Youth Sports Safety: 5 Questions Every Parent Should Ask, #5

ARE COACHES TRAINED IN KEY SPORT SAFETY GUIDELINES?

One of the most influential people in your child’s sports experience is the coach (or coaches).  These people set the team culture, organize team activities, and make decisions on equipment.  Most (if not all) high schools and youth sports leagues require coaches to complete a standard training program that minimally includes training in first aid and CPR and basic sport specific skills and drills.  More recently, training is also required in concussion recognition and management.  For those sports that require equipment (e.g., football and boys lacrosse) coaches may or may not have training in recognizing proper fit and use of equipment.  As a parent it is important to understand what is required by your organization’s governing body when it comes to training for coaches. 

Key Governing Organizations:

When focusing on youth sports and private leagues, many have a national organizing body that set policies and procedures for your local league.  These organizations not only have bylaws and guidelines for rosters and tournaments, but also often dictate policy on training for coaches and safety guidelines for athletes.  It is important to be familiar with the policies set by the governing organization.  There are hundreds of youth sports organizations out there ranging from the Amateur Athletic Union (AAU), Police Athletic League (PAL), YMCA/YWCA to USA Football and Little League.  It is always important for parents to research their leagues to understand what the league governs.  When investigating your governing organization you will want to consider the following:  1) required training for coaches, 2) concussion policy and education, 3) game safety rules, and 4) specific equipment guidelines.  Not all leagues govern the same things, but to give you a head start on some of the major national organizations that govern youth sports check out this list:

• USAFootball
• PopWarner Football
• AmericanYouth Football Organization
• LittleLeague Baseball & Softball
• BabeRuth League Baseball & Softball
• Amateur Softball Association of America
• US Lacrosse (Boys & Girls)
• American Youth Soccer Organization
• US Soccer (Boys & Girls)
• USAHockey (Boys & Girls)

Concussions:

A majority of states have some form of concussion legislation meant to protect young athletes.  This legislation not only sets guidelines for how concussions are evaluated and managed following injury but also requires education of parents and coaches on the recognition of the signs and symptoms of concussions.  Given the growing demand for education and training there are several qualified groups that offer training in this area.  Two of the more common programs are Concussion Health and the Centers for Disease Control (CDC) “Heads Up” on Concussions program.  Concussion recognition is also part of the Athletes Saving Athletes program offered by A4IA.  Remember, the state legislation focuses on school sports, not private youth leagues.  You should check with your local league and national governing body to obtain the details of  the concussion program and policies in your given league.  I would advocate for all leagues to have a standard concussion policy if one is not already in place and it should include education for coaches and parents.

Equipment:

Many sports require that participants wear protective equipment of some kind.  The amount and type of equipment varies by sport and position.  When utilizing equipment it is important to note the following:  1) equipment is appropriate to age group, 2) fit is appropriate and reassessed regularly, 3) participant wears/uses equipment as intended, and 4) equipment is in working order and not worn or broken.  Failure to follow these guidelines can increase the likelihood of injury.  Equipment has a specific purpose and its effectiveness improves when worn properly.  Given this, it is important to remember that no equipment will prevent all injuries.

Resources for fitting equipment:

USA Football

US Lacrosse

Helmets are one of the most commonly worn pieces of equipment in sports, especially given the popularity of tackle football in the United States.  Helmets in conjunction with a facemask are designed to prevent skull fractures and other injuries to the face.  Many recent technological changes have been made in an effort to decrease the occurrence of concussions, but helmets cannot eliminate concussions completely and do not prevent the possibility of neck injuries.  All helmets whether football, lacrosse, hockey, or baseball are certified by a national organization.  Football helmets must be reconditioned annually in order to ensure their effectiveness.  The National Operating Committee on the Standards for Athletic Equipment (NOCSAE) certifies football, lacrosse, baseball, and softball helmets.  Hockey helmets are certified by The Hockey Equipment Certification Council (HECC) in the United States.

Mouth guards are another common piece of equipment.  There is a wide variety of options when selecting a mouth guard.  Just like a football helmet, one of the most important factors in its effectiveness is fit.  When fitted properly the wearer should still be able to breathe and speak normally.  The purpose of mouth guards is to prevent dental injuries.  There is no current research that validates the claim that mouth guards help prevent concussions.  Be careful when spending additional monies on a mouth guard because it states that it will help prevent concussions, an unproven claim.  Heat and mold mouth guards typically cost much less than customized mouth guards made by a dentist.  Both can be effective, but typically, the fit is much better with a custom mouth guard if the cost is not prohibitive.  The key to the best fit with a heat and mold mouth guard is to follow the molding instructions carefully and be sure to suck on the mouth guard when molding, do not bite it.

