / rehabilitation equipment, countertops, stools, etc. must be cleaned everyday and/or following a possible contamination using Sanizide Spray Disinfectant (spray surface and allow to sit for 3 minutes before wiping off with a clean cloth) or Sanizide Wipes. All surfaces that are unable to be wiped should be sprayed with a Antibacterial aerosol spray such as Lysol. Coolers 1. Coolers, water bottles, pitchers, etc… must be cleaned and disinfected after every session using household dishwashing detergent or other appropriate cleaner. a. Thoroughly scrub the inside and outside of the cooler, water bottles, water bottle lids and carriers, pouring pitchers, etc. b. Thoroughly rinse all items with hot water allowing hot water to run through all spigots. c. Store water bottles upside down in their carriers and place the carriers in the designated area(s). d. Store water bottle lids in the designated container marked for lids. e. Store pouring pitchers upside down in the designated storage area(s). f. Coolers should be towel dried and then allowed to air dry. g. Store coolers upside down in the designated storage area(s). Cooler tops / lids should be stored standing up in their designated area(s).

Towels 1. Cloth towels should only be used on a single patient and should be laundered following every use. 2. Disposable towels should be used whenever feasible on the field / court and should be disposed of after a single use. a. Any towel subjected to potentially contaminated bodily fluids should be handled according to EHSS and OSHA guidelines.

Hydrocollator Packs / Covers

1. Hydrocollator covers should be laundered every day and/or following a possible contamination.

Durable Medical Equipment 1. Soft durable medical equipment such as neoprene sleeves, pads, splints, lace-up ankle braces, shoulder harnesses, walking boot liners, cast shoes, back braces, etc… must be laundered upon return to the athletic training facility before being returned to inventory and/or administered to another student athlete.

43 Radford University Sports Medicine 2018 Policies and Procedures Skin Infection Control

2. Hard durable medical equipment such as ankle braces, Aircasts, hard splints, etc.) must be disinfected using the aforementioned guidelines for cleaning of hard surfaces.

Whirlpools 1. A disinfecting agent (eg. Chlorazene) should be applied to the water each time a whirlpool is filled for use. Please follow the manufacturer’s recommendations in regards to the amount of disinfectant to apply. 2. Athletes MUST shower before all whirlpool treatments. Athletes who have not showered will not be allowed to use the whirlpool. 3. Whirlpools shall be cleaned on a daily basis, or as needed following every possible contamination; 4. Whirlpools are not to be used by student-athletes with open or draining wounds; 5. Whirlpools are to be cleaned using a commercial tub & tile cleaner AND a 1:10 diluted bleach solution or SaniZide Germicidal Spray. 6. Whirlpools are to be cleaned in the following manner: a. Spray the whirlpool cleaner in and around the sides of the whirlpool; b. Allow the whirlpool cleaner to sit for five (5) minutes or as directed by the manufacturer. c. Scrub all surfaces of the whirlpool, including the bottom, sides, turbine, etc. d. Rinse the tank with hot water and allow it to drain; e. Towel dry

7. Whirlpool turbines are to be cleaned using household bleach or ammonia by allowing the bleach or ammonia solution to circulate through a running turbine with hot water for ten (10) minutes. *DO NOT use bleach and ammonia at the same time as this will create harmful / hazardous fumes

SaniZide Disinfectant Spray Details

44 Radford University Sports Medicine 2018 Policies and Procedures Skin Infection Control

•

SaniZide Plus® Surface Disinfectant Spray

SaniZide Plus® is a convenient, fast-acting, multi-purpose, broad spectrum disinfectant/deodorizer for environmental surfaces. Our alcohol free formulation is a non-corrosive, EPA registered, quaternary ammonium compound.

Effective Against:

SaniZide Plus® helps you comply with the OSHA Bloodborne Pathogens Standard, which requires the use of an intermediate level (tuberculocidal) disinfectant where gross contamination is known to have occurred.

For Use On:

• Floors, walls, metal surfaces, stainless steel surfaces, porcelain, glazed ceramic tile, plastic surfaces, showerstalls, bathtubs, cabinets, or anywhere normally treated with a disinfectant.

• For plastic and painted surfaces, spot test on an inconspicuous area before use. SaniZide Plus® provides personal protection mandated by OSHA, and State Health Departments.

45 Radford University Sports Medicine 2018 Policies and Procedures Skin Infection Control

Taken from the 2010 National Athletic Trainers’ Association Position Statement: Skin Diseases

The nature of athletics exposes the skin of its participants to a wide variety of stresses. Trauma, environmental factors, and infectious agents act together to continually attack the integrity of the skin. Combined with the close quarters shared by athletes and generally poor hygiene practices, it is not difficult to see why skin infections cause considerable disruption to individual and team activities.1 Skin infections in athletes are extremely common. Authors of a recent literature review investigating outbreaks of infectious diseases in competitive sports from 1922 through 2005 reported that more than half (56%) of all infectious diseases occurred cutaneously. Recognition of these diseases by certified athletic trainers (ATs), who represent the first line of defense against spread of these infections to other team members, is absolutely essential.

Prophylactic measures and swift management of common skin infections are integral to preventing the spread of infectious agents. The following position statement and recommendations provide relevant information on skin infections and specific guidelines for ATs working with the athletes who contract them.

RECOMMENDATIONS Based on the current research and literature, the National Athletic Trainers’ Association (NATA) suggests the following guidelines for prevention, recognition, and management of athletes with skin infections. The recommendations are categorized using the Strength of Recommendation Taxonomy criterion scale proposed by the American Academy of Family Physicians on the basis of the level of scientific data found in the literature. Each recommendation is followed by a letter describing the level of evidence found in the literature supporting the recommendation: A means there are well-designed experimental, clinical, or epidemiologic studies to support the recommendation; B means there are experimental, clinical, or epidemiologic studies that provide a strong theoretical rationale for the recommendation; and C means the recommendation is based largely on anecdotal evidence at this time. The recommendations have been organized into the following categories: prevention, education, and management of the skin infections. The clinical features of the most common skin lesions are presented in Table 1.

Prevention 1. Organizational support must be adequate to limit the spread of infectious agents.

a. The administration must provide the necessary fiscal and human resources to maintain infection control.30,31 Evidence Category: B b. Custodial staffing must be increased to provide the enhanced vigilance required for a comprehensive infection-control plan. Evidence Category: C c. Adequate hygiene materials must be provided to the athletes, including antimicrobial liquid (not bar) soap in the shower and by all sinks.7,32–35 Evidence Category: B

46 Radford University Sports Medicine 2018 Policies and Procedures Skin Infection Control d. Infection-control policies should be included in an institution’s policies and procedures manuals. 22,31,36–38 Evidence Category: C e. Institutional leadership must hold employees accountable for adherence to recommended infection-control practices.8,30,39–43 Evidence Category: B f. Athletic departments should contract with a team dermatologist to assist with diagnosis, treatment, and implementation of infection control.44 Evidence Category: C

2. A clean environment must be maintained in the athletic training facility, locker rooms, and all athletic venues. a. Cleaning and disinfection is primarily important for frequently touched surfaces such as mats, treatment tables, locker room benches, and floors.9,10,45,46 Evidence Category: A b. A detailed, documented cleaning schedule must be implemented for all areas within the infection control program, and procedures should be reviewed regularly. Evidence Category: C c. The type of disinfectant or detergent selected for routine cleaning should be registered with the Environmental Protection Agency, and the manufacturer’s recommendations for amount, dilution, and contact time should be followed.10,31,47 Evidence Category: B

3. Health care practitioners and athletes should follow good hand hygiene practices.31,48 a. When hands are visibly dirty, wash them with an acceptable antimicrobial cleanser from a liquid dispenser.48,49 Evidence Category: A Correct hand-washing technique must be used, including wetting the hands first, applying the manufacturer’s recommended amount of antimicrobial soap, rubbing the hands together vigorously for at least 15 seconds, rinsing the hands with water, and then drying them thoroughly with a disposable towel.48 Evidence Category: A b. If hands are not visibly dirty, they can be decontaminated with an alcohol-based hand rub.17,18,41,50,51 Evidence Category: B c. Hands should be decontaminated before and after touching the exposed skin of an athlete and after removing gloves.52–56 Evidence Category: B

4. Athletes must be encouraged to follow good overall hygiene practices.57–59 a. Athletes must shower after every practice and game with an antimicrobial soap and water over the entire body. It is preferable for the athletes to shower in the locker rooms provided by the athletic department.57 Evidence Category: B b. Athletes should refrain from cosmetic body shaving.25 Evidence Category: B c. Soiled clothing, including practice gear, undergarments, outerwear, and uniforms, must be laundered on a daily basis.10 Evidence Category: B d. Equipment, including knee sleeves and braces, ankle braces, etc, should be disinfected in the manufacturer’s recommended manner on a daily basis.58 Evidence Category: C

47 Radford University Sports Medicine 2018 Policies and Procedures Skin Infection Control

5. Athletes must be discouraged from sharing towels, athletic gear, water bottles, disposable razors, and hair clippers.57,59 Evidence Category: A

6. Athletes with open wounds, scrapes, or scratches must avoid whirlpools and common tubs. Evidence Category: C

7. Athletes are encouraged to report all abrasions, cuts, and skin lesions to and to seek attention from an AT for proper cleansing, treatment, and dressing. Evidence Category: CAll acute, uninfected wounds (eg, abrasions,blisters, lacerations) should be covered with a semiocclusive or occlusive dressing (eg, film, foam, hydrogel, or hydrocolloid) until healing is complete to prevent contamination from infected lesions, items, or surfaces. Evidence Category: C

Education The sports medicine staff must educate everyone involved regarding infection-control policies and procedures.7,32–35,60

1. Administrators must be informed of the importance of institutional support to maintaining proper infectioncontrol policies.7,32–35,60 Evidence Category: B

2. Coaches must be informed of the importance of being vigilant with their athletes about following infectioncontrol policies to minimize the transmission of infectious agents.7,32–35,60 Evidence Category: B

3. Athletes need to be educated on their role in minimizing the spread of infectious diseases.

a. Follow good hygiene practices, including showering with antimicrobial soap and water after practices and games and frequent hand washing. 57–59 Evidence Category: B b. Have all practice and game gear laundered daily.10,17 Evidence Category: B c. Avoid sharing of towels, athletic gear, water bottles, disposable razors, and hair clippers.57,59 Evidence Category: B d. Perform daily surveillance and report all abrasions, cuts, and skin lesions to and seek attention from the athletic training staff for proper cleansing, treatment, and wound dressing. Evidence Category: C

4. The custodial staff must be included in the educational programs about infectious agents to be able to adequately help in daily disinfection of the facilities.10 Evidence Category: C

Please see the full NATA Position Statement on Skin Infections at http://www.nata.org/sites/default/files/position-statement-skin-disease.pdf

48

Radford University Sports Medicine Cleaning Procedures

All individuals participating in cleaning will adhere to EHSS Guidelines and Universal Precautions (wear gloves and wash hands after cleaning the training room and laundry)

Hard Surfaces 1. Treatment tables, taping tables, weight room / rehabilitation equipment, countertops, stools, etc. must be cleaned everyday and/or following a possible contamination using Sanizide Spray Disinfectant or Sanizide Wipes. WHEN USING SPRAY, SPRAY SANIZIDE LIBERALLY AND ALLOW TO SIT FOR 3 MINUTES BEFORE WIPING OFF WITH A CLEAN CLOTH. All surfaces that are unable to be wiped should be sprayed with a Antibacterial aerosol spray such as Lysol.

Coolers 1. Coolers, water bottles, pitchers, etc… must be cleaned and disinfected after every session using household dishwashing detergent or other appropriate cleaner. a. Thoroughly scrub the inside and outside of the cooler, water bottles, water bottle lids and carriers, pouring pitchers, etc. b. Thoroughly rinse all items with hot water allowing hot water to run through all spigots. c. Store water bottles upside down in their carriers and place the carriers in the designated area(s). d. Store water bottle lids in the designated container marked for lids. e. Store pouring pitchers upside down in the designated storage area(s). f. Coolers should be towel dried and then allowed to air dry. g. Store round coolers right side up with the tops off in the designated storage area(s). Ice chests should be sanitized and dried and then placed back in their place with the lids closed.

Towels 1. Cloth towels should only be used on a single patient and should be laundered following every use. a. Any towel subjected to potentially contaminated bodily fluids should be handled according to EHSS and OSHA guidelines.

Hydrocollator Packs / Covers 1. Hydrocollator covers should be laundered every day and/or following a possible contamination.

Durable Medical Equipment 1. Soft durable medical equipment such as neoprene sleeves, pads, splints, lace-up ankle braces, shoulder harnesses, walking boot liners, cast shoes, back braces, etc… must be laundered upon return to the athletic training facility before being returned to inventory and/or administered to another student athlete. 2. Hard durable medical equipment such as ankle braces, Aircasts, hard splints, etc.) must be disinfected using the aforementioned guidelines for cleaning of hard surfaces.

Whirlpools- Please follow cleaning instructions posted at the whirlpools.

49

Radford University Sports Medicine Preventing the Spread of Skin Infections

Although treatable, complications can be associated with “staph” and/or MRSA infections, making prevention the best measure to combat these infections. The Centers for Disease Control suggest the following measures for preventing staphylococcal skin infections, including MRSA:

1. Practice good hand hygiene by washing hands frequently and in a thorough fashion with soap and warm water or using an alcohol-based hand sanitizer.

2. TAKE A SHOWER WITH HOT WATER AND WASH WITH SOAP (liquid antibacterial soap, not bar soap) IMMEDIATELY following all activities (e.g. strength & conditioning sessions, practices, and competitions).

3. Avoid sharing towels, equipment, razors, soap (use liquid soap instead of bar soap), etc.

4. Use a barrier (e.g. clothing or a towel) between your skin and shared equipment.

5. Wipe surfaces of equipment before and after use with an approved disinfectant.

6. Clean and properly cover any open wounds such as turf burns, abrasions, lacerations, etc. with an appropriate bandage at all times.

7. Avoid whirlpools, hydrotherapy pools, cold tubs, swimming pools, and other common tubs if you have an open wound.

8. Maintain clean facilities and equipment.

9. Do not ignore skin infections, pimples, pustules, abscesses, etc. Report these to a Sports Medicine staff member and/or physician immediately.

50

Radford University Sports Medicine Therapeutic Whirlpool Guidelines

1. A disinfecting agent (eg. Chlorazene) should be applied to the water each time a whirlpool is filled for use. Please follow the manufacturer’s recommendations in regards to the amount of disinfectant to apply.

2. Athletes MUST shower before all whirlpool treatments. Athletes who have not showered will not be allowed to use the whirlpool.

3. Whirlpools shall be cleaned on a daily basis, or as needed following every possible contamination.

4. Whirlpools are not to be used by student-athletes with open or draining wounds.

5. Whirlpools are to be cleaned using a commercial tub & tile cleaner AND a 1:10 diluted bleach solution or SaniZide Germicidal Spray.

6. Whirlpools are to be cleaned in the following manner: a. Spray the whirlpool cleaner in and around the sides of the whirlpool; b. Allow the whirlpool cleaner to sit for five (5) minutes or as directed by the manufacturer. c. Scrub all surfaces of the whirlpool, including the bottom, sides, turbine, etc. d. Rinse the tank with hot water and allow it to drain; e. Towel dry and then wipe surfaces with bleach solution or SaniZide.

7. Whirlpool turbines are to be cleaned weekly (Friday) using household bleach or ammonia by allowing the bleach or ammonia solution to circulate through a running turbine with hot water for ten (10) minutes. *DO NOT use bleach and ammonia at the same time as this will create harmful / hazardous fumes .

51 52 53 Radford University Sports Medicine 2018 Policies and Procedures Appropriate Medical Coverage for Games, Practices and Conditioning Sessions

POLICY

It is the goal of the Sports Medicine staff at Radford University to cover every practice and game and conditioning session that is feasibly possible with one of the Staff Certified Athletic Trainers. However, due to the number of sports and the year-round nature of collegiate athletics, there are times where it is simply not possible to have someone at all of the events. In such cases, precedence will be given to 1) the in-season sports over the out of season sports; and 2) the contact or high risk sports over the non-contact or low risk sports. Below is a matrix of which sports will have precedence during each season regarding sports medicine coverage.

1. Medical Coverage for Team and Individual Practices Fall Sports Med Coverage Home Away Risk Risk Rank Team Practice Individuals Events Events Soccer, Men High 1 Yes (ATC) N/A Yes Yes Soccer, Women High 2 Yes (ATC) N/A Yes Yes Basketball, Men High 3 Yes (ATC) ATR N/A N/A Basketball, Women High 4 Yes (ATC) ATR N/A N/A Baseball Moderate 5 Yes (ATC) ATR Yes N/A Softball Moderate 6 Yes (ATC) ATR Yes Yes Women’s Lacrosse Moderate 7 ATR ATR Yes No Volleyball Moderate 8 Yes (ATC) ATR Yes Yes Track and Field Moderate 9 ATR ATR N/A N/A Cross Country Low 10 ATR ATR Yes Yes Tennis Low 11 ATR ATR Yes No Golf Low 13 No No Yes No Cheer Moderate N/A ATR N/A Yes N/A Dance Low N/A No N/A Yes N/A

Winter Sports Med Coverage Home Away Risk Risk Rank Team Practice Individuals Events Events Basketball, Men High 1 Yes (ATC) N/A Yes Yes Basketball, Women High 2 Yes (ATC) N/A Yes Yes Soccer, Men High 3 Yes (ATC) ATR N/A N/A Soccer, Women High 4 Yes (ATC) ATR N/A N/A Track and Field Moderate 5 Yes (ATC) Yes Yes Yes Baseball Moderate 6 Yes (ATC) N/A N/A N/A Softball Moderate 7 Yes (ATC) N/A N/A N/A Women’s Lacrosse Moderate 8 ATR ATR N/A N/A

54 Radford University Sports Medicine 2018 Policies and Procedures Appropriate Medical Coverage for Games, Practices and Conditioning Sessions

Volleyball Low 9 N/A ATR N/A N/A Tennis Low 10 ATR ATR Yes No Golf Low 12 No No Yes No Cross Country Low N/A N/A ATR N/A N/A Cheer Moderate N/A ATR N/A Yes N/A Dance Low N/A No N/A Yes N/A

Spring Sports Med Coverage Home Away Risk Team Practice Individuals Events Events Soccer, Men High 1 Yes (ATC) ATR Yes Yes Soccer, Women High 2 Yes (ATC) ATR Yes Yes Women’s Lacrosse Moderate 3 Yes (ATC) ATR Yes Yes Baseball Moderate 4 Yes (ATC) ATR Yes Yes Softball Moderate 5 Yes (ATC) ATR Yes Yes Track and Field Moderate 6 Yes (ATC) ATR Yes Yes Basketball, Men Moderate 7 Yes (ATC) ATR Yes Yes Basketball, Women Moderate 8 Yes (ATC) ATR Yes Yes Volleyball Low 9 ATR or WS ATR Yes Yes Tennis Low 10 ATR ATR Yes No Golf Low 12 No No Yes No Cross Country Low N/A N/A N/A N/A N/A Cheer Moderate N/A ATR N/A Yes N/A Dance Low N/A No N/A Yes N/A

*MSC, WSC and Lax may be covered by one ATC when they are both practicing on the practice fields.

*MBB/WBB and VB may be covered by one ATC when they are both practicing in the arena.

*Baseball and Softball may be covered by one ATC when they are both practicing outside. *At times, the ATC from MSC, WSC, BB, SB, VB may cover the Cupp ATR during track practices or make intermittent stops by lacrosse practice.

55 Radford University Sports Medicine 2018 Policies and Procedures Appropriate Medical Coverage for Games, Practices and Conditioning Sessions

2. Medical Coverage of Strength and Conditioning Sessions

It is also the goal of the Sports Medicine and Strength and Conditioning Staff’s to provide appropriate medical coverage for all strength and conditioning sessions that take place in and out of the weight room setting. Therefore, the two departments have combined and set forth the following guidelines. These guidelines follow the recommendations set forth in the Inter- Association Task Force for Preventing Sudden Death in Collegiate Conditioning Sessions: Best Practices Recommendations.

From the Task Force Recommendations, “A S&CC should be present during all strength and conditioning sessions and be prepared to provide first aid as soon as an athlete shows signs of distress. The S&CC should be able to administer CPR, apply an AED, and activate the emergency action plan (EAP) if needed. An athletic trainer or team physician should be present during each high-risk collegiate conditioning session (eg, sprinting, timed sessions, mat drills, stations). For lower-risk conditioning sessions and the strength portion of a conditioning program, an S&CC should be present and an athletic trainer should be on campus and accessible to assist if a problem arises. The institution should determine the need for and level of medical coverage for conditioning sessions. Among the factors to be considered are squad size, type of athlete, time of year (eg, immediately postseason, off season, in season, summer), expected environmental conditions, and planned duration and intensity level of the workout.”

A. Guidelines 1. The sports medicine staff and strength and conditioning staff will discuss planned conditioning sessions at the beginning of each day and will arrange appropriate coverage. 2. Any change in plans or additional conditioning sessions will be relayed to the sports medicine staff before the session begins so that the appropriate personnel can be present at the session. 3. All coaches, S&C staff and sports medicine staff involved in any practice and/or conditioning sessions will be informed of pertinent medical conditions of participating student-athletes (eg, sickle cell trait, asthma, acute illnesses, injuries, etc.). 4. A S&CC trained in CPR/AED will supervise all S&C sessions 5. A certified athletic trainer (ATC) will be available in the athletic training facility or a nearby facility during all S&C sessions. 6. An ATC will be on-site with the S&CC for any high-risk conditioning sessions (eg, sprinting, timed sessions, mat drills, stations, or any other non-traditional session held outside of the weight-room). The ATC will bring appropriate emergency medical equipment (AED, Oxygen, emergency inhalers, cooling equipment, cell phone, etc.) to the site of the conditioning session.

56 Radford University Sports Medicine 2018 Policies and Procedures Appropriate Medical Coverage for Games, Practices and Conditioning Sessions

Emergency Plan: Radford University Dedmon Center Arena- 2nd Floor Weight Room

Emergency Personal: Certified Strength Coaches and interns on site for all lifting and condition sessions; Certified Athletic Trainers either on site or accessible from the VCOM Center for Sports Medicine (located on second level of the Dedmon Center-540-831-6128)

Emergency Communication: Fixed telephone line is located in the staff office. On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: AED is maintained in the staff office. Splint bag is located in the VCOM Center for Sports Medicine. Spine board equipment is in the Dedmon Arena.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

If the situation is life threatening: 911 or (9911 on campus) And give the following information Caller: Hello, my name is ______I am calling from Radford University. We have a victim who has suffered from a possible type of injury (head, neck, leg, etc). The victim is conscious/unconscious (state one). We need an ambulance at the Dedmon Center Weight Room located on the second level of the Dedmon Center. The emergency entrance is through the glass doors of the side entrance, which faces the baseball field. Someone will meet the ambulance beside the road, to direct emergency personnel up the sidewalk and through the emergency entrance to the exact location of the victim. If you need to reach us again please dial (give the number you are calling from or 540-831-5500 if calling from a campus land line), which is campus police. Answer any other questions from the dispatcher; do not hang up until dispatcher has already done so. And then contact Campus Police 540-831-5500 or (x5500 on campus)

Additional Driving Directions: Off Campus • East Main Street: Take Right onto University Drive (Dedmon Center Bridge), after passing the Cupp stadium; the field hockey field, and DC parking lot entrance. After passing DC parking lot exit (and loop goes to left), Dedmon Center glass doors will be on the left across from baseball field. Enter through the sliding glass doors.

• West Main Street: Take Left onto University Drive (Dedmon Center Bridge), after passing the Cupp stadium; the Dedmon Center Field, and DC parking lot entrance. After passing DC parking lot exit (and loop goes to left), Dedmon Center glass doors will be on the left across from baseball field. Enter through the sliding glass doors.

On Campus • Take University Drive, after passing the Cupp stadium; the Dedmon Center Field, and DC parking lot entrance. After passing DC parking lot exit (and loop goes to left), Dedmon Center glass doors will be on the left across from baseball field. Enter through the sliding glass doors.

57 Radford University Sports Medicine 2018 Policies and Procedures Mental Health Concerns

INTRODUCTION:

When you think of a student-athlete’s health, we tend to think primarily of the physical/medical condition and what effect the injury will have on athletic performance. A student-athlete’s “mental health” might be viewed as secondary to physical health; however, it is just as important. Medical problems often have psychological or emotional consequences. Psychological problems (e.g. eating disorders, substance- related problems) have medical consequences. Given the inter-relationship between the physical and mental, it is helpful to think of student-athletes with mental health problems as “injured” – just as you would of a student-athlete who has a physical or medical problem. As with physical injuries, mental health problems may, by their severity, affect athletic performance and limit or even preclude training and competition until successfully managed and treated. Athletic Trainers, coaches, team physicians and administrators are all involved with the life of a student-athlete and may, at some point, encounter a student-athlete in distress. Often they have not sought any psychological support or intervention. The staff member’s role is crucial in identifying and referring students who are in distress.

