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North Star Athletic Association Athletic Training Policies and Procedures A hanbook for all member schools
Updated 5/23/17
NorthStar Athletic Association Athletic Trainer Contact Information
Bellevue
Mike Livergood, MS, ATC, CSCS - Head Athletic Trainer
Phone: 402-557-7057
Email: [email protected]
Dakota State University
Brad Gilbert – Head Athletic Trainer
Phone: 605-480-2608
Email: [email protected]
Dickinson State University
Timothy Kriedt – Head Athletic Trainer
Phone: 1-800-279-HAWK (4295) ext. 2184
Email: [email protected]
Mayville State University
Tim O’Brien – Head Athletic Trainer
Phone: 701-788-4844
Email: [email protected]
Presentation College
Blake Spindler - Director of Athletic Training Services; Head Football Athletic Trainer
Phone: 605-229-8321 Email: [email protected]
University of Jamestown
Mitch Lang MA, L/ATC – Head Athletic Trainer
701-320-0584
Email: [email protected]
Valley City State University
Anna Bratsch, MS, ATC – Head Athletic Trainer
701-845-7165
Viterbo University
Waldorf College
Heidi Laube - Head Athletic Trainer
Phone: 641-585-8394
Emai: [email protected]
General Athletic Training Operations
• The Athletic Training Room is a medical facility, please respect the room and athletes present as such. • As licensed medical professionals, Athletic Trainers receive thorough training in preventing, recognizing,
and treating critical situations in the physically active.
• If you need to use the athletic training room and an athlete is present do not discuss their injury or rehab process with them, regardless if the athlete is on your team. This is against HIPAA (Health Information Privacy Act) regulations.
• Coaches please contact the Certified Athletic Trainer assigned to your sport if you need an injury update. • Coolers must be approved by one of the Certified Athletic Trainers before they are removed from the
athletic training room. Coolers must be clean and put away when they are returned. • Athletes must bring a water bottle to practice/games. Cups are for game use only. • The hours of operation are 9 am – 11 am; 1 pm – 6 pm Monday thru Friday unless previous
arrangements have been made. Weekend coverage available by arrangement and per practice/competition schedules.
• Athletic Training Room will be Closed Sunday. Practice/Scrimmage coverage will only be provided if there is a Monday competition.
• Athletic Training Room will be closed on the following holidays: Thanksgiving Day, Christmas Eve, Christmas Day, Good Friday.
• Athletic Trainers will be available 1 hour before practice and 2 hours before competition. • List Athletic Trainers:
• Appointment times are available in the mornings and up until an hour and a half before practices begin for treatments, rehabilitation, and evaluations of any injuries.
• Student-Athletes are responsible for all medical costs. A copy of your insurance and a physical must be on file in the training room before you are allowed to practice.
• Not all sports can be covered at all times. In-season sports have priority over out of season sports. Home events have priority over away competitions. High-risk activities have priority over low-risk activities.
• Coaches are responsible to letting the athletic Training staff know when there are any changes made to the practice/competition schedule. A minimum of 24-hour notice is required for schedule changes. Failure to notify Athletic Training in a timely manner may result in denied service.
• Athletes will be treated on a first come, first serve basis. Pre-season/out of season practices will only be
covered during regular scheduled office hours.
Fall Winter Spring
Football Men’s/Women’s Basketball Football (when practicing)
Volleyball Track & Field Baseball/Softball
Cross Country Track & Field
Golf Volleyball
Baseball/Softball Golf
Game Day Policies and Procedures
• Original home team will have the responsibility of covering the event • The ATC’s of the host institution will have the following equipment available for the visiting
teams(s): o Taping Tables/Area o Emergency Splints o Crutches o Modalities available upon request
Modality availability may also vary depending on host site Modalities such as US, Laser, etc. will require North Star Traveling Athlete
Treatment Form • The host institution on game day will also provide:
o Water o Ice chest with bags o Biohazrd materials o Bench towels (volleyball and basketball only) o Form of communication across the sidelines – FOOTBALL ONLY
• Visiting teams are responsible for their own athletic training equipment • Cups will be available for game day only; practices will require athletes to bring their own
cup/water bottle. • Football Game day Policies and Procedures
o ATC required to travel with football o Supplies and equipment will be provided as stated above o On-site Ambulance required for all varsity football games o Physician or Physician Assistant coverage strongly advised, although not required.
• Each university should have Emergency Action Plans for all athletic venues attached in personal Policy and Procedure manuals
Spinal Injury Procedure
• Sudden death from a cervical spine injury is most likely to occur in football from a fracture-dislocation above the
C4 vertebrae.
• During initial assessment, the presence of any of the following, alone or in combination, requires the initiation of
the spin injury management protocol:
o Abnormal level of consciousness or progressive loss of consciousness
o Obvious swelling or deformity of the spine
o Spinal pain or tenderness with or without palpation
o Neurologic signs or symptoms
o Any doubt concerning injury
General Guidelines:
• The cervical spine should be in neutral position, and manual cervical spine stabilization should be applied
immediately.
