hb-2038 ~ natasha’s law...evan dupuis – el dorado patrick solis – el dorado christopher lopez...
TRANSCRIPT
HB-2038 ~ Natasha’s Law
Who is Natasha Natasha Helmick- Allen High School
Allen, Texas
Played soccer
Scholarship to Texas State- forfeited
First diagnosed concussion 8th grade
Who is Natasha Sustained 4 concussions in 5
years.
Played a game without vision in her left eye.
Sustain brain damage-her mother, Micky Helmick says that academically everything is 3 times harder for her.
Unable to recall much of her childhood.
Course Outline Introduction: This syllabus contains an outline of the required elements for
the two hour coaches’ concussion education training mandated by HB 2038 (Sec. 38.158). The purpose of this syllabus is to provide guidance and consistency for licensed health care providers as they develop the coaches’ education course. The most current information about brain injuries in sports should be imparted during the course.
Note: The mandated coaches’ concussion education course must be fulfilled by September 1, 2012. However, the duration of each educational session is left up to the discretion of the provider. Coaches must complete a total of two hours to fulfill the requirement. This may be in one session or multiple sessions. The coach must provide proper documentation of attendance to the ISD superintendent or the individual designated by the ISD superintendent. Two hours of concussion education training is required every two years and must be completed no later than September 1, 2012 and each subsequent two year period (2014, 2016 etc…)
Course Outline 1. Intent of Law
2. Definitions and Facts
3. Mechanism of Injury
4. Brain Physiology
5. Who is at Risk
6. Signs and Symptoms of a Concussion
7. Sideline Evaluation
8. Return to Play Protocols
9. Required Student/Parent RTP Documentation
10. Educational Considerations
11. Prevention Strategies
Intent of Law Sec. 38.153- Appoint Concussion Oversight Team (COT)
OVERSIGHT OF CONCUSSIONS BY SCHOOL DISTRICTS AND CHARTER SCHOOLS; RETURN-TO-PLAY PROTOCOL DEVELOPMENT BY CONCUSSION OVERSIGHT TEAM.
(a) The governing body of each school district and open-enrollment charter school with students enrolled who participate in an interscholastic athletic activity shall appoint or approve a concussion oversight team.
(b) Each Concussion oversight team shall establish a return-to-play protocol , based on peer-reviewed scientific evidence, for a student's return to interscholastic athletics practice or competition following the force or impact believed to have caused a concussion.
Intent of Law Sec. 38.154- COT Membership
Each concussion oversight team must include at least one physician and, to the greatest extent practicable, considering factors including the population of the metropolitan statistical area in which the school district or open-enrollment charter school is located, district or charter school student enrollment, and the availability of and access to licensed health care professionals in the district or charter school area, must also include one or more of the following:
(1) an athletic trainer
(2) an advanced practice nurse;
(3) a neuropsychologist; or
(4) a physician assistant.
SISD COT Dr. Tony Islas – Texas Tech
Dr. Justin Wright – Texas Tech
Athletic Trainers
Michelle Moe – Americas
Americas
Dennis Brown – Eastlake
Phillip Allen – Eastlake
Evan Dupuis – El Dorado
Patrick Solis – El Dorado
Christopher Lopez – El Dorado 9th Grade
Bernadette Nunez – Montwood
Montwood
Marcie Strutz – Socorro
Juan Renteria - Socorro
Intent of Law Sec. 38.154- COT Membership
If a school district or open-enrollment charter school employs an athletic trainer, the athletic trainer must be a member of the district or charter school concussion oversight team.
Each member of the concussion oversight team must have had training in the evaluation, treatment, and oversight of concussions at the time of appointment or approval as a member of the team.
Intent of Law Sec. 38.155- Required Annual form Acknowledging
concussion information (UIL Approved Form) REQUIRED ANNUAL FORM ACKNOWLEDGING
CONCUSSION INFORMATION. A student may NOT participate in an interscholastic athletic activity for a school year until both the student and the student's parent or guardian or another person with legal authority to make medical decisions for the student have signed a form for that school year that acknowledges receiving and reading written information that explains concussion prevention, symptoms, treatment, and oversight and that includes guidelines for safely resuming participation in an athletic activity following a concussion. The form must be approved by the University Interscholastic League.
