river bluff high school - amazon s3...exercise? 6. have you ever had discomfort, pain, tightness, or...
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RIVER BLUFF HIGH SCHOOL
2017 - 2018 ATHLETIC PAPERWORK CHECKLIST
Student Athlete’s Name: ________________________________ School: _____________ Date:__________
(As on birth certificate; not nicknames)
Athlete’s Grade (for the 17-18 school year): ______ Sport(s): _____________________________________
Did the athlete attend RBHS, MGM, or LMS all of last year? _____ if NOT, where? __________________
To Participate in athletics at River Bluff High School, the following items must be completed and on file:
1. _____ Current Physical. Must be dated after April 1, 2017 to be valid for 17-18 year.
(Must be on the form in this packet, signed and dated by athlete, parents and physician)
*Please double check that all lines requiring a signature are signed.
2. _____ Sports Health Form. (Must be filled out completely. This contains emergency contacts,
health insurance information and consent to participate and provide medical treatment.
Please include a copy of insurance card. Information on this sheet will only be used by the
RBHS Sports Medicine staff for medical purposes or in the event of an emergency.)
3. _____ Concussion Acknowledgment Form. (SC State Law. Must be signed by athlete and
parent/guardian)
4. _____ Athletic Parent Permission Form. (Must be signed by athlete and parent/guardian)
No athlete will be allowed to participate (tryout or practice) without all paperwork being turned in.
To be eligible to compete per the SCHSL, each athlete must have:
o Current Pre-Participation Physical Examination on file dated after April 1, 2017
o Parent Permission Form on file.
o Birth Certificate on file
o Academic eligibility
o * If new to RBHS due to a transfer, all transfer paperwork must be completed and approved.
Parent’s Permission & Acknowledgment of Risk for Son or Daughter to Participate in Athletics
Name of Athlete (please print)
As a parent or legal guardian of the above named student-athlete. I give permission for his/her participation in athletic events and the physical evaluation for that participation. I understand that this is simply a screening evaluation and not a substitute for regular health care. I also grant permission for treatment deemed necessary for a condition arising during participation of these events, including medical or surgical treatment that is recommended by a medical doctor. I grant permission to nurses, trainers and coaches as well as physicians or those under their direction who are part of athletic injury prevention and treatment, to have access to necessary medical information. I know that the risk of injury to my child/ward comes with participation in sports and during travel to and from play and practice. I have had the opportunity to understand the risk of injury during participation in sports through meetings, written information or by some other means. My signature indicates that to the best of my knowledge, my answers to the above questions are complete and correct. I understand that the data acquired during these evaluations may be used for research purposes.
Signature of AthleteDate
Signature of Parent/GuardianDate
PREPARTICIPATION PHYSICAL EVALUATION
HISTORY FORM (Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep a copy of this form in the chart.)
Name ___________________________________________________________________ Sex __F __M Age ___ Date of Birth ___________________ Grade ____
School __________________________________ Sport(s) __________________________________________________________ Date of Exam ________________
Address ___________________________________________________________________________________________________ Phone ______________________
EMERGENCY CONTACT NAME ______________________________________________ Relationship ____________________ Phone ______________________
Medicines and Allergies: Please list all of the prescription and over-the-counter medicines and supplements (herbal and nutritional) that you are currently taking
_____________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
Do you have any allergies? Yes No If yes, please identify specific allergy below.
Medicines Pollens Food Stinging Insects
GENERAL QUESTIONS Yes No
1. Has a doctor ever denied or restricted your participation in sports for any
reason?
2. Do you have any ongoing medical conditions? If so, please identify below
Asthma Anemia Diabetes Infections Other
___________________________________________________
3. Have you ever spent the night in the hospital?
4. Have you ever had surgery?
HEART HEALTH QUESTIONS ABOUT YOU Yes No
5. Have you ever passed out or nearly passed out DURING or AFTER
exercise?
6. Have you ever had discomfort, pain, tightness, or pressure in your chest
during exercise?
7. Does your heart ever race or skip beats (irregular beats) during exercise?
8. Has a doctor ever told you that you have any heart problems? If so, check
all that apply:
High blood pressure A heart murmur
High cholesterol A heart infection
Kawasaki disease Other ______________________
9. Has a doctor ever ordered a test for your heart? (For example, ECG/EKG,
echocardiogram)
10. Do you get lightheaded or feel more short of breath than expected during
exercise?
11. Have you ever had an unexplained seizure?
12. Do you get more tired or short of breath more quickly than your friends
during exercise?
