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University of Wisconsin – Madison Division of Intercollegiate Athletics Concussion Management Plan University of Wisconsin – Madison Division of Intercollegiate Athletics Concussion Management Plan Education 1. The sports medicine staff (licensed athletic trainers and team physicians) will review the NCAA regulations and recommendations on concussions. 2. Coaches, Team Physicians, Athletic Trainers, and Directors of Athletics will receive concussion education materials provided by the NCAA. 3. Coaches, Team Physicians, Athletic Trainers, and Directors of Athletics will be required to sign an acknowledgement of having read and understood the NCAA concussion education materials that they have been provided, and accept responsibility for reporting symptoms of a concussion experienced by a student-athlete that they may witness. 4. All student-athletes will receive educational materials provided by the NCAA and a presentation on concussion by a member of the athletic training staff. All student-athletes will sign an acknowledgement form that states they have received concussion education and understand the importance of immediately reporting symptoms of head injury/concussion to the sports medicine staff. Baseline Assessment 1. All student-athletes will complete baseline concussion assessment based on NCAA guidelines including: brain injury and concussion history, symptoms evaluation with the SCAT3 symptoms checklist, cognitive assessment utilizing Standardized Assessment of Concussion (SAC) and ImPACT, and balance evaluation utilizing the Balance Error Scoring System (BESS). 2. Team physicians will determine pre-participation clearance and/or the need for additional consultation or testing for each student-athlete. Student-athletes involved in the following higher risk contact/limited contact sports will undergo baseline testing prior to any organized practice and at a minimum of every two years during their athletic career. Contact/limited contact sports include: football, men’s and women’s soccer, men’s and women’s basketball, men’s and women’s ice hockey, softball, wrestling, volleyball, diving and pole vault student-athletes. . Management of Concussion Injury 1. Any student-athletes suspected of having a concussion or reporting concussion like symptoms, will be removed from activity and evaluated by a licensed athletic trainer or physician member of the sports medicine staff utilizing symptoms assessment (SCAT3 symptoms checklist), physical and neurological exam, cognitive assessment (SAC), and balance exam (BESS). The evaluation will also include clinical assessment for cervical spine trauma, skull fracture, and intracranial bleed when indicated. If the evaluation results in concern for a concussion, the student-athlete will be removed from athletic and classroom activity for the remainder of that day. 2. The department Emergency Procedure Plan will be utilized for any student athlete that has: a Glasgow Coma Scale of <13, prolonged loss of consciousness, focal neurological deficit, repetitive emesis, persistently diminished or worsening mental status, or possible spine injury (Appendix 1). 3. Student-athletes suspected of having a concussion and another responsible adult, will be provided and review the handout “Concussion Information for Student-Athletes and Family/Friends” following their evaluation. Student-athletes will be advised of the importance of being supervised by a responsible adult for the remainder of the day. Arrangements will be made for follow-up of the student-athlete the next day (Appendix 2). 4. Student-athletes suspected of having a concussion, will be referred to a physician for consultation and further evaluation. Student-athletes may be provided the “Documentation of Concussion” letter to outline any suggested temporary academic accommodations that may be necessary as a result of their concussion. Student-athletes will be expected to return to academics prior to returning to athletic participation (Appendix 3). 5. Student-athletes with a concussion, will undergo serial monitoring utilizing a graded symptom checklist. 6. Student-athletes with symptoms lasting longer than 72 hours will be followed by a physician weekly or as determined by the physician. 7. When a student-athlete’s concussion-related symptoms have improved, the student athlete will undergo concussion testing for comparison to their baseline concussion assessment. Student-athletes may begin the sport specific portion of the return-to-play progression after resolution of concussion related symptoms, a normal physical exam, when performing at or above pre-injury levels on all objective concussion assessments, and consultation with a physician. 8. Return-to-play progression from concussion injury will include the following six stages. The typical time frame consists of 24 hours between stages. Student-athletes must complete each stage without return of symptoms to progress to the next stage. If activity at any stage results in a return of symptoms or decline in test performance then the activity should be halted immediately and restarted 24 hours later if symptoms are resolved. Return-to-play is case dependent and the directing physician can shorten or lengthen the time frame when appropriate based on the individual student-athlete. Review by a physician will occur prior to participation in unrestricted activity. Stage 1 – No activity State 2 – Light exercise: <70% of age-predicted maximal heart rate Stage 3 – Sports–specific activities without the risk of contact from others Stage 4 – Noncontact training or practice involving others and resistance training Stage 5 – Unrestricted/Contact training or practice Stage 6 – Return to play Management of Individuals with Prolonged Concussion Symptoms The majority of student-athletes with concussion have symptoms improve at a steady rate, in cases when symptoms persist: 1. Student-athletes should be considered for referral to multi-disciplinary practitioners for specific evaluation of their symptoms. 