Signs of Students in Distress:

• References to (written or verbal). • Noted isolation from friends, classmates or other support persons. • Marked change in behavior. • Listlessness, lack of energy. • Impaired speech or garbled, disjointed thoughts. • High levels of irritability, unruly or abusive behavior. • Students who appear overly nervous, tense or tearful. • Anxiety, stress, depression. • Marked inability to make decisions. • Drug and alcohol abuse. • Normal emotions displayed to an extreme degree or for a prolonged period. • Threat to others. • Marked changes in personal hygiene. • Dramatic weight loss or change.

As a faculty or staff member, one may at some point become concerned about a student’s behavior. It is not always easy to discern the difference between inappropriate behavior and behavior that could signal a more significant problem. A student who exhibits any of the following behaviors may warrant further attention:

• Suddenly stops attending class. • Academic performance drops off considerably. • Demonstrates a loss of interest in normal activities or avoid friends. • Changes in appearance, e.g., a sudden, drastic weight loss or weight gain, blood shot eyes or disheveled grooming. • Demonstrates alarming changes in personality, e.g., suddenly interrupting others in class or acting out in an inappropriate manner or acting overly silly or crying in class. • Appears angry and aggressive or the opposite, suddenly becomes sullen and withdrawn. • Appears or reports feeling increasingly sad or tired. • Talks about a significant loss (a death, divorce or end of a relationship).

58 Radford University Sports Medicine 2018 Policies and Procedures Mental Health Concerns

• Talks about being in a relationship that appears to be abusive without realizing that such a relationship may not be normal or healthy. • Speaks or acts in an odd manner. • Communicates that life is not worth living, either written or verbal, and that he or she has considered suicide. • Indicates verbally or in writing that he or she wants to harm someone.

These behaviors can occur in class, at a campus event, in an advising session or anywhere on campus.

PROCEDURES:

1. How to respond when the student-athlete approaches you. When an individual approaches you, he or she is indicating a need to talk with you. The best way to respond is to listen. Listening is the most important part of communicating. Generally wait to speak until the student-athlete stops talking or appears to be waiting for you to respond. It is alright to ask questions for clarification, but be careful not to judge or be critical.

2. How to respond when the student-athlete is in need and has not approached you. The person approaching the student-athlete should be a person of some authority. More important, however is that this initial step should be taken by someone who has a good relationship with the student-athlete or who is comfortable in discussing important and sensitive issues. Even if you cannot understand the seriousness or difficulty of the student-athlete’s problem, you must accept that it is a serious problem for the individual. Depressive disorders, anxiety disorders, eating disorders and substance-related disorders are mental health problems in need of treatment. They are illnesses- not choices; that is why they are called disorders.

• Request to speak with the student in private. • Express your concern for the student in a direct, non-judgmental and straightforward manner. Openly acknowledge the specific behaviors that you have observed that are of concern to you. • Listen carefully and be empathic. • Avoid criticizing or sounding judgmental. • Try not to make agreements with the student that isolate you in dealing with the problem. • Consider SCS as a resource and discuss a referral with the student. These services are confidential and free of charge for students. • If the student refuses to make an appointment and you are concerned, contact SCS to discuss your concern.

3. Know Your Limits To avoid the student-athlete’s difficulties weighing too heavily on you, you need to know your limits. Be aware of what is reasonable to expect from yourself. You cannot change the person because you have limited control. Your responsibility is to recognize and refer. When you begin to feel undue stress or worry, it is time to take care of yourself and turn the problem over to someone else.

59 Radford University Sports Medicine 2018 Policies and Procedures Mental Health Concerns

4. Maintain Confidentiality One of the most important aspects of psychological management and treatment involves the issue of confidentiality. Healthcare practitioners are legally and ethically required to maintain the privacy and confidentiality of their patients. They cannot divulge any information about their patients to anyone without the patient’s written consent. Even then, the information is still restricted to what the patient agrees can be released, what is appropriate to be released, the conditions under which the information can be released and to whom.

5. Making a referral Many referrals are not accepted or used by the student-athlete. There are aspects of making a referral that increase the likelihood of it being successful. Know or at least have some knowledge regarding the referral person or agency. Share that knowledge with the student-athlete. Also, referrals are more often accepted when the referral is made to a specific person.

Encourage the student to call the SCS at 540-831-5226 and schedule an appointment with one of the counselors. Students may also stop in the lower level of Tyler Hall to schedule an appointment.

• Ideally, the student will make the appointment on his/her own. However, if you wish to be certain that the student makes an appointment, call the secretary at the SCS while the student is in your office and offer the phone to the student to schedule the appointment or you can walk over with the student to set up an appointment.

• If you are concerned about a student but are uncertain about the appropriateness of a referral, feel free to call the SCS and speak with one of the staff members.

• In an emergency, call the SCS at 540-831-5226 and let the secretary know that you need assistance with an urgent situation. If the emergency occurs after 5 p.m. or over the weekend, contact ACCESS/RAFT at 540-961-8400 or 911 for your local emergency response system and ask for a Crisis Intervention Trained Officer. On campus you can call the RU Police Department at 540-831-5500 and ask to speak to a Crisis Intervention Trained Officer.

6. Helping the student-athlete who resists treatment. The student-athlete may resist evaluation and treatment. In such a case, the student- athlete should be told that he or she is considered to be “injured” and that it’s your responsibility to take care of your injured student-athletes. If the student-athlete asks about being able to train and compete as a result of the difficulty and treatment, reply that the decision will have to be made by the healthcare professionals who manage the treatment.

7. Recommendations regarding individuals at risk for suicide When dealing with a student-athlete who has expressed or indicated an intent or plan, or attempted suicide, do not try to determine the “lethality” of the thought, gesture or attempt. Do not assume the person is engaging in suicidal thoughts or actions for “attention”. Make an immediate referral.

60 Radford University Sports Medicine 2018 Policies and Procedures Mental Health Concerns

If an attempt is already in progress, call EMS and have them transported to an emergency room. If an attempt has not already begun, call the ACCESS (540-961-8400) and ask to speak to a counselor for Emergency Assessment. The counselor will then call the student-athlete to set up a place to meet or do an assessment over the phone depending on the circumstances. If there is immediate concern that the student may harm themselves or others call 911 or the Radford University Police Department (540-831-5500) and ask to speak to a Crisis Intervention Trained officer regarding the situation.

Procedures for Referral of a Student-Athlete for Mental Health Concerns specific to the Athletics Department follows.

61 Radford University Sports Medicine 2018 Policies and Procedures Mental Health Concerns

DEPARTMENTAL PROCEDURES FOR MENTAL HEALTH CONCERN REFERRALS (SUMMARY):

Non-Emergency Referrals . Lend an Ear . Refer to RU Student Counseling Services (540) 831-5226: M-F 8a-5p during school . Call to set up an appointment with a counselor. . Counselor will determine need for Psychiatrist Intervention or other measures . If resistant then suggest that SA schedule directly with Student Counseling . Contact Director of AT Services and/or Team Physician and Senior Woman Administrator . Appointment scheduled with Team Physician for Assessment, medical appointment and determination for referral (if not already started) . Have regular, casual meetings with SA to keep abreast of their situation . Follow ups with Team Physician at a determined rate

After Hours . Contact NRV Community Services RAFT (24 hour hotline)- (540) 961-8400 . Ask to speak to a counselor on call . A student may also utilize RAFT as a resource in between counseling sessions.

Emergency Referrals (Non-Life Threatening) . Contact RU Student Counseling Services (540) 831-5226: M-F 8a-5p during school . Ask to speak to someone about an urgent referral. . If RUSCS is not available then call ACCESS/RAFT (540) 961-8400: For 24 hour Emergency and Assessment . Ask to speak to someone about an emergency assessment. . Contact Director of AT Services and SWA and inform . Follow standard protocol and set up appointments with Dr. Bolin and SCS ASAP

Emergency Referrals (When there is a perceived threat to self or others) . Assume all threats are real . Stay with person and try to have a calming influence . Contact RU Police Department 911 or (540) 831-5500: . Ask to speak to a Crisis Intervention Trained Officer. . Officer will transport to either SCS or to Hospital . Contact Director of AT Services and SWA and inform

62 Radford University Sports Medicine 2018 Policies and Procedures Student Athlete Physical Examinations

POLICY

All student-athletes participating on Radford University Athletics teams must have an annual pre-participation physical exam, before they can participate with his/ her team or any strength and conditioning sessions. The purpose of the physical is to identify any pre-existing conditions that could put the student-athlete at risk during practice or competition. The physician will determine the extent of the physical exam and if any follow-up medical testing is necessary.

1. Pre-Participation Physical Examinations It is the coaching staff’s responsibility to ensure that all student-athletes have their physicals prior to their official start date. The coaching staff and athletic training department will work together in the off-season to come up with a team’s scheduled time for on-site physical’s performed by Radford University team physicians. These scheduled dates and times will be prior to the first date of any scheduled practice for the academic school year. Coaches will also notify the Staff Certified Athletic Trainer of any student-athletes who join the team after the season begins. These student-athletes will not be allowed to participate until all Radford University Athletic Department pre-participation requirements are met. Physicals from outside physician’s may be acceptable for access to the weight room, however, full clearance for participation will not be granted until one of the designated Radford University team physicians has reviewed and signed off on the physical. Each physical examination focuses on the following areas of concern: 1. Evaluation of Medical History; 2. Evaluation of existing medical records; 3. Orthopedic Checks; 4. Comprehensive heart and lung evaluation (further diagnostics as indicated) 5. Sight; 6. Blood pressure, pulse and peak flow; 7. Blood analysis to include sickle cell solubility test (no drug screening); 8. Personal and mental evaluation (at physician's discretion). 9. A baseline neurocognitive (concussion) test.

A. New and Transfer Athlete Pre-participation Physical (Appendix 1) New and transfer student-athletes must complete a “New Athlete Pre-participation Physical” consisting of a medical history and physical exam. This physical is slightly more comprehensive than the “Return Athlete Pre-participation Physical”. In accordance with the Interassociation Consensus Statement on Cardiovascular Care of the College Student-Athlete, the New Athlete Pre-participation Physical will include a cardiovascular screen utilizing the American Heart Association’s 14 Point Recommendations (Appendix 2). If it is determined from medical history and/or physical exam that a student-athlete needs to do further cardiovascular work-up (such as EKG or ECHO), any special tests ordered will be reviewed by the team cardiologist who will then consult with the team physician when determining the clearance of the student-athlete.

63 Radford University Sports Medicine 2017 Policies and Procedures Student Athlete Physical Examinations

B. Return Athlete Pre-participation Physical Return Athletes may complete a “Return Athlete Pre-participation Physical”. If the athlete has not suffered a significant injury or illness since their last physical, they only need to complete the upper portion of the form consisting of vital signs and the medical questionnaire. If the athlete has had a significant injury or illness since their last physical, they will need to have the remaining portion of the physical completed by a Radford Team Physician for clearance. All athletes will be given the opportunity for a complete physical if they so choose.

C. The Prospective Student-Athlete (Tryout) The following policy was established to identify a protocol for prospective student- athletes to try out for a position on one of Radford University Athletic Teams.

Athletes trying-out for a team are required to first contact the Compliance department (or the coach may request this) to express interest in trying out for a team. The compliance department will then issue instructions to the student on how to utilize ARMS to complete the required NCAA forms and medical forms.

In terms of medical forms, the student is required to show proof of medical insurance and to sign a waiver of responsibility. They are also required to produce a physical that has been completed within the last 6 months and provide sickle cell status.

Once the student has completed the required medical items, they are to submit them to the Athletic Training staff. The Athletic Training staff will then notify the Compliance department that the student is cleared or not cleared medically to tryout. The Compliance department will then notify the Head Coach or designate if the student is eligible for tryout. It is the responsibility of the Head Coach, or designate, of each sport to ensure that the student is cleared by Compliance and Athletic Training prior to tryouts, practice or participation.

If selected for participation in a sport, the student-athlete must complete the required annual medical forms, and participate in a complete physical examination by a team physician. All tryouts are responsible for securing their own athletic physicals and are responsible for any costs incurred. Walk-on student-athletes who have appeared on a team roster for one complete season, are considered as team members for the purpose of physical exams only and may receive subsequent physical exams and post-eligibility exams at no cost.

If the student makes the team they are then required to return to the compliance coordinator to obtain final clearance. After meeting with the compliance coordinator, the student-athlete’s file will be sent to the NCAA clearinghouse to secure final eligibility. The coach and other agents of the athletic department will then be notified when eligibility is granted.

64 Radford University Sports Medicine 2017 Policies and Procedures Student Athlete Physical Examinations

Sickle Cell Testing NCAA legislation effective August 1, 2010, requires institutions, as part of the required medical examination, to include a sickle cell solubility test. All RU student-athletes who are beginning their initial year of eligibility and student-athletes trying out for a team, including transfers will be tested or provide proof of testing. Test results are required for all students before they are permitted to practice or compete. Those student-athletes testing positive for sickle cell trait will be afforded counseling on precautions and potential consequences of participating in sport with the condition.

2. Post Eligibility Examinations In order to ensure the health of student-athlete’s after leaving Radford University, student- athletes are required to undergo an exit physical examination within fourteen days of the end of eligibility or removal from the team. The exit physical will determine the student-athlete’s health status and allow the student-athlete to disclose on-going athletically-related injuries. Radford University Sports Medicine Department will provide payment for any medical services necessary for an athletically-related injury for up to one year after their date of eligibility.

3. High School Prospect The following policy was established to identify the parameters pertaining to Radford University Sports Medicine Department staff contact with potential student-athlete prospects. If the policy stated below does not adequately deal with a specific situation, a formal, written request must be submitted to the Compliance Coordinator prior to any involvement with the prospect.

A prospect is any student who has started classes in the ninth grade. An athletic training room employee may not have contact with any prospect, while serving as a representative on the institution’s athletic interests, prior to July 1st after the completion of the prospect’s junior year. In addition, no athletic training room employee is to make contact with a prospect eligible to be recruited until that prospect is on an official or unofficial campus visit. Any such contact that is made outside of these guidelines may be deemed a form of recruiting and could result in the athlete being ineligible to be recruited by Radford University. Under no circumstances shall contact be made during a dead period.

Certain restrictions apply in regards to the services sports medicine personnel may provide to a prospective student-athlete during his or her official or unofficial visit to campus. As per 13.12.2.6.1 in the NCAA manual, a member institution, through its regular team physician, may conduct a medical examination to determine the prospect’s medical qualifications to participate in intercollegiate athletics. No athletic department staff member may be present during this medical examination other than the athletic trainer. In addition, the medical examination may not include any test or procedure designed to measure the athlete’s skill level. Acceptable tests include isokinetic testing, MRI, x-ray, etc. It is a t the discretion of the NCAA as to whether or not the test is a necessary measure. If deemed necessary, the institution may pay for such special tests.

65 Radford University Sports Medicine 2017 Policies and Procedures Student Athlete Physical Examinations

Once an athlete has a National Letter of Intent (NLI) with Radford University or has been accepted for enrollment in a regular full-time program of studies at Radford University, it is permissible to administer medical examinations at any time. It is important to note that any physical rehabilitation or the usage of the athletic training room for treatment purposes may not occur until the first day of practice or the first day of classes, whichever is earlier. Any services other than this form of testing would be determined to be a tangible recruiting aid and thus an NCAA violation.

Any prospect who has signed an NLI and who is enrolled in summer school but has not started official team workouts may have access to the training room for routine services but is not eligible to have Radford University pay for surgery, therapy, or medication.

It is the policy of Radford University Sports Medicine Department that under no circumstances shall a member of the staff evaluate and provide a diagnosis to any prospect. In addition, no staff member shall allow a prospect to utilize the athletic training room except in instances cited above. Also, prior permission from the Director of Athletic Training Services will be mandatory when such instances arise. This policy will be strictly adhered to in order to avoid any liability on the part of the university towards the continued participation of the prospect.

Approved by: ______Date: ______Delmas Bolin, M.D., Head Team Physician, Medical Director

Approved by: ______Date: ______Chad Hyatt, ATC, Director of Athletic Training/Healthcare Coordinator

Acknowledged by: ______Date: ______Scott Kincaid, Associate Team Physician

______Date: ______Tom Knisely, Team Physician

______Date: ______VCOM Sports Medicine Fellow

______Date: ______VCOM Sports Medicine Fellow

______Date: ______VCOM Sports Medicine Fellow

______Date: ______VCOM Sports Medicine Fellow

66 Name______Sport ______Student Must Answer All Questions Prior to Exam

Has anyone in your immediate family had any of the following problems? Tuberculosis No_____ Yes_____ Who?______Diabetes No_____ Yes_____ Who?______Kidney Disease No_____ Yes_____ Who?______High Blood Pressure No_____ Yes_____ Who?______Cancer No_____ Yes_____ Who?______Epilepsy No_____ Yes_____ Who?______Heart Attack/Heart Disease No_____ Yes_____ Who?______Stroke No_____ Yes_____ Who?______Sudden Death No_____ Yes_____ Who?______(Cause) (Age) Your Personal Medical History (Check “yes” or “no” and explain all “yes” answers in the spaces following the list.) Scarlet Fever No___ Yes___ Measles No___ Yes___ Whooping Cough No___ Yes___ Chickenpox No___ Yes___ Diabetes No___ Yes___ Thyroid Disease No___ Yes___ Rheumatic Fever No___ Yes___ Stomach Problems No___ Yes___ Pneumonia No___ Yes___ Fatigue No___ Yes___ Depression/Anxiety No___ Yes___ Mumps No___ Yes___ Mono No___ Yes___ Kidney Infection No___ Yes___ Epilepsy No___ Yes___ Hypertension No___ Yes___ Heart Murmur No___ Yes___ Asthma No___ Yes___ Fainting Spells No___ Yes___ Hepatitis No___ Yes___ Migraines No___ Yes___ Hernia No___ Yes___ Blood in Urine No___ Yes___ Protein in Urine No___ Yes___ Anemia No___ Yes___ Abnormal Bruising No___ Yes___ Sickle-Cell Disease No___ Yes___ Hearing Problems No___ Yes___ Heart Disease No___ Yes___ Abnormal Heart Beat No___ Yes___ Undescended Testicle No___ Yes___ Scoliosis No___ Yes___ Suicidal Thoughts No___ Yes___ Menstrual Problems No___ Yes______Explain “Yes” answers below. Circle any questions to which you don’t know the answers YES NO YES NO 1. Have you had a medical illness or injury since your 11. Do you use any special protective or corrective equipment for last check up or sports physical?   your sport? (for example, knee brace, foot orthotics, retainer Do you have an ongoing or chronic illness?   for teeth, hearing aid)   2. Have you ever been hospitalized overnight?   12. Have you had any problems with your eyes or vision?   Have you ever had surgery?   Do you wear glasses or contacts?   3. Are you currently taking any prescription, non-prescription 13. Have you ever had a sprain, strain, or swelling after injury?   (over-the-counter) medications, pills or using an inhaler?   Have you broken, fractured any bones, dislocated any joints?   Have you ever taken any supplements or vitamins to help 14. Have you had any other problems with pain or swelling in muscles, you gain or lose weight or improve your performance?   tendons, bones or joints?   4. Do you have any allergies (for example, to pollen, If yes, check appropriate box and explain below. medicine, food, or stinging insects)?    Head  Chest  Hand  Thigh  Ankle Have you ever had a rash or hives develop during or  Neck  Shoulder  Finger  Knee  Foot after exercise?    Back  Wrist  Hip  Shin/Calf  Toes 5. Have you ever passed out during or after exercise?   15. Are you happy with your weight? (1=not at all, 5=all the time) 1 2 3 4 5 Have you ever been dizzy during or after exercise?   16. I feel stressed out 1 2 3 4 5 Have you ever had chest pain during or after exercise?   17. I often have trouble sleeping. 1 2 3 4 5 Do you tire more quickly than your friends during exercise?   18. I wish I had more energy most days of the week. 1 2 3 4 5 Have you ever had a racing of your heart or skipped heartbeats?   19. I think about things over and over. 1 2 3 4 5 Have you ever had high blood pressure or high cholesterol?   20. I feel anxious and nervous much of the time. 1 2 3 4 5 Have you ever been told that you have a heart murmur?   21. I often feel sad or depressed. 1 2 3 4 5 Have you had a severe viral infection (for example, 22. I struggle with being confident. 1 2 3 4 5 23. I don’t feel hopeful about the future. 1 2 3 4 5 myocarditis or monocucleosis) within the last month?   24. I have a hard time managing my negative emotions 1 2 3 4 5 Has a physician ever denied or restricted your participation 25. I have feelings of hurting myself or others. 1 2 3 4 5 in sports for any heart problems?   Females only: 6. Have you ever been diagnosed with a concussion?   1. When was your first menstrual period? ______How many concussions have you had (list date of most recent) 1 2 3 4 2. When was your most recent menstrual period? ______Have you every suffered from post-concussive syndrome?   3. How much time do you usually have from the start of one period to Have you ever been knocked unconscious?   the start of another? ______7. Do you have any current skin problems?   4. How many periods have you had in the last year? ______(example: itching, rashes, acne, warts, fungus or blisters)  5. What was the longest time between periods in the last year? ______8.Have you ever had a seizure?   Do you have frequent or severe headaches?   Please explain all “Yes” answers below. Have you had numbness/tingling in arms, hands, legs or feet?   ______Have you ever had a stinger, burner or pinched nerve?   ______9. Have you ever become ill/dizzy from exercising in the heat?   10.Do you cough, wheeze, or have trouble breathing during ______or after activity?   ______Do you have asthma?   Do you have seasonal allergies requiring medical treatment?   ______67

Name______Sport ______Radford University Athletics Pre-Participation Physical Form (New Student)rev 2018 *This side is to be filled out by the ATC or Nurse and/or Physician Name ______Sport(s) ______DOB ______Age ______HT ______WT ______BMI ______BP (Brachial/Seated) ______/______(______/______) Pulse ______Glasses: Yes _____ No _____ Contact Lenses: Yes _____ No _____ Vision: R: 20/______L: 20/______Both: 20/______History of Asthma: Yes _____ No _____ If Yes: Peak Flow Trial 1______, Trial 2 ______, Trial 3______, Highest Peak Flow ______MEDICAL EXAM Norm Abnormal (Explain) MUSC/SKEL EXAM Norm Abnormal (Explain) Ears Neck Eyes Shoulders Mouth/Teeth Elbows -TMJ -Gums/Tongue Nose Hands Lymph Nodes Wrists Thyroid Hips Lungs Knees Cardiac Quad/Hamstring Include precordial auscultation, femoral pulse and Marfan Screen Ankle/Foot Abdomen Back/Spine Genitalia/Male Toe/Heel Walk Hernia Duck Walk Skin/Scars Comments Neuro

List and give dates of any serious injuries or illnesses ______List any operations and dates ______Describe any emotional disturbances or adjustment problems ______Is there loss or seriously impaired function of any paired organ? No □ Yes □ If Yes: ______

Is the patient now under treatment for any medical or emotional condition? No □ Yes □ If Yes: ______List any medications the patient is currently taking, including dosage and scheduled administration: ______Labwork Indicated: No □ Yes □ ______

Sickle Dex: Negative □ Positive □ Needs Testing □ Waiver □ ______

EKG/ECHO Indicated: No □ Yes □ ______Normal □ Abnormal □ ______CLEARED for (list sport/activity): ______CLEARED after completing eval/rehab for: ______NOT CLEARED FOR ANY SPORT PARTICIPATION due to: ______

MD/DO Signature: ______Date of Exam: ______Printed Name of MD/DO: ______To be reviewed and completed by a Radford University Physician ___ CLEARED ___ CLEARED after ______NOT CLEARED ______RU Athletics Physician Signature ______Printed Name ______Date ______Terms Information on this form may be necessary in the event of an emergency. Failure to provide this information may result in delay or difficulty administering medical care. All omissions or incomplete information on this form are the responsibility of the student and his/her health care provider. This completed form must be on file with the Radford University Athletic Training Department prior to any participation in intercollegiate athletics at Radford University.