HEART HEALTH QUESTIONS ABOUT YOUR FAMILY Yes No
13. Has any family member or relative died of heart problems or had an
unexpected or unexplained sudden death before age 50 (including
drowning, unexplained car accident, or sudden infant death syndrome)?
14. Does anyone in your family have hypertrophic cardiomyopathy, Marfan
syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT
syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic
polymorphic ventricular tachycardia?
15. Does anyone in your family have a heart problem, pacemaker, or
implanted defibrillator?
16. Has anyone in your family had unexplained fainting, unexplained seizures,
or near drowning?
BONE AND JOINT QUESTIONS Yes No
17. Have you ever had an injury to a bone, muscle, ligament, or tendon that
caused you to miss a practice or a game?
18. Have you ever had any broken or fractured bones or dislocated joints?
19. Have you ever had an injury that required x-rays, MRI, CT scan,
injections, therapy, a brace, a cast, or crutches?
20. Have you ever had a stress fracture?
21. Have you ever been told that you have or have you had an x-ray for neck
instability or atlantoaxial instability? (Down syndrome or dwarfism)
22. Do you regularly use a brace, orthotics, or other assistive device?
23. Do you have a bone, muscle, or joint injury that bothers you?
24. Do any of your joints become painful, swollen, feel warm, or look red?
25. Do you have any history of juvenile arthritis or connective tissue disease?
MEDICAL QUESTIONS Yes No
26. Do you cough, wheeze, or have difficulty breathing during or after
exercise?
27. Have you ever used an inhaler or taken asthma medicine?
28. Is there anyone in your family who has asthma?
29. Were you born without or are you missing a kidney, an eye, a testicle
(males), your spleen, or any other organ?
30. Do you have groin pain or a painful bulge or hernia in the groin area?
31. Have you had infectious mononucleosis (mono) within the last month?
32. Do you have any rashes, pressure sores, or other skin problems?
33. Have you had a herpes or MRSA skin infection?
34. Have you ever had a head injury or concussion?
35. Have you ever had a hit or blow to the head that caused confusion,
prolonged headache, or memory problems?
36. Do you have a history of seizure disorder?
37. Do you have headaches with exercise?
38. Have you ever had numbness, tingling, or weakness in your arms or legs
after being hit or falling?
39. Have you ever been unable to move your arms or legs after being hit or
falling?
40. Have you ever become ill while exercising in the heat?
41. Do you get frequent muscle cramps when exercising?
42. Do you or someone in your family have sickle cell trait or disease?
43. Have you had any problems with your eyes or vision?
44. Have you had any eye injuries?
45. Doe you wear glasses or contact lenses?
46. Do you wear protective eyewear, such as goggles or a face shield?
47. Do you worry about your weight?
48. Are you trying to or has anyone recommended that you gain or lose
weight?
49. Are you on a special diet or do you avoid certain types of foods?
50. Have you ever had an eating disorder?
51. Do you have any concerns that you would like to discuss with a doctor?
FEMALES ONLY Yes No
52. Have you ever had a menstrual period?
53. How old were you when you had your first menstrual period?
54. How many periods have you had in the last 12 months?
Explain “yes” answers here
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I hereby state that, to the best of my knowledge, my answers to the above questions are complete and accurate.