• Traction MUST NOT be applied to the cervical spine.
• Immediate attempts should be made to expose the airway.
• If rescue breathing becomes necessary, the person with the most training and experience should establish an
airway and begin rescue breathing using the safest technique.
• If the spine is not in neutral position, rescuers should realign the cervical spine. However, the presence or
development of any of the following, alone or in combination, is a contraindication to realignment: pain caused or
increased by movement, neurologic symptoms, muscle spasm, airway compromise, and physical difficulty
repositioning the spine, encountered resistance or apprehension expressed by the patient.
• Manual stabilization of the head should be converted to immobilization using external devices such as foam head
blocks. Whenever possible, manual stabilization is resumed after the application of external devices.
• Athletes should be immobilized with a long spine board or other full-body immobilization device.
• Create as little motion as possible and complete the steps of the EAP as rapidly as is appropriate to facilitate
support of basic life functions and prepare for transport to the nearest emergency treatment facility.
Equipment Removal:
• Removal of helmet and shoulder pads in any equipment intensive sport should be deferred until the athlete has
been transported to an emergency medical facility except in 3 circumstances:
o The helmet is not properly fitted to prevent movement of the head.
o The equipment prevents neutral alignment of the cervical spine.
o The equipment prevents airway or chest access.
• Those involved in the pre-hospital care of injured football players should have the tools for face mask removal
readily available, which is to be done right away.
• If the athlete does not have a pulse, cut open jersey and shoulder pads down the center of the chest and perform
CPR.
Prevention
Axial loading is the primary mechanism for catastrophic cervical spine injury. Head-down contact, defined as initiating contact with the top or crown of the helmet, is the only technique that results in axial loading.
Both head down contact and spearing are dangerous and may result in axial loading of the cervical spine and catastrophic injury.
Football helmets and other standard football equipment do not cause or prevent axial-loading injuries of the cervical spine. Injuries that occur as a result of head-down contact are technique related and are preventable to the extent that head-down contact is preventable. Instinctively, players protect their eyes and face from injury by lowering their heads at impact. Therefore, coaches must allocate enough practice time to overcome this instinct. Athletes who continue to drop their heads just before contact need additional coaching and practice time.
With the head up the player can see when and how impact is about to occur and can prepare the neck musculature. Initiating contact with the shoulder while keeping the head up is the safest contact position.
The use of videos such as Heads Up: Reducing the Risk of Head and Neck Injuries in Football and Tackle Progressions can be utilized.
Concussion Procedure
Definition:
Concussion is a change in brain function, following a force to the head, which may be accompanied by temporary
loss of consciousness, but is identified in awake individuals, with measures of neurologic and cognitive
dysfunction.
Prevention:
Prevention of concussions will include enforcing the standard use of sport-specific and certified equipment (e.g.,
National Operating Committee on Standards for Athletic Equipment [NOCSAE]. Educational documents for athletes,
parents, coaches, etc. is available at the end of this document and in the Athletic Training room.
Assessment Tests and Tools:
The ImPACT program will be utilized by having the athlete complete a baseline exam prior to the start of the
season. For all assessment tests and tools (except ImPACT – testing will begin 24 hours post injury) there will be a
baseline test done immediately post injury then reassessed every 5 -10 minutes after than until symptoms clear or
athlete is referred. The concussion assessment battery includes a combination of tests for cognition, balance, and
self-reported symptoms known to be affected by concussions.
-Standardized Concussion Assessment Tool; SCAT3 (orientation, immediate memory, concentration, months in
reverse order, delayed recall) http://physicians.cattonline.com/scat
-Balance Error Scoring System
-Serial 7
-Symptom checklist (can include but not limited to: blurred vision, dizziness, drowsiness, lack of concentration, confusion, easily distracted, feel “in a fog” or “slowed down”, headache, inappropriate emotions, irritability, memory problems, nausea, poor balance, ringing in the ears, and sensitivity to light) -Immediate Post concussion Assessment and Cognitive Testing (ImPACT)
Treatment:
If the athlete’s symptoms persist or worsen or the level of consciousness deteriorates after a concussion, the
patient will be immediately referred to a physician trained in concussion management. Oral and written
instructions for home care will be given to the athlete and to a responsible adult (parent, roommate, etc.) who will
observe and supervise the athlete during the acute phase of the concussion while at home or in the dormitory.
Return to Activity:
Returning an athlete to participation after a head injury should follow a graduated progression that begins once
the athlete is complete symptom free and passing cognitive testing. At a MINIMUM the athlete diagnosed with a
sport related concussion must be removed from play and must not return to sport related activity for at least one
calendar day and are to be evaluated by a health care provider with expertise in sport related concussion.
The graduated Return-to-Play protocol:
Exertion Step: Activities:
1 Light aerobic exercise (walking, swimming, stationary cycling; no
resistance training)
2 Mode, duration and intensity-dependent exercise based upon sport
3 Sport-specific activity with no head impact
4 Non-contact sport drills and resumption of progressive resistance
training
5 Full-contact practice
6 Return to play
If at any point during the RTP progression, the athletes’ symptoms return, at least 24 hours must pass before the
protocol is reintroduced. The athlete must return to the last completed symptom free exertional step in the
protocol. An athlete with more than one concussion may take longer to recover and removal from contact sports
may be necessary.
