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AHSAA Middle/Junior High School Conference Sept 24, 2014. Marshall Smith Med, ATC, LAT Sports Medicine Director Southern Bone & Joint Specialist Dothan Al. Athletic Health Related Issues. Emergency Action Plans Heat Illness Concussions Hyponatremia. Emergency Action Plans.

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ahsaa middle junior high school conference sept 24 2014

AHSAAMiddle/Junior High School ConferenceSept 24, 2014

Marshall Smith Med, ATC, LAT

Sports Medicine Director

Southern Bone & Joint Specialist

Dothan Al

athletic health related issues
Athletic Health Related Issues
  • Emergency Action Plans
  • Heat Illness
  • Concussions
  • Hyponatremia
emergency action plans
Emergency Action Plans
  • When an Emergency occurs it affects more than just the people on the field or in the school.
emergency action plans1
Emergency Action Plans
  • Required by the State of Alabama.
  • Required by AHSAA
emergency action plans2
Emergency Action Plans
  • Review Annually
  • New Building Additions
  • New Buildings
  • Office Relocations/Staff/Classrooms
  • Redesigned Fields/Stadiums
  • Gate Locations
emergency action plans3
Emergency Action Plans


  • Know Locations
  • Boxes? Locked/ Alarms off-on
  • Batteries - need to be checked frequently
  • Pads- Check dates and proper sizes
emergency action plans4
Emergency Action Plans
  • Practice, Practice, Practice!!!
  • Who should be involved



Student Athletic Trainers


School Administrators

emergency action plans5
Emergency Action Plans
  • Scenarios for Practice

Injured athlete on Game field

Injured athlete on Practice field

Injured athlete in Gym/ Basement

Injured Student in school/ classroom

Every scenario will have different issues

to overcome.

emergency action plans6
Emergency Action plans
  • Encourage your staff to introduce themselves to the EMS staff at your games.
  • New staff on EMS units
  • May never have worked an athletic event!
  • Athletic events are different than MVA’s
heat illness
Heat Illness


Heat Cramps

Heat Exhaustion

Heat stroke

dangerous conditions
Dangerous Conditions
  • Heat Index – Know Temperature and Humidity Level
  • Test Air with WBGT Heat Index Monitor

65-73 Moderate Risk

73-82 High Risk

82+ Very High Risk

  • Weather Bug App- Very Good
noaa s national weather service heat index
NOAA’s National Weather Service Heat Index

Courtesy of NOAA’s National Weather Service www.nws.noaa.gov

signs of dehydration
Signs of Dehydration
  • Dry mouth
  • Thirst
  • Irritable or cranky
  • Headache
  • Bored or disinterested
  • Dizziness
  • Cramps
  • Excessive fatigue
  • Not able to keep up
  • Dark yellow urine
other factors for illness from heat
Other factors for Illness from Heat
  • Low fitness levels
  • High body fat
  • Sickness
  • Previous dehydration or heat illnesses
  • Inadequate heat acclimatization
  • Salt deficiency
  • Medications/Dietary supplements
serious health risks
Serious Health Risks
  • Dehydration Can Result In:
  • Heat Cramps
  • Heat Exhaustion
  • Heat Stroke
  • Recognize Warning Signs of Heat Illness
heat cramps
Heat Cramps
  • Are a mild heat illness that can be treated easily.
  • Intense muscle spasms can develop after exercising and losing large amounts of fluid and salt from sweating.
  • Athletes who sweat a lot or have a high concentration of salt may be more likely to get heat cramps.
heat cramps1
Heat Cramps
  • Signs/Symptoms
    • Intense pain
    • Persistent muscle contractions
  • Treatment
    • Hydration (sports drink and/or water)
    • Possibly extra sodium
    • Stretching, relaxation, massage
heat cramps2
Heat Cramps

When can the athlete play again?

  • As soon as they are symptom free.
  • Important to continue to monitor.
  • May need to change eating and drinking habits, become more fit, or get better adjusted to the heat.
heat exhaustion
Heat Exhaustion
  • Is a moderate Heat Illness that occurs when an athlete continues to be physically active even after suffering from ill effects of the heat.
  • The body struggles to keep up with the demands, leading to heat exhaustion.
heat exhaustion1
Heat Exhaustion
  • Signs/Symptoms
    • Loss of coordination, dizziness or fainting
    • Dehydration
    • Profuse sweating or pale skin
    • Headache, nausea, vomiting or diarrhea
    • Stomach/Intestinal cramps or muscle cramps
  • Treatment
    • Shade or air conditioned area
    • Remove excess clothing and equipment
    • Lie comfortably with feet above heart level
    • If not nauseous, rehydrate with water or sports drink
    • Monitor heart rate, blood pressure, CNS status and core temperature
heat exhaustion2
Heat Exhaustion

When can the athlete play again?