Signature of athlete ________________________________________ Signature of parent/guardian _________________________________ Date ______________________________
Parent’s Permission & Acknowledgement of Risk for Son or Daughter to Participate in Athletics As the parent or legal guardian of the above named student-athlete, I give my permission for his/her participation in athletic events and the physical evaluation for that participation. I understand that this is simply a screening
evaluation and not a substitute for regular health care. I also grant permission for treatment deemed necessary for a condit ion arising during participation of these events, including medical or surgical treatment that is
recommended by a medical doctor. I grant permission to nurses, athletic trainers and coaches as well as physicians or those under their direction who are part of athletic injury prevention and treatment, to have access to
necessary medical information. I know that the risk of injury to my child/ward comes with participation in sports and during travel to and from play and practice. I have had the opportunity to understand the risk of injury
during participation in sports through meetings, written information or by some other means. My signature indicates that to the best of my knowledge, my answers to the above questions are complete and correct. I
understand that the data acquired during these evaluations may be used for research purposes. Signature of athlete ____________________________________________________________________________________ Date _________________________
Signature of parent/guardian ____________________________________________________________________________ Date _________________________
PREPARTICIPATION PHYSICAL EVALUATION
PHYSICAL EXAMINATION FORM Name ______________________________________________________________________________________________ Date of Birth ___________________
EXAMINATION
Height Weight Male Female
BP / ( / ) Pulse Vision R 20/ L20/ Corrected Yes No
MEDICAL NORMAL ABNORMAL FINDINGS
Appearance
Marfan stigmata (kyphoscoliosis, high-arched palate, pectus excavatum, arachnodactyly,
arm span > height, hyperlaxity, myopia, MVP, aortic insufficiency)
Eyes/ears/nose/throat
Pupils equal
Hearing
Lymph nodes
Hearta
Murmurs (auscultation standing, supine, +/- Valsalva)
Location of point of maximal impulse (PMI)
Pulses
Simultaneous femoral and radial pulses
Lungs
Abdomen
Genitourinary (males only)b
Skin
HSV, lesions suggestive of MRSA, tinea corporis
Neurologicc
MUSCOSKELETAL
Neck
Back
Shoulder/arm
Elbow/forearm
Wrist/hand/fingers
Hip/thigh
Knee
Leg/ankle
Foot/toes
Functional
Duck-walk, single leg hop
a Consider ECG, echocardiogram, and referral to cardiology for abnormal cardiac history or exam. b Consider GU exam if in private setting. Having third party present is recommended. c Consider cognitive evaluation or baseline neuropsychiatric testing if a history of significant concussion.
Cleared for all sports without restriction
Cleared for all sports without restriction with recommendations for further evaluation or treatment for _________________________________________________ ________________________________________________________________________________________________________________________________________
Not cleared
Pending further evaluation
For any sports
For certain sports __________________________________________________________________________________________________________________
Reason ___________________________________________________________________________________________________________________________
Recommendations
_________________________________________________________________________________________________________________________
I have examined the above-named student and completed the participation physical evaluation. The athlete does not present apparent clinical
contraindications to practice and participate in the sport(s) as outlined above. If conditions arise after the athlete has been cleared for participation, the
physician may rescind the clearance until the problem is resolve and the potential consequences are completely explained to the athlete (and
parents/guardians).
Name of physician (print/type) __________________________________________________________________________ Date ___________________________
Address ____________________________________________________________________________________________ Phone __________________________
Signature of physician __________________________________________________________________________________________________________, MD or DO
2017 - 2018 SPORTS HEALTH FORM
EMERGENCY CONTACT INFORMATION
(Please Print Legibly) [Please do not leave any blanks unfilled]
Athlete’s Name _______________________________________________________________ SS# ___________________________
Sex _____ Age _____ Date of Birth __________________ Grade ______ Sport(s) _________________________________________
Allergies/ Medication Allergies:____________________________________ Medications: __________________________________
Significant Medical Issues/Existing Condition: _____________________________________________________________________
Glasses/Contacts: Y / N Sickle Cell Anemia/Trait: Y / N
Home Address _____________________________________________________ City ____________________ Zip _____________
Mother’s Name _________________________ Cell ________________ Work _______________ Email _____________________
Father’s Name _________________________ Cell ________________ Work _______________ Email _____________________
In an EMERGENCY, if the Parents cannot be reached, please notify:
Name ______________________________ Relation _________________ Phone ________________ Work #__________________
Preferred Hospital ________________________________________
Family Doctor _______________________ Phone _____________ Family Dentist _____________________ Phone ____________
HEALTH INSURANCE INFORMATION
Do you have health insurance? Y / N Do you have Medicaid? Y / N Medicaid Number_________________________
Name of Company _______________________________________Mailing Address _______________________________________
Insured’s Name _________________________________________SS# ___________________ Policy # _______________________
Does your insurance plan require you to be seen by your primary care physician before being seen by a specialist? Y / N
Does your insurance require a second opinion before surgery? Y / N
***Lexington School District 1 carries athletic accident insurance on all its athletes, intended to be an “excess” policy designed to
help pay secondarily to the athlete’s primary health insurance. In the event of injury, while participating as a part of a SCHSL
sanctioned sports team representing River Bluff High School, the athlete should seek the attention of the sports medicine staff as soon
as possible. One of the head athletic trainers will fill out the top portion of the insurance claim form (AKA Notification of Injury
Form). If the injury is a non-emergency, the form should be filled out prior to a physician visit. The parent/ guardian should
complete the claim form, follow the attached directions, and mail the completed form to the insurance company.
*** Sports Medicine staff should be notified of injury immediately or claim may be invalid. Please note the claim must be filed within 90 days of injury.