When to Refer an Athlete to a Physician:
Athletes will be assessed by a physician as necessary after concussion.
Day-of-injury referral
• Amnesia lasting longer than 15 min
• Deterioration of neurologic function*
• Decreasing level of consciousness*
• Decrease or irregularity in respirations*
• Decrease or irregularity in pulse*
• Increase in blood pressure
• Unequal, dilated, or unreactive pupils*
• Cranial nerve deficits
• Any signs or symptoms of associated injuries,
spine or skull fracture, or bleeding*
• Mental status changes: lethargy, difficulty
maintaining arousal, confusion, or agitation*
• Seizure activity*
• Motor, sensory, balance, or cranial nerve deficits
subsequent to initial on-field assessment
• Post-concussion symptoms that worsen
• Additional post-concussion symptoms as
compared with those on the field
• Athlete is still symptomatic at the end of the game
(especially at high school level)
*Requires that the athlete be transported
immediately to the nearest emergency
department.
Delayed referral (after the day of injury)
• Any of the findings in the day-of-injury referral category
• Post-concussion symptoms worsen or do not improve over time
• Increase in the number of post-concussion symptoms reported
• Post-concussion symptoms begin to interfere with the athlete’s daily activities (i.e., sleep disturbances or
cognitive difficulties)
Home Care:
No medication to be taken unless prescribed by the physician. Assume activities of daily living as long as they are
symptom free. Athletes should rest as much as possible avoiding stimulants such as movies, video games, television,
reading, computers, etc. Also avoid spicy food and alcohol.
Return-to-Learn:
The student athlete may appear physically normal but may be unable to perform as expected in the classroom due
to concussive symptomology. A team approach involving the student-athlete, athletic trainer, physicians, coaches,
counselors, administrators, and instructors will be utilized to ensure return to academics. It is important the health
care providers remain alert to the signs and symptoms of depression and other emotional responses to injury that
can be particularly challenging following concussive injury. We will work to prevent or minimize complications of
other co-morbidities that may accompany sport-related concussion (e.g. ADHD, migraine or other headache
disorders, learning disabilities and mood disorders). If the lights or computer screen aggravate symptoms,
individual accommodations will be requested.
Educational Materials:
http://fs.ncaa.org/Docs/health_safety/ConFactSheetsa.pdf
Any materials handed out to athletes will need to be acknowledged by the athlete by signing a recipient form
attached below.
Inclimate Weather Procedure
In the case of inclimate weather (temperatures, storms, etc.) the Athletic Trainer will have unchallengeable authority to clear a venue or adjust practice times. If an Athletic Trainer is not available the head coach or Athletic Director will monitor. Lightning may be the most frequently encountered severe-storm hazard endangering physically active people each year. Millions of lightning flashes strike the ground annually in the United States, causing nearly 100 deaths and 400 injuries. Three quarters of all lightning casualties occur between May and September, and nearly four fifths occur between 10:00 am and 7:00 pm, which coincides with the hours for most athletic or recreational activities. The lightning channel has an average peak current of 20000 A and is 5 times hotter than the surface of the sun. Safe Locations: In a building with 4 substantial walls, a solid roof, plumbing, and electric wiring – structures in which people live or work or a fully enclosed vehicle, with a metal roof and windows up. Unsafe Locations: Open fields, metal bleachers (or under them), fences, light poles, flag poles, pools or standing water, the highest point of a field or body of water, avoid using plumbing or landline phones during thunderstorm activity. Prevention:
The most effective means of preventing lightning injury is to reduce the risk of casualties by remaining indoors during lightening activity. Either 6 - mile radius; 30-second flash/bang; or “If you hear or see thunder or lightening we are done will 30 minutes after the last strike” are acceptable policies. Individuals will remain entirely inside a safe building or vehicle until at least 30 minutes have passed since the last lightning strike or the last sound of thunder.
Prehospital Care: Individuals who feel their hair stand on end, skin tingle, or hear crackling noises should assume the lightning-safe position (crouched on the ground, weight on the balls of the feet, feet together, head lowered, and ears covered). Do not lie flat on the ground. Survey the scene for safety. Activate the local EMS system. Evaluate and treat for hypothermia and shock, apnea, asystole fractures, and burns. Most deaths are due to cardiac arrest so be prepared to administer rescue breathing, CPR, or AED. Treat for concussive injuries, fractures, dislocations, and shock.