2. Results of the student-athletes evaluation can be utilized in seeking academic accommodations due to their injury if the need exists. Return to Learn Management Plan The Assistant AD for Academic Services is designated as the point person within athletics who will navigate, along with others listed below, the return-to-learn plan with the student-athlete. The Multi-Disciplinary Team that is charged with additional help to navigate the more complex cases of prolonged return-to-learn include (as each case dictates): Team Physician Athletic Trainer (ATC) Psychologist/Counselor Neuropsychologist consultant Faculty Athletic Representative(s) Sport Academic Advisor Course Instructor(s) School/College Administrators Disability Resource Center (McBurney) Coach(es) Return to learn progression from concussion injury will be in compliance with ADAAA. It will include the following stages: Stage 1: Onset of concussion injury No classroom activity on same day as concussion Academic point person (or sport academic advisor) receives notification from sports medicine/medical staff of injury and prescribed cognitive rest/Individualized Initial Plan (IIP) (i.e. no reading, television, computers, cell phone, etc.) Faculty are notified (as timely as possible) of injury to student-athlete and of the prescribed cognitive rest/IIP and approximate time frame of recovery/absence period o IIP to include the following: 1) Remaining at home/dorm if SA cannot tolerate light cognitive activity. 2) Gradual return to classroom/studying as tolerated o Stage 2: Continuation of concussion injury Academic advisor and faculty member have communicated and established basic plan for return to learn. Student-athlete recovery proceeds per established protocol. Academic point person (or sport academic advisor) receives updated notification from sports medicine/medical staff of return to learn progress and additional/continued prescribed cognitive rest/Individualized Initial Plan (IIP) Faculty notified of additional updates Gradual return planned Extended absence from learning (>1 week) Faculty notified of planned return to learn date/time details Modification of schedule/academic accommodations for up to 2 weeks Regular check-in meetings from advisor with SA and faculty member of assignments and progress for each class Re-evaluation by team physician and members of multi-disciplinary team Engage campus resources for cases not managed through schedule modification/ academic accommodations (consistent with ADAAA and to include both Learning Specialists and McBurney Center staff) Re-evaluation by team physician if concussion symptoms worsen with academic challenges Reducing Exposure to Head Trauma The following steps will be taken to emphasize ways to minimize head trauma exposure: 1. Concussion education presentations to student athletes will emphasize and encourage the utilization of proper technique of the individual sport and the importance of taking the head out of contact in collision sports. 2. Coaches adhere to relevant live contact practice NCAA legislation for preseason, in-season, postseason, bowl and spring practice. 3. Coaches will be provided Inter-Association Consensus statements that exist pertaining to their sport that attempt to identify ways to reduce head trauma exposure (Appendix 4). 4. Coaches will be provided the Independent Medical Care Guidelines (Appendix 5). Revised: 4-24-2015 Appendices Index Appendix 1……………………………………………………………………………………………………. Emergency Procedure Plan Appendix 2………………………………………… Concussion Information for Student-Athletes and Family/Friends Appendix 3…………………………………………………………………………………..…………… Documentation of Concussion Appendix 4………………………………………………………………………………………………..…. Football Practice Guidelines Appendix 5…………………………………………………………………..……………….. Independent Medical Care Guidelines Appendix 1 Emergency Procedures 2014-2015 Emergency 1 Table of Contents Introduction ..................................................................................................................... 4 Emergency Planning ...................................................................................................... 5 Know Your Location ...................................................................................................... 8 Non-SOC Events ........................................................................................................... 10 Camp Randall Stadium-Main Turf ......................................................................... 10 Camp Randall Stadium- Weight Room ................................................................. 10 Camp Randall Stadium-Wrestling Room .............................................................. 12 Camp Randall Memorial Shell ................................................................................ 12 Camp Randall-North Practice Field ....................................................................... 13 Field House ................................................................................................................ 13 Goodman Softball Diamond and Goodman Softball Training Complex ......... 14 Kellner Hall ............................................................................................................... 14 Kohl Center Arena .................................................................................................... 15 Kohl Center-Main Floor/Athletic Training Room/Weight Room/Locker Rooms ..................................................................................................................................... 15 Kohl Center-Nicholas Johnson Pavilion Gym....................................................... 16 LaBahn Arena Complex ........................................................................................... 16 McClain Facility ........................................................................................................ 17 McClimon Outdoor Track &Field/Soccer Complex ............................................. 17 Natatorium ................................................................................................................ 18 Nielsen Tennis Facility ............................................................................................. 18 Porter Boat House ..................................................................................................... 19 SERF – Pool ................................................................................................................ 19 Thomas Zimmer Championship Cross Country Course ..................................... 20 2 University Bay Fields ............................................................................................... 20 University Ridge Golf Course/Indoor Training Center ....................................... 21 Eagle’s Nest Ice Arena.............................................................................................. 21 SOC-covered events (as designated by athletic administration policies) .............. 22 Emergency Care and First Aid .................................................................................... 24 Know Who to Call ........................................................................................................ 31 Licensed Staff Athletic Trainers .................................................................................. 32 Sport Coverage.............................................................................................................. 