The County of Beaufort South Carolina is committed to supporting a comprehensive policy on concussion injury guidelines and management.  This policy will parallel the South Carolina General Assembly, 120th Session, 2013-2014 Bill for “Student Athlete Concussions Guidelines, and Management” Section 1,  Article 1, Chapter 63, Title 59 of the South Carolina Code of Laws.  While the State Bill focuses on mandates for the South Carolina State Department of Education, the County of Beaufort South Carolina will adopt the same policies and guidelines for organized athletic activities that take place on County property.

 

General Assembly of the State of South Carolina
Student athlete concussions, guidelines, and management

 

“SECTION 1. Article 1, Chapter 63, Title 59 of the 1976 Code is amended by adding:

 

"Section 59-63-75. (A) The South Carolina Department of Health and Environmental Control, in consultation with the State Department of Education, shall post on its website nationally recognized guidelines and procedures regarding the identification and management of suspected concussions in student athletes. The Department of Health and Environmental Control also shall post on its website model policies that incorporate best practices guidelines for the identification, management, and return to play decisions for concussions reflective of current scientific and medical literature developed by resources from or members of sports medicine community organizations including, but not limited to, the Brain Injury Association of South Carolina, the South Carolina Medical Association, the South Carolina Athletic Trainer's Association, the National Federation of High Schools, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics. Guidelines developed pursuant to this section apply to South Carolina High School League-sanctioned events.

 

“(B) A local school district shall develop guidelines and procedures based on the model guidelines and procedures referenced in subsection (A).

 

“(C) Each year prior to participation in athletics, each school district shall provide to all coaches, volunteers, student athletes, and their parents or legal guardian, an information sheet on concussions which informs of the nature and risk of concussion and brain injury, including the risks associated with continuing to play after a concussion or brain injury. The parent or legal guardian's receipt of the information sheet must be documented in writing or by electronic means before the student athlete is permitted to participate in an athletic competition or practice.

 

“(D)(1) If a coach, athletic trainer, official, or physician suspects that a student athlete, under the control of the coach, athletic trainer, official, or physician, has sustained a concussion or brain injury in a practice or in an athletic competition, the student athlete shall be removed from practice or competition at that time.

 

“(2) A student athlete who has been removed from play may return to play if, as a result of evaluating the student athlete on site, the athletic trainer, physician, physician assistant pursuant to scope of practice guidelines, or nurse practitioner pursuant to a written protocol determines in his best professional judgment that the student athlete does not have any signs or symptoms of a concussion or brain injury.

 

“(3) A student athlete who has been removed from play and evaluated and who is suspected of having a concussion or brain injury may not return to play until the student athlete has received written medical clearance by a physician.

 

“(4) In addition to posting information regarding the recognition and management of concussions in student athletes, the Department of Health and Environmental Control, in consultation with health care provider organizations, shall post on its website continuing education opportunities in concussion evaluation and management available to providers making such medical determinations. Such information must be posted by the department upon receipt from a participating health care organization.

 

“(5) The athletic trainer, physician, physician assistant, or nurse practitioner who evaluates the student athlete during practice or an athletic competition and authorizes the student athlete to return to play is not liable for civil damages resulting from an act or omission in rendering this decision, other than acts or omissions constituting gross negligence or willful, wanton misconduct. This immunity applies to an athletic trainer, physician, physician assistant, or nurse practitioner serving as a volunteer.

 

“(E) For purposes of this section:

 

“(1) 'Physician' is defined in the same manner as provided in Section 40-47-20(35).

 

“(2) 'Student athlete' includes cheerleaders.

 

“SECTION 2. This act takes effect upon approval by the Governor.

 

“Ratified the 4th day of June, 2013
Approved the 7th day of June, 2013.”

 

Background

 

A concussion is a type of traumatic brain injury that interferes with normal brain function.  The injury may be caused by a blow to the head, face or neck, or a blow to the body that causes a sudden jarring of the head.  A concussion can occur without a loss of consciousness, and proper management is essential for the immediate safety and long-term future of the injured individual.  A concussion can be difficult to diagnose and failing to recognize the sign and symptoms in a timely fashion can have dire consequences.  Medically, a concussion is a complex, pathophysiological event to the brain that is induced by trauma.

 

If an athlete sustains a second concussion during a recovery period, the risk of permanent brain injury increases significantly.  The consequences of a seemingly mild second concussion can result in brain swelling or permanent brain damage.  It can even be fatal.