Cold Weather Procedure Injuries from cold exposure are due to a combination of low air or water temperatures and the influence of wind on the body’s ability to maintain normothermic core temperature, due to localized exposure of extremities to cold air or surface. Environmental factors effecting cold weather injury can include: previous cold weather injury, race, geological origin, ambient temperature, use of medications, clothing attire, fatigue, hydration, age, activity, body size/composition, aerobic fitness level, acclimatization, and low caloric intake. Frostbite – localized response to cold, dry environment where moisture can exacerbate the condition. Frostbite can appear as frostnip, mild frostbite, and deep frostbite. Prevention:
o Wear proper clothing, dress in layers. o Stay hydrated, maintain energy levels, and well rested o Warm up thoroughly and keep warm throughout the practice or competition to prevent a drop in
muscle or body temperature o Always have a partner if the weather could cause a cold weather injury/illness o As a general rule, the threshold for potentially dangerous wind chill conditions is about minus -20
degrees Fahrenheit o Wind chill can accelerate heat loss from exposed skin
Practice and Competition Sessions:
o 30 degrees Fahrenheit and below: be aware of the potential for cold injury o 25 degrees Fahrenheit and below: provide additional protective clothing; cover as much exposed
skin as practical; provide opportunities and facilities for re-warming o 15 degrees Fahrenheit and below: consider modifying activity to limit exposure or to all more
frequent chances to re-warm o 0 degrees Fahrenheit and below: consider terminating or rescheduling activity
32 degrees is the coldest baseball and softball can play No lifts if the wind is higher than 28 MPH; Per OSHA Regulations. Must have safety equipment.
Heat Illness Procedure
• Athletes should be acclimatized to the heat gradually over a period of 7 to 14 days. • Dehydration:
· 1%-2% (1.5 - 3 lb. in a 150 lb. athlete) lost body weight causing thirst, irritability, headache, weakness, cramps, nausea, and decreased performance
· Dehydration of as little as 2% of body weight has a negative effect on performance and thermoregulation.
• Heat Cramps:
· Acute, painful, involuntary muscle contraction caused by dehydration, electrolyte imbalance, or neuromuscular fatigue.
• Heat Syncope:
· Also known as orthostatic vasodilatation; usually occurs in the first 5 days of acclimatization; caused by dehydration or lack of adequate blood supply causing fatigue, tunnel vision, pale or sweaty skin, decreased pulse rate, dizziness, lightheadedness, or fainting
• Heat Exhaustion:
· Core body temperature between 97°F to 104°F; causing dizziness, syncope, headache, diarrhea, decreased urine output, persistent muscle cramps, profuse sweating, chills, cool clammy skin, intestinal cramps, weakness, and hyperventilation
• Exertional Heat Stroke:
· Exertional Heat stroke is classified as a core body temperature of greater than 104˚F to 105˚F with associated CNS dysfunction. The CNS dysfunction may present as disorientation, confusion, dizziness, vomiting, diarrhea, loss of balance, staggering, irritability, irrational or unusual behavior, apathy, aggressiveness, hysteria, delirium, collapse, loss of consciousness, and coma.
· Most athletes with EHS will have hot, sweaty skin as opposed to the dry skin that is a manifestation of classical EHS
• Treatment Protocol:
· Remove from activity · Cold water immersion is the fastest cooling modality. If this is not available, cold water dousing or
wet ice towel rotation may be used to assist with cooling. · Athletes should be cooled first and then transported to a hospital unless cooling and proper medical
care is available onsite. · The water should be approximately 35˚F to 59˚F and continuously stirred to maximize cooling.
• Return to Play:
· Once any heat illness has occurred, recurrence is much more likely. · In all cases of EHS, the athlete must complete a 7 day rest period and obtained normal blood work
and physician clearance.
· They may begin a progression of physical activity, supervised by the ATC, from low to high intensity and increasing duration in a temperate environment, followed by the same progression in a warm to hot environment.
• Prevention: · Acclimatization, full hydration, planning practices around the warmest times of the day
• Hydration Recommendations
· Immediately after practice or competition replace fluids– drink at least 20 oz. Of water for every pound of weight loss
· 2-3 hours before exercise drink at least 17-20 oz. of water · 10-20 minutes before exercise drink another 7-10 oz. of water · Drink 7-10 oz. of water for every 10 minutes of exercise · Remember to drink beyond thirst · Cool beverages (50-59°F) are recommended
• Body weight changes, urine color, and thirst offer cues to the need for rehydration.
Sudden Cardiac Arrest
Sudden cardiac death is the leading cause of death in exercising young athletes.
Hypertrophic cardiomyopathy and coronary artery anomalies are responsible for approximately 25% and 14% of SCD, respectively.
In collegiate athletes, this incidence is slightly higher, with estimates ranging from 1:65000 to 1:69000. A recent report described the incidence of SCD in National Collegiate Athletic Associate student-athletes as 1:43000, with higher rates in black athletes (1:1700) and male basketball players (1:7000).
Through the pre-participation physicals and health history we can recognize a higher risk for this early.