Resource for selecting and fitting mouth guards:

American Dental Association

Football Skills:

Tackle football is a very popular sport in the United States with about one million participants in high school football alone.  The recent focus on concussions has also put focus on the health and safety of participants.  While Pop Warner already has weight and age guidelines in place, there has been a renewed focus on teaching proper tackling technique to young participants.  The USA Football Heads Up Tackling program focuses on training for coaches and helping kids use proper technique on the field.

Baseball Pitch Counts:

Pitch counts were first instituted in Little League baseball in 2007 after research showed that the number of pitches thrown was a primary factor in elbow and shoulder injuries in participants.  Since that time, coaches and teams have been expected to follow pitch count guidelines.  The USA Baseball Medical and Safety Advisory Committee published pitch count guidelines in 2006 that can be accessed by clicking HERE.  If you would like a brief summary of the guidelines used by Little League Baseball, click HERE.  A full rule book can be purchased from Little League Baseball/Softball.  

I place particular emphasis on pitch counts because a recent study by Fazarale, Magnussen, Pedroza and Kaeding (2012) in Sports Health:  A Multidisciplinary Approach demonstrated that coaches were deficient in their understanding and application of pitch counts for their players.  The 95 coaches (of 228 asked) who completed the survey were only able to answer 43% of the questions regarding pitch counts and rest periods correctly, while 73% reported that they followed the recommendations.  While many coaches feel they are following the guidelines, they may not be.  Parents should always follow up and be sure key guidelines are being followed.

As parents, you always want your child to participate in sports as safely as possible.  A big part of that is following up with coaches and asking the right questions about their training, coaching philosophy and technique.  Coaches set the culture for the entire team and have the best opportunity, outside of individual parents, to create an environment of respect and safety first.  Understanding a coach’s philosophy on checking equipment regularly, concussion programs, and following specific sport safety guidelines will go a long way toward ensuring the safety the entire team and league.

To review questions 1 - 4 of 5 questions parents should ask:

Does the league/high school have an Emergency Action Plan (EAP) in place?

Is there an Athletic Trainer available?

Is someone who is trained in CPR and AED available at all times?

Is there an AED available?

Submitted by Heather L. Clemons, MS, MBA, ATC

Remembering Will Wardrip

Many of you who are now friends of Advocates for Injured Athletes may not know the history of the foundation. On our website we honor Will Wardrip who died three years ago today. Will was a friend and inspiration to all, admired for his character and recognized by his HUGE smile. When Will passed away his mom and dad designated memorial funds to Advocates for Injured Athletes. Each day we have tried to honor Will with our work in creating a program to help save lives.
We miss you Willy.

Will Wardrip (November 12, 1992–October 25, 2009)
Tommy Mallon and Will Wardrip were friends and teammates. On May 23, 2009, Tommy collapsed after a collision with an opponent on the lacrosse field and suffered a fractured neck. Will watched from the sidelines as his dad, anesthesiologist Eric Wardrip, came on to the field to tend to Tommy. Dr. Wardrip stayed by our side, riding with us in the ambulance and remaining with us in the hospital until Tommy was transferred, several hours later, to the ICU. He was a tremendous support for our family. Tragically, on October 25, 2009, the Wardrip family lost Will in a car accident. We all share their grief and the pain of this loss; we all miss Will. We will work together to honor Will's memory.

Youth Sports Safety: 5 Questions Every Parent Should Ask, #4

IS THERE AN AED AVAILABLE?

An Automated External Defibrillator (AED) is a portable device that can assess a person’s heart rhythm and provide an electrical shock to restore a normal heart rhythm, if appropriate.  These devices are critical in the treatment of sudden cardiac arrest (SCA), since people who suffer from SCA often die within minutes of collapse if CPR is not initiated and an AED is not utilized.  The incidence of SCA in young athletes (< 35y/o) is quite low  at 0.4 – 0.6 per 100,000 in the United States, but because these events are often traumatic and catastrophic much effort has been focused on eliminating the possibility of SCA and improving survival rates when SCA does occur.  Discussing the details of SCA and its prevention is beyond the scope of this post, but if you would like more information on preventing SCA click, HERE.  The focus of this post is the role of AEDs in the treatment of SCA.  Studies have repeatedly shown that the availability of AEDs and their use within minutes of collapse significantly increase the survival rate, for anyone who has suffered SCA (whether young or old).  In order for the AED to be effective, it must be available.