33 Acknowledgements ...................................................................................................... 34 3 Introduction What is the purpose of this emergency guide? The purpose of this guide is to provide a reference and guide for University of Wisconsin staff to facilitate appropriate emergency situation management. Who is this emergency guide created for? This manual is most beneficial to those that are certified in First Aid and CPR; however, if one is not certified, there are contact phone numbers to aid in appropriately managing an emergency. Athletic training students, licensed staff athletic trainers, strength coaches, sport coaches, and many others interacting with the athletic environment will be using this guide. How should one use this guide? For every practice and competition, an emergency plan should be in place – Use the checklists in the first section to help Review the information so it is familiar to help in an emergency situation Keep it available as a resource checklist and phone reference when an emergency occurs Post it by a phone for emergency use What is included in this guide? A section to help establish an emergency plan A section that includes addresses and closest phone contacts in case of an emergency for all the various team practice and competition locations A section with reference lists for o Potential emergencies o Signs and symptoms o Emergency action plans Most treatment plans are reference lists for those certified in First Aid or CPR. **If you are not certified, know how to get in contact with a certified medical staff so they can establish a treatment plan for the emergency. (Either 911 or a licensed staff athletic trainer) Phone Directory on the back pages 4 Emergency Planning 5 Identifying a Life Threatening Emergency What is an emergency… Any life-threatening situation No breathing No pulse Unconscious Uncontrolled bleeding – heavy, steady, or spurting Loss of feeling (numbness) or ability to move What to do… CALL 911 If certified in First Aid or CPR, give appropriate care Call a licensed staff athletic trainer as soon as possible Maintain body position of athlete Identifying a Non-Life Threatening Situation Requiring Urgent Care What is a non-life threatening situation… Inability to walk or bear weight – especially if associated with immediate swelling and bruising Severe and prolonged abdominal pain (over 1 hour) Uncontrolled bleeding – moderate blood loss Severe headache not alleviated by medication Prolonged/frequent vomiting and diarrhea together Unexplained and significant numbness, weakness, or sensation difficulties in arms or legs Fever over 101°F - combined with abdominal pain Fever over 101°F - combined with inability to touch chin to chest due to neck pain Blow to head/shoulders combined with headache What to do… Contact a licensed staff athletic trainer as soon as possible If certified in First Aid or CPR, give appropriate care Refer to UWHC Emergency Department 600 Highland Avenue Madison, WI 53792 (608) 262-2398 (Emergency Room) 6 Establishing an Emergency Plan Home and Away Events Prior to activity, determine the following: 1. Closest phone and phone number at the event 2. Locate availability of responsible medical personnel 3. Address and specific ambulance entrance to facility or field 4. Determine number to emergency services (i.e. 911) 5. Who will call emergency number 6. Who will meet the ambulance 7. Where will the injured athlete be taken (Home events direct to UW Hospital) 8. Who will accompany the injured athlete Calling 911 Provide dispatcher with the following information: 1. Your name and position with the University 2. The name and location of emergency 3. Brief description of the emergency 4. Current care being rendered and by whom 5. Location of the injured person 6. Directions for easy medical personnel access 7. Telephone number from which you are calling 8. Request: “A PARAMEDIC SQUAD” be sent. (otherwise only campus police squad car is sent) 9. Be ready to review all information provided 10. Hang up when dispatcher indicates you should. 7 Know Your Location 8 Camp Randall Stadium & Stadium Complex Camp Randall Stadium and the Stadium Complex include the following facilities: Kellner Hall Field House McClain Center Camp Randall Memorial Shell North Practice Field Camp Randall Stadium and the Stadium Complex are controlled under two centers based on the events/activities that are taking place at that time. These are the Stadium Command Center (SCC) and the Stadium Operations Center (SOC). Stadium Command Center SCC is the central communications center for Camp Randall Stadium for normal stadium activities and events that do not require SOC. SCC is located in the Athletic Operations Building (AO Building) at 25 N. Breese Terrace. SCC is open from 6 am – 2 am Monday through Friday and 6 am – 10 pm Saturday and Sunday. Telephone number: 262-8065 SCC is SOC when SOC is not operational. There is an AED located inside on the wall next to the office door. Stadium Operations Control SOC is the central communications center for the Stadium Complex for football game day and other designated stadium events. These areas include the facilities listed above. Any communication with emergency personnel will be routed through SOC to determine the quickest response to the victim(s). SOC is located on the north end of the fourth level of the Press Box. Telephone number: 262-9130 Command Center Designation Football game day and other designated stadium events covered by Stadium Operations Center (SOC) Other events not covered by Stadium Operations Center (SOC) 9 Non-SOC Events Camp Randall Stadium-Main Turf Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Stadium Command Direct someone to meet EMS Address: 25 North Breese Terrace; 53711 Entrance: AO Building parking lot AED is available: Stadium Command Center – wall next to lobby Gate 1 Welcome Center – inside glass vestibule Hall of Champions Welcome Center – wall to the right of front desk Camp Randall Stadium- Weight Room Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Stadium Weight Room Offices Direct someone to meet EMS & use call box at gate to call Stadium Command to open gate Address: 1475 Engineering Drive; 53711 Entrance: Through Gate 3 to glass entry doors AED is available: Hall of Champions Welcome Center – wall to the right of front desk Mueller Sports Medicine Center, cubbies next to front entrance Sport Performance Lab inside Mueller Sports Medicine Center 10 Camp Randall Stadium- Fetzer Center & Football Offices Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Academic Offices Direct someone to meet EMS & use call box at gate to call Stadium Command to open gate Address: 1475 Engineering Drive; 53711 Entrance: Through