CONSENT TO PARTICIPATE IN ATHLETICS AND RISK WAIVER
As the parent or legal guardian of the above named student-athlete, I give my permission for his/her participation in athletic events and
the physical evaluation for that participation. I understand that the pre-participation physical examination is simply a screening
evaluation and not a substitute for regular healthcare. I grant permission to certified athletic trainers, coaches and nurses as well as
physicians or those under their direction who are part of athletic injury prevention and treatment, to have access to necessary medical
information. I know that the risk of injury to my child comes with participation in sports and also during travel to and from
competition and practice. I have had the opportunity to understand the risk of injury during participation in sports through meetings,
written information or by some other means.
CONSENT FOR MEDICAL TREATMENT/RELEASE OF INFORMATION
I/We give consent for certified athletic trainers, coaches, and physicians to use their own judgment in securing medical aid and ambulance
service in the case the parents/guardians can not be reached. In the event of an accident requiring immediate medical attention, I herby
grant permission to physicians, certified athletic trainers, and/or appropriate healthcare professionals to attend to my son/daughter. It is
understood that the school cannot be held responsible for any medical bills incurred because of illness or injury. Furthermore, I/We give
permission for our son/ daughter to be evaluated and treated by the school’s certified athletic training staff and/or team physicians if he/she
becomes injured while participating as an athlete at River Bluff High School during the school year. I/We also authorize the school’s
sports medicine staff to be given medical information concerning my son/daughter by a physician or their staff. Likewise, the school’s
sports medicine staff may release medical information to physician’s offices, coaching staff, nurses, administrators and faculty at River
Bluff High School as they see appropriate. I also commit to reporting ALL injuries to the Sports Medicine Staff, including but not limited
to any symptoms related to a concussion. I also understand that the sports medicine staff will follow return to play protocols for all injuries.
Student’s Signature _________________________________________________________________ Date _____________________
Parent’s Signature __________________________________________________________________ Date _____________________
Concussion Acknowledgement Form for Parents and Student Athletes
Student Athlete’s Name (Please Print): __________________________________________________________________
Sports Participating In: ___________________________________________________ School Year: 20_____ - 20_____
In accordance with the South Carolina State law “Student Athlete Concussions, Guidelines, Management” (R65, H3061),
schools are required to distribute information sheet to inform and educate student athletes and their parents of the nature
and risk of concussion and head injury to student athletes, including the risks of continuing to play after a concussion or
brain injury or returning to play too soon after a concussion or brain injury. The law requires that each year, before
beginning practice for an interscholastic sport, including cheerleading, a high school student athlete and the student
athlete’s parents must be given an information sheet, and both must sign and return the form acknowledging receipt of the
information to the athletic trainer. The law further states that a high school athlete who is suspected of sustaining a
concussion or brain injury in a practice or game, shall be removed from play at the time of injury and may not return to
play until the student athlete has received written medical clearance by a physician.
Parent and Student Athletes – please read the attached “Concussion – A fact sheet for student-athletes” information sheet
and the River Bluff High School Concussion Management Plan. After reading these fact sheets, please sign below and
ensure that your student athlete also signs the form. Once signed, have your student athlete return this form to the athletic
trainer or his/her coach.
I am a student athlete participating in the above mentioned sport(s). I have received and read the Concussion Information
Sheet and the Concussion Management Plan for my school. I understand the nature and risk of concussion and brain injury
to student athletes, including the risks of continuing to play after a concussion or brain injury. I agree to inform the
coaches and athletic trainers of any concussive symptoms that I encounter. I also understand that after written medical
clearance from a physician is given, I must be released by the athletic trainers at River Bluff High School after following
and completing a gradual stepwise 5 day return to play protocol.
______________________________________ __________________________________________ _______________
Printed Student Athlete Name Signature of Student Athlete Date
I, as the parent or legal guardian of the above named student, have received and read the Concussion Information Sheet and
River Bluff High School Concussion Management Plan. I understand the nature and risk of concussion and brain injury to
student athletes, including the risks of continuing to play after concussion or brain injury. I will inform the coaches and
athletic trainers of any concussive symptoms that I observe. I also understand that after written medical clearance from a
physician is given, my child must be released by the athletic trainers at River Bluff High School after following and
completing a gradual stepwise 5 day return to play protocol.
______________________________________ ___________________________________________ ______________
Printed Parent/ Guardian Name Signature of Parent/ Guardian Date
River Bluff High School Concussion Management Plan
4/2016
EDUCATION & ACKNOWLEDGEMENT
A concussion fact sheet will be available in the pre-participation physical examination packet as a part of the
education process of athletes and their parents. Before being allowed to participate, all River Bluff High School
student athletes and their parents must read the concussion fact sheet and sign the concussion awareness statement
acknowledging that they have read and understand the information on the fact sheet and this management plan
and understand their responsibility to report their injury and illnesses, including signs and symptoms of a
concussion, to a staff athletic trainer.