 

Definitions

 

Appropriate Health-Care Professional: an individual(s) from the following professions who are designated as the persons to diagnose whether an athlete has or does not have a concussion:

 

• MD-Medical Doctor licensed to practice medicine in South Carolina

• DO-Doctor of Osteopathic medicine licensed to practice in South Carolina

• PA-Physician’s Assistant licensed to practice in South Carolina

• NP-Registered Nurse Practitioner licensed to practice in South Carolina

• PM-Paramedic license to practice in South Carolina

• AT-Athletic Trainer certified nationally or by the State of South Carolina

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Facts

 

• Athletes who have had a concussion, at any point in their lives, have a greater chance of getting another concussion

• Young children and teens are more likely to get a concussion and can take longer to recover than adults

• Recognizing and responding properly to concussions when they first occur can help prevent further injury or even death

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Policy and Procedures

 

Educating Coaches, Parents, and Athletes:

 

In order to participate in any formal athletic activity using Beaufort County South Carolina facilities, each organization’s game official, coach, athlete and the athlete’s parent or guardian shall review on annual basis (every 12 months) information on concussions.  This information can be found through the South Carolina General Assembly Bill, Department of Health and Environmental Control (DHEC), the Center for Disease Control and Protection (CDC), and other national recognized sport organization groups.  After reviewing materials describing how to recognize a concussion and the short and long term health effects, all participants listed above shall sign a Beaufort County Parks and Recreation Concussion Awareness Form acknowledging receipt, review, and understanding of such information.  Parks & Recreation will determine procedures for ensuring annually that statements are distributed to and collected from all participants with appropriate signatures and a means of record keeping of such data.

 

Using standardized tools for assessment of potential signs of concussion:

 

The following are examples of some of the tools that are available for recognizing and assessing concussion and the degree of injury.   It is important to have a mechanism in place which can quickly help evaluate the status of an athlete and determine whether or not continued participation in the activity can take place.

 

• Sport Concussion Assessment Tool - 3rd Edition (SCAT3)

• Sport Concussion Assessment Tool – Children ages 5 to 12 years (Child – SCAT3)

• Concussion Signs and Symptoms Checklist - Center for Disease Control  Prevention (CDC)

• Pocket Concussion Recognition Tool (CRT) – FIFA /Olympic Foundation/ International Rugby Board

 

Both SCAT3 documents may be used by medical professionals in assessing possible concussion.  The Concussion Sign and Symptoms checklist from the CDC along with the Pocket Concussion Recognition Tool used by various professional sport organizations are both helpful tools which assist any individual to quickly identify possible concussion.

 

Removing Athlete from Play:

 

If a coach, athletic trainer, official, or physician suspects that a student athlete, under the control of the coach, athletic trainer, official, or physician, has sustained a concussion or brain injury in a practice or in an athletic competition, the student athlete shall be removed from practice or competition at that time.

 

A student athlete who has been removed from play may return to play if, as a result of evaluating the student athlete on site, the athletic trainer, physician or physician assistant pursuant to scope of practice guidelines determines in his best professional judgment that the student athlete does not have any signs or symptoms of a concussion or brain injury.

 

 A student athlete who has been removed from play and evaluated and who is suspected of having a concussion or brain injury may not return to play until the student athlete has received written medical clearance by a physician.

 

An athlete who is believed to have a concussion should be IMMEDIATELY REMOVED FROM PLAY and should not be returned to activity until they are assessed medically.   Athletes with a suspected concussion should not be left alone and should not drive a motor vehicle.  It is recommended that, in all cases of suspected concussion, the player is referred to a medical professional for diagnosis and guidance as well as return- to-play decisions, even if the symptoms resolve.

 

On site evaluations may be performed by the athletic trainer, physician, physician assistant pursuant to scope of practice guidelines using a recognized sport assessment evaluation tool / checklist regarding signs and symptoms of a concussion.  During this process it is important to identify any “Red Flag” signs or symptoms.  These include:

 

• Athlete complains of neck pain

• Increasing confusion or irritability

• Repeated vomiting

• Seizure or convulsion

• Weakness or tingling/burning in arms or legs

• Deteriorating conscious state

• Severe or increasing headache

• Unusual behavior change

• Double vision

 

If any of these signs or symptoms are present, the player should be safely and immediately removed from the field.  Consider transporting by ambulance (call 911) for urgent medical assessment.   Remember:  “IF IN DOUBT, PULL THEM OUT.”

 

Obtaining Permission to Return-to-Play:

 

A student athlete who has been removed from play and evaluated and who is suspected of having a concussion or brain injury shall not return to play or practice until at least 24 hours after the suspected injury and until the student athlete has received and provided the athletic trainer written medical clearance by a physician.

 

Community Involvement

 

All sport clubs are required to provide materials and training related to concussion management to their officials, coaches, players, and parents / guardians sponsoring organized athletic activity on County property.  There are many excellent instructional guides regarding implementation of proper concussion safety responses available through the Internet.  It is the responsibility of each sport organization to see that all appropriate individuals receive this training and that any required County forms are filled out and filed with Beaufort County Parks and Recreation.

Continued support in working towards providing a safer playing environment for our community athletes is a primary concern for Beaufort County.

 

 

References:

• General Assembly of the State of South Carolina, 120th Session, 2013-2014

• Center for Disease Control and Protection (CDC)

• South Carolina Department of Health and Environmental Control (DHEC)

• South Carolina High School League (SCHSL)

• Br J Sports Med / Sport Concussion Assessment Tool