Bennett Student-Athlete Performance Center Main Doors, elevator to floor needed AED is available: 3rd floor of Fetzer Center at bottom of stairwell 8th Floor in kitchen area of football offices Hall of Champions Welcome Center – wall to the right of front desk Sport Performance Lab inside Mueller Sports Medicine Center 11 Camp Randall Stadium-Wrestling Room Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Wrestling Offices 262-3586 Stadium Command 262-8065 Direct someone to meet EMS Address: 1440 Monroe St; 53711 Entrance: Have someone meet EMS at Gate 1 (Lot 18). Bring them in through Badger Alley using the Heritage Hall elevator located at Section V. AED is available: Wrestling Athletic Training Room Stadium Command Center – wall next to lobby Gate 1 Welcome Center – inside glass vestibule Hall of Champions Welcome Center – wall to the right of front desk Camp Randall Memorial Shell Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Main Entrance Front desk Direct someone to meet EMS Address: 1430 Monroe St; 53711 Entrance: Main entrance through Lot 18 AED is available: Main entrance lobby Running Track 12 Camp Randall-North Practice Field Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Hall of Champions Welcome Desk Direct someone to meet EMS at Lot 17 service road gate (Call button opens / Knox Box) Address: 1475 Engineering Drive, 53711, Entrance: South Gate to North Practice Field AED is available: North Concourse, middle of north wall between the West and East Gate Hall of Champions Welcome Desk Field House Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Training Room Office 263-6748 Volleyball Team Locker Room 263-6944 Direct someone to meet EMS Address: 25 North Breese Terrace; 53711 Entrance: Gate D (Parking Lot #19/AO Building parking lot) AED is available: Volleyball Athletic Training Room Stadium Command Center – wall next to lobby Gate 1 Welcome Center – inside glass vestibule 13 Goodman Softball Diamond and Goodman Softball Training Complex Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Indoor Training Center East Wall 262-4222 Goodman Training Room 265-0699 Maintenance Office Press Box Direct someone to meet EMS Address: 1010 Highland Ave; 53705 Entrance: Direct someone to meet EMS at gated entrance in Lot 82 off of Highland Ave, west side of Nielsen Tennis Center AED is available: Softball Indoor Training Center East Wall Press box Athletic Training Room Kellner Hall Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Welcome Center Lobby Direct someone to meet EMS Address: 1440 Monroe St; 53711 Entrance: Main entrance through Lot 18 AED is available: Gate 1 Welcome Center Lobby Level 3 Hallway Level 5 Lobby 14 Kohl Center Arena The Kohl Center Arena events are controlled under the Arena Control Center. The Arena Control Center is located in The Kohl Center, 601 West Dayton St., 53715; Utilize East Campus Mall Drive to enter Loading Dock/Arena Control Center area. Arena Control Center is open from 5:30am to 2:00am on weekdays and 7am to midnight on weekends. This is subject to change with the Kohl Center event schedule. Telephone number: 608-265-4704. All emergency situations involving participants will be handled and directed by Athletic Training Staff and/or Physician Staff on the courts or ice rink All athletic related extraction will take place as stated in the Emergency Plan All other Kohl Center emergencies will be handled through Event Management and the Arena Control Center. Kohl Center-Main Floor/Athletic Training Room/Weight Room/Locker Rooms Assess situation and provide necessary emergency care Call 911 Radio Arena Control – Arena Control will call 911 Phone: Arena Control 265-4704 Athletic Training Room 265-5698 Cell phone Direct someone to meet EMS at Arena Control Address: 105 East Campus Mall; 53715 Entrance: Arena Control AED is available: Outside Arena Control office Gates A, B, and C Mezzanine Elevator Lobby Coaches Offices Lobby 15 Kohl Center-Nicholas Johnson Pavilion Gym Assess situation and provide necessary emergency care Call 911 Radio Arena Control – Arena Control will call 911 Cell phone to call 911 – then notify Arena Control that EMS was called Phone Arena Control 265-4704 South Wall in Gym 265-3566 Cell Phone Direct someone to meet EMS at Arena Control Address: 105 East Campus Mall; 53715 Entrance: Arena Control AED is available: Pavilion gym wall near main entrance from Gate B ticket lobby Outside Arena Control office Gate B Mezzanine Elevator Lobby Coaches Offices Lobby LaBahn Arena Complex Assess situation and provide necessary emergency care Call 911 Radio Arena Control – Arena Control will call 911 Cell phone to call 911 – then notify Arena Control that EMS was called Phone: Arena Control 265-4704 Athletic training room 265-6667 Direct someone to meet EMS at East Campus Mall, West Gate of LaBahn Address: 105 East Campus Mall; 53715 Entrance: Ice surface: West Gate of LaBahn or Zamboni/ Service Garage, - located off the south side of the facility off loading dock 2nd floor: Direct through concourse to elevator to 2 nd floor AED is available: North Concourse, middle of north wall between the West and East Gate Hockey Athletic Training Room 16 McClain Facility-Athletic Training Room/Locker Rooms/Weight Room/Indoor Turf Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone McClain Training Room 262-3630 McClain Weight Room 262-9535 Direct someone to meet EMS at Gate 3 Camp Randall Entrance. Use Knox box to direct Stadium Command to keep gates open for EMS. Address: 1475 Engineering Drive; 53711 Entrance: Double Doors leading to ramp entrance in McClain Center AED is available: South wall near the ramp entrance to the Shell Performance Lab in Mueller Sports Medicine Center Hall of Champions Welcome Desk McClimon Outdoor Track &Field/Soccer Complex Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Track Shed 262-3256 Direct someone to meet EMS Address: 700 Walnut St; 53706 Entrance: Main entrance off Walnut St. AED is available: Pressbox 17 Natatorium Athletic Training Room/Pool/Diving Well/Upstairs Gyms Assess situation and provide necessary emergency care Call 911 Contact front desk to notify of situation/call EMS 262-3742 Phone: Cell Phone Aquatics Director’s Office 263-6421 Direct someone to meet EMS at main entry door Address: 2000 Observatory Dr; 53706 Entrance: Main Entrance off Observatory Dr. AED is available: Pool deck Main Office Gym 1-4 Hallway Gym 5 Hallway Nielsen Tennis Facility Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Front Desk 262-0410 Direct someone to meet EMS Address: 1000 Highland Dr; 53705 Entrance: Front Entrance of Nielsen (if athlete is indoors) Rear Entrance of Nielsen (if athlete is outdoors) accessed from the maintenance road through Lot 82 off of Highland Ave. Gate is on the west