As a parent it is important to know when and where AEDs will be available.  The American Heart Association (AHA) and other organizations have consistently encouraged the development of Public Access Defibrillators (PAD) programs across the country in an effort to improve survival rates from SCA.  According to recommendations by the AHA the following components should be part of a PAD program:

• Targeted site placement of AEDs to maximize use (malls, arenas, schools, etc.)
• Ongoing basic life support CPR and AED training of anticipated rescuers (eg, staff likely to be present during business hours) through an approved course
• Maintenance and testing of the AED device to ensure continued functionality
• Coordination with EMS and a medical provider, to include providing notification of or registering the type of AED and its location with the EMS communications or dispatch center in the EMS response area, by calling 9-1-1 when an AED is used, and through oversight be a medical professional with emergency response expertise
• Continuous quality improvement through the use of a written medical emergency response plan or medically approved protocol, reporting each Out of Hospital Cardiac Arrest (OHCA) and clinical use of a PAD for evaluation by the program’s medical director, and use of the findings to improve program performance
• Limited liability for AED users and others

Taken from HERE

Researchers used these guidelines to provide a current summary of PAD program legislation in the United States.  The researchers found that no state met all recommended guidelines.  To learn which guidelines your state meets click, HERE.  Please note, these results based on data available in 2010 and so your state may have since updated or changed its guidelines.  Refer to individual state AED legislative resources for the guidelines in your state.  A summary report that can help you get started is available HERE.  (This link has not been updated since January 2012 so any new legislation approved after its publication is not part of this chart.)

Currently 17 states require the availability of AEDs in schools.  Given this, there is a possibility that your athletic trainer will have access to an AED in an SCA emergency during high school sporting events, but is not a guarantee.  If your state does not require AEDs be available in schools I would encourage parents to work to develop a PAD for your child’s school.  AEDs cannot be effective if they are not available.  Lack of access is also of concern in youth sports.  Often times, practices and tournaments occur at local parks where PAD is not likely to be present.  If this is the case, it will be important to understand whether state legislation allows athletic trainers or other available emergency personnel to provide their own AED.

AEDs are designed so an untrained layperson can use the device appropriately when available.  Despite this, I encourage anyone who may be in a position to utilize an available AED to formally train in their use (coaches, parents, administrators) because not all states have instituted a Good Samaritan law related to AED use in the same way states have for the use of CPR.  This training also help care providers understand the relationship between CPR and AED.  AED training is available through the same organizations that provide CPR training.  For those trained in compression only CPR check out this video for how an AED would be utilized in this situation:

Again, SCA in youth athletes is a highly traumatic event and people are working to improve detection of risk factors and prevent it.  Should SCA occur the typical survival rate is about 8%, AEDs improve the survival rate to between 40% – 74%, making them a critical tool in the treatment of SCA.  PAD programs are increasing meaning more and more AEDs are becoming available, but recent research shows that many states have much work to do in legally supporting and implementing PAD programs, especially in schools.  The best thing parents can do for their children’s safety is to advocate for programs and resources that can help in emergencies.  Be an advocate for AEDs and AED training in your schools and communities.  

Next week's question:  Are coaches trained (and following) key sport safety guidelines?

Submitted by Heather L. Clemons, MS, MBA, ATC

Youth Sports Safety: 5 Questions Every Parent Should Ask, #3

IS SOMEONE WHO IS TRAINED IN CPR AND AED AVAILABLE AT ALL TIMES?

Continuing the discussion about the questions parents should ask before letting their children participate in youth and high school sports, let's talk about CPR and AED training.  Before I continue this discussion, I want to reiterate that I do not believe that it is in the best interest of any participant to depend only on individuals trained  in CPR and AED.  Athletic trainers should be available at all times, especially for youth participants.  See last week’s post for my arguments advocating for athletic trainers by clicking HERE.  That said, there is always value in having additional personnel trained in CPR and AED should an emergency arise.