I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct and that the attending practitioner, in case of emergency, may administer necessary medical treatment. In addition, I understand that my records will be destroyed 5 or 10 years after completion of athletic participation

Student-Athlete Signature______Date ______68 American Heart Association 14-Element Screening (Maron BJ Circulation 2014

Medical history (Parental verification recommended for high school and middle school athletes)

Personal History 1. Exertional chest pain/discomfort 2. Exertional syncope or near-syncope 3. Excessive exertional and unexplained fatigue/fatigue associated with exercise 4. Prior recognition of a heart murmur 5. Elevated systemic blood pressure 6. Prior restriction from participation in sports 7. Prior testing for the heart ordered by a physician

Family history 8. Premature death-sudden and unexpected before age 50 yr due to heart disease, in one or more relatives 9. Disability from heart disease in a close relative < 50 yo 10. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long-QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias

Physical exam

11. Heart Murmur-exam supine and standing or with valsalva, specifically to identify murmurs of dynamic L ventricular outflow tract obstruction 12. Femoral pulses to exclude aortic stenosis 13. Physical stigmata of Marfan syndrome 14. Brachial artery blood pressure (sitting, preferrably taken in both arms)

v Positive/abnormal screen warrants further evaluation and 12-lead EKG v AHA does NOT currently recommend routine 12-lead ECG

69 Section V

Emergency Action Plans Radford University Sports Medicine [Year] Emergency Action Plans

POLICY

An emergency situation is defined as a situation that is life threatening and endangering the health of the student-athlete. General illnesses, such as influenza, colds, etc, are not considered medical emergencies. Common musculoskeletal injuries, such as sprains, strains, etc, are also not considered medical emergencies.

During all events at which a Radford University Athletic Department Team Physician is present, he/she will make all final decisions regarding the immediate health care of the student-athletes at the playing venue. If the physician is not present at a specific athletic venue, then emergency action procedures are relegated to the present Staff Certified Athletic Trainer (ATC) on duty. S/he will activate EMS as soon as possible while caring for the student-athlete. Upon arrival, the EMT’s, paramedics and ER physicians will assume care and responsibility for the welfare of the student athlete. The person at the head of the athlete will be the team leader verbally in regards to the spine boarding process only. All other decision will be made by the paramedic/ EMT or physician. If possible, a staff ATC will accompany the student-athlete to the ER in the ambulance. The Director of Athletic Training and Head Team Physician are to be notified as soon as possible. Follow-up will be done by both the designated staff ATC and the team physician.

Purpose: Increase the awareness of action that is to be taken in the event of an emergency during NCAA affiliated venue at Radford University. The athletic training department has proposed the following guidelines for an EMERGENCY ACTION PLAN (EAP). This plan in intended to educate all parties involved in the event of an emergency. This plan is in adherence to the NCAA and NATA guidelines for medical coverage according to exposure to injury and priority of season at our institution. This plan complies with the policies of the athletic department’s handbook regarding student athletic eligibility. It also complies with recent guidelines set forth by the regarding annual CPR, basic first aid and AED certifications for the entire athletic department and athletic training staff.

PROCEDURES

During all events at which a Radford University Team Physician is present he/she will make all final decisions regarding the immediate health care of the student athletes at the playing venue. If a physician is not present then the responsibilities of the EAP are regulated to the present staff certified/licensed Athletic Trainer on duty. He/She will designate a secondary responder to activate EMS (when dialing from a campus phone 9-9-1-1) as soon as possible while caring for the student athlete. The secondary responder(s) will then contact campus security (x5500) and assist first responder. Thirdly, if no certified athletic trainer is present, the first responder becomes the responsibility of either the on-site coach or staff member. Upon arrival of the EMT/Paramedics will assume care and responsibility of the student-athlete. If available, an athletic training student or a member of the Radford University athletic department will accompany the student athlete in the ambulance. The Director of Athletic training and Staff certified athletic trainer should be notified when emergency has been appropriately handled in accordance with the EAP. Follow up will be done by the designated staff ATC.

70 Radford University Sports Medicine [Year] Emergency Action Plans

1. The first responder should secure the area and begin taking appropriate care of the student athlete by checking the ABC’s (airway, breathing, circulation) and is to stay with the student athlete until more qualified help arrives. If an athlete is unconscious or a head or neck injury is suspected, stabilize their head immediately and DO NOT MOVE THE ATHLETE unless the situation becomes unsafe.

2. The second responder should then call 911 or 9911 if calling from a campus phone and give the appropriate information (see specific venue) and remain on the line until the EMS dispatcher/operator states that he/she has the necessary information or disconnects the call.

3. The second responder should then contact the campus police at extension 5500 and then offer assistance to the first responder.

4. If available a third responder will meet EMS (see specific venue).

5. If available an athletic training student or a member of the Radford University athletic department will accompany the student athlete in the ambulance.

6. Insurance information will be available to accompany athlete to the emergency room.

7. Follow up will be done by the designated staff ATC (See communications and chain of command).

An Automated External Defibrillator (AED) is available at Radford University to be used in an emergency situation. One AED is available on-site for all athletic events.

1. Cervical Injury w/Out Compromised Airway

A. Staff ATC and team physician approach the athlete and determine no airway compromise. Airway, breathing and circulation are all intact. B. Sports Medicine Staff determine that cervical spine injury is present. C. Signal given to sideline ATC or athletic training student to bring rigid cervical collar, spineboard and additional help to the injured athlete. Prior to all games, the athletic training staff will determine the team of staff/MDs/aides that will respond to an emergency situation. D. Staff ATC concurrently gains control of the athlete’s head to limit movement of the c-spine. E. Second responder calls 911 to activate EMS. F. Typically, there will not be enough qualified personnel at an athletic event or Practice to spine board a student-athlete. Therefore, protocol is to maintain in-line Immobilization of the c-spine until EMS arrives. G. If the student-athlete is already in a supine position, then the available responders will attempt to place a rigid c-collar on the student-athlete while awaiting arrival of EMS.

71 Radford University Sports Medicine [Year] Emergency Action Plans

H. Once all emergency response staff is in place (one person at head, 3 people on the side that the patient is being rolled to), the head person states the orders (“1-2-3 roll”) in sequence to roll the athlete while the board is placed under the athlete. The board is slid under the athlete from the side by a 5th person. I. The athlete is then rolled back onto the board according to and on the count of the person at the head (“1-2-3 down”). Once the athlete’s entire body is on the board, straps are placed across the athlete to secure them to the board. J. Once athlete is secured to the board the head person will then give a command of (“1-2-3 lift”). The athlete is then placed on a gurney or a utility vehicle to be transported to the hospital for further evaluation.

2. Cervical Injury w/ Compromised Airway

A. Staff ATC and team physician approach the athlete and determine there is an unconscious non-breathing victim with a cervical spine injury present. B. Activate EMS, retrieve AED, oxygen equipment, cervical collar and spineboard; Also at this time, the head is being stabilized while the re-breather mask is applied and rescue breathing can then begin. C. If the athlete is face down, efforts will be made to cautiously turn him to a supine position using the “log roll” technique and onto a spineboard (if available). The ATC at the head of the athlete will cross his/her arms to facilitate rolling. Three people will be on the side of the student-athlete that they will be rolling towards; two people will be on the side of the student-athlete that they are rolling away from to stabilize at the hips. The roll will be directed by the ATC at the head of the athlete (“1-2-3 roll halfway”); the athlete will be rolled halfway and stopped, to allow the rollers a chance to adjust their hand and feet placement. The ATC at the head of the athlete will then give the order (“1-2-3 roll down”) to lower the athlete to the ground or spineboard, now face-up. D. At this point, the oxygen is applied with a non-rebreather mask at full oxygen flow of 12 liters/minute. E. Also at this point, the available responders will attempt to place a rigid c-collar on the student-athlete while awaiting arrival of EMS. F. If the student-athlete does not have a pulse, the athlete’s jersey will be cut up the middle to allow access to the chest and the AED will be used following standard AED procedures. G. Once the ambulance arrives on field, the EMT’s/paramedics may then assess the situation and, with the concurrence of the team physician, take the emergency action that they feel is necessary. H. Once an airway is established and it is decided by the team physician that the patient is stable, that athlete is spine boarded, taken off the field by stretcher or ambulance (always with the person at the head continuing stabilization) and transported to the emergency room. I. The scenario at the ER is the same as stated previously

72 Radford University Sports Medicine [Year] Emergency Action Plans

3. Unconscious Student-Athlete The unconscious student-athlete will be treated as above, assuming a cervical spine injury until such time that this injury can be ruled out.

4. Communications and Chain of Command In the case of a serious or life-threatening situation, all reasonable efforts will be made to contact the parents of the student-athlete. In the instance of death, the physician overseeing the case will first attempt to notify the parents prior to notifying any other party. All other efforts to communicate with the necessary parties will be carried out in the following order:

A. First responder contacts Director of Athletic Training (540-641-4678c, 540-831- 5877o)

B. Director of Athletic Training calls emergency contact

C. Director of Athletic Training contacts Head Team Physician

D. Director of Athletic Training contacts Staff Certified Athletic Trainer

E. Staff Certified Athletic Trainer contacts Coach

F. Director of Athletic Training contacts Athletic Director (214-205-3114c, 540- 831-5563o)

Attachments 1- Protocols for specific venues in the case of an emergency

73 Radford University Sports Medicine Emergency Action Plans

Emergency Plan: Radford University Dedmon Center Arena- 1st Floor Locker Rooms

Emergency Personal: Certified athletic trainer and additional sports medicine staff accessible from the VCOM Center for Sports Medicine (located on second level of the Dedmon Center- 540-831-6128)

Emergency Communication: Fixed telephone line in the Athletic Training Room (831-5164). Emergency phones located in the general locker rooms. On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: supplies (AED, splint kit, spine board) transported to site from the VCOM Center for Sports Medicine.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: The Donald N. Dedmon Center is located at 101 University Drive.

Emergency entrance for the Dedmon Center 1st Floor ATR and locker rooms is the Riverside Student Athlete Entrance next to loading dock.

Driving Directions: Once on University Drive (Dedmon Center Bridge), follow loop around to the Riverside Entrance; the student athlete entrance will be on the left next to the loading dock. EMS will take the elevator or stairs to the 1st floor.

Position where personal will meet emergency help: • On the sidewalk of the riverside entrance, directly outside the double door Student Athlete Entrance. • In 1st floor hallway outside of whichever room the emergency is located.

74 Radford University Sports Medicine Emergency Action Plans

Emergency Plan: Radford University Dedmon Center Arena- 2nd Floor Weight Room

Emergency Personal: Certified Strength Coaches and interns on site for all lifting and condition sessions; Certified Athletic Trainers either on site or accessible from the VCOM Center for Sports Medicine (located on second level of the Dedmon Center-540-831-6128)

Emergency Communication: Fixed telephone line is located in the staff office. On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: AED is maintained in the staff office. Splint bag is located in the VCOM Center for Sports Medicine. Spine board equipment is in the Dedmon Arena.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS)  911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested  Notify campus police at 831-5500 4. Direction of EMS to scene  Open appropriate gates  Designate individual to “flag down” EMS and direct to scene  Scene control: limit scene to first aid providers and move bystanders away from area

If the situation is life threatening: 911 or (9911 on campus) And give the following information Caller: Hello, my name is ______I am calling from Radford University. We have a victim who has suffered from a possible type of injury (head, neck, leg, etc). The victim is conscious/unconscious (state one). We need an ambulance at the Dedmon Center Weight Room located on the second level of the Dedmon Center. The emergency entrance is through the glass doors of the side entrance, which faces the baseball field. Someone will meet the ambulance beside the road, to direct emergency personnel up the sidewalk and through the emergency entrance to the exact location of the victim. If you need to reach us again please dial (give the number you are calling from or 540-831-5500 if calling from a campus land line), which is campus police. Answer any other questions from the dispatcher; do not hang up until dispatcher has already done so. And then contact Campus Police 540-831-5500 or (x5500 on campus)

Additional Driving Directions: Off Campus  East Main Street: Take Right onto University Drive (Dedmon Center Bridge), after passing the Cupp stadium; the field hockey field, and DC parking lot entrance. After passing DC parking lot exit (and loop goes to left), Dedmon Center glass doors will be on the left across from baseball field. Enter through the sliding glass doors.

 West Main Street: Take Left onto University Drive (Dedmon Center Bridge), after passing the Cupp stadium; the Dedmon Center Field, and DC parking lot entrance. After passing DC parking lot exit (and loop goes to left), Dedmon Center glass doors will be on the left across from baseball field. Enter through the sliding glass doors.

On Campus  Take University Drive, after passing the Cupp stadium; the Dedmon Center Field, and DC parking lot entrance. After passing DC parking lot exit (and loop goes to left), Dedmon Center glass doors will be on the left across from baseball field. Enter through the sliding glass doors.

75 Radford University Sports Medicine Emergency Action Plans

Emergency Plan: Radford University Dedmon Center Arena

Emergency Personal: Certified athletic trainer and student athletic trainer(s) on site for practice and competition; additional sports medicine staff accessible from Donald N. Dedmon Center Athletic Training Facility (located on lower level of the Dedmon Center)

Emergency Communication: Courtesy telephone is located next to the men’s bathroom. On campus dial 9-911. During a basketball game, telephone (831-5295) located on press row can be used to activate EMS. A cellular phone can also be used to activate EMS.

Emergency Equipment: supplies (AED, splint kit) are maintained on site for athletic competitions, spine board and additional supplies are transported from Donald N. Dedmon Center Athletic Training Facility.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: The Donald N. Dedmon Center Arena is located at 101 University Drive.

Emergency entrance is for the Dedmon Center Arena is through either the Southwest entrance doors or through the Riverside entrance depending upon the location of individual needing EMS.

Driving Directions:

1. Off Campus • East Main Street: Take Right onto University Drive (Dedmon Center Bridge), the Southwest Entrance is located on the left across form the East Gates of Cupp Stadium, or follow loop around to the Riverside Entrance. • West Main Street: Take Left onto University Drive (Dedmon Center Bridge), the Southwest Entrance is located on the left across form the East Gates of Cupp Stadium, or follow loop around to the Riverside Entrance.

2. On Campus • Take University Drive, the Southwest Entrance is located on the left across form the East Gates of Cupp Stadium, or follow loop around to the Riverside Entrance.

Position where personal will meet emergency help: • Outside of the doors to the Southwest entrance to Dedmon Center • Outside the foyer doors of the Riverside Entrance

76 Radford University Sports Medicine Emergency Action Plans

Emergency Plan: Radford University Baseball Field

Emergency Personal: Certified athletic trainer and athletic training student(s) on site for practice and competition; additional sports medicine staff accessible from the VCOM Center for Sports Medicine (located on second level of the Dedmon Center- 540-831-6128)

Emergency Communication: Emergency telephone is located on the parking lot side of the control building (facing the tennis court). On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: supplies (AED, splint kit, spine board) transported to field for each athletic event from Donald N. Dedmon Center Athletic Training Facility. An AED is also located on the parking lot side of the control building (facing the tennis court, next to the telephone).

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: The Baseball Field is located off of University Drive and can be accessed after following the loop past Cupp Stadium, Field Hockey field and DC parking lot entrance. After passing the DC parking lot entrance continue to left and take the side walk entrance to field.

Emergency entrance is either through the double gates at the first or third base side of the field. If the EMS is for a crowd member, follow EAP for softball and have EMS arrive at the baseball/softball parking lot BBF.

Driving Directions: Once on University Drive (Dedmon Center Bridge), continue to pass Cupp Stadium and DC parking lot entrance both on your right, then immediate right at the sidewalk entrance following parking lot DC in between the tennis courts and baseball field. EMS can access field through either the double gates on the first or third base side of the field

Position where personal will meet emergency help: • At the sidewalk entrance off of University Drive • At the double gates located in on the first or third base side of the field

77

Radford University Sports Medicine Emergency Plan: Radford University Softball Field Emergency Action Plans Emergency Personal: Certified athletic trainer and athletic training student(s) on site for practice and competition; additional sports medicine staff accessible from the VCOM Center for Sports Medicine (located on lower level of the Dedmon Center at 540- 831-6128)

Emergency Communication: Emergency telephone is located on the parking lot side of the control building (facing the tennis courts). On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: Supplies (AED, splint kit, spine board) transported to field for each athletic event from Donald N. Dedmon Center Athletic Training Facility. An AED is also attached to the press box located on the parking lot side of the control building (facing the tennis courts, next to the emergency telephone).

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: The Softball Field is located off of University Drive and can be accessed by going through the far left corner of Parking Lot DC on the access road in between the tennis courts and railroad tracks.

Driving Directions: Once on University Drive (Dedmon Center Bridge), after passing Cupp stadium and the field hockey field, turn Right into parking lot DC. Proceed to the far left corner of the parking lot to the access road between the tennis courts and railroad tracks to parking lot BBF. EMS can access the field through the double gates located in right field near the storage shed

Position where personal will meet emergency help: • At the entrance to the access road in the far left corner of the DC parking lot • At the double gates located in right field by the storage shed

78 Radford University Sports Medicine

Emergency Action Plans

Emergency Plan: Radford University Tennis Courts

Emergency Personal: Certified athletic trainer and athletic training student(s) on site for practice and competition; additional sports medicine staff accessible from the VCOM Center for Sports Medicine (located on lower level of The Dedmon Center at 540-831-6128)

Phone Numbers Chad Hyatt (Dir. Of Athletic Training) 540-641-4678 cell 540-831-5877 office Katherine Moreno (Tennis Athletic Trainer) 469-360-3136 cell 540-831-5164 office Dedmon Center Athletic Training Facility 540-831-6128 Main Athletic Offices 540-831-6194

Emergency Communication: Emergency telephone is located on the parking lot side of the control building between the baseball and softball fields (facing the tennis court). On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: AED is located on the parking lot side of the control building between the baseball and softball fields (facing the tennis court). A splint bag with a bag valve mask will be transported from the Dedmon Center for each match.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: The Tennis courts are located adjacent to the far left side of DC parking lot (near courts). To reach the far courts, take the access road in the far left corner of the DC parking lot to the softball/baseball parking lot. Emergency entrance is dependent upon which court needs EMS. For the near courts, after passing the field hockey venue, turn right into the DC parking lot and go to the far left side of the parking lot on to the sidewalk that splits the upper and lower courts. For the far courts, take the access road in the far left corner of the DC parking lot towards the softball/baseball parking lot.

Driving Directions:

1. Off Campus • East Main Street: Take Right onto University Drive (Dedmon Center Bridge), after passing the Cupp stadium; Dedmon Center Field, turn right into the DC parking lot for near courts, go to the far left side of the DC parking lot onto the sidewalk that splits the upper and lower courts. For the far courts, turn right into the DC parking lot and take the access road in the far left corner of the DC parking lot towards the softball/baseball parking lot. • West Main Street: Take Left onto University Drive (Dedmon Center Bridge), after passing the Cupp stadium; the Dedmon Center Field, turn right into the DC parking lot for near courts, go to the far left side of the DC parking lot onto the sidewalk that splits the upper and lower courts. For the far courts, turn right into the DC parking lot and take the access road in the far left corner of the DC parking lot towards the softball/baseball parking lot.

2. On Campus • Take University Drive, after passing the Cupp stadium; the Dedmon Center Field, turn right into the DC parking lot for near courts, go to the far left side of the DC parking lot onto the sidewalk that splits the upper and lower courts. For the far courts, turn right into the DC parking lot and take the access road in the far left corner of the DC parking lot towards the softball/baseball parking lot

Position where personal will meet emergency help: • At the entrance to the DC parking lot • At the sidewalk that splits the courts into upper and lower or in the softball parking lot, depending upon which court needs EMS.

79 Radford University Sports Medicine Emergency Action Plans

Emergency Plan: Dedmon Center Lower Practice Fields

Emergency Personal: Certified athletic trainer and athletic training student(s) on site for practice and competition; additional sports medicine staff accessible from the VCOM Center for Sports Medicine (located on second level of the Dedmon Center- 540-831-6128)

Emergency Communication: First responder must use a cellular phone to activate EMS (911). There is also an emergency telephone call box located in adjacent Parking Lot Z.

Emergency Equipment: supplies (AED, splint kit, spine board) transported to venue for each competition from VCOM Center for Sports Medicine or Patrick D. Cupp Athletic Training Room.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: RU Lower Level Practice Fields are located directly east of Lot Z by the New River

Emergency entrance is in the far right corner of Lot Z or the jogging trail entrance on the right after passing the baseball field

Driving Directions:

• Once on University Drive (Dedmon Center Bridge), Follow loop around Dedmon Center, passing stadium, arena and baseball field, Parking Lot Z is straight ahead after passing baseball field, Fields are located east of Lot Z along the river, below the baseball field

Position where personal will meet emergency help: • One person will meet EMS at the entrance of parking Lot Z closest to the practice fields.

80 Radford University Sports Medicine Emergency Action Plans

Emergency Plan: Dedmon Center Field

Emergency Personal: Certified athletic trainer and athletic training student(s) on site for practice and competition; additional sports medicine staff accessible from the VCOM Center for Sports Medicine (located on second level of the Dedmon Center- 540-831-6128)

Emergency Communication: Courtesy fixed phones located on the 3rd floor of the Dedmon Center near entrance facing Dedmon Center Field. On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: supplies (AED, splint kit, spine board) transported to field for each athletic event from Donald N. Dedmon Center Athletic Training Facility.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: The Dedmon Center Field is located directly across from the South side of the Dedmon Center on University Dr.

Emergency entrance is at the far right corner of DC Parking lot, directly across from the administrative entrance on the South side of the Dedmon Center.

Driving Directions: Off University Drive (Dedmon Center Bridge), after passing Cupp stadium, the Dedmon Center Field will be on your right. Take a right into the parking lot DC and head straight until the lot ends. Enter the field through the double gates in the far right corner of parking lot DC.

Position where personal will meet emergency help: • At the entrance to the DC lot across form the administrative entrance of the Dedmon Center • At the double gates located in the far right corner of the DC Lot

81 Radford University Sports Medicine Emergency Action Plans

Emergency Plan: Patrick D. Cupp Stadium- Athletic Training Room and Locker Rooms

Emergency Personal: Sports medicine staff accessible from Patrick D. Cupp Stadium Athletic Training Facility (located on lower level of Patrick D. Cupp Stadium)

Emergency Communication: Fixed telephone line accessible from Patrick D. Cupp athletic training facility located on the lower level of Patrick D. Cupp Stadium (831-7831), courtesy phones located on 1st Level across from athletic training room and in the 2nd level lobby. On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: supplies (AED, splint kit, spine board) maintained on site in Cupp Athletic Training Facility.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: Patrick D. Cupp Stadium is located off of University Drive on the right.

Emergency entrance is the half-circle parking lot on the right (east side of the track) once passing Cupp Stadium off University Drive.

Driving Directions: Off University Drive (Dedmon Center Bridge), after passing Cupp Stadium, take the first right into the half-circle parking lot. EMS will go through the double gates located in the half-circle driveway entrance on the East side of Patrick D. Cupp Stadium.

Position where personal will meet emergency help: • At the double gates on the east side of Cupp Stadium half-circle driveway entrance

82

Emergency Action Plans Radford University Sports Medicine Emergency Plan: Patrick D. Cupp Stadium- Soccer Field and Track

Emergency Personal: Certified athletic trainer and student athletic trainer(s) on site for practice and competition; additional sports medicine staff accessible from Patrick D. Cupp Stadium Athletic Training Facility (located on lower level of Patrick D. Cupp Stadium)

Emergency Communication: Fixed telephone line accessible from Patrick D. Cupp athletic training facility (831-7831) located on the lower level of Patrick D. Cupp Stadium, courtesy phones located on 1st level across from athletic training room and in the 2nd level lobby. On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: Supplies (AED, splint kit, spine board) maintained on site of athletic event; additional equipment accessible from Cupp Athletic Training Facility.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: Patrick D. Cupp Stadium is located off of University Drive on the right.

Emergency entrance is along University Drive. It is the half-circle parking lot on the immediate right once passing Cupp Stadium. It is on the east side of the track.

Driving Directions: Venue Directions: Patrick D. Cupp Stadium is located off of University Drive on the right.

Emergency entrance is the half-circle parking lot on the right (east side of the track) once passing Cupp Stadium off University Drive.

Driving Directions: Off University Drive (Dedmon Center Bridge), after passing Cupp Stadium, take the first right into the half-circle parking lot. EMS will go through the double gates located in the half-circle driveway entrance on the East side of Patrick D. Cupp Stadium.

Position where personal will meet emergency help: • At the double gates on the east side of Cupp Stadium half-circle driveway entrance

83 Radford University Sports Medicine Emergency Action Plans

Emergency Plan: Throwing Area for Track and Field

Emergency Personal: Certified athletic trainer and student athletic trainer(s) on site for competition only; first responder (coach/student athletic trainer) at practice; additional sports medicine staff accessible from Patrick D.Cupp Athletic Training Facility (located on lower level of Patrick D.Cupp Stadium)

Emergency Communication: First responder must use a cellular phone to activate EMS (911) directly.

Emergency Equipment: supplies (AED, splint kit, spine board) transported to venue for each competition from Patrick D. Cupp Athletic Training Facility.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: RU Throwing Venue is located off of Stockton St. (Adjacent to Hunter Ridge Apartments)

Emergency entrance is the parking lot directly in front on Throwing Venue.