side of the courts AED is available: Nielsen Reservation Desk Nielsen Indoor Courts Goodman Softball Training Center Goodman Athletic Training Room Goodman Press Box 18 Porter Boat House Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Boathouse Phone 890-0359 Direct someone to meet EMS Address: 680 Babcock Dr; 53706 Entrance: Main entrance on Babcock Dr. AED is available: Main (2nd) floor – inside wave tank entrance doors 3rd floor lobby – outside erg room SERF – Pool Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Swim storage room (between locker room and pool) 262-8245 Main Office Area Direct someone to meet EMS Address: 715 W. Dayton St; 53703 Entrance: Front Entrance off Dayton St. AED is available: Cashier’s Office Pool deck Cardio Room Weight Room Gyms 1 & 2 19 Thomas Zimmer Championship Cross Country Course (University Ridge Cross Country Course) Assess situation and provide necessary emergency care Call 911 Contact Club House 845-7700 Phone: Cell Phone Club House Maintenance Shop Direct someone to meet EMS in lower parking lot (across the main drive) Address: 9002 Country Trunk PD, Verona, WI Entrance: University Ridge main entrance off PD AED is available: Golf Training Center lobby entrance Maintenance Shed Clubhouse Pro Shop University Bay Fields Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Waisman Center front desk (north side of building) Nielsen Tennis Facility front desk Direct someone to meet EMS Address: University Bay Fields on Highland Dr Entrance: Off Highland Dr. (Lot #82) AED is available: Nielsen Tennis Center Reservation Desk Goodman Indoor Training Center Goodman Athletic Training Room Goodman Press box 20 263-1656 262-0410 University Ridge Golf Course/Indoor Training Center Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Main Office 845-7700 Direct someone to meet EMS in a golf cart at URidge entrance at Highway PD or at entrance to O.J. Noer Turfgrass Research facility entrance (Holes 4,5,6,7 only) to guide to injured individual Address: University Ridge: 9002 Country Trunk PD, Verona University O.J. Noer Turfgrass Research Facility: 2502 County Hwy M, Verona Entrance: Off PD of M, depending on location of emergency Contact Club House to provide specific location including hole number, tee, fairway, or green and meet EMS on golf cart at entry AED is available: Training Center lobby entrance Maintenance Shed Clubhouse Pro Shop Eagle’s Nest Ice Arena Assess situation and provide necessary emergency care Call 911 Telephone: - Cell phone - Main office: 845-7465 Direct someone to meet EMS Address: - 103 Lincoln, Verona Entrance: - Main entrance facing east towards parking lots 21 SOC-covered events (as designated by athletic administration policies) Camp Randall Stadium All emergencies should be directed immediately to 911 and all extrication strategies will be handled by SOC. If possible, contact security personnel, per mar, or other nearby official to help control the scene and help with meeting EMS. AEDs are located in the following areas: East 6th , 7th , and 8th Levels in Staircase 3 Football Office West 7th, 8th, and 9th levels in the elevator lobby Gate 1 Welcome Center Lobby (upon opening Jan 2014) Fetzer Center (upon opening Jan 2014) Main Turf Football Games All emergency situations involving participants will be handled and directed by the Athletic Training Staff and Physician Staff on field. Communication with SOC will be handled by a physician on the field. All extrication will be through the southwest corner of the stadium and through the AO Building lot. All other stadium emergencies will be handled through SOC. Other events All events that involve athlete participation will be handled by the Athletic Training Staff and Physician Staff on field. All other events will be controlled by SOC and designated personnel. Kellner Hall All emergencies should be directed immediately to 911 and all extrication strategies will be handled by SOC. If possible, contact security personnel, per mar, or other nearby official to help control the scene and help with meeting EMS. AED is available: Gate 1 Welcome Center Lobby Level 3 Hallway Level 5 Lobby 22 Field House Assess situation and provide necessary emergency care Call 911 Phone: Cell Phone Training Room Office 263-6748 Volleyball Team Locker Room 263-6944 Coordinate with SOC Direct someone to meet EMS Address: 25 North Breese Terrace; 53711 Entrance: Gate D (Parking Lot #19/AO Building parking lot) AED is available: Volleyball Athletic Training Room Stadium Command Center – wall next to lobby Gate 1 Welcome Center – inside glass vestibule McClain Center Assess situation and provide necessary emergency care Call 911 Coordinate with SOC Camp Randall Memorial Shell Assess situation and provide necessary emergency care Call 911 Coordinate with SOC North Practice Field Assess situation and provide necessary emergency care Call 911 Coordinate with SOC 23 Emergency Care and First Aid Approaching an Unconscious Person To find out if a victim is unconscious, ask the victim if he or she is OK. If you know the person, use his or her name. Speak loudly. If the victim does not respond to you, assume he or she is unconscious. Emergency Action Call 911 immediately If certified in CPR, give appropriate care Airway Difficulties The following are two of many airway difficulties one might encounter. Asthma: A condition that narrows the air passages and makes breathing difficult. It may be triggered by an allergic reaction to pollen, food, medications, bites or stings, or by physical or emotional stress. A typical signal of asthma is wheezing when the person breathes out. A person’s chest may look larger than normal because air becomes trapped in the lungs. Normally, asthma is controlled with medication. Medications open the airway and make breathing easier. Choking: A conscious person who is choking has the airway blocked by food or an object. The airway may be partially or completely blocked. If the choking person is coughing forcefully, let them try to cough up the object. 