Required Annual form Acknowledging concussion information (UIL Approved Form)
Yearly Paperwork UIL Pre-Participation Physical
2012-2013 UIL Steroid Form (HS only)
2012-2013 UIL Concussion Acknowledgement Form
UIL Acknowledgement of Rules Form
SISD Failure to Warn
SISD Release of Liability
Intent of Law Sec. 38.156-Removal from play in practice or competition
A student shall be removed from an interscholastic athletics practice or competition immediately if one of the following persons believes the student might have sustained a concussion during the practice or competition:
(1) a coach;
(2) a physician;
(3) a licensed health care professional (Athletic Trainer), or
(4) the student's parent or guardian or another person with legal authority to make medical decisions for the student.
Intent of Law Sec. 38.157-RTP in practice and competition
A student removed from an interscholastic athletics practice or competition under Section 38.156 may not be permitted to practice or compete again following the force or impact believed to have caused the concussion until:
(1) the student has been evaluated, using established medical protocols based on peer-reviewed scientific evidence, by a treating physician chosen by the student or the student's parent or guardian or another person with legal authority to make medical decisions for the student;
(2) the student has successfully completed each requirement of the return-to-play protocol established under Section 38.153 necessary for the student to return to play;
Intent of Law Sec. 38.157-RTP in practice and competition (Cont’)
(3) the treating physician has provided a written statement indicating that, in the physician's professional judgment, it is safe for the student to return to play; and
(4) the student and the student's parent or guardian or another person with legal authority to make medical decisions for the student:
(A) have acknowledged that the student has completed the requirements of the return-to-play protocol necessary for the student to return to play;
(B) have provided the treating physician's written statement under Subdivision (3) to the person responsible for compliance with the return-to-play protocol under Subsection (c) and the person who has supervisory responsibilities under Subsection (c); and
Intent of Law Sec. 38.157-RTP in practice and competition (Cont’)
(C) have signed a consent form indicating that the person signing:
has been informed concerning and consents to the student participating in returning to play in accordance with the return-to-play protocol;
understands the risks associated with the student returning to play and will comply with any ongoing requirements in the return-to-play protocol;
consents to the disclosure to appropriate persons, consistent with the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191), of the treating physician's written statement under Subdivision (3) and, if any, the return-to-play recommendations of the treating physician; and
understands the immunity provisions
Intent of Law Sec. 38. 158-Training courses for coaches, athletic
trainers, and licensed health care professionals
(a) The University Interscholastic League shall approve for coaches of interscholastic athletic activities training courses that provide for not less than two hours of training in the subject matter of concussions, including evaluation, prevention, symptoms, risks, and long-term effects. The league shall maintain an updated list of individuals and organizations authorized by the league to provide the training.
Intent of Law Sec. 38.159- Immunity Claus
This subchapter does not: (1) waive any immunity from liability of a school district or open-
enrollment charter school or of district or charter school officers or employees;
(2) create any liability for a cause of action against a school district or open-enrollment charter school or against district or charter school officers or employees;
(3) waive any immunity from liability under Section 74.151, Civil Practice and Remedies Code; or
(4) create any cause of action or liability for a member of a concussion oversight team arising from the injury or death of a student participating in an interscholastic athletics practice or competition, based on service or participation on the concussion oversight team.
Intent of Law Sec. 38.159- Immunity Claus (cont)
(b) The Department of State Health Services Advisory Board of Athletic Trainers shall approve for athletic trainers training courses in the subject matter of concussions and shall maintain an updated list of individuals and organizations authorized by the board to provide the training.
(c) The following persons must take a training course in accordance with Subsection (e) from an authorized training provider at least once every two years: (1) a coach of an interscholastic athletic activity; (2) a licensed health care professional who serves as a member of
a concussion oversight team and is an employee, representative, or agent of a school district or open-enrollment charter school; and
(3) a licensed health care professional who serves on a volunteer basis as a member of a concussion oversight team for a school district or open-enrollment charter school.
Intent of Law Sec. 38.159- Immunity Claus (cont)
(d) A physician who serves as a member of a concussion oversight team shall, to the greatest extent practicable, periodically take an appropriate continuing medical education course in the subject matter of concussions.
Intent of Law Sec. 38.159- Immunity Claus (cont)
(e) For purposes of Subsection (c): (1) a coach must take a course described by
Subsection (a); (2) an athletic trainer must take:
a course described by Subsection (b); or a course concerning the subject matter of concussions that has
been approved for continuing education credit by the appropriate licensing authority for the profession; and
(3) a licensed health care professional, other than an athletic trainer, must take: a course described by Subsection (a) or (b); or a course concerning the subject matter of concussions that has
been approved for continuing education credit by the appropriate licensing authority for the profession.
Intent of Law Sec. 38.159- Immunity Claus (cont)
(f) Each person described by Subsection (c) must submit proof of timely completion of an approved course in compliance with Subsection (e) to the school district superintendent or the superintendent's designee or, in the case of a home-rule school district or open-enrollment charter school, a person who serves the function of a superintendent or that person's designee.
