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Save the Brain Montana
September 24, 2015
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Paul Coats RN, FNP
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DAI
Contusion Micro bleeds
Cerebral edema SDH SAH Intra-parenchymal bleed
Mass effect Hydrocephalus
Herniation syndromes
DEATH
Concussion
The Pyramid of TBI
Abnormal Conventional Imaging
2010 2.5 million ER visits 50,000 deaths
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Concussions
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Concussion Symptoms
Physical •Headache •Ringing in ears •Blurry Vision •Nausea •Neck Pain •Off Balance •Dizzy
Cognitive •Confusion •Feeling Slowed Down •Memory Loss •Difficulty Thinking Clearly •Slowed Speech
Emotional •Sadness •Anxiety •Nervousness •Personality Changes •Depression
Sleep •Feeling Exhausted •Trouble Falling Asleep •Drowsiness •Sleeping less than Usual •Excess Sleep
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Sports Concussion Stats • 47% of all reported sports concussions occur during high
school football • 1 in 5 high school athletes will sustain a sports
concussion during the season • 33% of high school athletes who have a sports
concussion report two or more in the same year • 4 to 5 million concussions occur annually, with rising
numbers among middle school athletes • 90% of most diagnosed concussions do not involve a loss
of consciousness
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Sports Concussion
• Football: 64 -76.8 • Boys' ice hockey: 54 • Girl's soccer: 33 • Boys' lacrosse: 40 - 46.6 • Girls' lacrosse: 31 - 35 • Boys' soccer: 19 - 19.2 • Boys' wrestling: 22 - 23.9 • Girls' basketball: 18.6 - 21 • Girls' softball: 16 - 16.3 • Boys' basketball: 16 - 21.2 • Girls' field hockey: 22 - 24.9 • Cheerleading: 11.5 to 14 • Girls' volleyball: 6 - 8.6 • Boys' baseball: Between 4.6 - 5 • Girls' gymnastics: 7
Incidence per 100,000 athletic exposures
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Concussion Consequences
Short term: Headache Balance problems Vision problems Tinnitus
Learning difficulty Memory issues Poor judgment Poor focus
Depression Irritability Anxiety
Insomnia Hypersomnia Fatigue
Long term: Dementia Parkinsonism Depression Increased Suicide Risk
School issues Relationship issues Work issues Criminal issues
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It’s the Right Thing to do
Why ? Stories
Law
THE PERFECT STORM Wellness More Activity More Sports More Injuries Concussions are Common
Media Politics
Neuroscience Confusion
Liability Cost
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Official Confusion
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Aristotle’s modes of Persuasion Ethos: Credibility or ethical appeal. Legit experts.
Logos: Logic. Clear, effective, evidence-based.
Pathos: Emotions. Relevant. Stories.
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Consensus Statements • Pre-participation baseline testing • Sideline evaluation • Post concussion evaluation • Return to play protocol • Return to Learning
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What is Save the Brain? Cohesive and coherent sports concussion evaluation and treatment system for Montana.
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Educational Effort
Doctors Midlevel Providers Athletes
Chiropractors Physical Therapists
School Nurses
Coaches & Athletic Trainers
Community Leaders
Parents Educators
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Save the Brain Campaign
• Education, Tools, Training, Support, Tracking
• Better concussion management
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Education: Talks/Presentations Community Sports Organizations (multiple), Service Groups, Parent
groups, EMS, Coaches, Police, Firefighters Schools Kids in High School, Middle, Elementary levels. Superintendants, Principals, Teachers, Athletic
Directors, Playground staff Clinicians Doctors, Chiropractors, Physical Therapists, PA’s, NP’s,
School Nurses, Athletic Trainers
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Tools Concussion Recognition Cards Clinical assessment tools SCAT 3 Child SCAT 3 Concussion notices Concussion Information Return to Play protocol and clearance forms Return to learning protocol School recommendations form
Save the Brain Website
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Training Over 150 clinicians
Eureka, Whitefish, Kalispell, Lakeside, Bigfork, Columbia Falls, Missoula, Helena.
Doctors, NP’s, PA’s, DC’s, PT’s, OT’s, SLP’s, CAT’s, EMT’s/Paramedics, RN’s
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Pre-Participation Baseline Testing
• Cognitive Functioning • SCAT • ImPact
• Balance & Coordination • SCAT • Biodex
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Sideline Concussion Recognition
Anyone can do it!
When in Doubt, Take Them OUT
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Post Concussion Evaluation
• Trained licensed healthcare professional does the first and last evaluation
• Supervises non-licensed “Monitor”
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Return to Play Protocol • Brain and body rest
Gradually build back up
• 72 hours between steps for kids < 13 years old
• 24 hours between steps for people > 13 years old
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School Recommendations • Hard brain work slows
down recovery
• Thinking is brain work
• Stimulation is brain work
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Save the Brain Campaign Goals
• 2014: Unite healthcare providers. Awareness.
• 2015: Baseline testing during sports physical. Education Realm. Expand outside of Flathead. Refine.
• 2016: Prevention. Continue to expand and refine.
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Opportunity • Dylan Steiger’s Act • High Public Interest • Committed Titans and Champions • Tools that work • Processes that work • Technology and media mechanisms • Montana- where everybody knows your name
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Challenges • Geography • Variable levels of resources in communities • Multiple demographics • Administrative resources • Costs and funding
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Proposal • Collaborative partnership: Private, Public and Non-profit
• Save the Brain • Titans • Tools • Trainings
• Governor’s Traumatic Brain Advisory Council • Funding for trainings and materials • Priority determination
• Brain Injury Alliance of Montana • Administrative support • Website design and maintenance
• University of Montana • Research
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Outcome • Cohesive, coherent concussion prevention, assessment,
and management strategy for Montana featuring:
• Guidelines with mechanisms to improve as the science evolves
• Flexible, community resource-based implementation • Improved public awareness • Improved clinician training • Statewide Website • Concussion registry • Saved Brains
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Save the Brain Campaign