There are a variety of organizations that offer the opportunity to be trained and certified in cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AED).  Depending on your role, you may have the option to take a course for the “lay person,” a “professional rescuer” and some organizations even offer Emergency Medical Technician (EMT) course work.  The following organizations offer training:

American Heart Association

American Red Cross

Emergency Care and Safety Institute

You can check out their websites to find out more information about courses offered in your area.  Information typically available on the website will include a description of the type of course offered, dates, locations, and costs.  Certified instructors in your area at the local fire department, school district or college or university may also offer courses.  Typically, once you earn your certification it is active for two years at which time you must re-certify to maintain your active status, but organization requirements can vary so read your card carefully.

If there is not an athletic trainer available (I would argue even if there is one available), minimally at least one of the coaches or other team/league/school personnel need to be certified in CPR and AED.  Many high schools (and some youth leagues) actually mandate this for coaches as part of standard policy.  Parents should be diligent in making sure coaches and staff members who are required to maintain these certifications do.  As an example, often times many college coaches must be certified in CPR and AED even though an athletic trainer is available regularly as part of a university requirement, making them an important resource in an emergency.

Individuals trained in CPR and AED have the ability to quickly assess a situation and ascertain whether it is a life-threatening emergency and activate Emergency Medical Services (EMS).  Additionally, they are able to provide immediate care in the situation of choking, someone who is not breathing, and someone in the midst of a cardiac emergency.  This list of situations is not as broad in scope as what an athletic trainer can handle, but it does allow care to be provided to someone whose life hangs in the balance.  It is important to emphasize that if you are working with youth athletes you want to be sure you enroll in a course that addresses utilizing these techniques on children and not just adults.  Some of the expectations vary slightly due to the size of a given victim. 

Being certified to provide CPR and use an AED can be an invaluable set of skills in an emergency, but you do not have to be certified to help should you see someone collapse.  There are also opportunities to be trained in something called compression only CPR.  This is a continuous version of CPR that does not require rescue breathing, meaning no mouth-to-mouth contact.  If an AED is available, you should utilize it; it is designed to walk you through all the necessary steps to use it properly, even if you have not had any formal training.  You do not have to be worried about legal ramifications when helping someone who has collapsed, despite not being certified; Good Samaritan laws protect you.  Athletes who complete the Athletes Saving Athletes program through Advocates for Injured Athletes are trained in compression only CPR.  An A4IA video will be coming soon, in the meantime check out this video from the Sarver Heart Center at the University of Arizona College of Medicine, the developers of the technique.

Again, I want to emphasize how important it is to have a full-time athletic trainer, who is trained to recognize and manage many more emergency situations beyond those covered by CPR and AED training, available as often as possible.  It is also important to have additional individuals who are trained in the key emergency situations that are covered by CPR and AED training to assist the athletic trainer as necessary.  In the worst case, individuals trained in CPR and AED (whether coaches or other staff) must be available to activate EMS as the first line of defense in an emergency when an athletic trainer is not available.  Parents need to be sure someone is available to help your child when needed, so you should always ask what resources are available.

I focused mostly on CPR here and did not specifically address the role of the AED in emergency care in a suspected cardiac emergency, but I will address AEDs specifically in my next post, when answering the question:

 Are AEDs available?  

Submitted by Heather L. Clemons, MS, MBA, ATC

Youth Sports Safety: 5 Questions Every Parent Should Ask, #2

IS THERE AN ATHLETIC TRAINER AVAILABLE?

There are a variety of health care providers out there that may be able to help to your child at any given time, but I am advocating for the availability of athletic trainers because of the specific combination of skills and training they can provide.  In doing so, I am not minimizing the care a person trained as an Emergency Medical Technician (EMT) or a layperson trained in first and CPR can provide.  Often times, athletic trainers, EMTs and others need to cooperate in emergencies in order to have a successful outcome for the individual who requires assistance.  I simply hope to demonstrate the key combination of knowledge and skills an athletic trainer can provide.

The three key organizations you need to be aware when understanding the knowledge and skills of an athletic trainer are the National Athletic Trainers’ Association (NATA), the Board of Certification, Inc. (BOC), and the Commission on Accreditation for Athletic Training Education (CAATE).  Knowing what resources these organizations provide and how to access them will be important when advocating for an athletic trainer for your organization.  CAATE focuses on the requirements for the education of entry-level athletic trainers (ATs) and now post-professional training for ATs.  The BOC is responsible for administering the national exam that ATs must pass to practice as athletic trainers and assuring ATs meet necessary continuing education requirements and abide by the required standards of practice.  This organization can also provide you access to information regarding individual state licensure requirements for ATs.  The NATA is the professions’ advocacy group, working to improve and promote the profession of athletic training through research, governmental advocacy, and professional promotion among others.  The NATA is also responsible for developing and disseminating many of the key position statements made available throughout this post.