24 Signs and Symptoms Coughing Wheezing or high pitched sound with breathing Unable to get a breath in Bluish skin/lips Hands at throat to signify choking Chest pain, hands and feet tingling Emergency Action Call 911 If certified in CPR, give appropriate care If victim is a know asthmatic, use asthma medications prescribed to the athlete Cardiac (Heart) Difficulties The major sign of a cardiac emergency is pain in the chest that does not go away. The pain can be anything from discomfort to an unbearable crushing sensation in the chest. Pain may spread from the chest to the left shoulder, jaw, or back. It is usually not relieved by changing position, or taking medication. Any chest pain that is severe, lasts longer than 10 minutes, or persists even during rest requires medical care at once. Signs and Symptoms Pressure, squeezing, tightness, aching, or heaviness in the chest Difficulty breathing Pale or bluish skin color Becoming confused, faint, drowsy, or unconscious Emergency Action Call 911 If you are certified in CPR, give appropriate care until EMS arrives 25 Circulatory/Bleeding Difficulties External Bleeding Signs and Symptoms Heavy, steady, or spurting blood Emergency Action Call 911 If you are certified in first aid, give appropriate care until EMS arrives Light bleeding If you are certified in first aid, give appropriate care Please refer athlete to staff athletic trainer and/or physician Internal Bleeding Signs and Symptoms Tender, swollen, bruised, or hard areas of the body such as the stomach Rapid, weak pulse Cool or moist skin Pale or bluish skin Vomiting or coughing up blood Excessive thirst Becoming confused, faint, drowsy, or unconscious Emergency Action Call 911 Position the athlete comfortably If you are trained in CPR and first aid, give appropriate care 26 Shock Shock occurs when there is a diminished amount of blood available to the circulatory system due to dilated blood vessels and disruption of osmotic fluid balance. Shock is a possibility in any injury, but specifically with severe bleeding, fractures, and internal injuries and allergic reactions. Signs and Symptoms Symptoms may come rapidly or have delayed onset Pale, cool, moist skin Eyes – staring, not engaging, dilated Rapid breathing rate – shallow breaths Rapid pulse – decreased blood pressure Progressive restlessness or irritability – altered consciousness Difficulty breathing due to swollen airway Emergency Action Call 911 If you are certified in First Aid, give appropriate care If shock is the result of a known allergic reaction, assist in administering the appropriate prescription medication Traumatic Neurological Problems Possible Signs and Symptoms Dizziness Numbness Absence of sensation and movement in the extremities Altered level of consciousness Localized neck pain Unwilling to move because of neck pain Altered vital signs Extreme headache 27 Emergency Action Call 911 If certified in First Aid or CPR, give appropriate care Heat Illness Heat Cramps Signs and Symptoms Muscle spasm – usually in legs or abdomen Emergency Action Move athlete to a cool place to rest Give cool water to drink Lightly stretch the muscle – gentle massage is OK NO salt tablets or salt water Heat Exhaustion Signs and Symptoms Skin – cool, moist, pale, or flushed Headache Nausea Dizziness Weakness Exhaustion Emergency Action Get the athlete out of the heat Loosen tight clothing Remove perspiration soaked clothing Apply cool, wet cloths to the skin Fan the athlete If conscious, give cool water to drink (4 oz/15 min) Ice packs on wrists, ankles, groins, and armpits Call 911 if athlete refuses water, vomits, or starts to lose consciousness If certified in CPR, give appropriate care 28 Heat Stroke Signs and Symptoms Skin – red, hot, dry Changes in consciousness Rapid, weak pulse Rapid, shallow breathing Emergency Action Call 911 Treat according to principles above for heat exhaustion If certified in CPR, give appropriate care Cold Illness Frostbite Signs and Symptoms Lack of feeling in affected area Skin appears waxy Area cold to the touch Area may be discolored (flushed, white, yellow, or blue) Emergency Action Handle the affected area gently Never rub the affected area Warm area gently by soaking in water less than 105°F Keep the frostbitten area in water until skin becomes red and feels warm Loosely bandage the area with a dry, sterile dressing Seek medical attention by a physician as soon as possible Hypothermia Signs and Symptoms Shivering Numbness Glassy stare Change in personality Slow, irregular pulse Loss of consciousness 29 Emergency Action Call 911 If certified in CPR, give appropriate care If able, take patient to a warm place Remove wet clothes Warm with blankets and dry clothes Warm liquid to drink Do not warm body/area too quickly Hot water bottles/zip lock bags (wrapped in towels) in armpits and neck Sudden Injury or Illness If you are certified in First Aid/CPR, give appropriate care then notify staff athletic trainer for all situations. If the patient: Has an obvious visible deformity, encourage them to stay calm. Call 911. If certified in First Aid, give appropriate care Vomiting – Place them on their side Fainting – Position him or her on their back and elevate the legs 8-10 inches, if you do not suspect a head or back injury Has a seizure – Do not hold or restrain the person or place anything between the patient’s teeth. Remove any nearby objects that might cause injury. Cushion the patient’s head using folded clothing or a small pillow Known diabetic in a diabetic emergency – give the patient some form of sugar. If patient is unconscious, call 911. If certified in CPR, give appropriate care. 30 Know Who to Call Athletic Training Facilities McClain 262-3630 Field House 263-6748 Goodman Diamond 265-0698 Kohl Center 265-4285 Nicholas Pavilion 257-5916 Natatorium Pool 263-2461 SERF 262-8245 Coliseum 263-4350 LaBahn 265-6772 Other Facilities Nielsen Tennis Center 262-0410 Porter Boathouse 890-0359 Natatorium 262-3742 SERF 262-4757 Shell 263-6566 McClimon Track 262-3256 31 Licensed Staff Athletic Trainers Name Cell Phone Stefanie Arndt 608-443-8989 Tricia DeSouza 608-219-8134 Kyle Gibson 608-301-7672 Chuck Hart 608-225-6829 Dennis Helwig 608-576-9550 Andy Hrodey 608-225-6824 Gary Johnson 608-225-0302 Michael Moll 608-225-6825 Brian Lund 608-345-3272 Ashley Parr 608-225-1653 Michita (Mich) Toda 608-225-6826 Enrique (Henry) Perez-Guerra 608-225-6823 Ashley Pyne 608-514-5222 Jen Sanfilippo 608-219-2550 Kristy Walker 608-225-6820 Graduate Assistant/Intern Athletic Trainers Nora Gilman 608-224-9007 Abby Johnson 608-224-9949 Alyson Kelsey 608-260-5536 Tony Pennuto 608-224-9620 32 Sport Coverage Sport Athletic Trainer(s) Physician(PCP/ Ortho) Event Manager Basketball (M) Perez-Guerra Bernhardt/Dunn Jones Basketball (W) Arndt Carr/Scerpella Pietrowiak Crew (M) DeSouza/A. Johnson Carr/Orwin/ M. Wilson Burgess Crew (W) DeSouza/A. Johnson Bernhardt/Orwin/ M. Wilson Burgess Cross Country (M&W) Hart/Kelsey Bernhardt/Orwin Pietrowiak Football Moll/Lund/ Gibson J. Wilson/Baer/M. Wilson/J. Johnson Nelson/Burgess/ Jones Golf (M & W) Sanfilippo Landry/Orwin/ M. Wilson Nelson/Pietrowiak Ice Hockey (M) Hrodey Landry/Orwin Bee Ice Hockey (W) Helwig Brooks/Orwin Burgess Soccer (M) Toda/Pennuto Brooks/Dunn Burgess Soccer (W) Toda Carr/Dunn Pietrowiak Softball Parr Landry/Scerpella Bee Spirit Squads Arndt/Hrodey Landry/Baer/M. Wilson Swim/Dive (M&W) PerezGuerra/Gilman Landry/Orwin Burgess/Pietrowiak Tennis (M&W) Parr/Post Carr/Orwin/ Spellman Bee Track (M & W) Hart/Kelsey/Wa