Staff athletic trainers and coaches will complete the CDC Concussion Course in accordance with SCHSL rules.
When an athlete is concussed, an attempt to contact his/her parent will be made as soon as possible. Both parent
and athlete should have further education in concussion management, including but not limited to the “Athlete
Information” portion of the SCAT3 Form (Sports Concussion Assessment Tool 3rd
Edition) and/or individual
advice from the athletic training staff on concussion signs, symptoms, and care.
EVALUATION
Any athlete experiencing symptoms should report to the athletic training staff as soon as possible.
Any athlete exhibiting signs, symptoms, or behaviors consistent with concussion shall be removed from athletic
activities by an athletic trainer (or coach/ referee in the absence of the athletic trainer) and evaluated by a medical
staff member (staff athletic trainer or team physician) as soon as possible.
A physical examination with a battery of neurological tests or a SCAT3 Assessment will be performed by a staff
athletic trainer as soon as possible after the time of injury for any athlete exhibiting signs, symptoms, or behaviors
consistent with concussion.
All concussed athletes will be evaluated by a River Bluff High School team physician or a physician of the
parent’s choice that is trained in concussion management.
A concussed athlete should regularly report to the athletic training room for assessment of symptoms (ideally each
school day). The “Symptom Evaluation” portion of the SCAT3 document will be used to assess symptoms and
the severity of those symptoms. Complete SCAT3 assessments may also be conducted periodically to monitor
recovery. In the instance the concussed athlete is a middle school student athlete, the daily assessment will be
provided by the designated individual at that school or a time will be scheduled to meet with the RBHS medical
staff at River Bluff High Schools campus until the athlete is asymptomatic.
RETURN TO PLAY
No concussed athlete will return to play the same day.
A concussed athlete must be given medical clearance by a physician trained in concussion management.
Once a concussed athlete in asymptomatic, the athlete will undergo stepwise exertional testing over several days
administered by the athletic training staff as described in the Zurich Consensus Statement. Only upon successful
completion of the stepwise testing and a physician’s written clearance, may the athlete return to play.
(Day 1 – Light aerobic exercise, Day 2 – Moderate aerobic exercise, Day 3 – Heavy non-contact activity,
Day 4 – Sports Specific Practice, Day 5 – Full contact practice, Day – 6 Return to competition)
In the event that a symptomatic athlete is cleared by a physician, the RBHS athlete will not return to play until the
stepwise return to play protocol outlined in the consensus statement is followed and passed.
OTHER CONSIDERATIONS
The school nurse will be notified as soon as possible by a staff athletic trainer of a concussed athlete. The athletic
trainer, school nurse or designated individual will notify the athlete’s guidance counselor and a notification will
be made to the athlete’s teachers and the administration. A concussion fact sheet and/or a list of classroom
accommodations granted by the treating physician will be provided as necessary.
This plan will be reviewed annually by the RBHS Concussion Policy Team, which may consist of the athletic
training staff, the principal (or his designee), athletic director, school nurse, and team physician.
CONCUSSIONA fAct sheet for student-Athletes
What is a concussion? A concussion is a brain injury that:
• Is caused by a blow to the head or body.– From contact with another player, hitting a hard surface such
as the ground, ice or floor, or being hit by a piece of equipment such as a bat, lacrosse stick or field hockey ball.
• Can change the way your brain normally works.• Can range from mild to severe.• Presents itself differently for each athlete.• Can occur during practice or competition in ANY sport. • Can happen even if you do not lose consciousness.
hoW can i prevent a concussion?Basic steps you can take to protect yourself from concussion:
• Do not initiate contact with your head or helmet. You can still get a concussion if you are wearing a helmet.
• Avoid striking an opponent in the head. Undercutting, flying elbows, stepping on a head, checking an unprotected opponent, and sticks to the head all cause concussions.
• Follow your athletics department’s rules for safety and the rules of the sport.
• Practice good sportsmanship at all times.• Practice and perfect the skills of the sport.
it’s better to miss one game than the Whole season. When in doubt, get checked out.For more information and resources, visit www.NCAA.org/health-safety and www.CDC.gov/Concussion.