Driving Directions: Off University Drive (Dedmon Center Bridge), turn left onto Stockton Street, take the first right at the bottom of the hill into the throwing venue parking lot.

Position where personal will meet emergency help: • One person will meet EMS at the entrance of the Throwing Venue Parking lot.

84 Radford University Sports Medicine Emergency Action Plans

Emergency Plan: Radford University Indoor Hitting Facility

Emergency Personal: Certified athletic trainer and athletic training student(s) on site for practice and competition; additional sports medicine staff accessible from the VCOM Center for Sports Medicine (located on second level of the Dedmon Center- 540-831-6128)

Emergency Communication: Emergency telephone is located in Head Baseball Coach’s office on the desk. On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: supplies (AED) permanently stationed in a cabinet on the wall just inside the student- athlete entrance.

Roles of First Responders: 1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 1. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area • *If the situation is life threatening: 911 or (9911 on campus) And give the following information

Caller: Hello, my name is ______I am calling from Radford University Athletics Indoor Hitting Facility. We have a victim who has suffered from a possible type of injury (head, neck, leg, etc). The victim is conscious/unconscious (state one). We need an ambulance at the indoor facility which is located off University Drive. Turn right into parking lot DC and follow the parking lot around the tennis courts until you arrive at the softball field parking lot BBF. Someone will meet the ambulance at the entrance of parking lot DC and at the softball parking lot BBF, to direct emergency personnel to the exact location of the victim. If you need to reach us again please dial (give the number you are calling from or 540-831-5500 if calling from a campus land line), which is campus police. Answer any other questions from the dispatcher; do not hang up until dispatcher has already done so. And then contact Campus Police 540-831-5500 or (x5500 on campus)

Driving Directions: Off Campus • East Main Street: Take Right onto University Drive (Dedmon Center Bridge), after passing the Cupp stadium; the field hockey field, turn Right into the DC Parking lot proceed to far left corner down access road between tennis court and railroad tracks to parking lot BBF, EMS can access the facility by going on the gravel path between the softball field and the railroad tracks. • West Main Street: Take Left onto University Drive (Dedmon Center Bridge), after passing the Cupp stadium; the field hockey field, turn Right into the DC Parking lot proceed to far left corner down access road between tennis court and railroad tracks to parking lot BBF, EMS can access the facility by going on the gravel path between the softball field and the railroad tracks. On Campus • Take University Drive, after passing the Cupp stadium; the DC Field will be on the right, turn Right into the DC Parking lot and proceed to far left corner down access road between tennis court and railroad tracks to parking lot BBF, EMS can access the facility by going on the gravel path between the softball field and the railroad tracks.

85 Radford University Sports Medicine [Year] Emergency Action Plans

Emergency Plan: Radford University Intramural Facility

Emergency Personal: Certified athletic trainer and athletic training student(s) on site for practice and competition; additional sports medicine staff accessible from the VCOM Center for Sports Medicine (located on second level of The Dedmon Center- 540-831-6128

Emergency Communication: First responder must use a cellular phone to activate EMS (911).

Emergency Equipment: supplies (AED splint kit, spine board) transported to venue for each competition from Donald N. Dedmon Center Athletic Training Facility. .

Roles of First Responders: 1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 1. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

If the situation is life threatening: 911 or (9911 on campus) And give the following information Caller: Hello, my name is ______I am calling from Radford University Intramural Facility. We have a victim who has suffered from a possible type of injury (head, neck, leg, etc). The victim is conscious/unconscious (state one). We need an ambulance at the intramural facility which is located off Whitehall Street. After traveling about 500ft. turn right into parking lot IM. Someone will meet the ambulance at the entrance of parking lot IM to direct emergency personnel to the exact location of the victim. If you need to reach us again please dial (give the number you are calling from or 540-831-5500 if calling from a campus land line), which is campus police. Answer any other questions from the dispatcher; do not hang up until dispatcher has already done so. And then contact Campus Police 540-831-5500 or (x5500 on campus)

Driving Directions: Off Campus • East Main Street: Take Right onto Whitehall Street; continue 500ft with the intramural field on the right; turn right into lot IM; EMS can access the facility through the gate in that lot. • West Main Street: Take Left onto Whitehall Street; continue 500ft with the intramural field on the right; turn right into lot IM; EMS can access the facility through the gate in that lot. On Campus • From Main Street; Take Right onto Whitehall Street; continue 500ft with the intramural field on the right; turn right into lot IM; EMS can access the facility through the gate in that lot.

86 Radford University Sports Medicine Emergency Action Plans

Emergency Plan: Peters Hall

Emergency Personal: Certified athletic trainer and athletic training student(s) on site for practice and competition; additional sports medicine staff accessible from the VCOM Center for Sports Medicine (located on second level of the Dedmon Center- 540-831-6128) or Patrick D. Cupp Training Room

Emergency Communication: Emergency phone is located outside of the Learning Resource Center if a student worker or building manager is unavailable. The student workers in each area outside the gym and in the fitness area have radios that can notify the Building manager to activate EMS. On campus dial 9-911. A cellular phone can also be used to activate EMS.

Emergency Equipment: Supplies (AED, Splint Kit) are transported to the site for competition, additional supplies, such as a spine board can be found in the Dedmon Center Athletic Training Facility or Patrick D. Cupp Athletic Training Facility.

Roles of First Responders:

1. Immediate care of injured or ill student athlete. 2. Emergency equipment retrieval 3. Activation of emergency medical system (EMS) • 911 call ( provide name, address, telephone number; number of individuals injured; condition of injured; first aid treatment; specific directions; other information as requested • Notify campus police at 831-5500 4. Direction of EMS to scene • Open appropriate gates • Designate individual to “flag down” EMS and direct to scene • Scene control: limit scene to first aid providers and move bystanders away from area

Venue Directions: Peters Hall is located on Radford University’s Main Campus on Fairfax St. off of Jefferson St.

Emergency entrance is at the end of Adams Street, follow the sidewalk at the dead end of Adams Street towards the handicap ramp on your left hand side and through the double doors of Peters Hall which is located across from Cook Hall, and directly beside the Buchanan house.

Driving Directions: Off Jefferson Street turn onto Calhoun Street towards campus. At the end of Calhoun take a right onto Adam Street and follow to the dead end. The handicap ramp to the double doors is located at the rear of Peters Hall on your left.

Position where personal will meet emergency help: • One person will meet EMS at the entrance to the double doors at the rear entrance of Peter’s across from Cook Hall. Another person will meet EMS outside the doors of Peter’s Gym.

87 Section VI

Medical Conditions Policies and Protocols Radford University Sports Medicine 2018 Policies and Procedures Independent Medical Care and the Interdisciplinary Health Care Team

STATEMENT Radford University Athletics will follow the guidelines of the Inter-association Consensus: Independent Medical Care Guidelines and reiterated in the NCAA Sports Medicine Handbook.

POLICY Diagnosis, management, and return to play determinations for the college student-athlete are the responsibility of the institution’s athletic trainers (working under the supervision of a physician) and the team physician. Even though some have cited a potential tension between health and safety in athletics,1,2 collegiate athletics endeavor to conduct programs in a manner designed to address the physical well-being of college student-athletes (i.e., to balance health and performance).3,4 In the interest of the health and welfare of collegiate student-athletes, a student- athlete’s health care providers must have clear authority for student-athlete care. The foundational approach for independent medical care is to assume an “athlete-centered care” approach, which is similar to the more general “patient-centered care,” which refers to the delivery of health care services that are focused only on the individual patient’s needs and concerns.5 The following 10 guiding principles, listed in the Inter-Association Consensus Statement on Best Practices for Sports Medicine Management for Secondary Schools and Colleges,5 are paraphrased below to provide an example of policies that can be adopted that help to assure independent, objective medical care for college student-athletes:

1. The physical and psychosocial welfare of the individual student-athlete should always be the highest priority of the athletic trainer and the team physician.

2. Any program that delivers athletic training services to student-athletes should always have a designated medical director.

3. Sports medicine physicians and athletic trainers should always practice in a manner that integrates the best current research evidence within the preferences and values of each student-athlete.

4. The clinical responsibilities of the athletic training staff will be performed in a manner that is consistent with the written or verbal instructions of a physician or standing orders and clinical management protocols that have been approved by the program’s designated medical director.

88 Radford University Sports Medicine 2018 Policies and Procedures Independent Medical Care and the Interdisciplinary Health Care Team

5. Decisions that affect the current or future health status of a student-athlete who has an injury or illness should only be made by a properly credentialed health professional (e.g., a physician or an athletic trainer who has a physician’s authorization to make the decision).

6. In every case that a physician has granted an athletic trainer the discretion to make decisions relating to an individual student-athlete’s injury management or sports participation status, all aspects of the care process and changes in the student-athlete’s disposition should be thoroughly documented.

7. Coaches must not be allowed to impose demands that are inconsistent with guidelines and recommendations established by sports medicine and athletic training professional organizations.

8. An athletic trainer’s role delineation and employment status should be determined through a formal administrative role for a physician who provides medical direction.

9. An athletic trainer’s professional qualifications and performance evaluations must not be primarily judged by administrative personnel who lack health care expertise, particularly in the context of hiring, promotion, and termination decisions.

10. Member institutions should adopt an administrative structure for delivery of integrated sports medicine and athletic training services to minimize the potential for any conflicts of interest that could adversely affect the health and well-being of student-athletes.

GUIDELINES

Team physician authority becomes the linchpin for independent medical care of student- athletes. Six preeminent sports physicians associations agree with respect to “… athletic trainers and other members of the athletic care network report to the team physician on medical issues.”6 Consensus aside, a medical-legal authority is a matter of law in 48 states that require athletic trainers to report to a physician in their medical practice. The NCAA Sports Medicine Handbook’s Guideline 1B opens with a charge to athletics and institutional leadership to “create an administrative system where athletics health care professionals – team physicians and athletic

89 Radford University Sports Medicine 2018 Policies and Procedures Independent Medical Care and the Interdisciplinary Health Care Team

trainers – are able to make medical decisions with only the best interests of student-athletes at the forefront.”7 Multiple models exist for collegiate sports medicine. Athletic health care professionals commonly work for the athletics department, student health services, private medical practice, or a combination thereof. Irrespective of model, the answer for the college student-athlete is established independence for appointed athletics health care providers.

Institutional medical line of authority should be established independently of a coach, and in the sole interest of student-athlete health and welfare. Medical line of authority should be transparent and evident in athletics departments, and organizational structure should establish collaborative interactions with the medical director and primary athletics health care providers (defined as all institutional team physicians and athletic trainers) so that the safety, excellence and wellness of student-athletes are evident in all aspects of athletics and are student-athlete centered.

Institutions should, at a minimum, designate a licensed physician (M.D. or D.O.) to serve as medical director, and that medical director should oversee the medical tasks of all primary athletics health care providers. Institutions should consider a board certified physician, if available. The medical director may also serve as team physician. All athletic trainers should be directed and supervised for medical tasks by a team physician and/or the medical director. The medical director and primary athletics health care providers should be empowered with unchallengeable autonomous authority to determine medical management and return-to-play decisions of student-athletes.

REFERENCES

1. Matheson GO. Maintaining professionalism in the athletic environment. Phys Sportsmed. 2001 Feb;29(2)

2. Wolverton B. (2013, September 2) Coach makes the call. The Chronicle of Higher Education. [Available online] http://chronicle.com/article/Trainers-Butt-Heads-With/141333/

3. NCAA Bylaw 3.2.4.17 (Div. I and Div. II; 3.2.4.16 (Div. III).

90 Radford University Sports Medicine 2018 Policies and Procedures Independent Medical Care and the Interdisciplinary Health Care Team

4. National Collegiate Athletic Association. (2013). 2013-14 NCAA Division I Manual. Indianapolis, IN: NCAA.

5. Courson R et al. Inter-association consensus statement on best practices for sports medicine management for secondary schools and colleges. J Athletic Training 2014; 49:128-137.

6. Herring SA, Kibler WB, Putukian M. Team Physician Consensus Statement: 2013 update. Med Sci Sports Exerc. 2013 Aug;45(8):1618-22.

7. National Collegiate Athletic Association. (2013). 2013-14 NCAA Sports Medicine Handbook. Indianapolis, IN: NCAA.

8. Delany J, Goodson P, Makeoff R, Perko A, Rawlings H [Chair]. Rawlings panel on intercollegiate athletics at the University of North Carolina at Chapel Hill. Aug 29 ‘13. [Available online] http://rawlingspanel.web.unc.edu/files/2013/09/Rawlings-Panel_Intercollegiate-Athletics-at- UNC-Chapel-Hill.pdf

*This Consensus Best Practice, Independent Medical Care for College Student-Athletes, has been endorsed by the American Academy of Neurology, American College of Sports Medicine, American Association of Neurological Surgeons, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy for Sports Medicine, College Athletic Trainers’ Society, Congress of Neurological Surgeons, National Athletic Trainers’ Association, NCAA Concussion Task Force, Sports Neuropsychological Society

91 Radford University Sports Medicine 2018 Policies and Procedures Independent Medical Care and the Interdisciplinary Health Care Team

POLICIES SPECIFIC TO THE RADFORD UNIVERSITY ATHLETIC DEPARTMENT

1. Radford University Athletics designates the Head Team Physician as the medical director of the sports medicine team. 2. Radford University Athletics also designates the Director of Athletic Training Services as the medical coordinator for the sports medicine team. 3. The medical director and the medical coordinator will make all decisions regarding the hiring, firing, evaluation and training of the sport medicine team, including staff certified athletic trainers, physical therapists, team physicians, nutritionists and other athletic healthcare providers that serve as members of the sports medicine team. No member of the sports medicine team will have a direct line of report to a coach or any other non-medical member of the athletic department. 4. The athletic training staff will operate under the direction of the medical director and the medical coordinator. 5. The Head Team Physician/medical director is empowered with the unchallengeable autonomous authority to determine medical management and return-to-play decisions of student- athletes, as well as other decisions that may affect the well-being of the student athletes. 6. In the direct absence of the medical director, the primary healthcare providers (certified athletic trainers and team physicians) will be relegated the autonomous authority to determine medical management and return-to-play decisions of student-athletes. 7. If the return-to-play status of a student-athlete is ever in question by a primary healthcare provider, then the decision will be delayed until the student-athlete can be seen by the Head Team Physician/medical director.

Approved by: ______Date: ______Delmas Bolin, M.D., Head Team Physician, Medical Director

Approved by: ______Date: ______Chad Hyatt, ATC, Director of Athletic Training/Healthcare Coordinator

Approved by: ______Date: ______Robert Lineburg, Director of Athletics

92 Radford University Sports Medicine 2018 Emergency Management Protocols Responding to Sudden Cardiac Arrest (SCA)/AED Policies and Procedures

POLICIES

1. Policy Statement Sudden cardiac arrest (SCA) affects over 400,000 people annually in the United States, and is also the leading cause of death in young athletes. Healthy-appearing competitive athletes may harbor unsuspected cardiovascular disease with the potential to cause sudden death. Athletes are considered the healthiest members of our society, and an unexpected death during training or competition is a tragic event with wide-spread implications. Cardiopulmonary resuscitation (CPR) is critical to maintaining the supply of oxygen to vital organs, but the single most effective treatment for cardiac arrest is defibrillation. Access to early defibrillation and an automated external defibrillator (AED) should be part of standard emergency planning for coverage of athletic activities.

The American Heart Association uses four (4) links in a chain (the "Chain of Survival") to illustrate the important time-sensitive actions for victims of SCA.  Early recognition of the emergency and activation of the emergency medical services (EMS) or local emergency response system: "phone 911.  Early bystander CPR: immediate CPR can double or triple the victim’s chance of survival from VF SCA.  Early delivery of a shock with a defibrillator: CPR plus defibrillation within 3 to 5 minutes of collapse can produce survival rates as high as 49% to 75%.  Early advanced life support followed by post resuscitation care delivered by healthcare providers.

2. Recognition of SCA Recognition of SCA in athletes may be difficult due to the relatively low overall occurrence. High suspicion of SCA should be maintained for any collapsed and unresponsive athlete. Barriers to recognizing SCA in athletes may include inaccurate assessment of pulse or respirations, agonal gasping, and myoclonic or seizure-like activity.

PROTOCOL

1. Management of SCA CPR: Victims of cardiac arrest need immediate CPR. CPR provides a small but critical amount of blood flow to the heart and brain. CPR prolongs the time ventricular fibrillation (VF) is present and increases the likelihood that a shock will terminate VF (defibrillate the heart) and allow the heart to resume an effective rhythm and effective systemic perfusion. CPR is especially important if a shock is not delivered for 4 or more minutes after collapse. Defibrillation does not "restart" the heart; defibrillation "stuns" the heart, briefly stopping VF and other cardiac electrical activity. If the heart is still viable, its normal pacemakers may then resume firing and produce an effective ECG rhythm that may ultimately produce adequate blood flow.

93 Radford University Sports Medicine 2018 Emergency Management Protocols Responding to Sudden Cardiac Arrest (SCA)/AED Policies and Procedures

“Effective” chest compressions are essential for providing blood flow during CPR . To give "effective" chest compressions, "push hard and push fast." Compress the adult chest at a rate of about 100 compressions per minute, with a compression depth of 1 to 2 inches (approximately 4 to 5 cm). Allow the chest to recoil completely after each compression, and allow approximately equal compression and relaxation times. Minimize interruptions in chest compressions. Rescuer fatigue may lead to inadequate compression rates or depth. Significant fatigue and shallow compressions are seen after 1 minute of CPR, although rescuers may deny that fatigue is present for 5 minutes. When 2 or more rescuers are available, it is reasonable to switch the compressor about every 2 minutes (or after 5 cycles of compressions and ventilations at a ratio of 30:2). Every effort should be made to accomplish this switch in <5 seconds. If the 2 rescuers are positioned on either side of the patient, one rescuer will be ready and waiting to relieve the "working compressor" every 2 minutes.

AED: An AED should be applied as soon as possible and turned on for rhythm analysis in any collapsed and unresponsive athlete. CPR should be implemented while waiting for an AED if not immediately available. Interruptions in chest compressions should be minimized and CPR stopped only for rhythm analysis and shock. CPR should be reinitiated immediately after the first shock with repeat rhythm analysis following two minutes or five cycles of CPR.

Healthcare providers must practice efficient coordination between CPR and defibrillation. When VF is present for more than a few minutes, the myocardium is depleted of oxygen and metabolic substrates. A brief period of chest compressions can deliver oxygen and energy substrates, increasing the likelihood that a perfusing rhythm will return after defibrillation (elimination of VF). Analyses of VF waveform characteristics predictive of shock success have documented that the shorter the time between a chest compression and delivery of a shock, the more likely the shock will be successful. Reduction in the interval from compression to shock delivery by even a few seconds can increase the probability of shock success.

The rescuer providing chest compressions should minimize interruptions in chest compressions for rhythm analysis and shock delivery and should be prepared to resume CPR, beginning with chest compressions, as soon as a shock is delivered. When 2 rescuers are present, the rescuer operating the AED should be prepared to deliver a shock as soon as the compressor removes his or her hands from the victim’s chest and all rescuers are "clear" of contact with the victim. The lone rescuer should practice coordination of CPR with efficient AED operation.

2. Shock First Versus CPR First When any rescuer witnesses SCA and an AED is immediately available on-site, the rescuer should use the AED as soon as possible. When the SCA is not witnessed and/or the time interval from collapse to first shock is greater than 5 minutes, two minutes of CPR should be performed prior to defibrillation.

3. Advanced Airway Once an advanced airway(endotracheal tube or Combi-Tube) is in place, 2 rescuers no longer deliver cycles of CPR (ie, compressions interrupted by pauses for ventilation). Instead, the

94 Radford University Sports Medicine 2018 Emergency Management Protocols Responding to Sudden Cardiac Arrest (SCA)/AED Policies and Procedures compressing rescuer should give continuous chest compressions at a rate of 100 per minute without pauses for ventilation. The rescuer delivering ventilation provides 8 to 10 breaths per minute. The 2 rescuers should change compressor and ventilator roles approximately every 2 minutes to prevent compressor fatigue and deterioration in quality and rate of chest compressions. When multiple rescuers are present, they should rotate the compressor role about every 2 minutes.

4. Provisions to Coordinate with Local EMS In the event of a cardiopulmonary emergency, the 911 emergency system should be activated as quickly as possible. The first responders should provide initial care as appropriate to the situation and coordinate with other emergency medical service providers upon their arrival in the provision of CPR, defibrillation, basic life support, and advanced life support.

5. Operator Considerations The Radford University Sports Medicine program utilizes the Samaritan PAD AED unit. These AEDs are semi-automatic defibrillators that use an algorithm that analyzes the patient’s electrocardiographic (ECG) rhythm and indicates whether or not it detects a shockable rhythm. They require operator interaction in order to defibrillate the patient. AEDs are for use by trained personnel (first responders, coaches, certified athletic trainers, athletic training students, and team physicians) who are authorized by a physician/medical director and have, at a minimum, American Heart Association (or comparable) CPR and AED training.

6. Procedures for Training and Testing in the Use of AED Personnel using the AED must complete a training session each year to include instruction in:

 The proper use, maintenance, and periodic inspection of the AED  Defibrillator safety precautions to enable the user to administer a shock without jeopardizing the safety of the patient, the use or other individuals  Assessment of an unconscious person to determine if cardiac arrest has occurred and the appropriateness of applying an AED  Recognizing that an electrical shock has been delivered to the patient and that the defibrillator is no longer charged  Rapid, accurate assessment of the patient’s post-shock status to determine if further activation of the AED is necessary  The operations of the local emergency medical services system, including methods of access to the emergency response system, and interaction with emergency medical services personnel  The role of the user and coordination with other emergency medical service providers in the provision of CPR, defibrillation, basic life support, and advanced life support  The responsibility of the user to continue care until the arrival of medically qualified personnel

95 Radford University Sports Medicine 2018 Emergency Management Protocols Responding to Sudden Cardiac Arrest (SCA)/AED Policies and Procedures

7. Procedures to Ensure the Continued Competency Required for AED Use Sports medicine personnel using the AED should complete a review session annually using the AED training device and/or the AED computer simulation software to ensure continued competency in the use of the device. A record will be maintained documenting medical staff competency training on the AED.

8. Medical Control Reporting and Incident Review A report detailing the emergency scene and treatment will be documented in writing by the responding medical professionals along with the Director of Athletic Training and the Medical Director.

9. Location of and Maintenance Required for AEDs The Radford University Sports Medicine program has nine (9) AED units. They are located at:

1. 2nd Floor of Dedmon Center (hallway b/t ATR and WR) 2. Dedmon Arena (Cupp Stadium Entrance) 3. Dedmon Arena Weight Room (Permanent Unit) 4. Dedmon Center Indoor Track (Administrative Entrance) 5. Cupp Athletic Training Room 1 (float unit) 6. Cupp Athletic Training Room 2 (float unit) 7. Cupp Athletic Training Room 3 (float unit) 8. Cupp Stadium Locker Room Entrance (Seasonal unit) 9. Baseball/Softball Control Building (Seasonal unit) 10. Baseball Home Dugout (Seasonal unit) 11. Indoor Hitting Facility (Permanent Unit)

The AED’s have a green indicator light that flashes so long as the battery is at full capacity and capable of delivering a shock. They are equipped with packaged non-rechargeable batteries and adult pads with a 3-year lifespan. Personnel using the AED on a regular basis and after each time the AED is used should inspect and clean the AED and check to make sure that all necessary supplies and accessories are readily available. A monthly check will be performed on the units to ensure readiness for shock and that all necessary equipment is present (CPR facemask, gloves and disposable razor. The maintenance log is kept in the Director of Athletic Training’s office.

Appendix A: AED Treatment Algorithm

Approved by: ______Date: ______Delmas Bolin, M.D.

96 Radford University Sports Medicine 2018 Emergency Management Protocols Responding to Sudden Cardiac Arrest (SCA)/AED Policies and Procedures

References 1. Andersen J, Courson RW, Kleiner DM, McLoda TA. National Athletic Trainers' Association Position Statement: Emergency Planning in Athletics. J Athl Train 2002;37(1):99-104. 2. Hazinski MF, Markenson D, Neish S, et al. Response to cardiac arrest and selected life-threatening medical emergencies: the medical emergency response plan for schools: A statement for healthcare providers, policymakers, school administrators, and community leaders. Circulation 2004;109(2):278-91. 3. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005;112(24 Suppl):IV1-203. Part 4: Adult Basic Life Support. Circulation 2005;112(24_suppl):IV19-IV34. Part 5: Electrical Therapies: Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing. Circulation 2005;112(24_suppl):IV35-IV46.