Athletic Trainers must graduate from an accredited athletic training education program (typically a Bachelor’s degree) and pass a national examination sponsored by the Board of Certification, Inc. in order to practice as an athletic trainer.  In reality, almost 70% of athletic trainers have earned a Master’s degree.  In all but a few states, athletic trainers must also be registered, certified or licensed (the designation depends on the legislation within that state) with their state in order to practice in that specific state.  When seeking out the services of an athletic trainer it is important that they can provide proof of their national certification, state licensure and CPR/AED certification.  If a person, referring to him or herself as an athletic trainer cannot provide this documentation, s/he may not have the complement of skills listed below and may not be an athletic trainer as defined in your state.

Athletic Trainers certified by the Board of Certification, Inc. are equipped with a full complement of skills that can be advantageous to parents who want to be sure that their children are safe during sports participation.  These skills are grouped into five domains:

Injury/Illness Prevention and Wellness Protection

Athletic trainers have the ability to assess a situation and take steps to minimize the potential for injury or illness for participants.  It can range from moving extra equipment to a safe place so participants do not run into it and risk being injured or assessing the heat index to determine if the weather is appropriate for practice and to what degree.  For example, a coach may remember to remove extra equipment, but they may or not be trained in the decision-making required to be sure key precautions are taken when practicing in hot and humid conditions.  The best way to treat heat illness is to prevent it, by changing your practice time, increasing water breaks, and decreasing the amount of equipment worn.  An athletic trainer can help coaching staffs make the correct decisions in these situations, among many others and provide a safe participation environment.

Clinical Evaluation and Diagnosis

Athletic trainers have the ability to evaluate athletes who are injured or become ill during participation and make the appropriate decisions on the immediate care they may require.  ATs may also decide whether continued participation is warranted, often a conflict of interest for coaches in the heat of a contest.  Immediate care decisions can include basic first aid such as RICE (rest, ice, compression, and elevation) or even referral to a specialist for follow up care.  In the worst case, athletic trainers are qualified to recognize when Emergency Medical Services (EMS) must be activated for immediate transport to a local hospital.

Immediate and Emergency Care

As mentioned above ATs can recognize when EMS needs to be activated.  ATs are trained to take the appropriate intermediate steps necessary until EMS arrives to maximize the potential of a positive long-term outcome for the participant requiring assistance.  Athletic trainers have the skills and techniques to recognize and treat a variety of emergent conditions including sudden cardiac trauma, concussions, head/neck injuries, heat illness, exertional rhabdomyolosis (sickle cell trait), and fractures, among others.  These situations are probably the most worrisome for parents and I believe it is important to have someone available who can handle such a wide variety of emergencies.

 Treatment and Rehabilitation

Athletic trainers provide initial treatment for injuries, but in situations where long-term rehabilitation may be required, can also provide rehabilitative services.  The ability to provide these services will depend on the setting in which the athletic trainer is employed and your state legislation which describes if and how these services can be provided by an athletic trainer.

Organizational and Professional Health and Well Being

Athletic trainers have a Standards of Professional Practice (BOC) and Code of Professional Ethics (NATA), ensuring that the best care possible will be provided to all patients.  Additionally, athletic trainers are required to participate in annual continuing education to remain up-to-date in their clinical practice.  Regular participation in continuing education is necessary to maintain the ATC© credential.  This practice assures that athletic trainers are using current best practices when caring for participants.

To learn more about the specific knowledge and skills an athletic trainer can offer you and your organization review the National Athletic Trainers’ Association document, “Athletic Training Services:  An Overview of Skills and Services Provided by Athletic Trainers.”  Coaches and other medical personnel such as EMTs may not have this specific range of knowledge and training making athletic trainers an ideal option for improving sports participation safety for athletes of all levels.