(g) A licensed health care professional who is not in compliance with the training requirements under this section may not serve on a concussion oversight team in any capacity.
Intent of Law Sec. 38.160- Commissioner may adopt rules
SECTION 3. Subchapter D, Chapter 38, Education Code, as added by this Act, applies beginning with the 2011-2012 school year.
SECTION 4. Notwithstanding Section 38.158(f), Education Code, as added by this Act, a person required under Section 38.158(c), Education Code, as added by this Act, to take a training course in the subject of concussions must initially complete the training course not later than September 1, 2012.
SECTION 5. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2011.
Definitions and Facts Concussion
Type of traumatic brain injury that interferes with normal function of the brain.
Occurs when the brain is rocked back and forth or twisted inside the skull as a result of a blow to the head or body.
Definitions and Facts Concussion Myths and Facts
Used to be believed that a player had to lose consciousness or be “knocked –out” to have a concussion. Majority of concussions do not involve a LOC
Less than 10% of players actually lose consciousness with a concussion
The terms “ding” and “bell ringer” were once used to refer to minor head injuries and thought to be a normal part of sports. There is no such thing as a minor brain injury.
Any suspected concussion must be taken seriously.
Definitions and Facts Concussion Myths and Facts
Used to be believed that the night of the injury you must wake up the athlete up every few hours to make sure that they did not fall into a coma.
DO NOT wake them up, let them rest, but you can check on them to make sure they are still breathing.
Rest is the best treatment
Cognitive rest, including staying home from school
Physical Rest
Decrease stimuli such as computer games, TV, iPods, and texting.
Mechanism of Injury: Direct or Indirect blow to the body causing impulsive
forces transmitted to the brain
Direct Blow Indirect Blow
Movement Forces Linear Movement
Rotational Movement
Movement Combinations
Brain Physiology Growth
Adolescent brain
Reaction to Injury
Healing process
Who is at Risk? Gender
Among sports played by both sexes, girls suffer more concussions than boys.
Concussion symptoms last longer in female athletes
Who Is at Risk? Younger Athletes
Greater brain H2O content
Higher brain-blood volume
Degree of myelination
Skull geometry
Less Neck Strength
Learning Disabilities
Sport Specific risks Concussion rate is 40% higher for female soccer players
Concussion rate is 240% higher for female basketball players
Repeat Concussions
Prolonged Symptoms
Headaches
Difficulty concentrating
Poor memory
Sleep problems
Grades worsening/school performance
Might affect School necessary
accommodations ARD might be
needed
Second Impact Syndrome
Avoid at all costs
A player who returns to activity before
healing completely is at higher risk for
repeated concussions
Signs and symptoms are the same just
more sever lasting longer.
Proper recognition with proper care can
help prevent further injury or even
death
Signs and Symptoms of Concussions
Signs and Symptoms of Concussions COACHES
Dazed or Shocked
Confused (doesn’t know play)
Forgets plays
Personality Differences
Can’t recall events
Unsure of game, score, or opponent
Answers questions slowly
Signs and Symptoms Headache
Nausea
Double Vision
Feeling Sluggish
Feeling foggy
Sensitivity to light
Sensitivity to noise
Concentration problems
Signs and Symptoms of Concussions Sideline Evaluation
Remove from play
Assessment by Athletic Trainer (if applicable)
Medical Referral
NEVER RETURN TO PLAY on same day
Signs and Symptoms of Concussions
Physical Symptoms
Cognitive Symptoms
Emotional Symptoms
Physical Signs
Headache Dizziness Nausea Feeling “Unsteady” Feeling “Stunned” Feeling “Dazed” Feeling “Bell Rung” Feeling “dinged” Visual Disturbances Tinnitus (ringing in ears) Diplopia (Double Vision)
Confusion Amnesia Disorientation Poor Concentration Memory Disturbance
Depression Irritability Moodiness
Loss Of Consciousness Poor Coordination Easily Distracted Poor Concentration Slow Responses Vomiting “Glassy eyed” Photophobia (sensitive to light) Aphasia Personality Change Inappropriate behavior Impaired Physical Activity
Concussions interfere with
School, Work and social interactions
Students may have difficulty with
◦Short and long term memory
◦Concentration
◦Organization
Symptoms may last a week or two but some may
last for months. Returning to quickly can prolong
symptoms.