97 Radford University Sports Medicine 2018 Emergency Management Protocols Responding to Sudden Cardiac Arrest (SCA)/AED Policies and Procedures

Appendix A: AHA AED Treatment Algorithm

98 Radford University Sports Medicine 2018 Emergency Management Protocols Anaphlaxis/Epi-pen Policy

POLICIES

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

The Radford University Sports Medicine staff utilizes the Epi-Pen Auto-Injector, a disposable delivery system for self-administration. The Epi-Pen has a spring activated needle that is designed to deliver a single precise dose (0.3 mg of 1:1000 solution) of epinephrine to adults when activated. The Epi-Pen Jr. has a spring-activated needle that is designed to deliver a single precise dose (0.15 mg. of 1:1000 solution) of epinephrine to infants/children under 8 years old when activated. It may be necessary in very severe reactions to administer a second dose after five minutes if initial response is inadequate.

PROCEDURES

1. Emergency Care for Anaphylaxis and/or Severe Asthma with Epi-Pen The Sports Medicine staff should: • call for EMS (if not on-site or in-route) • maintain a patent airway • suction any secretions • administer oxygen therapy at 15 liters/minute with non-rebreather device • be prepared to assist ventilation with positive pressure ventilation with bag-valve-mask • administer epinephrine by a prescribed auto-injector • initiate early emergency transport

2. Indications/Contraindications for Epinephrine Administration Epinephrine should be administered if the patient exhibits signs and symptoms of a severe allergic reaction (anaphylaxis), including respiratory distress and/or shock (hypoperfusion) or severe asthma. Patients who have progressed to severe asthma experience a combination of the following: shortness of breath (>30 respirations/min.), mental status changes (anxious, confused, combative, drowsy), inability to speak in sentences, sweaty and unable to lie down. There are no contraindications for the administration of epinephrine in a life-threatening allergic reaction or severe asthma; however, precautions should be taken with elderly patients or patients with heart disease or hypertension.

3. Administration of Epinephrine • Check the Epi-Pen to ensure the medication has not expired, has not become discolored, and

99 Radford University Sports Medicine 2017 Emergency Management Protocols Anaphlaxis/Epi-pen Policy

does not contain particulates or sediments. • Prep skin site with alcohol • Remove the gray safety cap from the auto-injector • Place the tip of the auto-injector against the lateral aspect of the patient’s thigh midway between the waist and knee • Push the injector firmly against the thigh until the spring-loaded needle is deployed and the medication is injected (at least 10 seconds) • Dispose of the auto-injector in a biohazard container designed for sharp objects. Be careful not to prick yourself since the needle will now be protruding from the end of the injector • Record that epinephrine was administered, the dose, and the time of administration

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

5. Reassessment Following the administration of epinephrine, it is necessary to reassess the patient. Reassessment should include continued evaluation of airway, breathing and circulatory status. Decreasing mental status, decreasing blood pressure and increasing difficulty in breathing indicate the allergic reaction or severe asthma is worsening. If the condition is worsening, consider the following interventions: injection of second dose of epinephrine if second autoinjector is available, provide emergency care for shock, be prepared to administer positive pressure ventilation with supplemental oxygen if breathing becomes inadequate, and be prepared to initiate CPR and apply AED if patient becomes pulseless. If the patient’s condition improves following administration of epinephrine, continue to perform ongoing assessments. Be aware patient may complain of side effects from the epinephrine. Conscious patients may also be administered 50 mg. diphenhydramine orally or sublingually for antihistamine effects. Continue oxygen therapy with a nonrebreather device and treat for shock if necessary. Any patient requiring epinephrine administration should be transported to the closest available medical facility for follow-up evaluation and treatment as soon as possible. Remember that epinephrine is short-acting (10-20 minutes) and signs and symptoms may return as drug wears off.

6. Procedures for Training and Testing in Use of Epi-Pen Auto-Injector Personnel should complete a training session each year with review of signs and symptoms and emergency medical care for allergic reaction, anaphylaxis, anaphylactic shock, and severe asthma. Personnel should complete a training session each year with instruction in the proper use and maintenance of the Epi-Pen and practice with the Epi-Pen Trainer.

Approved by: ______Medical Director Date: ______Delmas Bolin, M.D.

100 101 102 Radford University Sports Medicine 2018 Emergency Management Protocols Asthma Management Protocol

POLICIES

1. Asthma Introduction Although the exact causes of asthma are unknown, several factors, including exercise, may induce an asthma attack. The majority of patients with asthma and patients with allergies will have exercise-induced bronchospasm (EIB). EIB usually occurs during or minutes after vigorous activity, reaches its peak 5-10 minutes after stopping the activity, and usually resolves in another 20-30 minutes.

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

Quick relief medications are used to treat asthma symptoms or an asthma episode. The most common quick relief medications are the short-acting beta-agonists that relieve asthma symptoms by relaxing the smooth muscles around the airways. Common beta-agonists include Proventil and Ventolin (albuterol), Maxair (pirbuterol), and Alupent (metaproterenol). Atrovent (ipatroprium), an anticholinergic, is a quick relief medication that opens the airways by blocking reflexes through nerves that control the smooth muscle around the airways. Steroid pills and syrups, such as Deltasone (prednisone), Medrol (methylprednisolone), and Prelone or Pediapred (prednisolone) are very effective at reducing swelling and mucus production in the airways; however, these medications take 48-72 hours to take effect.

Long-term control medications are used daily to maintain control of asthma and prevent asthma symptoms. Intal (cromolyn sodium) and Tilade (nedocromil) are long-term control medications which help prevent swelling in the airways. Inhaled steroids are also long-term control medications. In addition to preventing swelling, they also reduce swelling inside the airways and may decrease mucus production. Common inhaled steroids include Vanceril, Vanceril DS, Beclovent, and Beclovent DS (beclomethasone), Azmacort (triamcinolone), Aerobid (flunisolide), Flovent (fluticasone) and Pulmicort (budesonide). Leukotriene modifiers are new long-term control medications. They may reduce swelling inside the airways and relax smooth muscles around the airways. Common leukotriene modifiers include Accolate (zafirlukast), Zyflo (zileuton) and Singulair (monteleukast). Another long-term control medication, Theophylline, relaxes the smooth muscle around the airways. Common theophyllines in oral form include Theo-Dur, Slo-Bid, Uniphyl and UniDur. Serevent (salmeterol), in inhaler form, is also a long-term control medication. As a long-acting betaantagonist, it opens the airways in the lungs by relaxing smooth muscle around the airways.

103 Radford University Sports Medicine 2018 Emergency Management Protocols Asthma Management Protocol

3. Inhaled Medications Inhaled medications are delivered directly to the airways, which is useful for lung disease. Aerosol devices for inhaled medications may include the metered-dose inhaler (MDI), MDI with spacer, breath activated MDI, dry powder inhaler or nebulizer. The most commonly used inhaled medications are delivered by the MDI, with or without the spacer. There are few side-effects because the medicine goes right to the lungs and not to other parts of the body.

It is critical that the patient use the prescribed MDI correctly to get the full dosage and benefit from the medication. Unless the inhaler is used in the right manner much of the medicine may end up on the patient’s tongue, the back of their throat, or in the air. Use of a spacer or holding chamber helps significantly with this problem and their use is strongly recommended. A spacer is a device that attaches to a MDI and holds the medication in its chamber long enough for the patient to inhale it in one or two slow deep breaths. This eliminates the possibility of inadequate medicine delivery from poor patient technique.

PROTOCOL 1. Using the MDI The RU Sports Medicine staff may assist a student-athlete in the use of a prescribed MDI as follows: • Remove the cap from MDI and hold the inhaler upright • Shake the inhaler • Tilt patient head back slightly and have patient breathe out • Open mouth with inhaler 1-2 inches away (or mouth to spacer mouthpiece if spacer available) • Press down on the inhaler to release the medication as patient starts to breathe in slowly • Patient breathes in slowly for 3-5 seconds • Patient holds breath for 10 seconds to allow the medication to reach deeply into the lungs • Repeat puffs as prescribed; waiting 1 minute between puffs may permit the 2nd puff to go deeper into the lungs If possible, ausculate breath sounds and measure peak expiratory flow rate (PEFR) prior to and after MDI administration.

104 Radford University Sports Medicine 2018 Emergency Management Protocols Asthma Management Protocol

2. Basic Life Support Treatment for Severe Asthma Patients who have progressed to severe asthma experience a combination of the following: shortness of breath (>30 respirations/min.), mental status changes (anxious, confused, combative, drowsy), inability to speak in sentences, sweaty and unable to lie down. If the patient is not responding to or is unable to properly use their MDI, the sports medicine staff should:

• call for EMS (if not on-site or in-route) • maintain a patent airway • suction any secretions • administer oxygen therapy at 15 liters/minute with non-rebreather device • be prepared to assist ventilation with positive pressure ventilation with bag-valve-mask • administer epinephrine by a prescribed auto-injector (refer to Epi-Pen Policies and Procedures) • initiate early emergency transport

3. Procedures for Training and Testing in Use of MDI Personnel should complete a training session each year with review of signs and symptoms of asthma and instruction in the proper use of MDI with and without spacer.

Approved by: ______Medical Director Date: ______Delmas Bolin, M.D.

105 Radford University Sports Medicine 2018 Emergency Management Protocols Emergency Oxygen Airway Protocol

POLICIES

1. Introduction In any patient care situation, the first responder must immediately establish and maintain a patent airway. Various procedures and devices are available to assist in this all-important step. Once the airway is established, the first responder must determine whether the patient is breathing. If breathing is adequate, one must provide continued maintenance of the airway and administer supplemental oxygen. If breathing is inadequate, or absent, artificial respiration should be initiated.

PROCEDURES

1. Basic Airway Management and Oxygen Administration In the absence of trauma, the preferred technique for opening the airway is the head- tilt/chin-lift maneuver. With suspected trauma and/or an unconscious patient, the modified jaw thrust technique should be utilized to open the airway. In the unconscious patient without an intact gag reflex, an oropharyngeal (OP) airway may be inserted into the mouth to lift the base of the tongue forward. A properly sized OP airway will extend from the patient’s mouth to the angle of the jaw or the earlobe. The nasopharayngeal airway may be inserted into the patient’s nostril to relieve soft- tissue upper airway obstruction in cases where use of an OP airway is not advised (presence of gag reflex, injury to oral cavity, patient’s teeth clenched). A properly sized nasopharyngeal airway is slightly smaller than the diameter of the patient’s nostril and is equal to or slightly longer than the distance from the patient’s nose to earlobe. The nasopharyngeal airway should be lubricated with a water-soluble gel and inserted into the right nostril.

In the field, an airway may be compromised by a number of elements. Suctioning will remove vomitus, blood, and other fluids and secretions from the airway. The Radford University Sports Medicine oxygen kits are outfitted with a manual suction device. Since suctioning reduces a patient’s access to oxygen, each attempt should be limited to ten-fifteen seconds. If possible, hyperventilate the patient with oxygen prior to and following each suctioning effort.

The Radford University oxygen kits are outfitted with supplemental oxygen, bag valve mask (BVM), and non-rebreather masks. Trauma patients should be supplied oxygen at 15 liters per minute through a non-rebreather mask. Patients in respiratory distress or arrest should be given positive-pressure ventilation with a BVM with 100 percent oxygen at 15 liters per minute. If available, utilize continuous cardiac monitoring and O2 sat with pulse oximetry with all airway emergencies.

106 Radford University Sports Medicine 2018 Emergency Management Protocols Emergency Oxygen Airway Protocol

2. Procedures for Training and Testing in Use of Emergency Airway Management and Oxygen Therapy

Personnel should complete a training session each year, to include instruction in the proper use, maintenance, and periodic inspection of airway and oxygen equipment.

Approved by: ______Medical Director Date: ______Delmas Bolin, M.D.

107 Radford University Sports Medicine 2018 Emergency Management Protocols Exertional Heat Illness Protocol

POLICIES

1. Recognition of Heat Stroke The ability to rapidly and accurately assess core body temperature and CNS functioning is critical to the proper evaluation of exertional heat stroke. Medical staff should be properly trained and equipped to assess core temperature via rectal thermometer when feasible.

Most critical criteria for determination are 1) hyperthermic (rectal temperature > 104F) immediately post-incident and 2) CNS dysfunction (altered consciousness, coma, convulsions, disorientation, irrational behavior, decreased mental acuity, irritability, emotional instability, confusion, hysteria, apathy).

Other possible salient findings include nausea, vomiting, diarrhea, headache, dizziness, weakness, hot and wet or dry skin (important to note that skin may be wet or dry at time of incident), increased heart rate, decreased blood pressure, increased respiratory rate, dehydration, and combativeness.

Aggressive and immediate whole-body cooling is the key to optimizing treatment of exertional heat stroke. The duration and degree of hyperthermia may determine adverse outcomes. If untreated, hyperthermia-induced physiologic changes resulting in fatal consequences may occur within vital organ systems (e.g., muscle, heart, brain, etc.).

PROCEDURES

1. Emergency Treatment of Heat Stroke

Immediate whole-body cooling is the best treatment for exertional heat stroke and should be initiated within minutes post-incident. It is recommended to cool first and transport second if onsite rapid cooling is possible. Cooling can be successfully verified by measuring rectal temperature. If onsite cooling is not an option, the athlete should be immediately transferred to the nearest medical facility.

The following procedures are recommended if exertional heat stroke is suspected: 1) Activate EMS and prepare hospital for a heat emergency 2) remove clothing and equipment 3) move athlete immediately to air-conditioned facility or shaded area if possible 4) cool athlete immediately by: • immerse athlete in tub of cold water*; stir water and, if necessary, add ice throughout cooling process or • place ice bags, or ice over as much of body as possible, cover body with cold towels (replace towels frequently), fan body or spray with cold water

108 Radford University Sports Medicine 2018 Emergency Management Protocols Exertional Heat Illness Protocol

4) monitor ABCs, core temperature, and CNS (cognitive, convulsions, orientation,consciousness, etc.) 5) place an intravenous line using normal saline (if appropriate medical staff available) 6) cease aggressive cooling when core temperature goes below 102 F (15 minutes of cooling if rectal temp is not available; continue to monitor 7) transport athlete to nearest emergency medical facility

* Ice/cold water immersion has proven to have superior cooling rates to other modes. However, oftentimes with heat stroke the athlete is unresponsive. This may complicate airway management and other emergency interventions if the athlete is immersed in water. The medical staff should make the decision on the most feasible mode of cooling based upon athlete’s physical presentation. Choice of cooling modes may also be dependent on other factors, such as size limitations, availability of cooling options and maintaining safety of athlete.

2. Recognition of Heat Exhaustion Most critical criteria for determination are 1) athlete has obvious difficulty continuing intense exercise in heat, 2) lack of severe hyperthermia (usually < 104F) and 3) lack of severe CNS dysfunction. If any CNS dysfunction is present, it will be mild and symptoms will subside quickly with treatment and as activity is discontinued.

Other possible salient findings include physical fatigue/dizziness, dehydration and/or electrolyte depletion, ataxia and coordination problems, syncope, profuse sweating, pallor, headache, nausea, vomiting, diarrhea, stomach/intestinal cramps, persistent muscle cramps, and rapid recovery with treatment.

109 Radford University Sports Medicine 2018 Emergency Management Protocols Exertional Heat Illness Protocol

3. Emergency Treatment of Heat Exhaustion The following procedures are recommended if heat exhaustion is suspected: 1) remove athlete from play and immediately move to an air-conditioned or shaded area 2) remove excess clothing and equipment 3) cool athlete 4) have athlete lie comfortably with legs propped above heart level 5) if athlete is not nauseated, vomiting, or experiencing any CNS dysfunction, rehydrate orally with chilled electrolyte drink or water. If athlete is unable to take oral fluids, implement intravenous line using normal saline (if appropriate medical staff is available). 6) Monitor heart rate, blood pressure, respiratory, core temperature, and CNS status 7) Transport to nearest emergency medical facility if rapid improvement is not noted with prescribed treatment.

Approved by: ______Medical Director Date: ______Delmas Bolin, M.D.

110 Radford University Sports Medicine 2018 Emergency Management Protocols Orthopedic Emergency Protocol

POLICIES

1. Initial Evaluation

The primary goals of the initial orthopedic evaluation are to 1) determine whether or not a true orthopedic emergency is present, 2) begin appropriate treatment, and 3) determine the mode of transport for emergencies or routine extremity trauma.

Evaluation of neurovascular status is the first step in the initial evaluation. Distal pulse, motor, sensation, and capillary refill (PMSC) should be assessed with any deficiencies and/or changes noted. Visual inspection for deformity and palpation for deformity and point tenderness should be performed, followed by evaluation for gross joint instability. Clinical tests for suspected long bone fractures such as torque, compression and percussion may be utilized as appropriate by the athletic trainer. Application of Initial Evaluation splints for fracture or gross joint instability is the final step prior to transport. If splints are applied to an extremity injury, PMSC should be evaluated both before and after placement of splints.

* Never allow in obvious orthopedic injury to distract from an underlying injury or illness which may be life-threatening.

PROCEDURES

1. Orthopedic Emergencies

The increased incidence of bleeding, neurovascular compromise, and treatment complications resulting from infection classify open fractures and/or dislocations as a true orthopedic emergency. Open fractures and dislocations should have a sterile, moist compressive dressing applied as rapidly as possible. The dressing should be soaked in Betadine and applied to the open wound. If Betadine is not available, saline solution should be used. As with any open wound, direct pressure should be used to control major bleeding. If direct pressure does not stanch the flow of blood, arterial pressure points should be used. Tourniquets should not be applied to control bleeding. Treatment should then be identical to that of a closed fracture with immediate transport to the closest appropriate emergency facility by ambulance.

The athletic trainer must also be aware of internal hemorrhage. Occult hemorrhage into the pelvis or femur fracture can account for significant blood loss.

Large joint dislocations (shoulder, elbow, hip, knee and ankle) constitute an orthopedic emergency. Special attention should be given to knee and elbow dislocations as well as dislocations of the sternoclavicular joint. These most commonly result in neurovascular complications, necessitating emergency management.

111 Radford University Sports Medicine 2018 Emergency Management Protocols Orthopedic Emergency Protocol

Delay in treatment of fractures and dislocations with neurovascular compromise may lead to disastrous consequences including loss of limb and even death. Immediate reduction or realignment by a physician should be performed. If a physician or an emergency facility is not readily available, the athletic trainer may attempt these maneuvers to restore circulation as a part of emergency medical care in a potentially life- or limb-threatening situation. This procedure may be performed by athletic training staff who:

1. are emergency medical technician-intermediates (EMT-I) and have large joint dislocation reduction training;

2. who have verbal orders from the team physician or physician assistant in regards to joint reduction after consulting regarding patient’s current signs and symptoms and medical history. If, however, in the clinical opinion of the ATC/EMT-I, the athlete is in a life-or limb-threatening situation that would benefit from joint reduction and a MD verbal order is not immediately available then the ATC/EMT-I should call 911 and may attempt to reduce the dislocation. If unable to reduce, the athletic trainer should immobilize the joint in the position found, continue to monitor PMSC, and immediate transport to the closest appropriate emergency facility by ambulance.

Any emergency situations where there is neurovascular compromise should be considered a “load and go” situation and emphasis placed on rapid evaluation, treatment and transportation. In order to provide the best possible care for Radford University Athletics, transportation to one of the utilized medical facilities is based upon the strengths of each facility.

2. Splinting of Orthopedic Injuries

Splints are used to decrease pain, increase ease of transportation, to prevent closed fracture from becoming open, to minimize damage to nerves, muscles and blood vessels, and to prevent movement at fracture sites or in the presence of gross instability. The basic rule of splinting is to splint in the position of function. With experience or in the presence of a physician, limb realignment before the application of a splint is acceptable. There are three basic types of splint: 1) rigid, 2) vacuum, and 3) traction. Rigid splints are useful with non-aligned fractures or in the presence of gross instabilities of joints. Vacuum splints consist of a fabric or vinyl splint containing small styrofoam beads. The splint is placed on the extremity and secured with straps. A pump is attached and the air is drawn from the splint, compressing the beads together and creating a hard splint conformed to the extremity. Vacuum splints are versatile because of their adaptability to the position of the injured extremity. Traction splints are most frequently used to treat lower extremity femoral fractures. They exert a steady longitudinal pull on the extremity. Traction splints are not suitable for the upper extremity because of potential damage to neurovascular structures in the axilla.

112 Radford University Sports Medicine 2018 Emergency Management Protocols Orthopedic Emergency Protocol

Splinting Guidelines

General rules to follow during the application of a splint include:

• Splinting is useful in emergency situations, for decreased pain, and to allow for easier transport. • Deformity, gross instability, or crepitus is an indication for immediate splinting, and prompt referral of an unstable joint to an orthopedic surgeon is necessary. • Assess neurovascular status (PMSC) prior to and after the application of a splint; • Cover all wounds with sterile compressive dressings prior to the application of a splint; • Pad the splint to prevent local pressure; • Immobilization of the joint above and below a fracture or dislocation will decrease movement at the injury site; • Splinting can be performed in the position of deformity but with experience limb alignment may be helpful • “When in doubt, splint”.

3. Procedures for Training in Orthopedic Evaluation and Splinting/Immobilization:

Personnel should complete a training session each year with review of signs and symptoms of orthopedic injury, evaluation techniques, and splinting/immobilization applications.

Approved by ______Medical Director Date: ______Delmas Bolin, M.D.

Approved by ______Orthopedic Surgeon Date: ______Chris Catterson, M.D.

113 Radford University Sports Medicine 2018 Policies and Procedures Sickle Cell Screening and Policies

POLICIES

1. Background Sickle Cell Trait (SCT) is the inheritance of an abnormal gene which can cause deformation (“sickling”) of the red blood cells. Approximately one in every 12 African- Americans has sickle cell trait (compared to ~ one in 2,000 to 12,000 white Americans). The gene for sickle cell trait is also present in individuals of Mediterranean, Middle Eastern, Indian, Caribbean and South / Central American ancestry. All newborns in the US are required to be screened for sickle cell.

SCT has been associated with exertional rhabdomyolysis, renal failure, as well as death and complicating factors include extreme exertion, increased heat, altitude & dehydration. Over a seven year span, nine athletes participating in NCAA sports died as a complication of sickle cell trait. It is because of this that the NCAA now mandates testing or proof of testing prior to any practice, competition or conditioning.

2. Legislation Effective as of the 2010-2011 academic year, all athletes participating in NCAA Division I sports must have sickle cell testing performed, show proof of sickle cell testing or sign a waiver demonstrating that they understand the importance of testing for sickle cell, decline testing and thereby release their institution from any liability related to declining testing. In accordance with this legislation, the Radford University Sports Medicine Department is mandating that all student-athletes be tested for sickle cell trait, show proof of a prior test or sign a waiver releasing Radford University, its officers, employees and agents from any and all costs, liability, expense claims, demands or causes of action on account of any loss or personal injury that might result from non-compliance with the mandate of the NCAA and the Radford University Sports Medicine Department.

PROCEDURES

1. Sickle Cell Screening (NCAA mandated) All athletes will be screened for hemoglobin S with the sickledex test, and positive results confirmed with hemoglobin electrophoresis. Any positive results will be managed with the following steps. A. Communication The athlete’s sickle cell status will be communicated to all relevant parties: •The athlete •Parent/guardian if athlete a minor or if athlete desires them notified •Entire staff of Certified Athletic Trainers and Athletic Training Students •Strength and Conditioning Staff •Team physicians •Coaches (required to watch NCAA Sickle Cell Education Video)

114 Radford University Sports Medicine 2018 Policies and Procedures Sickle Cell Screening and Policies

B. Counseling The athlete will have a counseling session with the team physician regarding the implications of his/her sickle cell status. The student-athlete will also be required to watch the NCAA Sickle Cell Educational Video.

C. There is no contraindication to participation in sport for the athlete with sickle cell trait.

D. Appropriate precautions for athletes with sickle cell trait will require a combined effort involving the athlete, coaches, strength staff and sports medicine staff.

2. Signs and Symptoms of Sickle Cell • Fatigue • Abdominal pain • Leg or low back muscle cramping • Fever • Leg or low back pain and weakness • Rapid heartbeat • Difficulty breathing • Chest pain • Dizziness • Excessive thirst • Nausea • Frequent urination • Soft, flaccid muscle tone • Immediate symptoms with no early warning signs • Collapse early in exercise

3. Precautions to be Taken for Athletes with Sickle Cell Trait A. Build up slowly in training with paced progressions, allowing longer periods of rest and recovery between repetitions. B. Encourage participation in preseason strength and conditioning programs to enhance the preparedness of athletes for performance testing which should be sports-specific. Athletes with sickle cell trait should be excluded from participation in performance tests such as mile runs, serial sprints, etc., as several deaths have occurred from participation in this setting. C. Cessation of activity with onset of symptoms [muscle ‘cramping’, pain, swelling, weakness, tenderness; inability to "catch breath", fatigue]. D. If sickle-trait athletes can set their own pace, they seem to do fine. E. All athletes should participate in a year-round, periodized strength and conditioning program that is consistent with individual needs, goals, abilities and sport-specific demands. Athletes with sickle cell trait who perform repetitive high speed sprints and/or interval training that induces high levels of lactic acid should be allowed extended recovery between repetitions since this type of conditioning poses special risk to these athletes. Beginning of the year conditioning tests for athletes with SCT will be delayed for a period of 7 days (minimum) while the athlete has time to acclimate. F. Ambient heat stress, dehydration, asthma, illness, and altitude predispose the athlete with sickle trait to an onset of crisis in physical exertion.