When considering adding an athletic trainer to your high school or sports league staff it is important to remember the following:

• Athletic trainers always work under the direction of a physician (which means your league/district must have a medical director for the AT to work under).
• When hiring an AT confirm s/he has the appropriate credentials to provide the care you require and expect.
• To verify the professional credentials of an athletic trainer with the BOC, click HERE.
• To verify the registration, certification or licensure status of an athletic trainer most states provide an online search option at the state licensing website.
• To verify current CPR/AED certification request a copy of their card (front & back)
• When an AT works with minors (children under 18) certain non-emergency decisions require a parent’s consent.  Where appropriate be sure signed informed consent forms are available in the case of an emergency and a parent cannot be reached.
• Have clear expectations for the AT (and parents) when the AT will be available and working.  For example, when will coverage be provided?  Events only?  Practice and events?  If an AT is covering simultaneous events/practices is there a hierarchy of when and how these concurrent events will be covered?

The National Athletic Trainers’ Association advocates for the availability of athletic trainers at all events and venues:

“In an effort to safeguard athletes in organized sports and minimize injuries at both practices and competitions, the NATA recognizes that athletes of all ages and levels of participation should have equitable access to the health care services delivered by a highly qualified, licensed or otherwise regulated, academically qualified professional athletic trainer. NATA believes that the minimum standard of health care for athletes should include employing an athletic trainer who is directed by a physician, having emergency action plans, and establishing safety and medical protocols and procedures at every public and private sports venue and for every sporting event.” 

-Taken from NATA Official Statement on Providing Quality Health Care and Safeguards to Athletes of All Ages and Levels of Participation

KEY POSITION/OFFICIAL STATEMENTS TO BE AWARE OF FROM THE NATA:

• Full-time, on-site athletic trainer coverage for secondary school sports
• NATA recommends athletic health care providers adopt a “Time Out” system before sporting events
• National Athletic Trainers’ Association Position Statement: Preventing Sudden Death in Sports
• National Athletic Trainers’ Association Position Statement:  Preventing Pediatric Overuse Injuries
• For other statements addressing a range of topics including concussion, heat illness, head/neck injuries, eating disorders, and steroids among others, click HERE.

QUESTION #3:  Is there someone trained in CPR/AED available at all times?... will be addressed in the next post. 

Submitted by Heather L. Clemons, MS, MBA, ATC

Youth Sport Safety: 5 Questions Every Parent Should Ask

DOES THE LEAGUE/HIGH SCHOOL HAVE AN EMERGENCY ACTION PLAN (EAP) IN PLACE?

An emergency action plan, often referred to as an EAP, is a written document that clearly delineates what steps should be followed in an emergency situation.  Specific contents of an EAP should include:  1) available personnel and their roles, 2) available equipment (AEDs, splints, spineboards, etc.), and 3) be specific to the venue and/or activity.  Additionally, the plan should be practiced regularly (minimally this is typically defined as annually) and reviewed to be sure the procedures are specific to current best practice for the care of injuries and illnesses.  For more information on the specifics of developing an EAP you can start with National Athletic Trainers’ Association Position Statement: Emergency Planning in Athletics.  While its focus is college athletics, it can be a great starting point for any organization looking to develop or update their EAP.

While many colleges are required to have an established EAP via NCAA guidelines, this may or may not be true for your school district or sports league.  Getting a copy of your school’s or league’s EAP is a great place to start in understanding the kind of care your son or daughter would receive while participating in sports should an emergency arise.  It will give you insight into the level of planning the organization has taken, what type of emergency training coaches and other staff have, who will be available and when, and what sort of equipment is available to help in an emergency. 

Some EAPs will be broader in scope and list the basic steps necessary to follow in an emergency, but others may be have several specific components that address specific injuries and situations.  Specific situations or injuries addressed may include a sudden cardiac trauma, asthma attack, heat illness, head/neck injuries and concussions.  The more specific an EAP can be, the more effective it will be should it need to be initiated.

A note on concussions:  A majority of states has enacted legislation that requires a specific concussion evaluation and treatment policy is in place.  This legislation often times also requires education of parents and key staff to recognize concussions.  Be sure when asking about the EAP that you inquire about your organization’s concussion policy.  Even if state legislation doesn't mandate a policy in your state, your organization's governing body may have a policy requirement.  

To learn whether your state has passed concussion legislation click HERE.

To review the National Federation of State High Association's position statement on concussions click HERE.

QUESTION #2:  Is there an athletic trainer available?... will be addressed in the next post.

Submitted by: Heather L. Clemons, MS, MBA, ATC