What are the symptoms of a concussion?You can’t see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. Concussion symptoms include:
• Amnesia.• Confusion.• Headache.• Loss of consciousness. • Balance problems or dizziness. • Double or fuzzy vision. • Sensitivity to light or noise. • Nausea (feeling that you might vomit).• Feeling sluggish, foggy or groggy. • Feeling unusually irritable.• Concentration or memory problems (forgetting game plays, facts,
meeting times). • Slowed reaction time.
Exercise or activities that involve a lot of concentration, such as studying, working on the computer, or playing video games may cause concussion symptoms (such as headache or tiredness) to reappear or get worse.
What should i do if i think i have a concussion? Don’t hide it. Tell your athletic trainer and coach. Never ignore a blow to the head. Also, tell your athletic trainer and coach if one of your teammates might have a concussion. Sports have injury timeouts and player substitutions so that you can get checked out.
Report it. Do not return to participation in a game, practice or other activity with symptoms. The sooner you get checked out, the sooner you may be able to return to play.
Get checked out. Your team physician, athletic trainer, or health care professional can tell you if you have had a concussion and when you are cleared to return to play. A concussion can affect your ability to perform everyday activities, your reaction time, balance, sleep and classroom performance.
Take time to recover. If you have had a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have a repeat concussion. In rare cases, repeat concussions can cause permanent brain damage, and even death. Severe brain injury can change your whole life.
Reference to any commercial entity or product or service on this page should not be construed as an endorsement by the Government of the company or its products or services.
DO YOU KNOW YOUR STUDENT’S SICKLE CELL TRAIT STATUS?
If you know that your son or daughter is a carrier of the sickle cell trait, it is important that you
document this information on his or her annual physical form (question #42 on the approved SCHSL
physical form) and notify the co-head athletic trainers. While an athlete's status may not be a limiting
factor for athletic participation, coaches and staff must be educated on how to handle potential
emergencies should they arise.
For several years the NCAA has required athletes to show proof of sickle cell trait status. The SCHSL
does not require student athletes to show proof, but we encourage parents to be certain when
responding on the physical form. If you do not know your son or daughter’s sickle cell trait status there
are several options available to obtain his or her status:
1) If your son or daughter was born in South Carolina from 1997 to the present, you can obtain
his/her newborn screening results through DHEC at the following link:
http://www.scdhec.gov/Health/FHPF/LabCertificationServices/NewbornMetabolicScreening/NBSInfor
mation/
If you can’t gain access via the link or have a question that isn't answered on the DHEC site
email Roberta Bartholdi at [email protected].
2) If your son or daughter was born in South Carolina before 1997, contact your child’s initial medical
provider or pediatrician to obtain your newborn screening results.
3) If your child was not born in the state of South Carolina or the above options failed, we
recommend a blood test. Contact James R. Clark Sickle Cell Foundation as they sometimes offer
free testing. Your child can also get tested at DHEC or through his or her pediatrician.
Please consider these options if you are unsure of your student-athlete’s sickle cell trait status.
What is sickle cell trait?
Know your sickle cell trait status.
Engage in a slow and gradual preseason conditioning regimen.
Build up your intensity slowly while training.
Set your own pace. Use adequate rest and recovery between repetitions, especially during “gassers” and intense station or “mat” drills.
Avoid pushing with all-out exertion longer than two to three minutes without a rest interval or a breather.
If you experience symptoms such as muscle pain, abnormal weakness, undue fatigue or breathlessness, stop the activity immediately and notify your athletic trainer and/or coach.
Stay well hydrated at all times, especially in hot and humid conditions.
Avoid using high-caffeine energy drinks or supplements, or other stimulants, as they may contribute to dehydration.
Maintain proper asthma management.
Refrain from extreme exercise during acute illness, if feeling ill, or while experiencing a fever.
Beware when adjusting to a change in altitude, e.g., a rise in altitude of as little as 2,000 feet. Modify your training and request that supplemental oxygen be available to you.
Seek prompt medical care when experiencing unusual physical distress.
People at high risk for having sickle cell trait are those whose ancestors come from Africa, South or Central America, India, Saudi Arabia and Caribbean and Mediterranean countries.
sickle cell trait is not a disease. Sickle cell trait is the inheritance of one gene for sickle hemoglobin and one for normal hemoglobin. Sickle cell trait will not turn into the disease. Sickle cell trait is a life-long condition that will not change over time.
A FAct Sheet For Student-AthleteS
Do you knoW if you have sickle cell trait?
hoW can i Prevent a collaPse?
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SICKLE CELL TRAITDuring intense exercise, red blood cells containing the sickle hemoglobin can change shape from round to quarter-moon, or “sickle.”