115 Radford University Sports Medicine 2018 Policies and Procedures Sickle Cell Screening and Policies

•Adjust work/rest cycles for environmental heat stress •Emphasize hydration •Control asthma •No workout if an athlete with sickle trait is ill •Watch closely the athlete with sickle cell trait who is new to altitude. Modify training and have supplemental oxygen available for competitions

G. Educate to create an environment that encourages athletes with sickle cell trait to report any symptoms immediately; any signs or symptoms such as fatigue, difficulty breathing, leg or low back pain, or leg or low back cramping in an athlete with sickle cell trait should be assumed to be sickling.

4. Emergency Medical Care of an Athlete with Sickle Cell Trait 1- Check vital signs. 2- Administer high-flow oxygen, 12-15 lpm (if available), with a non-rebreather face mask. 3- Cool the athlete, if necessary. 4- If the athlete is obtunded or as vital signs decline, call 911, attach an AED, start an IV (physician or EMS required), and get the athlete to the hospital fast. 5- Tell the EMS and doctors to expect explosive rhabdomyolysis and grave metabolic complications. 6- Proactively prepare by having an Emergency Action Plan and appropriate emergency equipment for all practices and competitions.

References: 1. NATA Consensus Statement: Sickle Cell Trait and the Athlete. 2007. 2. Athletic Training’s Sickle Cell Policy

Approved by: ______Date: ______Delmas Bolin, M.D.

116

Radford University Sports Medicine Sickle Cell Testing and Education Acknowledgement Form

About Sickle Cell Trait: . Sickle cell trait is an inherited condition of the oxygen-carrying protein, hemoglobin, in the red blood cells. . Approximately one in every 12 African-Americans has sickle cell trait (compared to approximately one in 2,000 to 12,000 white Americans). . The gene for sickle cell trait is also present in individuals of Mediterranean, Middle Eastern, Indian, Caribbean and South / Central American ancestry. . SCT is usually benign, but during intense, sustained exercise, hypoxia (lack of oxygen) in the muscles may cause sickling of red blood cells (red blood cells changing from a normal disc shape to a “sickle” shape), which can accumulate in the bloodstream and “logjam” vessels, leading to collapse from the rapid breakdown of muscles starved of blood and oxygen. . Over a seven year span, nine athletes participating in NCAA sports died as a complication of sickle cell trait.

Sickle Cell Trait Screening: . The NCAA mandates that all NCAA student-athletes have knowledge of their sickle cell trait status before the student-athlete participates in any intercollegiate athletics event, including strength and conditioning sessions, practices, competitions, etc. . All newborns in the US are required to be screened for sickle cell and those records are kept on file. . The Radford University Sports Medicine Department offers sickle cell trait screening in the form of a blood test to all student-athletes as part of the pre-participation examination process, however, please see the following statement. . FALL SPORTS: It is required that new student-athletes participating in the fall sports of volleyball, soccer and cross country complete the steps to confirm their sickle cell trait status before reporting to campus in August to avoid delays in clearance for participation due to the turnaround time of the testing (minimum of 24 hours).

Printed Name of Student Athlete______Sport ______SSN (last 4 digits) ______

_____ I have been tested prior to arriving at Radford University and have provided the necessary documentation to satisfy the NCAA regulations (please attach the lab report). Test Date _____/_____/_____ Result ______

_____ I have been tested for sickle cell trait and I am awaiting the results from my physician (to be returned at a later date).

_____ I agree to screening for sickle cell trait upon arrival at Radford University. Test Date _____/_____/_____ Result ______

SICKLE CELL TRAIT ACKNOWLEDGEMENT: Please read thoughtfully and carefully before signing.

_____ I understand and acknowledge that the NCAA and the Radford University Athletic Department mandate that all student-athletes have knowledge of their sickle cell trait status. Additionally, I have read and fully understand the aforementioned facts about sickle cell trait and sickle cell trait testing. I have had all questions that I may have regarding sickle cell trait and disease answered to my satisfaction.

Student Athlete Signature ______Date ______

Parent/Guardian Signature (if SA is under 18) ______Date ______

Witness ______Date ______

117

Radford University Sports Medicine Sickle Cell Testing and Education Acknowledgement Form

Radford University Student-Athlete Options for Obtaining Sickle Cell Status

1) Obtain the results of your Newborn Infant Screening (Easiest way to confirm your sickle cell status) *Recommended first option for all student-athletes Contact your pediatrician or hospital where you were born to obtain the results of your newborn infant screening. Ensure with your physician that your sickle cell status can be confirmed with the results of the screening. Attach a copy of the screening results to this document to return with your information packet. This is the easiest way to determine your sickle cell status and does not require any additional blood work, unless it is determined that you have sickle cell trait. If it is determined that you have the trait, then you should have additional blood work completed to confirm whether you are simply a carrier of the trait or if you have sickle cell anemia (your physician can help you obtain this blood work).

2) Have your testing completed at the Student Health Center while you are on campus for Quest (Orientation) *Recommended for all other SA’s that cannot obtain newborn screen

You may obtain sickle cell screening through our student health center when you are on campus for orientation. Simply take the form provided in this packet to the health center and the staff will perform the blood draw and fax the results of the testing to our team physician. You will be notified if you have a confirmatory test for sickle cell trait. The cost of the testing is less than $10.

3) Request a “Sickle Dex” from your Physician *Recommended for SA’s that cannot obtain their Newborn Screen or be tested during Quest.

Radford University will not be responsible for the cost of the testing. If you choose this option, see if there is a cash price for the test.

Please have your physician’s office notify you when your results are back and request a copy of them so that you can return them with your packet or bring them with you when you report to campus. Please notify your Athletic Trainer if your results are not returned with your packet.

118

Radford University Sports Medicine Student Athlete Acknowledgement of Sickle Cell Trait Education

This is to certify that I, ______, RUID#______, DOB ______was already aware of the fact or that I have been notified by the sports medicine staff of Radford University that I am a carrier of the Sickle Cell Trait.

I understand the following (please initial next to each statement):

_____ I am a carrier of the sickle cell trait _____ Sickle cell trait is not a disease. Sickle cell trait is the inheritance of one gene for sickle hemoglobin and one for normal hemoglobin. Sickle cell trait will not turn into the disease. _____ Sickle red cells may accumulate in the bloodstream during intense exercise, blocking normal blood flow to the tissues and muscles. _____ During intense exercise, athletes with sickle cell trait have experienced significant physical distress, collapsed and even died. _____ Heat, dehydration, altitude and asthma can increase the risk for and worsen complications associated with sickle cell trait, even when exercise is not intense.

_____ Furthermore, I understand that if I ever experience any symptoms such as muscle pain, abnormal weakness, undue fatigue or breathlessness, or any type of unusual physical distress that I will report them immediately to my coaches, strength staff and/or sports medicine staff.

I also acknowledge the following (please initial next to each statement):

_____ The sports medicine staff at Radford University has gone over proper precautions regarding my safe participation with sickle cell trait. _____ I have watched the NCAA Student Athlete with Sickle Cell Trait Video _____ I have been counseled by a Radford University team physician about safe participation with sickle cell trait _____ All questions that I have regarding my safe participation and any other questions about sickle cell trait have been answered to my satisfaction.

Furthermore, I understand that in an effort to make my participation in intercollegiate athletics as safe as possible and in an effort to prevent any unnecessary physical distress or sickling episodes on my behalf, the sports medicine staff of Radford University needs to disclose my sickle cell status and I hereby grant them permission disclose this information to the following (please initial next to each group):

_____ My parents/guardian ____ My teammates _____ My coaching staff _____ The strength and conditioning staff of Radford University _____ All members of the sports medicine staff of Radford University

Signed:______Date: ______Witness:______

Radford University Sports Medicine P.O. Box 6913 Radford, VA 24142 540-831-5877 p 540-831-6114 f

119 Name: ______Sport: ______Radford University Student Athlete Acknowledgement of Sickle Cell Trait Education Test

1. Which of the following is a symptom that may be experienced by a student athlete with sickle cell trait? a. Muscle pain b. Abnormal weakness c. Undue fatigue d. Breathlessness e. All of the above

2. What should you do if you experience any sickling symptoms? a. Ignore the symptoms and tough it out b. Tell your athletic trainer but ask him/her not to tell the coaches c. Slow down but keep running/playing d. Stop activities and tell your athletic trainer and coaches to get immediate care e. None of the above

3. There are some factors that can increase the risk for and worsen complications associated with sickle cell trait. Which of the following is not one of those factors? a. Heat b. Early morning workout c. Dehydration d. High altitude e. Asthma

4. True or false. Sickle cell trait can eventually turn into sickle cell disease. a. True b. False

5. True or false. There have been no sickle cell trait related sudden deaths reported among intercollegiate athletics? a. True b. False

______Student Athlete Signature Date

______Staff Athletic Trainer Date

120 A Fact Sheet for COACHES SICKLE CELL TRAIT

Do you know the facts? u Student-athletes with sickle cell trait should not be excluded from athletics participation. u The NCAA recommends that athletics departments confirm the sickle cell trait status in all student- athletes. u Between 2000-09, a reported seven football student-athletes with sickle cell trait died during conditioning activities. Other causes of sudden death include cardiovascular conditions, heat illness and respiratory distress (asthma). u Complications associated with sickle cell trait are not limited to football. Other levels of competitive sports What is Sickle cell trait is not a disease. Sickle have documented cases in distance sickle cell trait is the inheritance of one gene racing and during “suicide sprints” for sickle hemoglobin and one for normal on the court, laps on a track, or a cell hemoglobin. Sickle cell trait will not turn long training run. trait? into the disease. u Unlike heat-related or cardiac conditions, athletes with sickle cell u During intense exercise, red blood cells containing sickle hemoglobin can trait may present as being fatigued change shape from round to quarter-moon, or “sickle.” and can often talk, but may be u Sickle red cells may accumulate in the bloodstream during experiencing ischemic pain and intense exercise, blocking normal blood flow to the tissues and muscles. weakness in their muscles. Pushing the athlete to continue beyond this u During intense exercise, athletes with sickle cell trait have experienced point for “toughness” or discipline significant physical distress, collapsed and even died. can lead to a fatal collapse. u Heat, dehydration, altitude and asthma can increase the risk for and worsen complications associated with sickle cell trait, even when exercise is not intense. u Knowledge of sickle cell trait status can be a gateway to education and simple precautions that may prevent collapse among athletes with sickle cell trait, allowing them to thrive in sport.

121 SICKLE CELL TRAIT Fact Sheet for COACHES | PAGE 2

The role An important note to head coaches and their staff is that the incidents of sudden death in athletes with sickle cell trait have been exclusive to conditioning of the sessions rather than game or skill practice situations. coaching While the definite cause of collapse among sickle cell trait athletes is not yet known, one hypothesis about what may be happening is that exercise intensity is a leading staff factor for sudden collapse, rather than the medical condition itself. Coaches should conduct appropriate sport-specific conditioning based on sound scientific principles and be ready to intervene when student-athletes show signs of distress. Student-athletes can begin to experience symptoms after only one to three minutes of sprinting, or in any other full exertion of sustained effort, thus quickly increasing the risk of complications. Many times, these complications occur when athletes are being pushed beyond their physiological limit while in an already-compromised position.

Provide an environment in which the following precautions can be activated. In general, student-athletes with sickle cell trait should: u Slowly build up their intensity while training. Ensure u Have their fitness tests scheduled later in the training program. Use student-athlete a progressive, periodized program well-being and evaluate their performance once they are acclimated to the comes first stress about to be placed Planned emergency upon them. response and prompt access u Be allowed to set their own pace to medical care are critical while conditioning. components to ensure adequate response to an u Implement a slow and gradual athlete who collapses or is preseason conditioning regimen in distress. Knowledge of a that prepares them for the rigors student-athlete’s sickle cell of the sport. trait status should facilitate u Be provided adequate rest and prompt and appropriate recovery between repetitions, medical care during a medical especially during “gassers” and emergency. Institutions intense station or “mat” drills. should have an emergency Be given alternatives for action plan in place that is u u Maintain proper asthma performance testing, rather than reviewed and rehearsed at management. serial sprints or timed mile runs, least annually with all athletics especially if these activities are not u Refrain from extreme exercise personnel. All coaches and specific to the sport. during acute illness, if feeling ill, or the strength and conditioning while experiencing a fever. staff should be certified in u Stop activity immediately upon first aid and CPR. struggling or experiencing u Beware when adjusting to a change symptoms such as muscle pain, in altitude, e.g., a rise in altitude abnormal weakness, undue fatigue of as little as 2,000 feet. Modify or breathlessness. training and have supplemental oxygen available. u Stay well hydrated at all times, especially in hot and humid u Seek prompt medical care when conditions. experiencing unusual physical distress. u Refrain from consuming high- caffeine energy drinks and supplements, or other stimulants, as they may contribute to dehydration.

For more information and resources, visit www.NCAA.org/health-safety 122 A Fact Sheet for Student-athletes SICKLE CELL TRAIT

What is u During intense exercise, red blood cells containing the sickle hemoglobin can change shape from round to sickle quarter-moon, or “sickle.” cell trait? u Sickled red cells may accumulate in the bloodstream during intense exercise, blocking normal blood flow to Sickle cell trait is not a the tissues and muscles. disease. Sickle cell trait is the inheritance of one gene for u During intense exercise, athletes with sickle cell trait sickle hemoglobin and one have experienced significant physical distress, collapsed for normal hemoglobin. Sickle and even died. cell trait will not turn into the u Heat, dehydration, altitude and asthma can increase the disease. Sickle cell trait is a risk for and worsen complications associated with sickle life-long condition that will not cell trait, even when exercise is not intense. change over time. u Athletes with sickle cell trait should not be excluded from participation as precautions can be put into place.

Do you u Sickle cell trait occurs in about 8 percent of the U.S. African-American population, and between one in 2,000 to know if you one in 10,000 in the Caucasian population. have sickle u Most U.S. states test at birth, but most athletes with sickle cell trait? cell trait don’t know they have it. u The NCAA recommends that athletics departments confirm People at high risk the sickle cell trait status in all student-athletes. for having sickle cell trait u Knowledge of sickle cell trait status can be a gateway are those whose ancestors to education and simple precautions that may prevent come from Africa, South or collapse among athletes with sickle cell trait, allowing Central America, India, Saudi you to thrive in your sport. Arabia and Caribbean and Mediterranean countries.

how can i prevent a collapse? u Know your sickle cell trait status. u Engage in a slow and gradual preseason conditioning regimen. u Build up your intensity slowly while training. u Set your own pace. Use adequate rest and recovery between repetitions, especially during “gassers” and intense station or “mat” drills. u Maintain proper asthma management. u Avoid pushing with all-out exertion longer than two to u Refrain from extreme exercise during acute illness, three minutes without a rest interval or a breather. if feeling ill, or while experiencing a fever. u If you experience symptoms such as muscle pain, u Beware when adjusting to a change in altitude, e.g., a rise abnormal weakness, undue fatigue or breathlessness, in altitude of as little as 2,000 feet. Modify your training and stop the activity immediately and notify your athletic request that supplemental oxygen be available to you. trainer and/or coach. u Seek prompt medical care when experiencing u Stay well hydrated at all times, especially in hot and unusual physical distress. humid conditions. u Avoid using high-caffeine energy drinks or supplements, For more information and resources, visit www.NCAA.org/health-safety or other stimulants, as they may contribute to dehydration. 123 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

Policy Statement

The Radford University Athletic Department recognizes that sport induced concussions pose a significant health risk for those student- athletes participating in athletics. With this in mind, we have implemented policies and procedures to assess and identify those student-athletes who have suffered a concussion. The department also recognizes that baseline neurocognitive testing on student- athletes who participate in those sports which have been identified as collision and/or contact sports and/or who have had a history of concussions prior to entering Radford University will provide significant data for return to competition decisions. Under the guidance of the team physician, this baseline data will be used in conjunction with clinical evaluations and exertional testing to determine when it is safe for a student-athlete to return to competition.

Procedure 1. The Radford University Athletic Department (RUAD) will require student-athletes to sign a statement in which student-athletes accept the responsibility for reporting their injuries and illnesses to the sports medicine staff, including signs and symptoms of concussions (attachment A). During the review and signing process student-athletes will be provided with the NCAA Concussion Fact Sheet for Student-Athletes. The Director of Athletic Training Services will coordinate the educational session and the signed document will be kept in the student-athlete’s ARMS file. 2. All Radford University coaches, strength coaches, athletic trainers and team physicians and the Athletic Director are required to sign a statement in which the coach accepts the responsibility for reporting signs and symptoms of concussions. During the review and signing process, the coaches will be presented with the NCAA Concussion Fact Sheet for Coaches. The Director of Athletic Training Services will coordinate the signing of the aforementioned documents on an annual basis for the medical personnel and coaches. 3. In an attempt to reduce the risk for concussion among the student-athletes, the RU Sports Medicine staff will make an attempt to educate coaches on reducing exposure to head trauma. This may include avoiding contact specific drills, technique, additional neck strengthening, etc. The coaching, strength and sports medicine staffs will also be assigned an on-line concussion education course to be completed each year. 4. RUAD will have on file and annually update an emergency action plan2,3,4 for each athletics venue to respond to student-athlete catastrophic injuries and illnesses, including but not limited to concussions, heat illness, spine injury, cardiac arrest, respiratory distress (e.g. asthma), and sickle cell trait collapses. All athletics healthcare providers and coaches shall review and practice the plan annually. These sessions will be conducted prior to the start of the sport season. 5. RUAD sports medicine staff members shall be empowered to have unchallengeable authority to determine management and return-to-play of any ill or injured student-athlete, as he or she deems appropriate. Conflicts or concerns will be forwarded to the Director of Athletic Training Services and the Head Team Physician for remediation. 6. RUAD shall have on file a written team physician–directed concussion management plan2,6 (attachment B) that specifically outlines the roles of athletics healthcare staff (e.g., physician, certified athletic trainer, nurse practitioner, physician assistant, neuropsychologist). In addition, the following components have been specifically identified for the collegiate environment: a. RUAD coaches will receive a copy of the concussion management plan (attachment F) and a fact sheet on concussions in sport. The Director of Athletic Training will maintain a list of staff that have completed the requirement on file. b. RUAD sports medicine staff members and other athletics healthcare providers will practice within the standards as established for their professional practice (e.g., team physician7, certified athletic trainer8, physical therapist, nurse practitioner, physician assistant, neurologist9, neuropsychologist10). c. RUAD shall record a baseline assessment6,10,11,12 for each student-athlete. The same baseline assessment tools (attachment H) should be used post-injury at appropriate time intervals. The baseline assessment should consist of the use of: 1) SCAT 3 or SCAT 5 and 2) imPACT (cognitive and neuropsychological testing). Neuropsychological testing has been shown to be effective in the evaluation and management of concussion. Post injury neuropsychological test data may be shared with a neuropsychologist for consultation at the discretion of the team physician. Neuropsychological testing has proven to be an effective tool in assessing neurocognitive changes following concussion and can serve as an important component of an institution’s concussion management plan. However, neuropsychological tests should not be used as a standalone measure to diagnose the presence or absence of a concussion as RUAD uses a comprehensive assessment by its sports medicine staff. d. When a student-athlete shows any signs, symptoms or behaviors consistent with a concussion, the athlete will be removed from practice or competition, by either a member of the coaching staff or sports medicine staff. If removed by a coaching staff member, the coach will refer the student-athlete for evaluation by a member of the sports medicine staff. The sports medicine staff will then evaluate the student-athlete for signs and symptoms of concussion. Visiting sport team members evaluated by RUAA sports medicine staff will be managed in the same manner as RUAD student-athletes. 124 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

e. A student-athlete diagnosed with a concussion will be withheld from the competition or practice and shall not return to activity for the remainder of that day. Student-athletes that sustain a concussion outside of their sport will be managed in the same manner as those sustained during sport activity. f. The student-athlete will receive serial monitoring for deterioration. Athletes will be provided with written home instructions (attachment D) upon discharge; preferably with a roommate, guardian, or someone that can follow the instructions. g. The student-athlete will be monitored for recurrence of symptoms both from physical exertion and also mental exertion, such as reading, phone texting, computer games, watching film, athletic meetings, working on a computer, classroom work, or taking a test. Academic advisors and professors will be notified by letter (attachment E) of student-athlete’s concussion, with permission for release of information from the student-athlete. Within the letter will be the recommended accommodations for the student-athlete during their recovery. The letter may be updated as the student-athlete progresses through the stages of recovery. h. The student-athlete will be evaluated by a team physician as outlined within the concussion management plan. Once asymptomatic and post-exertion assessments are within normal baseline limits, return to play shall follow a medically supervised stepwise process (attachment C) i. Final authority for Return-to-Play13 shall reside with the team physician or the physician’s designee as noted in the concussion management flowchart. 7. RUAD will document the incident, evaluation, continued management, and clearance of the student-athlete with a concussion. 8. Although sports currently have rules in place; Athletics staff, student-athletes and officials will continue to emphasize that purposeful or flagrant head or neck contact in any sport should not be permitted.

Protocol RUAD Baseline Testing 1. Radford University Athletics will insure that a Certified Athletic Trainer, Physician or other medical personnel with training in the diagnosis, treatment and initial management of acute concussion is present at all NCAA varsity competitions in the following contact/collision sports: basketball; lacrosse; pole vault; and soccer. To be present means to be on site at the campus or arena of the competition. Medical personnel may be from either team, or may be independently contracted for the event. The Athletic Department will also insure that a Certified Athletic Trainer or Physician is available at all NCAA varsity practices in the aforementioned sports. To be available means that, at a minimum, medical personnel can be contacted at any time during the practice via telephone, messaging, email, beeper or other immediate communication means. Further, the case can be discussed through such communication, and immediate arrangements can be made for the athlete to be evaluated. The Radford University Athletic Department will make every attempt to be on-site for competitions and available for practices for all sports, whether contact or non-contact. 2. Every new (first year or transfer) student-athlete will receive a pre-participation exam that includes a medical history questionnaire asking about brain injury and concussion history, symptom evaluation, cognitive assessment and balance evaluation. In addition, every new student-athlete in the sports of baseball, basketball, volleyball, lacrosse, soccer, and softball, at a minimum, will receive a pre-season baseline assessment for concussion consisting of an 1) imPACT and 2) SCAT 3. Any student-athlete with a history of concussion will receive this baseline testing as well. The team physicians will determine pre- participation clearance and/or the need for additional testing. The results of the imPACT for each student-athlete will be available on the imPACT website and the copies of the SCAT 3/5 will be kept in the student-athlete’s medical file. 3. All baselines are reviewed by a member of the sports medicine staff to insure their validity. If they are deemed not valid, the student-athlete will be asked to repeat the tests until a valid test is obtained. If a student-athlete baseline falls above a 4 on the Modified Bess portion of the SCAT3/5, the student-athlete will repeat the initial baseline. If the score remains above a 4, that will be used as their score.

Concussion Management and Return to Play 1. When a student-athlete shows any signs, symptoms or behaviors consistent with a concussion, the athlete shall be removed from practice or competition and evaluated by a Radford University healthcare provider. Furthermore, if there is a question about the state of mental clearing it is best to err on the side of caution and withhold the student-athlete from further competition until a physician’s assessment can be arranged. 2. Any student-athlete that scores below a 13 on the Glasgow Coma Scale, has any loss of consciousness, focal neurological deficits, repetitive emesis, persistently diminished or worsening mental status and/or other neurological signs/symptoms, or has signs or symptoms of a cervical spine injury, skull fracture or intracranial bleed will be immediately transported via EMS to Carilion New River Valley Medical Center per the Radford University Athletics Emergency Action Plan. 3. A student-athlete suspected of sustaining a concussion will be evaluated by the team’s athletic trainer or the team physician, if available. The student-athlete will be given a sideline evaluation, and if further testing needs to be done, will be moved to a quiet 125 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

room free from distractions, if possible, to insure an accurate evaluation. The evaluation will consist of a SCAT3/5 to be completed in its entirety. The SCAT3/5 will not be used to determine a student-athlete’s status, rather, the individual scores from the batteries contained within the SCAT3/5, in combination with the physical evaluation, will be used to make the return to play decisions. If at any time the student-athlete scores lower than a “25” on the SAC portion of the SCAT3/5, the SA will be removed from practice/competition for the rest of that day and referred to a team physician. If at any time the SA scores a “5” or greater on the modified BESS portion of the SCAT3, the SA will be removed from practice/competition for the rest of that day and referred to a team physician. 4. An assessment of symptoms will be performed at the time of injury in conjunction with the SCAT3/5 and then 1 to 3 hours post injury, 24 hours, and subsequent days to track symptom recovery.

