DOB: 7/5/2007 Team: Buckeyes Coach: Tim Mercer S: Pt. is a 6 y.o. male flag football player.

He went helmet to helmet with another player during the second half of the FUFFL team play. Pt. has no hx of head or neck inj. Pt. would not respond to questions from the ATS. O: No blood or obvious deformity. Pt. was supine on the ground on approach. He was grasping the anterior portion of the neck. Palpation of the C-spine revealed no deformity or rigidity. Pt. was able to move both UE and LE and responded to physical stimuli in both. His pulse and RR were normal. Pt. was stabilized for all testing. A: Diff. Diagnosis included concussion, C-spine injury, ANT. C-spine contusion. P: Pt. was removed f/ field, per fathers request. He was immediately referred for further testing. *Note: Pt. was able to respond to physical stimuli, and both the coaches and the father stated that the pt. reacted in a way that was normal for him. The father wished to take him to the hospital personally in lieu of activating the EMS. Before the pt. was released f/ my care, he had both opened his eyes, and responded w/ a smile to his father. Loriann D. Mathews, ATS Return to Play Protocols The patient was examined by a physician promptly after the initial evaluation. A CAT scan was returned negative and the diagnosis of a concussion confirmed. Concussion management protocols are as follows: 1. The patient must be symptom free for a minimum of 24 hours. 2. The patient must be cleared by a licensed physician before progressive activity testing can begin. a. This is typically done in conjunction with an IMPACT test to test cognitive function of the patient. 3. After physician clearance, the patient will begin a minimum 3 day RTP protocol, with progressively more difficult activity. This period can be extended based on severity of concussion symptoms, patient risk, and physician directive. An example of RTP progression: 1. Day 1: 25 crunches, 10 push-ups, 25 jumping jacks, repeat. a. The patient is monitored for returning S/Sx between all activity. 2. Day 2: Dynamic warm-up: high knees, butt-kicks, C-skips, etc. 25 crunches, 10 push-ups, 25 jumping jacks, jogging (<50% speed)

a. Again, patient is monitored for returning S/Sx. 3. Day 3: Dynamic warm-up, progressive running drills (straight line, gradual stop, figure Ss, and zig-zag- with cuts), increase speeds gradually, begin sport specific activities such as catching a football, running routes, etc. 4. Day 4: Controlled Contact: Patient returned to practice to begin reintegrating with team. Patient can perform all activities in an observable setting, as tolerated. *If at any point, S/Sx return, the patient will start over at Day 1 after S/Sx disappear.