• Personal history: o Exertional chest pain/discomfort o Unexplained syncope/near syncope o Excessive Exertional and unexplained dyspnea/fatigue associated with exercise o Prior recognition of a heart murmur o Elevated systemic blood pressure
• Family history: o Premature death (sudden and unexpected, or otherwise) before age 50 years to due heard disease o Disability from heart disease in a close relative less than 50 years of age o Specific knowledge of certain cardiac condition in family members
• Physical examination: o Heart murmur o Femoral pulses to exclude aortic coarctation o Physical stigmata of Marfan syndrome o Brachial artery blood pressure
Sudden cardiac arrest should be suspected in any athlete who has collapsed and is unresponsive. A patient’s airway, breathing, circulation, and heart rhythm (using the AED) should be assessed. An AED should be applied as soon as possible for rhythm analysis. If no pulse is palpable, the patient should be treated for SCA, and CPR should be initiated.
A goal of less than 3-5 minutes from the time of collapse to delivery of the first shock is strongly recommended.
Skin Conditions
• This section will describe how the prevention principles will be applied, how infected persons will be identified, and how to communicate information about potentially infected persons to the proper personnel.
Skin diseases, especially CA-MRSA are reaching pandemic proportions, so we should be prepared to provide fiscal and human resources for controlling infection in an ever-changing environment.
• Athletes have unique characteristics that make them particularly susceptible hosts. They participate in high-risk activities and have constant assaults to the integrity of their skin making transmission that much easier.
• Combined with the close quarters shared by athletes and generally poor hygiene practices, it is not difficult to see why skin infections cause considerable disruption to individual and team activities.
• Prevention: o Adequate hygiene materials must be provided to the athletes, including antimicrobial liquid (not
bar) soap in the shower and by all sinks. • Infection-control policies should be included in an institutions policies and procedure manual. • Custodial staff must be vigilant with following infection control policies. • A clean environment must be maintained in the athletic training facility, locker rooms, and all athletic
venues. Standard precautions and preventive measures must become the norm in athletic facilities. The adherence to recommended practices can significantly minimize the transmission of infectious diseases.
o Cleaning and disinfection is primarily important for frequently touched surfaces such as treatment tables, locker room benches, and floors.
• Athletes must be encouraged to follow good overall hygiene practices. o Athletes must shower after every practice and game with an antimicrobial soap and water. It is
preferable for the athletes to shower in the locker rooms provided by the athletic department. o Athletes should refrain from cosmetic body shaving. o Soiled clothing, including practice gear, undergarments, outerwear, and uniforms, must be laundered
on a daily basis. o Equipment, including knee sleeves and braces, ankle braces, etc., should be disinfected in the
manufacture’s recommended manner on a daily basis. o Hand hygiene is the single most important practice in reducing the transmission of infectious
agents. The correct technique for hand washing includes wetting the hands first, applying an appropriate amount of product, rubbing the hands together vigorously for at least 15 seconds, rinsing the hands with water, and then drying thoroughly with a disposable towel.
• Athletes must be discouraged from sharing towels, athletic gear, water bottles, disposable razors, and hair clippers.
• Athletes with open wounds, scrapes, or scratches must avoid whirlpools and cold tubs. • Athletes are encouraged to report all abrasions, cuts, and skin lesions to and seek attention from an Athletic
Trainer for proper cleansing, treatment, and dressing. All acute, uninfected wounds should be covered with a semi occlusive dressing until healing is complete.
Bacterial Infections:
• Athletes with suspicious lesions must be isolated from other team members. All bacterial infections will be referred to a physician for culture and diagnosis. Topical and/or oral antibiotic treatments will begin.
• To return to activity needs to include ALL of the following: o There should be no new skin lesions for at least 48 hours. o After completion of 72 hour course of directed antibiotic therapy.
o No drainage or exudate from the wound. o Active infections may not be covered for competition.
Fungal Infections:
• In contact sports, the skin-on-skin contact of the participants and abrasions, both clinical and subclinical, also lend themselves to the passage of fungal infections from one athlete to the next
• Immediate showering after each training session and thoroughly drying all areas, especially areas where two skin areas may touch or rub together (creases, folds, etc.), is recommended, as well as the use of absorbent sports briefs and the application of bacteriostatic powder.
• Return to activity: o Once lesions respond adequately to treatment, generally 3 days of topical treatment in minor cases
or 2 weeks of systemic treatment in more severe cases. o Athletes with solitary or closely clustered, localized lesions will not be disqualified if the lesions are
in a body location that can be covered securely. o Lesions that can be covered will be covered with bioclusive followed by pre wrap and stretch tape. o Dressings should be changed after each match so that the lesion can air dry.
Viral Infections:
• The most common viral infections among athletes are herpes simplex and molluscum contagiosum. Outbreaks of both of these have been known to spread throughout an entire team.
• An individual suspected of having a contagious skin disease should be immediately isolated from other team members until seen by a physician and the infection is properly managed.
• Primary treatment is with antiviral drugs. • Return to activity:
o According to NCAA guidelines, the athlete may not return to participation until he or she has received 5 days of oral antiviral therapy and all lesions have a dried, adhered crust.