*NO STUDENT-ATHLETE SUSPECTED OF HAVING A CONCUSSION IS PERMITTED TO RETURN TO PLAY THE SAME DAY, AND NO STUDENT-ATHLETE IS PERMITTED TO RETURN TO PLAY WHILE SYMPTOMATIC FOLLOWING A CONCUSSION.

5. After clinical evaluation, if indicated, the student-athlete will be referred to the team physician. The Student-Athlete Home Instruction Sheet should be given to the athlete at this time. A copy of the instruction sheet should also be given to a roommate or other adult that will be with the student-athlete over the next 24 hours. Time should be taken to explain the contents of the sheet to the student-athlete and the other adult. 6. On the first day post-injury, the student-athlete should have a follow up clinical evaluation and symptom completed. 7. Follow-up clinical evaluations and symptom are completed daily until the student-athlete is asymptomatic. 8. Once the student-athlete is asymptomatic; the student-athlete may be scheduled for a follow up SCAT 3/5 and imPACT. 9. Once the follow up SCAT 3/5 and imPACT are completed, the student-athlete will be scheduled for follow up clinical evaluation with the team physician. The results of the follow up testing should be presented with the student-athlete’s baseline testing during the evaluation with the team physician. 10. Once the student-athlete 1) is asymptomatic, 2) has obtained SCAT3/5 and imPACT scores are back to baseline, and 3) has a normal clinical evaluation, the team physician may direct the Athletic Trainer to begin a five step graduated exertional return to play protocol with the student-athlete and to assess for increasing signs and symptoms. Signs and symptoms should be reassessed immediately following all exertional activities. 11. Upon satisfactory completion of the Exertional Return to Play Protocol(attachment C), the student-athlete may be rescheduled for evaluation by a team physician to determine final clearance for full participation. No student-athlete may return to full activity or competitions until asymptomatic in limited, controlled, and full-contact activities, and cleared by the team physician.

*Continued post-concussive symptoms, prior concussion history and any diagnostic testing results along with neurocognitive testing and physical exam, will be utilized by the team physician in establishing a timeline for a student-athlete’s return to activity. It is important to note that this timeline could last over a period of days to weeks or months, or potential medical disqualification from Radford University Athletics. All cases will be handled on a case-by-case basis. The decision by the Radford University Team Physician for all cases of a student-athlete’s return to activity is final. The student-athlete will continue to be monitored other conditions that can be associated with concussion that include but are not limited to: post-concussion syndrome; sleep dysfunction; migraine or other headache disorders; mood disorders such as anxiety and depression; ocular or vestibular dysfunction. Any student- athlete exhibiting signs and/or symptoms of these additional diagnoses will be referred to the proper medical professionals for continued care.

Exertional Return to Play Protocol (Activities performed under the supervision of an ATC) 1. The student-athlete may begin the following return to play protocol only after passing the assessments above and receiving clearance from the team physician. During the RTP protocol, the athletic trainer will monitor concussion like symptoms before, during and after each step. In some cases, steps 1,2,3 and even 4 may be completed on the same day, but typically will occur over multiple days. Steps 4 and 5 should be on separate and subsequent days. The team physician will determine how many steps may be completed in a given day. a. Light Aerobic Exercise- 20 minute stationary bike ride (10-14 mph). Objective is to increase heart rate. b. Sport Specific Exercise- 20 minutes of passing, dribbling, throwing, jogging. Objective is to add body weight movement without head impact c. Intense Aerobic Exercise and Resistance Training- Interval Bike ride: 30 second sprint, 30 second recovery x 10, Body weight circuit: squats/pushups/sit ups for 20 seconds x 3. Objective is to add intensity and increase internal pressures during resistance training. d. Non-contact practice and Increased Resistance Training- Allow to participate in all non-contact practice drills and resume normal weight room activity. Objective is to add coordination and cognitive load with exercise. 126 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

e. Full Contact Practice- Participate in all normal practice and training activities. Objective is to restore confidence and allow assessment of functional skills by coaching and medical staff. IF AT ANY POINT DURING THIS PROCESS THE STUDENT-ATHLETE BECOMES SYMPTOMATIC, THE STUDENT-ATHLETE SHOULD BE STOPPED AND RE-ASSESSED DAILY UNTIL ASYMPTOMATIC. THE STUDENT-ATHLETE MAY ATTEMPT THE SAME STEP ONCE THEY ARE ASYMPTOMATIC.

Academic Recommendations following a Concussion (Return to Learn) 1. Following a concussion, individuals need both cognitive and physical rest to allow for the best and safest recovery. Activities such as reading, watching TV or movies, playing video games, working/playing on the computer and/or texting stimulates the brain and can lead to prolonged symptom recovery. 2. Immediately following a concussion, mental rest is the key. Student-Athletes present a challenge as they will often have school the day following an injury. Healthcare providers need to consider if modifications to school activities should be made to help facilitate a more rapid recovery. For instance, a student-athlete diagnosed with a concussion may need to begin their recovery by remaining at home/dorm for a number of days if they cannot tolerate light cognitive activity. 3. A student-athlete will not be allowed to attend classes on the same day as concussion. 4. When the student-athlete is able to tolerate light cognitive activity and when cleared by the physician to do so, the student-athlete may begin a gradual return to the classroom and studying as tolerated. If a student-athlete suffers worsening of concussion symptoms with academic challenges, the student-athlete will be scheduled for a re-evaluation by a physician. 5. The athletic trainer, team physician and the athletic academic advisor will work together to make sure the correct modifications are made for a successful academic progression, which should be provided to the professors of the involved student-athlete. 6. Each student-athlete suffering from a concussion will be designated a point-person from the medical care team to help them through the process. This person may be an ATC, academic advisor or a designate from the Dean of Students Office or Office of Disability Services. 7. Academic advisors and professors will be notified by letter (attachment E) of the student-athlete’s concussion, with permission for release of information from the student-athlete. Within the letter will be the recommended accommodations for the student- athlete during their recovery. The letter may be updated as the student-athlete progresses through the stages of recovery. Accommodations may be made for up to 2 weeks following injury. If the student-athlete’s symptoms last longer than 2 weeks, then a re-evaluation by the team physician and other members of the multidisciplinary team shall be performed. 8. For cases that cannot be managed through schedule modification and/or academic accommodations, other campus resources may be engaged. These other resources may include learning specialists, student counseling, the Dean of Students Office, the Office of Disability Services, the ADAAA office, etc. 9. If it is determined that a student-athlete needs modifications in the classroom, then the same modifications will be put into place with regards to their sport. For example, if a student-athlete is instructed to not go to class, then they will not be allowed to come to practice. If they are on limited coursework, then they will be given a limited amount of film and playbook work to study, etc.

Reducing Head Trauma Exposure 1. The Radford University Athletic Department will operate under the guidelines set forth by the Interassociation Consensus: Independent Medical Care for College Student-Athletes Best Practices as described in the Department’s own policy, “Independent Medical Care and the Interdisciplinary Health Care Team”. In summary of this policy, the medical director and primary athletics health care providers (Physicians and Athletic Trainers) will be empowered with unchallengeable autonomous authority to determine medical management and return-to-play decisions of student-athletes. This includes, but is not limited to, the management of and return-to-play following concussions and other injuries. 2. In an attempt to reduce the risk for concussion among the student-athletes, the RU Sports Medicine staff will make an attempt to educate coaches on reducing exposure to head trauma. This may include avoiding contact specific drills and gratuitous contact during practices, taking a safety first approach to sport, taking the head out of contact, educating on safe play and proper technique, additional neck strengthening, etc. The coaching, strength and sports medicine staffs will also be assigned an on-line concussion education course to be completed each year.

Approved by: ______Head Team Physician Date: ______Delmas Bolin, M.D.

Approved by: ______Assistant AD for Sports Medicine Date: ______Chad Hyatt, ATC, LAT

127 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

Reference Documents 1. NCAA and CDC Educational Material on Concussion in Sport. Available online at www.ncaa.org/health-safety 2. NCAA Sports Medicine Handbook. 2009-2010. 3. National Athletic Trainers’ Association Position Statement: Emergency Planning in Athletics. Journal of Athletic Training, 2002; 37(1):99–104. 4. Sideline Preparedness for the Team Physician: A Consensus Statement. 2000. Publication by six sports medicine organizations: AAFP, AAOS, ACSM, AMSSM, AOSSM, and AOASM. 5. Recommendations and Guidelines for Appropriate Medical Coverage of Intercollegiate Athletics. National Athletic Trainer’s Association. 2000. Revised 2003, 2007, 2010. 6. Consensus Statement on Concussion in Sport 3rd International Conference on Concussion in Sport Held in Zurich, 2008. Clinical Journal of Sport Medicine, 2009; 19(3):185-200. 7. Concussion (Mild ) and the Team Physician: A Consensus Statement. 2006. Publication by six sports medicine organizations: AAFP, AAOS, ACSM, AMSSM, AOSSM, and AOASM. 8. National Athletic Trainers’ Association Position Statement: Management of Sport-Related Concussion. Journal of Athletic Training, 2004; 39:280-297. 9. Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. Neurology, 1997; 48:581-5. 10. Neuropsychological evaluation in the diagnosis and management of sports-related concussion. National Academy of position paper. Moser, Iverson, Echemendia, Lovell, Schatz Webbe, Ruff , Barth. Archives of Clinical Neuropsychology, 2007; 22:909–916. 11. Who should conduct and interpret the neuropsychological assessment in sports-related concussion? Echemendia RJ, Herring S, Bailes J. British Journal of Sports Medicine, 2009; 43:i32-i35. 12. Test-retest reliability of computerized concussion assessment programs. Broglio SP, Ferrara MS, Macciocchi SN, Baumgartner TA, Elliott R Journal of Athletic Training, 2007; 42(4):509-514. 13. The Team Physician and Return-To-Play Issues: A Consensus Statement. 2002. Publication by six sports medicine organizations: AAFP, AAOS, ACSM, AMSSM, AOSSM, and AOASM.

128 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

Attachment A Radford University Student-Athlete Concussion Statement I ______acknowledge that it is my responsibility to report any injuries and illnesses to the medical and coaching staffs at Radford University, including signs and symptoms of concussions. These symptoms include, but are not limited to the following…

Amnesia, Confusion, Headache, Loss of Consciousness, Balance problems or dizziness, Double or fuzzy vision, Sensitivity to light or noise, Nausea, Feeling Sluggish, foggy or groggy, Feeling unusually irritable, Concentration or memory problems, and Slowed reaction time.

______I agree to abide by the recommendations set forth by my athletic trainer and team physician with regards Initial to allowing me to return to play and to the classroom if I should sustain a concussion.

______I also agree to notify the Radford University Sports Medicine Staff if I suspect that any of my teammates Initial have sustained a concussion or are displaying signs and or symptoms of a concussion.

______I have read and understand the NCAA Concussion Fact Sheet. Initial

______I have watched the NCAA Concussion Video, Don’t Hide It, Report It, Take Time to Recover Initial

After reading the NCAA Concussion Fact Sheet and watching the NCAA Concussion Video I am aware of the following information: A concussion is a brain injury, which I am responsible for reporting to my Initial team physician or athletic trainer.

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

You cannot see a concussion, but you might notice some of the symptoms Initial right away. Other symptoms can show up hours or days after the injury.

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

I will not return to play in a game or practice if I have received a blow to Initial the head or body that results in concussion-related symptoms.

Following concussion the brain needs time to heal. You are much more likely Initial to have a repeat concussion if you return to play before your symptoms resolve.

In rare cases, repeat concussions can cause permanent brain damage, and Initial even death.

______Printed Name of Student-Athlete Signed Name of Student-Athlete Date

129 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

Attachment B

Radford University Athletics Concussion Flowchart Obtain Baseline Testing: SCAT 3/5 and IMPACT testing data obtained for all student-athletes

Concussion Identified and Assessed: Physical examination and assessment of concussion symptoms by medical staff (athletic trainer, physician assistant and/or physician: if physician not immediately available, athlete should be referred to physician for evaluation within 24 hours of injury if possible if not emergent; if emergent, athlete should be transported to closest emergency department); athlete held from all physical activity; given concussion information home instruction sheet; notify parent/guardian of concussion; Athlete repeats baseline testing with SCAT 3/5 (within 3 hours) and IMPACT (within 24 hours of injury if possible)

Concussion Management: Complete mental and physical rest; possible Omega 3 fatty acid supplementation; re-assess athlete daily by medical staff; administer symptom checklist daily until completely asymptomatic; notify academic advisor and professors of academic modifications (Returning to Learn Letter)

Athlete Asymptomatic: Athlete repeats baseline testing with SCAT3 and IMPACT (unless directed otherwise by physician and/or neuropsychologist)- May be repeated every two days until scores return to baseline as long as athlete remains asymptomatic.

Test Results Return to Baseline: Test Results NOT Returned to Perform Exertional Return to Play Baseline: When medically cleared Protocol when directed by team by physician, repeat test battery; physician consider neuropsych consult with more detailed test battery

Completion of Exertional RTP Protocol: When medically cleared by Athlete may resume normal activity after physician, repeat Exertional RTP final clearance from team physician Protocol.

Return to Full Competition: Athlete may return to full competition after completing all steps and with proper coaching on how to avoid further unneccesary contact

130 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

Attachment C

Radford University Athletics Exertional Return to Play Protocol

SCAT 3/5 and IMPACT testing Within Normal Limits

Graduated Exertional Testing 1. Light Aerobic Exercise- 20 min stationary bike ride (10-14 mph) 2. Sport Specific Activity- 20 min passing, dribbling, throwing, jogging 3. Intense Aerobic Exercise and Resistance Training- Interval Bike ride: 30 second sprint, 30 second recovery x 10, Body weight circuit: squat/pushups/sit ups for 20 seconds x 3 If no change or increase in symptoms, move to next step.

4. Non-Contact Practice and Increased Resistance Training- Allow to participate in all non-contact practice drills and resume normal weight room activity. If no change or increase in symptoms, move to next step.

5. Limited to Full Contact Practice- start out with limited contact during first half of and if asymptomatic allow full participation for the second half of practice.

If no change or increase in symptoms, final return to play decision made by team physician or his/her designate.

IF AT ANY POINT DURING THIS PROCESS THE STUDENT-ATHLETE BECOMES SYMPTOMATIC,

THE STUDENT-ATHLETE SHOULD BE STOPPED AND RE-ASSESSED DAILY UNTIL

ASYMPTOMATIC. THE STUDENT-ATHLETE MAY ATTEMPT THE SAME STEP ONCE THEY ARE

ASYMPTOMATIC.

131 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

Attachment D Radford University Athletics Concussion Information: Home Instruction Sheet

Name ______Date ______

You have had a head injury or concussion and need to be watched closely for the next 24-48 hours

It is OK to: There is no need to: DO NOT: Use Tylenol (acetaminophen) Check eyes with a light Drink Alcohol Use an ice pack to head/neck for Wake up every hour Eat spicy foods comfort Stay in bed Drive a car Eat a light meal Use aspirin, Aleve, Advil or other Go to sleep NSAID products

Special Recommendations: ______

______

WATCH FOR ANY OF THE FOLLOWING PROBLEMS:

Worsening headache Stumbling/loss of balance Vomiting Weakness in one arm/leg Decreased level of Consciousness Blurred Vision Dilated Pupils Increased irritability Increased Confusion

If any of these problems develop, call your athletic trainer or physician immediately.

Athletic Trainer ______Phone ______

Physician ______Phone ______

You need to be seen for a follow-up examination at ______AM/PM at: ______.

Recommendations provided to ______

Recommendation provided by ______

132 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

Attachment E

Radford University Athletics Return to Learning Plan for Diagnosed Concussion (Academic Accomodations)

The Radford University Sports Medicine Department would like to inform you that ______sustained a concussion on ______. He/she was evaluated by______, MD, team physician. ______will undergo additional concussion testing over the next few days. A concussion or mild traumatic brain injury can cause a variety of physical, cognitive, and emotional symptoms. Concussions range in significance from minor to major, but they all share one common factor — they temporarily interfere with the way your brain works. We would like to inform you that during the next few weeks this athlete may experience one or more of these signs and symptoms.

Headache Nausea Balance Problems Dizziness Diplopia - Double Vision Confusion Photophobia – Light Sensitivity Difficulty Sleeping Misophonia – Noise Sensitivity Blurred Vision Feeling Sluggish or Groggy Memory Problems Difficulty Concentrating

As a department, we wanted to make you aware of this injury and the related symptoms that the student-athlete may experience. Although the student is attending class, please be aware that the side effects of the concussion may adversely impact his/her academic performance. Below, you will find the modifications needed for this particular student at this time. We will continue to monitor the progress of this athlete and anticipate a full recovery. As symptoms begin to subside, a progression back into the classroom will begin. Should you have any questions or require further information, please do not hesitate to contact us.

____ SA will not be in class until symptoms improve (re-evaluate daily)

____ SA may attend class, but cannot undergo heavy coursework (assignments, tests, presentations, etc.) at this time

____ SA may attend class with minor modifications (e.g. extended time, access to class notes, extensions for projects/papers

____ SA has no restrictions for coursework, attendance or assignments

Thank you in advance for your time and understanding with this circumstance. Please feel free to contact Chad Hyatt or Alix Guynn if you need any clarification on the matter.

______Chad Hyatt, ATC Alix Guynn Team Physician Director of Athletic Training Director of SA Support Services Team Physician, Radford University (540) 831-5877 (540) 831-6717 (540) 831-5877 [email protected] [email protected]

.

133 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

Attachment F

Radford University Athletics Coaches Acknowledgement of Receipt of Concussion Plan and Information Sheet

I hereby acknowledge that I have received a copy of the Radford University Concussion Management Plan and the NCAA Concussion Fact Sheet for Coaches and that I have read and understand the material. I further acknowledge that all of my questions have been answered to my satisfaction. I agree to follow the steps set forth in the plan by notifying the ATC or Physician to seek further evaluation of any of my athletes that I suspect may have sustained a concussion. I also agree to comply fully with the recommendations from the RU Sports Medicine Staff in regards to return the return to play status of my athletes.

Printed Name Signature Date

______Sport

______Team ATC Signature Date

______Assistant AD for Sports Med Signature Date

______Director of Athletics Signature Date

134 Radford University Sports Medicine 201 8 Policies and Procedures Concussion Management Policy: Safe Return to Sport and Learning

Attachment G

Radford University Radford University Sports Medicine Sports Medicine Concussion Assessment Guidelines Post- Concussion Symptom Checklist Scale None Mild Moderate Severe Observe the Athlete for the Following: 0 1 2 3 4 5 6 DATE 1. Orientation TIME Who are you? Who am I? What year is it? Opponent? What play did you just run? What happened? 2. Immediate Memory Symptom Repeat list of three words (carpet, practice, elephant) Headache Repeat words again Repeat words one more time Nausea 3. Neurologic Screen Vomiting Test Cranial Nerves Balance Problems Retrograde Amnesia (Who helped you off?) Antegrade Amnesia (Pre-Game meal?) Dizziness Strength & Sensation of all four extremities Fatigue Balance (Romberg & Tandem Rhomberg) Trouble falling asleep Coordination (finger-nose-finger, tandem walk)

4. Concentration Sleeping more than usual Repeat 3 series of digits backwards Sleeping less than usual Months in reverse order Drowsiness 5. Delayed Recall Sensitivity to light Repeat list of three words from earlier 6. Exertional (Contraindicated if showing any symptoms) Sensitivity to noise 5 jumping jacks, 5 push ups, 20 yd jog, 20 yd sprint Irritability Sadness Recheck every 15 minutes & Monitor vitals Nervousness

Feeling more emotional Notes Numbness or tingling Feeling slowed down Feeling mentally foggy Difficulty concentrating Difficulty remembering Visual Problems

Total (1 point for each symptoms with a

maximum possible 22)

Symptom Severity Score (Add all scores in table, maximum possible 22x6=132) Symptoms worse with physical activity (Y/N) Symptoms worse with mental activity (Y/N) Continue to SCAT3 Testing (Y/N) and imPACT (Y/N) Evaluator’s Initials

135 CONCUSSION SAFETY WHAT COACHES NEED TO KNOW

What is a concussion? A concussion is a type of traumatic brain injury. It follows a force to the head or body and leads to a change in brain function. It is not typically accompanied by loss of consciousness.

How can I tell if an athlete has a concussion? You may notice the athlete … The athlete may tell you he or she is experiencing … • Appears dazed or stunned • A headache, head pressure or that he or she • Forgets an instruction doesn’t feel right following a blow to the head • Is confused about an assignment or position • Nausea • Is unsure of the game, score or opponent • Balance problems or dizziness • Appears less coordinated • Double or blurry vision • Answers questions slowly • Sensitivity to light or noise • Loses consciousness • Feeling sluggish, hazy or foggy Note that no two concussions are the same. All possible • Confusion, concentration or memory problems concussions must be evaluated by an athletic trainer or team physician.

What can I do to keep student-athletes safe?

Preseason In-Season Time of Injury Recovery

What can Create a culture in which Know the signs and Remove athletes from play Follow the recovery and concussion reporting is symptoms of concussions. immediately if you think they return-to-play protocol I do? encouraged and promoted. have a concussion and refer established by team them to the team physician physicians and athletic or athletic trainer. trainers.

Why does Athletes who don’t The more people who Early removal from play can Team physicians and athletic immediately seek care for a know what to look for in a mean a quicker recovery trainers have the training it matter? suspected concussion take concussed athlete, the more and help avoid serious to follow best practices longer to recover. likely a concussion will be consequences. related to the concussion identified. recovery process.

Tips and Be present when your Check in with your team Provide positive reinforcement Tell athletes that decisions team physician or athletic physician or athletic trainer if when an athlete reports a related to their return to play strategies trainer provides concussion you want to learn more about suspected concussion. and health are entirely in the education material to your concussion safety. hands of the team physician team. Tell your team that and athletic trainer. this matters to you.

You play a powerful role in setting the tone for concussion safety on your team. Let your team know that you take concussion seriously and reporting the symptoms of a suspected concussion is an important part of your team’s136 values. NCAA | SPORT SCIENCE INSTITUTE | CONCUSSION SAFETY | WHAT COACHES NEED TO KNOW

What happens if an athlete gets a concussion What do I need to know about repetitive and keeps practicing or competing? head impacts? • Due to brain vulnerability after a concussion, • Repetitive head impacts mean that an individual an athlete may be more likely to suffer another has been exposed to repeated impact forces to concussion while symptomatic from the first one. the head. These forces may or may not meet the • In rare cases, repeat head trauma can result in brain threshold of a concussion. swelling, permanent brain damage or even death. • Research is ongoing but emerging data suggest • Continuing to play after a concussion increases that repetitive head impact also may be harmful the chance of sustaining other injuries too, not just and place a student-athlete at an increased risk concussion. of neurological complications later in life. • Athletes with a concussion have reduced concentration and slowed reaction time. This means Did you know? they won’t be performing at their best. • Most contact or collision teams have at least • Athletes who delay reporting concussion may take one student-athlete diagnosed with a concussion longer to recover fully. every season. • Your school has a concussion management What are the long-term effects of plan, and team physicians and athletic trainers a concussion? are expected to follow that plan during a • We don’t fully understand the long-term effects of a student-athlete’s recovery. concussion, but ongoing studies raise concerns. • NCAA rules require that team physicians and athletic • Athletes who have had multiple concussions may trainers have the unchallengeable authority to make have an increased risk of degenerative brain disease, all medical management and return-to-play decisions and cognitive and emotional difficulties later in life. for student-athletes. • We’re learning more about concussion every day. To find out more about the largest concussion study ever conducted, which is being led by the NCAA and U.S. Department of Defense, visit ncaa.org/concussion.

For more information, visit ncaa.org/concussion. NCAA ia a trademark of the National Collegiate Athletic Association. 137 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

POLICY STATEMENT

This policy should be followed out on any patient who requires medical attention due to illness or injury. All staff must follow this policy and record their findings. OTC Medication may be administered by licensed and certified Athletic Trainers and Physicians only. Prescription medications may be administered by a licensed physician only. At no time should an athletic training student be the party responsible for administering OTC medications. Each administration of an OTC medication is to be logged out in the OTC Log for the facility.

The purpose of this policy is to prevent the spread of disease and serve the population in which we cover by providing physician directed OTC medication therapy.