lker Bernhardt/Orwin Pietrowiak Volleyball Walker Bernhardt/Orwin Bee Wrestling G. Johnson J. Wilson/M. Wilson/Baer Burgess 33 Acknowledgements The following text books and administrative plan have played a very important role in developing this manual: 1. Community First Aid and Safety; American Red Cross 2. Modern Principles of Athletic Training; Daniel D. Arnheim 3. Sports Medicine Quick Reference Manual for Athletic Trainers; David J. Burnett 4. Camp Randall Emergency Plan 34 Appendix 2 Appendix 3 Appendix 4 Football practice guidelines Year-Round Football Practice Contact Guidelines Purpose: The Safety in College Football Summit (see appendix) resulted in inter-association consensus guidelines for three paramount safety issues in collegiate athletics: 1. Independent medical care in the collegiate setting; 2. Concussion diagnosis and management; and 3. Football practice contact. This document addresses year-round football practice contact. Background: Enhancing a culture of safety in collegiate sport is foundational. Football is an aggressive, rugged, contact sport,1 yet the rules clearly state that there is no place for maneuvers deliberately designed to inflict injury on another player.1 Historically, rules changes and behavior modification have reduced catastrophic injury and death. Enforcement of these rules is critical for improving player safety.2 Despite sound data on reducing catastrophic football injuries, there are limited data that provide a strong foothold for decreasing injury risk by reducing contact in football practice.3-8 Regardless of such scientific shortcomings, there is a growing consensus that we must analyze existing data in a consensus-based manner to develop guidelines that promote safety. “Safe” football means “good” football. NCAA regulations currently do not address inseason, full-contact practices. The Ivy League and Pac-12 Conference have limited inseason, full-contact practices to two per week and have established policies for full-contact practices in spring and preseason practices through their Football Practice Standards and Football Practice Policy, respectively. Neither address full-pad practice that does not involve live contact practice, as defined below. Both conferences cite safety concerns as the primary rationale for reducing full-contact practices; neither conference has published or announced data analysis based on their new policies. In keeping with the intent of both conferences and other football organizations, the rationale for defining and reducing live contact practice is to improve safety, including possibly decreasing student-athlete exposure for concussion and sub-concussive impacts. Reduced frequency of live contact practice may also allow even more time for teaching of proper tackling technique. The biomechanical threshold (acceleration/deceleration/rotation) at which sport-related concussion occurs is unknown. Likewise, there are no conclusive data for understanding the short- or long-term clinical impact of sub-concussive impacts. However, there are emerging data that football players are more frequently diagnosed with sport-related concussion on days with increased frequency and higher magnitude of head impact (greater than 100g linear acceleration).9-11 Traditionally, the literature addressing differing levels of contact in football practice correlated with the protective equipment (uniform) worn. This means that full-pad practice correlated with full-contact and both half-pad (shell) and helmet-only practice correlated with less contact. However, coaches, administrators and athletics health care providers who helped to shape these guidelines have noted that contact during football practice is not determined primarily by the uniform, but rather by whether the intent of practice is centered on live contact versus teaching and conditioning. There are limited data that address this issue, and such data do not differentiate whether the intent of the practice is live tackling or teaching/conditioning. Within these limitations, non-published data from a single institution reveal the following:10 The total number of non-concussive head impacts sustained in helmets-only and full-pad practices is higher than those sustained in games/scrimmages. Mild- and moderate-intensity head impacts occur at an essentially equal rate during fullpad and half-pad practices when the intent of practice is not noted. Severe-intensity head impacts are much more likely to occur during a game, followed by full-pad practices and half-pad practices. There is a 14-fold increase in concussive impacts in full-pad practices when compared to half-pad or helmets-only practices. Offensive linemen and defensive linemen experience more head impacts during both fullpad and half-pad practices relative to all other positions. The guidelines below are based on: expert consensus from the two day summit referenced above; comments and recommendations from a broad constituency of the organizations listed; and internal NCAA staff members. Importantly, the emphasis is on limiting contact, regardless of whether the student-athlete is in full-pad, half-pad, or is participating in a helmet-only practice. Equally importantly, the principles of sound and safe conditioning are an essential aspect of all practice and competition exposures. These guidelines must be differentiated from legislation. For each section below that addresses a particular part of the football calendar, any legislation for that calendar period is referenced. As these guidelines are based on consensus and limited science, they are best viewed as a “living, breathing” document that will be updated, as we have with other health and safety guidelines, based on emerging science or sound observations that result from application of these guidelines. The intent is to reduce injury risk, but we must also be attentive to unintended consequences of shifting a practice paradigm based on consensus. For example, football preseason must prepare the student-athlete for the rigors of an aggressive, contact, rugged sport. Without adequate preparation, which includes live tackling, the student-athlete could be at risk of unforeseen injury during the inseason because of inadequate preparation. We plan to reanalyze these football practice contact guidelines at least annually. Additionally, we recognize that NCAA input for these guidelines came primarily from Division I Football Bowl Subdivision schools. Although we believe the guidelines can also be utilized for football programs in all NCAA divisions, we will be more inclusive in the development of future football contact practice guidelines. Definitions: Live contact practice: Any practice that involves live tackling to the ground and/or full-speed blocking. Live contact practice