Cleaning Schedules
Area Times Per Day Times of Day
Athletic Training Room
(treatment tables, taping tables,
and other commonly touched
surfaces)
3 times/day Morning, mid day, and at the end
of the day
Locker rooms (benches, carpet,
other commonly touched
surfaces)
Once a day At the end of the day, once
everyone is gone
Shower rooms in public locker
rooms (walls, fixtures, and
flooring)
Once a day At the end of the day, once
everyone is gone
Weight Room (benches, bars, and
other commonly touched
surfaces)
Once a day At the beginning or end of day
when no one is in there
***All areas should be cleaned with a cleaner with bactericide, fungicide, and virucidal efficacy.
Student Athlete Forms
• A physical will be required for 1st year participants
• An up to date health history will be turned in every year of participation
• HIPPA and informed consent
• Emergency contact and insurance form (including a photo of the insurance card)
• Additional recommended forms/policies listed below:
Sickle Cell Trait Testing and Acknowledgement Policy
Name: _______________________________________________________________ Sport: ___________________________ About Sickle Cell Trait: Sickle cell trait is an inherited condition of the oxygen carrying protein, hemoglobin, in the red blood cells. Sickle cell trait is a somewhat common condition. It is estimated that three million Americans have sickle cell. Sickle cell trait is most predominant in African-Americans and those of Mediterranean, Middle Eastern, Indian, Caribbean, and South and Central American ancestry, but persons of all races and ancestry may test positive for sickle cell trait.
Sickle cell trait is usually benign, but during intense, sustained exercise, hypoxia (lack of oxygen) in the muscles may cause sickling of the red blood cells (red blood cells changing from a normal disc shape to a crescent or “sickle” shape), which can accumulate in the bloodstream and “jam” blood vessels, leading to collapse from the rapid breakdown of muscles starved of blood. Sickle Cell Trait Testing: The NAIA encourages that all student-athletes have knowledge of their sickle cell trait status before the student-athlete participates in any intercollegiate athletics event, including strength and conditioning sessions, practices, competitions, etc. Testing can be accomplished with a simple blood test that is relatively inexpensive. If a test is positive, the athlete will not be disqualified from participating in sports, but will however, be offered counseling on the implications of sickle cell trait, including health, athletics, and family planning. Student-athletes will also receive further information of the Sickle Cell Trait and precautions that should be taken. If there is any knowledge of family history of the sickle cell trait, the Valley City State University Athletic Training staff requires that the student athletes gets tested prior to completing in athletics; or signs the following Sickle Cell trait testing waiver: _______ YES ________ NO I have no known knowledge of the Sickle Cell trait in my family’s history. Sickle Cell Trait Testing Waiver I, __________________________________________________, herby affirm that I have fully disclosed in writing any prior medical history and/or knowledge of sickle cell trait status to (school name) Athletic Training staff. Additionally, I have read and fully understand the aforementioned facts about sickle cell trait testing. I do not wish to undergo sickle cell trait testing as party of my pre-participation physical examination and voluntarily agree to release, discharge, indemnify, and hold harmless, (school name), their Athletic Training staff, and team physician from any and all costs, liabilities, expenses, claims, demands, or causes of action on account of any loss or personal injury that might result from my non-compliance with the mandate of the NAIA and (school name) department of athletics. Student-Athlete Signature _______________________________________________________ Date ______________________ Guardian Signature _______________________________________________________________ Date ______________________ (if under 18) Reviewed by (school name) Athletic Training Staff ____________________________________________________________________ Drug Testing Policy Consent Form
Participation in (school name) athletics is voluntary. Any student---athlete choosing to participate in intercollegiate athletics is choosing to accept and abide by all terms of the drug testing policy and consents to all aspects of the policy. A student---athlete who tests positive on his/her first drug screen will be suspended from 10% of competition and will be required to attend mandatory counseling sessions. A student---athlete who receives a second positive test within one calendar year of an initial positive test will be declared ineligible for further participation in (school name) intercollegiate sports. A student--- athlete who test positive for a second time, after one year has elapsed will be suspended from 50% of competition. If there are less than 50% competitions remaining in the season, suspension will carry over into the following season. A student---athlete who receives a third positive test will be declared ineligible for further participation in (school name) intercollegiate sports.
I herby certify that I have received and have read the (school name) Substance Abuse policy. I
agree to submit to a RANDOM substance abuse test.
I understand that if my performance/actions/behavior indicates it is necessary, I agree to submit to a REASONABLE SUSPICION substance abuse test. I understand and agree that the results of my drug tests, if any, will be disclosed to the Director of Athletics and Head Coach of your sport. I agree to disclose my drug testing results only for the purpose related to my eligibility for participation in regular season and postseason athletic competition.
I consent and agree to be tested. I have freely and knowingly decided to cooperate.
Signature of Student---Athlete Date
Signature of Parent/Legal Guardian (if student Date is under the age of 18)
Name (Please print full legal name)
Substance Abuse Policy
Introduction
(school name) recognizes the adverse effects of drug use. Not only is the use of drugs illegal, it also poses a great threat to the physical and mental wellbeing of our student athletes. It is our objective to discourage the use of illegal drugs both on and off campus. (school name) ate recognizes that is a privilege for a student---athlete to be a part of our athletic teams and with this privilege comes the expectations of maintaining integrity on and off the playing field.