PROCEDURES

1. OTC and Prescription Medication Administration OTC medications will be provided to student-athletes on a case by case basis as deemed necessary by an Athletic Training staff member. All uses of OTC medications are approved by a Team Physician. Per federal and state laws only single doses of OTC medication will be provided. Prescription medications will be provided for student-athletes for conditions related to sports participation as determined by a Team Physician. The Team Physician or an Athletic Training staff member must approve the purchase of the medication. The Athletic Training Department will try to offset prescription costs by filing claims to the student’s primary insurance carrier. The Athletic Training Department follows all recommendations made by the NCAA regarding all prescription medication to include, but not limited to the following:

A. Drug-dispensing practices are subject to and should be in compliance with all state, federal and Drug Enforcement Agency (DEA) regulations. Relevant items include appropriate packaging, labeling, counseling and education, record keeping, and accountability for all drugs dispensed.

B. Certified athletic trainers should not be assigned duties that may be performed only by physicians or pharmacists. A team physician cannot delegate diagnosis, prescription-drug control or prescription-dispensing duties to athletic trainers.

C. Drug-distribution records should be created and maintained where dispensing occurs in accordance with appropriate legal guidelines. The record should be current and easily accessible by appropriate medical personnel.

D. All prescription and over-the-counter (OTC) medications should be stored in designated areas that assure proper environmental (dry with temperatures between 59 and 86 degrees Fahrenheit) and security conditions.

E. All drug stocks should be examined at regular intervals for removal of any outdated, deteriorated or recalled medications.

138 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

. Medication is periodically reviewed to ensure that all EXPIRED medication is removed from inventory. . Any expired medication found in inventory is removed. All expired medications (OTC and Prescription) will be documented on an inventory list and will be disposed of in biohazard waste. Biohazard waste disposal is handle by Scimed.

F. All emergency and travel kits containing prescription and OTC drugs should be routinely inspected for drug quality and security.

G. Individuals receiving medication should be properly informed about what they are taking and how they should take it. Drug allergies, chronic medical conditions and concurrent medication use should be documented in the OTC log and the student-athlete’s medical record and readily retrievable.

H. Follow-up should be performed to be sure student-athletes are complying with the drug regimen and to ensure that drug therapy is effective. This procedure is performed through record keeping in the student-athlete’s medical file

. Any medications on the NCAA Banned Substance List will be prohibited . If any student-athlete does not show improvement while taking OTC medication, then arrangements will be made for evaluation by a Team Physician.

2. Medication Tracking and Storage The RU Sports Medicine Department utilizes an inventory management computer software program to monitor usage of all medications including prescribing physician, dosage amount, and personnel medication issued to.

All medications are maintained in locked offices and/or cabinets that provide sufficient, safe, dry, well ventilated storage that is temperature controlled and free from dust, insects, rodents and contamination and/or in the possession of an Athletic Training staff member and team physicians. All OTC medications are logged out on the OTC log. Prescription medications are recorded in the student- athletes electronic medical file.

Purchase of OTC and prescription medications will be conducted within the rules of procurement as set by the state of Virginia and Radford University. Team Physicians will issue written prescriptions for prescription medication in the name of the student-athlete who will then proceed to pharmacy of choice to obtain medication at their own expense. Over The Counter Medications will be logged out on the appropriate form and the encounter will be documented. All over the counter medications will be stored in a secure location in either the Dedmon Center or Cupp Stadium Athletic Training Facilities or a secure portable athletic training kit. All OTC stocks will be checked for expiration dates on the following months (Feb, May, August, Nov.) per the Radford University Sports Medicine Yearly Events Calendar.

Laminated OTC Card for portable Athletic Training Kits (Note: these cards will be transferred into the OTC drug Log after usage)

139 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

RU Sports Medicine OTC Log Athlete Date Time Medication Reason Lot # Exp. Clinician (sport) (packs) Date John Doe 1/7/2007 3:30 APAP (1 pack) headache 1543 1/25/07 Chad Hyatt (FB) PM

OTC Logs located in Dedmon Center Staff Office, Cupp Stadium Storage Area and Physician’s Suite (Note: Drug Name, Dosage, Lot # and Expiration Date are located at the bottom of the Excel document for each medication given). Completed sheets will be kept on file for 4 years.

Name Date, Reason Allergie Currently # Comments Clinician's (Sport) Time Taking s? taking Packs Signature Medicine other meds? given John 6 / 21/ sore none Non-aspirin 4 every 4-6 John Doe Doe 07 knees hrs

140 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

3. Symptom Evaluation and Referral Procedures Cold/Sore throat A. Question for presence and duration of symptoms: 1. Head and/or nasal congestion 2. Ear congestion vs. ear ache Observe with otoscope: (if available) a. redness of external auditory canal? b. fluid behind tympanic membrane. 3. History of allergies. 4. Chest congestion 5. Cough. a. dry or productive? b. phlegm color? (green/brown = refer to Physician) 6. Sore throat. a. redness? b. swelling of tonsils? c. sinus drainage on posterior pharyngeal wall? d. pustules/exudates. If either present, refer to Physician. 7. Headache. 8. Nausea 9. Vomiting. (number of episodes) 10. Diarrhea. (number of episodes) 11. Temperature. (sweats/chills) 12. Anterior/posterior cervical lymph nodes. (swollen/tender)

B. Refer to Physician any severe, prolonged symptoms, elevated temperature, throat pustules or exudates, green/brown phlegm, swollen lymph glands. Gastrointestinal Disorder A. Question for presence and duration of symptoms: 1. Nausea. 2. Vomiting. 3. History of problems. 4. Diarrhea. Stool color. a. weight loss, if long duration. 5. Eat anything unusual? 6. Stomach pain: a. location? b. palpate for tenderness, rebound pain. c. cramping associated with diarrhea? d. blow to area? e. menstrual difficulties? f. Kehr’s sign 7. Temperature. 8. Current medications.

141 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

B. Refer to Physician any intense, inexplicable stomach pain, increased temperature, persistent symptoms especially with significant weight loss.

4. Symptomatic Treatment Recommendations (check allergies, other medications and interactions)

Symptomatic treatment with over the counter medications should always begin with a thorough history to check for allergies, other medications that are currently being taken and any drug interactions. A Certified Athletic Trainer may issue a 3 Day supply(unit dose) maximum to a student- athlete under physician direction. Athletic training students are not to administer OTC medications. A. Nasal/ear congestion (3 day dose pack) 1. Cold Relief (Tylenol Cold) 2. Sinus P/P 3. May recommend Muccinex-D 4. Nasal Saline Spray B. Cough (3 day dose pack) 1. Cough drops 2. Recommend Robitussin DM or Muccinex DM 3. If non-productive, recommend hot, steamy shower and humidify room C. Sore throat (3 day dose pack) 1. Throat lozenges 2. Chloraseptic 3. APAP 4. I-Prin 5. Recommend Robitussin DM D. Body aches, headache, fever, muscle pain, joint pain (3 day dose pack) 1. APAP 2. Back Pain-Off 3. Mediproxen 4. I-Prin 5. Medi-Seltzer 6. Aspirin E. Nausea/vomiting (3 day dose pack) 1. Diotame, Diamode 2. Alcalak 3. Clear fluids 4. No extremes of temperature 5. Bland diet - B.R.A.T. (bananas, rice, applesauce, toast) 6. No caffeine, dairy or fried foods F. Diarrhea (3 day dose pack) 1. Diotame, Diamode or Immodium AD 2. Re-hydrate 3. Avoid dairy products and fried and/or fatty foods * Emphasize rest, diet, and fluids ** “Come back if symptoms persist.”

142 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

5. Symptom Treatment/Referral Matrix

SYMPTOMS FLU COLD/SINUS SORE THROAT EAR INFECTION BRONCHITIS Runny Nose Sometimes Always Sometimes

Fever over 101 Always Sometimes Sometimes

Cough Sometimes Sometimes Always

Aches Always Sometimes Sometimes Sometimes

Congestion Sometimes Always Sometimes

Ear Pain Sometimes Sometimes Always

Throat Pain Sometimes Always Sometimes

General The Flu typically Colds usually last Usually last 3-5 days. Usually lasts 1-2 Usually lasts 1-2 Information lasts 7-10 days. 1-3 weeks. Get Beware of tender weeks. Get extra weeks. Get extra Get plenty of rest extra sleep and lymph nodes, fever, sleep and plenty of sleep, plenty of and fluids. plenty of fluids. white patches in the fluids, avoid smoke. fluids and avoid Use a humidifier throat or lack of cough. smoke. Use a and saline drops. humidifier and suck on lozenges or hard candy. Medications Fendol, I-Prin, Fendol, I-Prin, APAP, I-Prin, Cepacol, APAP, I-Prin, OTC Fendol, I-Prin, Super Super Quaifenesin Liquid. Ear Drops. Super Quaifenesin Quaifenesin Antibiotics are of little Antibiotics are of little Quaifenesin (Script) Antibiotics (Script) use. use. (Script). are of little use. Antibiotics are of Antibiotics are of little use. little use. Limit participation with a fever and refer to a physician if symptoms vary or last longer than listed above. See your Sport Athletic Trainer for an appointment.

143 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

6. Radford University Sports Medicine OTC Formulary

Coldonyl (Medique) Cold, Hay fever, Sinus w/o Drowsiness 2 tablets

Dose: Adults- 2 tablets every 4 hours.

Warning: Keep out of reach of children. In case of accidental overdose, contact a poison control center or a doctor immediately. As with any drug, if you are pregnant or nursing a baby, seek the advice of a health professional before using this product.

Contains: Acetaminophen 325 mgs., Guaifenesin 100mgs., Phenylephrine Hydrochloride 5 mgs. 1 tablet.

APAP (Medique) Extra strength maximum dose non-aspirin. 2 tablets

Dose: Adults- 2 tablets every 4 hours: Do not exceed 8 per day.

Warning: Keep out of the reach of children. In case of accidental overdose, contact a poison control center or a doctor immediately. If you are pregnant or nursing a baby, seek the advice of a health professional before using this product.

Contains: Acetaminophen 500 mg/ tablet.

Diotame (Medique) Upset stomach, Heartburn, Indigestion, Diarrhea, and Nausea 2 tablets

Dose: Children 9 years to 12 years: take 1 tablet, Children 6 years to 9 years: take 2/3 tablet, Children 3 years to 6 years: 1/3 tablet, children under 3 years: consult a physician.

Warning: Do not use to treat nausea or vomiting for children and teenagers who are recovering from chicken pox or flu. Do not use: if you are allergic to aspirin since an adverse reaction may occur even though this product does not contain aspirin. Allergic to salicylates. Stop using and ask doctor if: nausea or vomiting is present because this could be an early sign of Reye syndrome, a rare but serious illness, this product contains salicylates, if taking aspirin, and ringing in ear occurs. If symptoms persist or diarrhea is accompanied by a high fever or continues more then two days.

Contains: Bismuth, subsalicylate 262 mgs.

144 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

Alcalak: (Medique) Acid, Indigestion, Heartburn, Sour stomach, and Upset stomach. 2 tablets

Dose: Adults and children 12 years and older: take 2 tablets every 2-3 hours as symptoms occur or as directed by a physician. Do not take more then 19 tablets in a 24 hour period or use a maximum dosage of this product for more then two weeks except under the advise and supervision of a physician.

Warning: Ask a doctor or a health professional before use if you are: taking a prescription drug. Ant- acids may interact with certain prescription drugs. Stop using this product and ask a doctor if: symptoms last more then two weeks. Do not exceed the recommended dosage. Keep this and all drugs out of reach of children. As with any drug if you are pregnant or nursing a baby, seek the advice of a health professional before using this product.

Contains: Calcium Carbonate 120mg/ tablet.

Diamode: (Medique) Controls symptoms of diarrhea. 1 tablet

Dose: Adults and children 12 years and older: take 2 tablets after the first lose bowel movement followed by 1 tablet after each subsequent lose bowel movement.; but not more then 4 tablets a day for no more then 2 days. Children 9-11 years: between 60 and 95 lbs take one tablet after the first lose bowel movement followed by ½ tablet after each subsequent lose bowel movement but no more then 3 tablets a day for no more then 2 days. Children 6-8 between 48-59 lbs take 1 caplet after the first lose bowel movement followed by ½ caplet after each subsequent bowel movement but no more then 2 caplets and day for not more then 2 days. Children under 6 years old under 47 lbs should consult a physician before use. Not intended for use in children under 6 years old. Do not exceed recommended dosage. Drink plenty of clear fluids to prevent dehydration with may accompany diarrhea.

Warning: If accidental overdose contact a physician or poison control center immediately. As with any drug if you are pregnant or nursing a baby, seek the advice of a health professional before using this product. Do not use for more then 2 days unless directed by a physician. If diarrhea is accompanied by a fever of higher then 101 degrees F, if blood or mucus is present in the stool, if you have had a rash or other allergic reactions to loperamide hydrochloride. If you are taking anti-biotic, or have a history of liver disease consult a physician before using this product.

Contains: Lopermaide Hydrochloride 2mg

145 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

Mediproxen: (Medique) Temporarily relieves aches and pains due to common cold, menstrual cramps, muscular aches, back ache, tooth ache, head ache, minor pain of arthritis and temporarily reduces fever. 1 tablet.

Dose: Adults and children 12 years and older: take 1 tablet every 8 to 12 hours while symptoms persist. For the first dose you may take two tablets with in the first hour. The smallest effective dose should be used. Do not take more then directed and drink a full glass of water with each dose.

Warning: Do not take more then 2 tablets in an 8-12 hour period or 3 tablets in a 24 hour period. People over the age of 65, do not take more then 1 tablet every 12 hours, unless directed by a doctor and children under 12 years of age. Do not give this product to children under 12 years of age unless directed by a doctor. Allergy alert: Naproxen and Sodium may cause a serious allergic reaction which may include hives, facial swelling, and asthma (wheezing). Ask a doctor before use if: the painful area is red or swollen, you take other drugs on a regular basis, you are under a doctors care for any continuing condition or you have serious side effects of pain reliever. Stop use and ask doctor if: an allergic reaction occurs, seek medical help right away if any unexpected symptoms occur, symptoms continue or worsen, you have difficulty swallowing or it feels like the pill is stuck in your throat, you develop heartburn, stomach pain occurs with the use of this product or even if mild symptoms persist. If pregnant or breast feeding ask a health professional before use. IT IS ESPECIALLY IMPORTANT NOT TO USE NAPROXEN SODIUM DURING THE LAST 3 MONTHS OF PREGNANTCY UNLESS SPECIFICLY DIRECTED TO DO SO BY A DOCTOR BECAUSE IT MAY CUASE PROBLEMS IN THE UNBORN CHILD OR COMPLICATIONS DURING DELIVERY. If accidental overdose contact a physician or poison control center immediately. Keep out of reach of children.

Contains: Naproxen 200mg Sodium 20mg.

Back Pain-Off (Medique) Back pain and muscular aches. 2 Tablets

Dose: Adults and children 12 years and older take 2 tablets every 6 hours while symptoms persist not to exceed 8 tablets in 24 hours or as directed by a doctor.

Warning: Alcohol warning: if you consume 3 or more alcoholic drinks everyday ask your doctor weather you should take a acetaminophen or other pain relievers. Acetaminophen may cause liver damage. Do not use: on children and teenagers for chicken pox or flu symptoms before a doctor is consulted about Reye syndrome, a rare but serious illness, with any other product containing acetaminophen, for more than 10 days unless directed by a doctor. Ask a doctor before use if: your allergic to salicylate (including aspirin), have asthma, have stomach problems (such as heartburn, upset stomach, or stomach pain) that persists or reoccur, if you ulcers or bleeding problems, if you are taking a prescription drug for anticoagulation (thinning the blood), diabetes, gout, or arthritis. Stop use and ask a doctor if: symptoms do not improve, new symptoms occur, pain or fever persist or get worse, redness or swelling is present, if ringing of the ears or loss of hearing occurs. Do not exceed recommended dosage. Keep out of the reach of children. . As with any drug if you are pregnant or nursing a baby, seek the advice of a health professional before using this product.

146 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

Caffeine Warning: a recommended dose of this product contains about as much caffeine as a cup of coffee. Limit the use of caffeine containing medications, foods, or beverages while taking this product because too much caffeine may cause nervousness, irritability, sleeplessness and occasionally rapid heart beat.

Contains Magnesium Salicylate 290mg, Acetaminophen 250mg, caffeine 50mg

Diphen (Medique) Runny nose, Sneezing, Itching of the nose or throat, Itchy, watery eyes. 1 tablet.

Dose: Adults and children 12 years and older take 1 capsule every 4-6 hours as needed. Do not take more than 12 capsules in 24 hours, or as directed by a doctor.

Warning: Ask a doctor before use if you have: a breathing problem such as, emphysema or chronic bronchitis, glaucoma, difficulty in urination due to enlargement of the prostate gland. If you are: taking any drugs for asthma, taking sedatives or tranquilizers. Do not exceed recommended dosage. Keep out of the reach of children. As with any drug if you are pregnant or nursing a baby, seek the advice of a health professional before using this product.

Contains: Diphenhydramine hydrochloride 25mg

Medi-Lyte: To minimize fatigue and prevent muscle cramps and heat prostration due to excessive perspiration. 2 tablets

Dose: Take 1 tablet with a full glass of water, 5 to 10 times a day depending on temperature and conditions.

Warning: Ask doctor before use if you have or are being treated for: heart disease, high blood pressure. Ask a doctor before using if you are on a salt restricted diet. Stop use and ask a doctor if you have diarrhea and muscle twitching. If you are pregnant or breast feeding, ask a health professional before use. Keep out of the reach of children. In case of accidental overdose contact a doctor or poison control center immediately. Prompt medical attention is critical for adults as well as for children even if you do not notice any signs or symptoms.

Contains: Potassium Chloride 40mg, Calcium Phosphate 18mg, Magnesium Carbonate 9mg, cellulose, corn starch, croscarmellose sodium, D&C yellow #10 aluminum lake, hydroxypropyl methylcellulose, pharmaceutical glaze, silicon dioxide, stearic acid, talc, triacetin.

147 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

I-Prin (Medique) Common cold, minor pain of arthritis, muscular aches, backache, toothache, headache, menstrual cramps. 2 tables

Dose: Adults and children 12 years and older: take 1 tablet every 4 to 6 hours while symptoms occur. If pain or fever does not respond to 1 tablet, 2 tablets may be used, but do not exceed 6 tables in 24 hours, unless directed by a doctor. The smallest effective dose should be used.

Warning: Alcohol warning; If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen may cause stomach bleeding. Do not use: for children under 12 years of age unless directed by a doctor, if you have ever had an allergic reaction to any other pain reliever/fever reducer, with any other pain reliever/fever reducer, with any other product containing ibuprofen. Ask a doctor before use if: you take other drugs on a regular basis, you are under a doctor’s care for any continuing medical condition, you have problems or side effects with any pain reliever/fever reducer. Stop using this product and ask a doctor if: an allergic reaction occurs. Seek medical help right away, stomach pain occurs with use of this product, any new or unexpected symptoms occur, fever gets worse or lasts more then 3 days, pain gets worse or last more then 10 days, the painful area is red or swollen. . Do not exceed recommended dosage. Keep out of the reach of children. As with any drug if you are pregnant or nursing a baby, seek the advice of a health professional before using this product. IT IS ESPECIALLY IMPORTANT NOT TO USE IBUPROFEN DURING THE LAST 3 MONTHS OF PREGNANTCY UNLESS SPECIFICLY DIRECTED TO DO SO BY A DOCTOR BECAUSE IT MAY CUASE PROBLEMS IN THE UNBORN CHILD OR COMPLICATIONS DURING DELIVERY.

Contains: Ibuprofen 200mg

Aspirin: (Medique) Headache, minor arthritis pain, toothache, muscular aches, common cold, menstrual cramps. 2 tablets

Dose: Adults and children over 12 years of age; take 1 or 2 tablets with water every 4 hours as needed. Do not take more then 12 tablets in 24 hours, or as directed by a doctor.

Warning: Do not use: for mare then 10 days for pain unless directed by a doctor, for more then 3 days for fever unless directed by a doctor, if you ever have had an allergic reaction to aspirin or any other pain reliever/fever reducer. Ask a doctor before use if you have: asthma, stomach problems (heartburn, upset stomach, or stomach pain) which persist or recur, gastric ulcer, or bleeding problems. Ask a doctor before use if you are: allergic to aspirin, taking a prescription drug for anticoagulation (thinning of the blood), diabetes, gout, or arthritis. Stop using and ask a doctor if: pain or fever persists or gets worse, new or unexpected symptoms occur, an allergic reaction occurs seek medical help right away, redness or swelling is present, ringing in the ears or loss of hearing occurs. Do not exceed recommended dosage, Keep this and all drugs out of the reach of children. In cased of accidental overdose, contact a physician or poison control center immediately. As with any drug, if you are pregnant or nursing a baby, seek the advice of a health professional before using this product.

Contains: Aspirin 325 mg/tablet

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Medi-Seltzer (Medique) Antacid and Pain Reliever 2 tablets

Dose: Adults up to the age of 60: take 2 tablets every 4 hours. Do not exceed 8 tablets in 24 hours or do not use the maximum dosage for more than 10 days. 60 years and older: do not exceed 4 tablets in 24 hours or do not use the maximum dosage for more than 10 days.

Warning: Do not use if: allergic to aspirin, overly full from food or drink, Ask a doctor if severe stomach pain occurs after taking this product. Ask a doctor before use if you have: been placed on a sodium restricted diet, stomach problems (such as heartburn, upset stomach or stomach pain) that last or come back, asthma, ulcers, and bleeding problems. Ask a doctor or pharmacist before use if you are: taking a prescription drug. Aspirin and antacids may interact with certain prescription drugs. Stop use and ask a doctor if: Pain lasts for more than 10 days or gets worse, redness or swelling is present, new symptoms occur, ringing in the ears or loss of hearing occurs. Do not exceed recommended dosage, Keep this and all drugs out of the reach of children. In cased of accidental overdose, contact a physician or poison control center immediately. As with any drug, if you are pregnant or nursing a baby, seek the advice of a health professional before using this product.

Contains: Aspirin 325 mg, Citric Acid 1000mg, Sodium Bicarbonate (heat-treated) 1916 mgs

Approved by: ______Date: ______Delmas Bolin, M.D.

149 Radford University Sports Medicine 2018 Policies and Procedures Prescription and Over the Counter (OTC) Medication Administration and/or Referral

7. BRAT Diet BRAT Diet (Bananas, Rice, Applesauce, and Toast) TREATMENT OF NAUSEA, VOMITING AND/OR DIARRHEA THE “BRAT DIET” NAUSEA, or a sick queasy feeling in the stomach maybe accompanied by the desire to vomit or actual VOMITING of foodstuff contents of the gastrointestinal system. DIARRHEA is a symptom of gastrointestinal disease resulting in loose, watery often frequent bowel movements. It may be “acute”, beginning suddenly and resolving over a few days with dietary discretion, or of a “chronic” ongoing process. Causes of this symptom are similar to the ones listed for nausea and vomiting.

TREATMENT: A short-term gastrointestinal (stomach or bowel) illness requires a change in your diet to begin the recuperation process.

FOR NAUSEA AND VOMITING

First six hours: See your Athletic Trainer immediately. Allow your stomach to “rest” by not drinking or eating anything other than ice chips or sips of water. After the first couple of hours, you can progress to suck on a hard candy or popsicle (no chewing). Your athletic trainer will instruct you on your activity status.

(Day One) Gradually add clear liquids if the vomiting has ceased. Beginning with a sip or two of fluids every ten minutes. Suggestions include water, apple juice, flat soda, weak tea, jello (in liquid or gelatin form), broth or bouillon (clear based from non-greasy soup). If symptoms of nausea or vomiting return, begin the process again, taking nothing by mouth for an hour or so.

(DAY TWO) - Begin BRAT Diet by adding bland foods like bananas, rice, applesauce, crackers, cooked cereals (Farina, Cream of Wheat), toast and jelly.

(DAY THREE) - Progress to a “regular” diet by adding such things as soft cooked eggs, sherbert, stewed fruits, cooked vegetables, white meat of chicken or turkey.

WHAT FOODS TO AVOID Avoid milk and dairy products for three days. Avoid fried, fatty, greasy and spicy foods. Avoid pork, veal, salmon and sardines. Avoid raw vegetables such as parsnips, beets, sauerkraut, corn on the cob, cabbage family, onions. Avoid citrus fruits: pineapples, oranges, grapefruits, tomatoes. Other fruits to avoid are cherries, grapes, figs, currants, raisins, rhubarb, seeded berries. Avoid extremely hot or cold beverages. Avoid Alcohol. Avoid coffee and caffeinated sodas. Drink plenty of water or Gatorade to avoid dehydration from fluid losses due to your illness. Get plenty of sleep.

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