Sickled red cells may accumulate in the bloodstream during intense exercise, blocking normal blood flow to the tissues and muscles.
During intense exercise, athletes with sickle cell trait have experienced significant physical distress, collapsed and even died.
Heat, dehydration, altitude and asthma can increase the risk for and worsen complications associated with sickle cell trait, even when exercise is not intense.
Athletes with sickle cell trait should not be excluded from participation as precautions can be put into place.
Sickle cell trait occurs in about 8 percent of the U.S. African-American population, and between one in 2,000 to one in 10,000 in the Caucasian population.
Most U.S. states test at birth, but most athletes with sickle cell trait don’t know they have it.
The NCAA recommends that athletics departments confirm the sickle cell trait status in all student-athletes.
Knowledge of sickle cell trait status can be a gateway to education and simple precautions that may prevent collapse among athletes with sickle cell trait, allowing you to thrive in your sport.
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For more information and resources, visit www.NCAA.org/health-safety
SPORTS MEDICINE INFORMATION FOR PARENTS & ATHLETES
Co-Head Athletic Trainers
Scott Ganucheau, MS, ATC, SCAT
Office: (803) 821-0847
Stacey Baynham, MS, ATC, SCAT
Office: (803) 821-0848
What is an Athletic Trainer?
Certified athletic trainers are health care professionals who specialize in preventing, recognizing, managing and rehabilitating injuries
that result from physical activity. As part of a complete health care team, the certified athletic trainer works under the direction of a
licensed physician and in cooperation with other health care professionals, athletics administrators, coaches and parents.
Athletic trainers (ATs) must earn a degree from an accredited athletic training curriculum. Accredited programs include formal
instruction in areas such as injury/illness prevention, first aid and emergency care, assessment of injury/illness, human anatomy and
physiology, therapeutic modalities, and nutrition. More than 70 percent of certified athletic trainers hold at least a master’s degree.
Here at River Bluff High School we have the ability to do an initial evaluation of the injured athlete and give our medical
recommendation of what you and your athlete should do. We also have the ability and equipment to rehabilitate most injuries.
What happens when my student athlete gets injured?
First, your student athlete should be evaluated by one of the 3 certified athletic trainers on the sports medicine staff at RBHS.
Once evaluated, they will be treated for their injury and a decision will be made if they need to see a physician. If you are not
present at the game or practice, you will be contacted ASAP by one of the athletic trainers for our recommendation.
Treatment times in the RBHS athletic training room are immediately after school and by appointment or as available during
Independent Learning Time. All injured athletes are expected to report to the athletic training room immediately after school
for treatment until cleared for participation. They should come dressed in shorts and t-shirt. After treatment all athletes will
report to practice wearing the appropriate gear even if they cannot participate. All athletes are expected to be at practice even
if injured if only for learning purposes.
We have a group of Team Physicians from Palmetto Health USC Orthopedics (formerly known as Moore Center for
Orthopedics/ USC Sports Medicine). If necessary or requested, we will be able to assist you in scheduling you an appointment
quickly and efficiently but if you already have a family physician or orthopedist you are comfortable with, we encourage you
to continue using them. Please let us know if we can help you with scheduling any appointments, as we have many medical
contacts in the midlands.
AFTER ANY DOCTORS VISIT: Athlete must bring a note of diagnosis from the treating physician with notes of any
restrictions or (clearance note) for full release to return to play. The athlete will still need to be released by the Athletic
Trainer after following return to play protocols
My student athlete was injured during a team function, but did not report it to the RBHS staff. What should I do?
If at all possible, contact a member of the sports medicine staff for a recommendation before going to the doctor. We may be able to
save you an unnecessary trip to the emergency room or doctor’s office. If unable to contact any of the Athletic Trainers before visit,
please bring a note from the Physician of the diagnosis/ treatment plan and any other important paperwork from the Physician.
Athletes may not be allowed to participate in practice or games without providing the Sports Medicine staff proper written
documentation from the doctor.
What kind of physician should my child see?
It depends on the medical issue that the athlete is dealing with. Please keep this in mind when making appointments for your children.
Orthopedics is the branch of medicine concerned with diseases, injuries, and conditions of the musculoskeletal system --
relating to the body's muscles and skeleton, and including the joints, ligaments, tendons, and nerves. Orthopedists specialize in
athletic injuries such as sprains, strains, spasms, etc.