  • Should not be allowed to return until all symptoms are gone.
  • Avoid intense practice in heat for a few days.
  • If received medical treatment, not until doctor approves and gives specific return to play instructions.
heat stroke
Heat Stroke
  • Is a severe heat illness that occurs when an athlete’s body creates more heat than it can release, due to the strain of exercising in the heat.
  • Results in rapid increase in core body temperature.
  • Can lead to permanent disability or death.
heat stroke1
Heat Stroke
  • Signs/Symptoms
    • Core body temperature 104°F+
    • CNS dysfunction
    • Nausea, vomiting or diarrhea
    • Headache, dizziness or weakness
    • Hot & wet or dry skin
    • Increased heart rate, decreased blood pressure or fast breathing
    • Dehydration
    • Combativeness
  • Treatment
    • 911
    • Aggressive whole-body cooling (cold water immersion)
    • Fans/ice/cold towels over much of the body if immersion is not available.
heat stroke2
Heat Stroke

When can an athlete play again?

  • When the doctor approves and gives specific return to play instructions.
  • Parents should work with doctors to rule out or treat other conditions that may cause continued problems.
  • Should return very slowly under the supervision of health care professional.
  • Meet with prospective players and parents to educate them.
  • Discuss pre-season conditioning program
  • Avoid mid-day heat
  • Take regular breaks in shade
  • Slowly increase practice time and intensity
  • Pre-participation physical
  • Emergency action plan
  • ATC on site if possible.
activity guidelines
Activity Guidelines
  • 5-10 minute rest & fluid break after 25-30 minutes of activity
  • 5-10 minute rest & fluid break after 25-30 minutes of activity/should be in shorts & t-shirt with helmet & should pads.
  • 5-10 minute rest & fluid break after every 15-20 minutes of activity/shorts & t-shirt only.
  • Cancel or postpone all outdoor practices. Practice in air conditioned space.
acclimation to heat
Acclimation to Heat
  • Promote conditioning
  • Usually takes 10-14 days
  • Carefully observe athletes
  • Encourage athletes to drink before, during and after exercise
  • Take regular drink breaks in shade
  • Helpful Beverages: water and sports drinks with adequate electrolytes
  • Harmful Beverages: fruit juice, CHO gels, soda, sports drinks 8%+CHO, caffeinated drinks
monitor weight loss
Monitor Weight Loss
  • Athletes should weigh before and after practice
  • Check weight charts
  • Up to 3 percent weight loss through sweating is normal
heat illness1
Heat Illness


Teach Nutrition

Teach Hydration

Instruction in Proper Pre-Game Meal

Education and Support

Korey Stringer Institute


what is a concussion
What is a Concussion?
  • A traumatic injury that alters normal brain function
  • It is a problem with function, not structure: can’t see it or x-ray it
  • Any force applied to the body that causes the brain to shift or rotate, causing damage to brain cells that results in chemical changes that renders the brain vulnerable to subsequent injury and may take weeks to heal
what is a concussion1
What is a Concussion?
  • A common problem in ALL sports
  • Potential for serious complications including death
  • Can even occur with a mild jolt or hit; Do not have to lose consciousness- <10%
  • Occurs at all levels of play, but risk of serious injury is more significant in adolescents
  • Trained medical personnel are not always available to evaluate these injuries
definition of concussion
Definition of Concussion
  • “Concussion is a brain injury defined as a complex pathological process affecting the brain…Featuring pathologic and biomechanical injury.”
  • Zurich,2012
  • International Conferences on Concussions in Sport:Vienna 2001Prague 2004Zurich 2008Zurich 2012
state focus
State Focus
  • AHSAA – Point of emphasis rule for 2010 for all sports
  • “Any player who shows signs, symptoms or behaviors of a concussion must be removed from the game and shall not return to play until cleared by an appropriate health care professional (a medical doctor under AHSAA rules)”
  • Previous rule stated athlete had to be unconscious or apparently unconscious
state focus continued
State Focus Continued:


Alabama Concussion Law

  • Any athlete who receives a concussion must immediately be removed from play and not be allowed to return until a doctor says its safe and gives written permission
  • All youth sports programs and recreational organizations must distribute information sheets detailing the symptoms and risks of concussion and other forms of traumatic brain injury
state focus continued1
State Focus Continued:


Alabama Concussion Law

  • Athletes and their parents or guardians must sign the information sheets acknowledging they have read and understand the material
  • Coaches must also receive annual training on how to recognize concussion symptoms and how to treat an athlete with a concussion
why such a concern in high schools
Why Such a Concern in High Schools
  • Adolescents are more vulnerable to sustaining concussions and their brain takes longer to heal after sustaining an injury
  • Most high schools in Alabama do not have a licensed certified athletic trainer or physician available at all practices or games so coaches are responsible for the health and safety of their team
common signs and symptoms
Common Signs and Symptoms


  • Headache
  • Nausea/Vomiting
  • Dizziness
  • Balance Problems
  • Visual Problems
  • Fatigue/Feeling Tired
  • Light & Noise Sensitivity
  • Numbness/Tingling


  • Feeling mentally foggy
  • Feeling slowed down
  • Difficulty remembering
  • Difficulty concentrating
common signs and symptoms1
Common Signs and Symptoms


  • Irritability
  • Sadness
  • More emotional
  • Nervousness


  • Drowsiness
  • Sleeping less than usual
  • Sleeping more than usual
  • Trouble falling asleep


Using Concussion Clinical Trajectories to Inform Targeted Treatment Pathways



Concussion Clinical


Treatment and Rehab


Risk Factors


Previous Concussions








Motion sensitivity,

Ocular Hx?

new advances in concussion treatment
New Advances in Concussion Treatment
  • Vestibular and Ocular Motor Assessment
  • Balance Assessment
recognize balance problems bess test balance error scoring system
Recognize Balance Problems BESS Test(Balance Error Scoring System)

University of North Carolina Sports Medicine Research

Laboratory Chapel Hill, NC 27599-8700

vestibular and ocular motor assessment
Vestibular and Ocular Motor Assessment
  • Smooth Pursuits- H test
  • Saccades- Horizontal (eyes only)
  • Saccades – Vertical ( eyes only)
  • Convergence (near point) less than 8cm
  • VOR- Horizontal ( head with eyes)
  • VOR- Vertical ( head with eyes)
  • VMR- Horizontal ( body, head and eyes)
  • Headache, dizziness, nausea, fogginess
  • Commonly referred to as a low level of sodium in the blood.
  • Water Intoxication-without Na replacement during strenuous exercise.
  • Can result from excess fluid in the body relative to the normal amount of sodium, or it may be due to a loss of sodium and body fluid.

Symptoms may consist of:

Mental Changes- Confusion




Muscle Spasms




Mechanics of Hyponatremia

  • When the sodium levels in the blood are low, water tends to enter cells causing them to swell.
  • When this occurs in the brain it causes Cerebral Edema. (Swelling in the Brain)
  • Causes increased pressure in the brain.
  • Only occurs in Severe cases
hyponatremia treatment and prevention
HyponatremiaTreatment and Prevention
  • Treated with IV fluids and Electrolyte replacements.
  • Gradual replacement of fluids during exercise and following exercise.
  • Monitor diet and lifestyle
  • Gradual Hydration and Food intake prior to athletic event and exercise to increase sodium levels.
Marshall Smith Med, ATC,LAT

Southern Bone & Joint Specialist

Dothan Al


Heat Stress and Athletic Participation. National Federation of State High School Associations.16 July 2008. http:www.nfhs.org/web/2005/03/sports_medicine_heat_stress_and_athletic_participation.asp

How to Recognize, Prevent & Treat Exertional Heat Illnesses. National Athletic Trainers’ Association. 16 July 2008 http://www.nata.org/newsrelease/archives/000056.htm

Kendrick Fincher Memorial Foundation. 16 July 2008. http://www.kendrickfincher.org/index.htm

National Oceanic and Atmospheric Administration’s National Weather Service Heat Index. United States Department of Commerce. Chart. 23 July 2008. http://www.weather.gov/os/heat/index.shtml

Parents’and Coaches’ Guide to Dehydration and Other Heat Illnessess in Children. National Athletic Trainers’ Association. June 2003.


Preseason Heat-Acclimatization Guidelines for Secondary School Athletics. Journal of Athletic Training Volume 44 Number 3 June 2009. National Athletic Trainers Association


Recommendations for Hydration to Prevent Heat Illness. National Federation of State High School Associations. 16 July 2008. http://www.nfhs.org/core/contentmanager/uploads/heatstressflyers.pdf

Heat Illness: Prevention and Treatment. Lynn Carr. August 2008.