Purpose The Athletic Department believes that random drug testing and testing based on reasonable suspicion are appropriate to help ensure to the following
• To promote health, safety and welfare of student---athletes who participate in (school name) intercollegiate athletics
• To prevent and deter illegal drug use and abuse among student---athletes • To offer assistance and education to athletes using drugs • Identify problems with substance abuse at its earliest stage • To educate student---athletes on the physiological and psychological dangers inherent in the use
and misuse of drugs • To protect student---athletes, and others whom they compete against, from potential injury as a
result of drug use
Definition • Controlled Substance--- any of a category of behavior---altering or addictive drugs whose possession
and use are restricted by law.
Testing Procedures
Disclosure of substance abuse/safe harbor A student-athlete who has engaged in prohibited drug use is encouraged to seek assistance from the athletic training staff by voluntarily disclosing his or her use prior to an announced drug test. The athletic trainer will direct the student-athlete to medical services. If the student-athlete seeks assistance prior to being identified as having violated this policy or being notified that he or she must undergo screening, the impermissible use will not be deemed an offense for purposes of determining sanctions under this policy; however, the student-athlete will be ineligible to participate in intercollegiate sports pending an evaluation. The student-athlete entering the Safe Harbor Program will be required to take a drug test immediately to establish a baseline for follow-up testing. A student-athlete will not be permitted to enter the Safe Harbor Program thirty (30) days prior to NAIA or Conference post-season competition. The student-athlete will be required to undergo an evaluation by the (school name) counselor. (School name) shall determine the appropriate form(s) of intervention and rehabilitation needed by the student-athlete, based on the circumstances of the case. The counselor will provide a summary of his or her findings and recommendations to the Director of Athletics. The student-athlete will be permitted to remain in the Safe Harbor Program for a reasonable period of time, not to exceed thirty (30) days, as determined by the treatment plan. However, the student-athlete will not be permitted to return to participation in intercollegiate sports until the counselor has interviewed the student-athlete following the conclusion of the recommended treatment (or stage of treatment, as applicable) and has determined that reentry into intercollegiate sports is appropriate. If the counselor deems it necessary, the student-athlete will be required to undergo drug testing as part of the reentry evaluation.
Periodic Random Drug Screening (School name) will periodically randomly select student---athletes to participate in drug screening. Drug
testing will be conducted during the course of the academic year. The University will test no more ten student---athletes each year. However, (school name) reserves the right to drug test student---athletes at any time if there is reasonable suspicion. The drug screening may include, but is not limited to, testing for marijuana (THC), amphetamines (AMP), benzodiapines (BZO), cocaine (COC), methamphetamine (METH), opiates (OPI), oxycodone (OXY), Anabolic Steroids
Reasonable Suspicion A student---athlete may be subject to testing at any time when the Director of Athletics or his/her designee determines there is individualized reasonable suspicion to believe the participant is using a banned substance. Such reasonable suspicion may be based on objective information as determined by the Director of Athletics or by an Associate/Assistant Athletic Director, Head Coach, Assistant Coach, Head Athletic Trainer, Assistant Athletic Trainer, or Team Physician, and deemed reliable by the Director of Athletics or his/her designee. Reasonable suspicion may be found, but not limited to
1) observed possession or use of substances appearing to be prohibited drugs; 2) arrest or conviction for a criminal offense; 3) observed abnormal appearance, conduct or behavior reasonably interpretable as being caused by the use of prohibited drugs or substances. Among the indicators which may be used in evaluating a student---athlete’s abnormal appearance, conduct or performance are: class attendance, significant GPA changes, athletic practice attendance, increased injury rate or illness, physical appearance changes, academic/athletic motivational level, emotional condition, mood changes, and legal involvement.
Follow---up Testing A student---athlete who has returned to participation in intercollegiate sports following a positive drug test under this policy may be subject to follow---up testing. Testing will be unannounced and will be required at a frequency determined by the Athletic Director or his/her designee in consultation with the counselor or specialist involved in the student---athlete’s case
Refusal/Failure to be tested
If a student---athlete fails to show up for the test at the specified time or otherwise fails to provide the urine sample when requested, he/she will be required to meet with the Head Coach, Head Athletic Trainer and Athletics Director. At this meeting, the student---athlete will be given the opportunity to explain his/her actions. If, as a result of that meeting, the Athletics Director determines that the reason(s) given are not satisfactory, the student---athlete will be suspended immediately for a period of one year from date of refusal and will not be allowed to participate in any practice, conditioning, or weight---training with the team during suspension.
The student---athlete will also be considered to have two strikes against him/her in regards to the (school name) Athletics Drug Policy. Any other refusal or failure to be tested and/or positive drug test will result in immediate and permanent suspension from further practices and competition without opportunity for further competition at (school name). Loss of eligibility due to the above reasons may result in the inability to renew any athletic scholarships, and existing scholarships may be subject to cancellation as determined by Director of Athletics.