A family doctor is a physician whose practice is not oriented to a specific medical specialty such as sports medicine but
instead covers a variety of general medical problems in patients of all ages. In addition to diagnosing and treating illness, they
also provide preventive care, including routine checkups, health-risk assessments, immunization and screening tests, and
personalized counseling on maintaining a healthy lifestyle. Family physicians also manage other medical conditions, often
coordinating care provided by other subspecialists
SPORTS MEDICINE INFORMATION FOR PARENTS & ATHLETES
Team Physicians at Palmetto Health USC Orthopedics:
Dr. Mickey F. Plymale, Dr. S.Wendell Holmes Jr., Dr. Frank K. Noojin III, and Dr. David A. Scott
Other options to see a physician other than normal operating hours.
After evaluation, we can then send you to see one of our team orthopedists at the Black and Blue Clinic at Palmetto Health
USC Orthopedics (formerly known as Moore Center Orthopedics). The Black and Blue Clinic is open from 8 a.m. – 11 a.m.
on Saturday mornings during the fall season.
Palmetto Health USC Orthopedics also offers a convenient care clinic for walk-in appointments that go past normal office
hours. It is open Monday through Thursday from 12 p.m – 8 p.m. and Saturday 8 a.m. – 12 p.m. for orthopedics injuries at the
Lexington office [104 Saluda Pointe Drive, Lexington, SC 29072]. Ask an Athletic Trainer for more information.
Lexington Urgent Care [811 W Main St, Lexington, SC 29072] is open until 10:00 p.m. This may save you some time instead
of going to an emergency room for minor medical conditions that need immediate care.
Does my student athlete have insurance provided by the school?
YES. All student athletes have insurance while they play sports for Lexington District One Schools. However, this is provided as a
secondary insurance to help with any medical costs that your primary insurance may not pick up.
IT MAY NOT PAY ALL YOUR MEDICAL COSTS.
Remember, you sign an assumption of risk on your physical for Lexington School District One. Injuries will likely occur. Be prepared.
If you do not have insurance, we recommend you purchase insurance somewhere while your student athlete participates in athletics.
This is a school athletic insurance not a general athletic insurance and it covers school hours only. IT WILL NOT COVER NON-
ATHLETICS AFTERSCHOOL ACTIVITIES, CLUB ATHLETICS, AND OR ANY INJURIES SUSTAINED OUTSIDE OF RIVER
BLUFF ATHLETICS.
How do I file the school insurance?
An insurance form must be filled out and must be signed by the sports medicine staff. It is very important that the sports medicine staff
is notified immediately about the injury or the claim may be invalid or denied. This form is then given to you or sent home for you to
fill out. Please take this form with you to the scheduled doctor’s appointment. Instructions to send itemized bills and notification of
injury are included on the back of the form. The address is located in the top left corner of the notification of injury form. The
insurance company will contact you to handle claims from there. Please return these to the insurance company as soon as possible to
make sure your claim is handled as soon as possible. This needs to be completed within 90 days of the date of injury. Please keep a
copy of the form for your records. The sports medicine staff is not responsible for filing claims; they are only responsible for filling out
the forms. If you have any questions, please contact the sports medicine staff.
Note to all Gator student athletes and parents from the Sports Medicine Staff.
REQUIRED PHYSICAL: Each student athlete is required to have a physical examination prior to any participation in any
interscholastic sport, including workouts, conditioning, try-outs, practice, etc. It must be dated after April 1, 2017. Sports physicals
will be offered in the spring for the next school year for a minimal charge. If you choose not to attend these sessions, you will be
responsible for obtaining a physical before the athlete is allowed to participate.
1. HYDRATE
o Make sure you drink plenty of fluids the entire pre-season and in-season. Even when you are not thirsty, drink!
o Stay away from tea, sodas, and energy drinks. Concentrate on drinking plenty of water and/ or sports drinks.
2. EAT
o Always eat before practice but give yourself enough time to digest before participating in activity.
o Eat breakfast, lunch and dinner. Do not skip a meal. Good nutrition is important for you to perform at your best.
o Eat a well-balanced meal even when you are not practicing.
3. REPORT Any and ALL injuries or illnesses to the Sports Medicine Staff. We are here to help with all health related issues.
4. RETURN the Medical Information Sheet as well as a copy of your insurance card to the Sports Medicine Staff as soon as possible.
This sheet will give us the information to contact you. So please make sure all phone numbers are up-to-date. This will insure that
your son/daughter receives appropriate medical care in a timely fashion. If we are unable to contact you, these forms will provide all
the information that the healthcare provider will need to proceed with the appropriate treatment of the athlete.