may occur in full-pad or half-pad (also known as “shell,” in which the player wears shoulder pads and shorts, with or without thigh pads). Live contact does not include: (1) “thud” sessions, or (2) drills that involve “wrapping up;” in these scenarios players are not taken to the ground and contact is not aggressive in nature. Live contact practices are to be conducted in a manner consistent with existing rules that prohibit targeting to the head or neck area with the helmet, forearm, elbow, or shoulder, or the initiation of contact with the helmet. Full-pad practice: Full-pad practice may or may not involve live contact. Full-pad practices that do not involve live contact are intended to provide preparation for a game that is played in a full uniform, with an emphasis on technique and conditioning versus impact. Legislation versus guidelines: There exists relevant NCAA legislation for the following: 1. Preseason practice a. DI FBS/FCS – NCAA Bylaws 17.9.2.3 and 17.9.2.4 b. DII – NCAA Bylaws 17.9.2.2 and 17.9.2.3 c. DIII – NCAA Bylaws 17.9.2.2 and 17.9.2.3 2. In-season practice: No current NCAA legislation addresses contact during inseason practices. 3. Postseason practice: No current NCAA legislation addresses contact during postseason practices. 4. Bowl practice: No current NCAA legislation addresses contact during bowl practice. 5. Spring practice: a. DI FBS/FCS – NCAA Bylaw 17.9.6.4 b. DII – NCAA Bylaw 17.9.8 c. DIII – NCAA Bylaw 17.9.6 – not referenced to as spring practice, but allows five (5) week period outside playing season. The guidelines that follow do not represent legislation or rules. As noted in the appendix, the intent of providing consensus guidelines in year one of the inaugural Safety in College Football Summit is to provide consensus-based guidance that will be evaluated “real-time” as a “living and breathing” document that will become solidified over time through evidence-based observations and experience. Preseason practice guidelines: For days in which institutions schedule a two-a-day practice, live contact practices are only allowed in one practice. A maximum four (4) live contact practices may occur in a given week, and a maximum of 12 total may occur in preseason. Only three practices (scrimmages) would allow for live contact in greater than 50 percent of the practice schedule. Inseason practice guidelines: Inseason is defined as the period between six (6) days prior to the first regular-season game and the final regular-season game or conference championship game (for participating institutions). There may be no more than two (2) live contact practices per week. Postseason guidelines: (FCS/DII/DIII) There may be no more than two (2) live contact practices per week. Bowl practice guidelines: (FBS) There may be no more than two (2) live contact practices per week. Spring practice guidelines: Of the 15 allowable sessions that may occur during the spring practice season, eight (8) practices may involve live contact; three (3) of these live contact practices may include greater than 50 percent live contact (scrimmages). Live contact practices are limited to two (2) in a given week and may not occur on consecutive days. References: 1. NCAA Football: 2013 and 2014 Rules and Interpretations. 2. Cantu RC, Mueller FO. Brain injury-related fatalities in American football, 19451999. Neurosurgery 2003; 52:846-852. 3. McAllister TW et al. Effect of head impacts on diffusivity measures in a cohort of collegiate contact sport athletes. Neurology 2014; 82:1-7. 4. Bailes JE et al. Role of subconcussion in repetitive mild traumatic brain injury. J Neurosurg 2013: 1-11. 5. McAllister TW et al. Cognitive effects of one season of head impacts in a cohort of collegiate contact sport athletes. Neurology 2012; 78:1777-1784. 6. Beckwith JG et al. Head impact exposure sustained by football players on days of diagnosed concussion. Med Sci Sports Exerc 2013; 45:737-746. 7. Talavage TM et al. Functionally-detected cognitive impairment in high school football players without clinically-diagnosed concussion. J Neurotrauma 2014; 31:327-338 8. Miller JR et al. Comparison of preseason, midseason, and postseason neurocognitive scores in uninjured collegiate football players. Am J Sports Med 2007; 35:1284-1288. 9. Mihalik JP, Bell DR, Marshall SW, Guskiewicz KM. Measurement of head impacts in collegiate football players: an investigation of positional and event-type differences. Neurosurgery 2007; 61:1229-1235. 10. Trulock S, Oliaro S. Practice contact. Safety in College Football Summit. Presented January 22, 2014, Atlanta, GA. 11. Crison JJ et al. Frequency and location of head impact exposures in individual collegiate football players. J Athl Train 2010; 45:549-559. *This Inter-Association Consensus: Year-Round Football Practice Contact Guidelines, has been endorsed by: American Academy of Neurology American College of Sports Medicine American Association of Neurological Surgeons American Football Coaches Association 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 Football Championship Subdivision Executive Committee National Association of Collegiate Directors of Athletics National Athletic Trainers’ Association National Football Foundation NCAA Concussion Task Force Sports Neuropsychological Society Appendix 5 Independent medical care guidelines Independent Medical Care for College Student-Athletes Guidelines Purpose: The Safety in College Football Summit (see appendix) resulted in inter-association consensus guidelines for three paramount safety issues in collegiate athletics: 1. Independent medical care in the collegiate setting; 2. Concussion diagnosis and management; and 3. Football practice contact. This document addresses independent medical care for college student-athletes in all sports. Background: Diagnosis, management, and return to play determinations for the college student-athlete are the responsibility of the institution’s athletic trainer (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 studentathlete’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 an athletic trainer should always 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 a program’s designated medical director. 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. 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 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.8 Guidelines: 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-HeadsWith/141333/ 3. NCAA Bylaw 3.2.4.17 (Div. I and Div. II; 3.2.4.16 (Div. III). 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/RawlingsPanel_Intercollegiate-Athletics-at-UNC-Chapel-Hill.pdf *This Consensus Best Practice, Independent Medical Care for College Student-Athletes, has been endorsed by: 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