Drug Testing Reasonable Suspicion Reporting Form
I, _________________________________, under the reasonable suspicion clause that is outlined
Valley City State Univerisity Athletics Dept. Staff Member
in the (school name) Drug Testing Policy, report the following objective sign(s), symptom(s) or behavior(s) that I reasonably believe warrant ____________________________ Name of Student-Athlete
be referred to the Director of Athletics or his/her designee for possible drug testing. The following sign(s), symptom(s) or behavior(s) were observed by me over the past _____ hours and/or ______ days.
Please check below all that apply:
The Student-Athlete has shown:
_____ irritability
_____ loss of temper
_____ poor motivation
_____ failure to follow directions
_____ verbal outburst (e.g. to faculty, staff, teammates)
_____ physical outburst (e.g. throwing equipment)
_____ emotional outburst (e.g. crying)
_____ weight gain
_____ weight loss
_____ sloppy hygiene and/or appearance
The Student-Athlete has been:
_____ late for practice
_____ late for class
_____ not attending class
_____ receiving poor grades
_____ staying up too late
_____ missing appointments
_____ missing/skipping meals
The Student-Athlete has demonstrated the following:
_____ dilated pupils
_____ constricted pupils
_____ red eyes
_____ smell of alcohol on the breath
_____ smell of marijuana
_____ staggering or difficulty walking
_____ constantly running and/or red nose
_____ recurrent bouts with a cold or the flu (give dates ________ )
_____ over stimulated or “hyper”
_____ excessive talking
_____ withdrawn and/or less communicative
_____ periods of memory loss
_____ slurred speech
_____ recurrent motor vehicle accidents and/or violations (give dates ________ )
_____ recurrent violations of Student Code of Conduct
Other specific objective findings include:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Signatures:
______________________
__________________________________________ Signature of Reporting Athletic Training Staff and Date
Reviewed By: _______________________________ _____________________
Director of Athletics/Designee Date
Reasonable suspicion finding upheld ____
Reasonable suspicion finding denied ____
North Star Traveling Athlete Treatment Form
Athlete Information
Name of Athlete _____________________________________________________________________________________
Athlete’s Home Institution _________________________________________________________________________
Age __________ Sex: ☐ M ☐ F Year: ☐ FR ☐ SO ☐ JR ☐ SR
Injury Information
Injured Side: ☐ R ☐ L Body Part ______________________ Nature of Injury: ☐ Acute ☐ Chronic
Treatment to be provided
E-stim
☐ IFC ☐ Premod ☐ Micro ☐ HiVolt ☐ Russian ☐ BiPhasic
Time _________ min ☐ Ice ☐ Heat
Ultrasound
Time _________ min Intensity _________ W/cm2 ☐ 3 MHz ☐ 1MHz
☐ Continuous 100% ☐ Pulsed 50% ☐ Pulsed 20% ☐ Pulsed 10%
Combo
Time _________ min Intensity _________ W/cm2 ☐ 3 MHz ☐ 1MHz
Game Ready
Time _________ min Pressure _________
Laser
☐ Bone/Joint ☐ Mus/Ten/Lig ☐ Increase Circulation ☐ Relax Muscle ☐ Pain/Stiffness
☐ Muscle Spasm
☐ Acute ☐ Chronic ☐ Continuous ☐ Low ☐ Med ☐ High
Athletic Trainer Signature_________________________________________________ Date_____________________
Athletic Trainer Print Name ____________________________________________________________________________
NorthStar Athletic Association - NAIA-ATA Injury Report
Host Institution Information
Host Institution:
Athletic Trainer:
Tournament /Event: Sport: Athlete Information
Name of Athlete:
Athlete’s Home Institution:
Age: Sex: M F Year FR SO JR SR Injury Information
Injured Side: R L DOI: Nature of Injury: Acute Chronic Re-injury
Current Date:
Injured Region: Thoracic spine Elbow Thumb 5 finger Hip Lower leg 2nd toe 3rd toe
Head Lumbar spine Forearm 2nd finger Chest Groin Ankle 4th toe
Face Shoulder Wrist 3rd finger Abdomen Thigh Foot 5th toe
C-spine Upper arm Hand 4th finger Pelvis Knee 1st toe
Specific Region: Injury Sprain 1
Strain 1 Dislocation Fracture Concussion 1 Neurotrauma Heat exhaustion Allergy
Sprain 2 Strain 2 Subluxation Laceration Concussion 2 Tendonitis/Bursitis Heat stroke Cold/flu
Sprain 3 Strain 3 Contusion Spasm Concussion 3 Heat cramps Impingement Other
Comments:
Injury Management Athletic Trainer E.R. Refer to Physician
Athlete Status Continue to play Out of 1/2 game Out of game Out of tournament Attending Athletic Trainer
Name Signature:
Institution
Concussion Education Acknowledgement Form
Educational material on concussion prevention, recognition, and care has been provided to me. I agree to abide by my institutions concussion policy and report to a health care professional with expertise in sport related concussion if I witness or experience concussion symptoms, even if the concussion is not sport related.
________________________________________________________________ ____________________________________
Signature of Athlete Date
________________________________________________________________
Printed Name of Athlete