Lifting weights at home or school
conditioning etc. all activities have to STOP
Rest for student with concussion
School
Stay home or attend school half day
Take naps or allow rest time
Extend time to complete assignments/tests
Allow time to visit school nurse for treatment of
Written instructions for homework
Repeat and present new information slowly
Share progress and difficulties
Rest for Home
Sleep often
Limit brain stimulation
◦Phone
◦Computer
◦Music
◦TV
◦Texting
◦Gaming
Sideline Evaluation Remove from Play
Assessment by Athletic Trainer
Medical Referral and evaluation
DO NOT return to play the same day
Return to play only after satisfying requirements of TEC 38.157
Emergency Loss of consciousness
Decreasing level of consciousness
Unusual Drowsiness
Unable to be awakened
Difficulty getting attention
Irregular breathing
Persistent vomiting
Worsening headache
Seizures
Removal from Activities When in doubt sit them out
Notify athletic trainer if available
Notify parent or guardian
Advise parents to seek medical attention with the Dr. of their choice
Notify school administrator
DO NOT allow student to return to any activity until all requirements have been met and check list is on file. (Coach can not sign off)
Return to Play Protocols Determined by the COT for the applicable ISD
Daily Assessment Tools
Activity Progressions
Neurocognitive Testing
Balance Testing
Required Student/Parent RTP Documentation Signed HIPPA consent form
Written Physical clearance by doctor
Signed Acknowledgement of immunity clause
Signed Acknowledgement of successful completion of RTP protocol
Signed Acknowledgement of risk for RTP after concussion
Our Protocol No activity for one week after injury & until athlete is 24
hours symptom free
Physician clearance to begin activity
Day 1- Light aerobic exercise with no resistance training
5-10 min on a stationary bike
Day 2- Sport specific activity
Day 3- Non-contact training drills with resistance training
Day 4- Full contact training drills
Cont.
Our Protocol Note – Athlete progression continues as long as the
athlete is asymptomatic at current activity level. If the athlete experiences any post concussion symptoms, he/she will wait until they are symptom free for 24 hours and start the progression again at the last symptom free step.
Day 5- Once the student has completed steps a-f as listed above, he/she may return to their sport activity with no restrictions.
Educational Considerations Academic accommodations
Taking day off from School
Informing the athletes’ Teachers
Privacy considerations
Prevention Strategies Equipment
Helmets
Pads
Mouth Pieces
Coaching/Teaching
Rule compliance/changes
Aggression
Education
HB 2038 FAQ’s http://uiltexas.org/files/health/UIL-CMP-FAQ-Resources.pdf
HB 2038 Document http://www.capitol.state.tx.us/tlodocs/82R/billtext/html/HB02038F.htm
13. When is the student athlete removed from
activity if a concussion is suspected?
A student athlete shall be removed from a practice or competition
immediately if a coach, a physician, a licensed health care
professional, or the student’s parent o rguardian or another person who
has authority to make legal decision for the studen tbelieves the
student athlete might have sustained a concussion. Coach means the
coach of the student’s team.
Coaches are encouraged to use the utmost caution regarding a
suspected concussion, including calling the student athlete over to the
sideline so that the coach can form a belief that the student may have
suffered a concussion. The act of calling a player over to the sideline
does not by itself constitute a belief that the student athlete might have
sustained a concussion. (See attached legislative intent letter from the
author and the sponsor of the new law).
14. When is the student athlete allowed to
return to activity?
A student athlete shall not return to practice or competition
until the student athlete has been evaluated and cleared in
writing by his or her treating physician and all other notice
and consent requirements have been met. The student
athlete must satisfactorily complete the protocol established
by the school district’s COT or charter school’s COT.
16. May a licensed health care professional sign the
treating physician's written release?
No, the law requires that written release must be signed
by the treating physician.
Treatment decisions are solely within the
physician/patient relationship
19. Can a coach monitor a student athlete's compliance
with the return-to-play protocol if the school district does
not employ an athletic trainer?
Yes.
The superintendent or his/her designee has supervisory responsibilities of
the athletic trainer, coach (as outlined above), or other person responsible
for the compliance with the return-to-play protocol. This provides a second
person for checks and balances purposes. The superintendent or his/her
designee is also responsible for distributing and collecting the required
forms, including the physician’s written authorization for
return to play.
Note: A superintendent is not able to appoint a coach as the
supervisory designee because Education Code, Section 38.158(c)
specifically, in part, states: "The person who has supervisory
responsibilities of under this subsection may not be a coach of an
interscholastic athletics team."
20. Can a coach authorize the return to play of the
student athlete?
No.
Under no circumstance can a coach authorize a student athlete's
return to play.
Education Code, Section 38.158(b).
Any Questions?