Revised AYSA Concussion Policy & Return Forms

 

UPDATED CONCUSSION RETURN TO PLAY FORMS & INFORMATION
Return to Play Forms Updated for 2015/16 Season

AYSA has a set of revised Concussion "Return to Play" forms for the upcoming 2015/16 season. Revised with the assistance of AYSA partner, Banner Concussion Center, the "Return to Play" forms are intended to ensure that any AYSA player who sustains a head injury/concussion has proper medical clearance from the injury prior to returning to play.
 
REVISED POLICY & FORMS:
 
 
 
 
AYSA HEAD INJURY/CONCUSSION POLICY & PROCEDURES (PORTION OF):
 
Head Injury - During a Game: 
If a head injury occurs during a game, Referees are instructed to IMMEDIATELY remove the injured player for the remainder of the game and to pull that players pass and submit it (player pass) to the AYSA office the next business day. If playing a game out-of-state, the host association will mail the pass to AYSA. The player's coach and/or the referee are to then advise the player to seek qualified medical care to evaluate the injury.
 
Head Injury - During a Practice or Training Session: 
If a player sustains a head injury during a team practice/training session or scrimmage where a referee is not present, the player's coach is to IMMEDIATELY remove the injured player from any/all team activities. The coach is to then advise the player to seek qualified medical care to evaluate the injury. Additionally, the coach/team manager is required to pull the players pass and submit it to the AYSA office immediately. (Please contact the AYSA office if you have any questions (602) 433-9202)
 
Head Injury - Future Participation:
Once a player pass has been submitted to AYSA due to a head injury, that player is NOT eligible to participate in any AYSA club/team activities. This includes any/all team practice/training sessions, scrimmage games, private training sessions and any physical participation in any team/club activities.
 
If a player is dual-registered with US Youth Soccer Association through AYSA and another soccer organization, the player whose AYSA pass was pulled may NOT resume activity with any United States soccer member (USClub, AYSO, USASA, etc.) until medically cleared.
 
 
AYSA RETURN TO PLAY FORMS (Explanation of):
 
Player passes will remain with AYSA until a player submits either the Initial Physician Evaluation Form (Explanation below) or the Follow-up Physician Form (Explanation below) to AYSA indicating that the player is medically cleared to resume competition. The player pass will then be returned and the player may resume competition at that time.
 
The "Return to Play" forms (Initial Evaluation Form (OR) Follow-up Physician Form) MUST be completed in-full and signed by either a Medical Doctor (MD) or Doctor of Osteopathy (DO). There are NO EXCEPTIONS to this policy.
 
Initial Physician Evaluation Form:
(First page of "Return to Play" forms) - This form is to be presented to the tending MD or DO when having an initial head injury/concussion evaluation. (This form must be presented whether sustaining a head injury at practice/training or a game) If following an initial evaluation by either a MD or DO it is deemed that the player has NOT suffered a concussion, the tending MD or DO will check the section indicating the player is medically cleared to resume competition. The fully completed form should then be submitted (by the player, coach or team manager) to AYSA for prompt return of the player pass which will then allow the player to resume all soccer related activities (If a player pass was pulled and submitted to AYSA, the player may NOT return and participate in ANY physical team activities until the actual player pass has been physically returned to the team/player by AYSA).
 
However, if following an evaluation the tending MD or DO concludes that the player DID suffer a concussion (or he/she cannot conclude with medical certainty that they did NOT suffer a concussion), the MD or DO will need to check that column at the bottom of the "Initial Physician Evaluation" form indicating that the player will need to follow-up with a physician, signifying that the player is NOT medically returned to play. (This form is to then be retained by the player throughout the process of healing and submitted to AYSA when later cleared to return to play.)
 
Follow-up Physician Evaluation Form:
(Second page of the "Return to Play" Forms) - If the initial MD or DO whom evaluated the player indicates that a concussion occurred or if the tending doctor is uncertain, a follow-up visit with a MD or DO to identify the course of action to work their way through the concussion recovery will be necessary (At this point, it is strongly advised that the athlete/player seek an MD or DO who specializes in treatment of concussion).
 
Each time a concussed player attends a follow-up appointment, they will need to print page two of the "Return to Play" forms called the "Follow-up Physician Evaluation Form" and present it to the Doctor at that time for completion. (Note: If a player has the need to meet with a doctor more than once, he/she should bring a blank copy of the "Follow-up Physician Evaluation Form" each time until he/she is cleared to play.)
 
Once the tending follow-up MD or DO determines that athlete/player may resume full activity and that the athlete/player has been cleared, he/she will be required to sign the "Follow-up Physician Evaluation Form" indicating that the athlete/player is cleared to return to full activity due to the fact that they have had a complete neurological exam and neurocognitive testing which indicates complete recovery and has completed gradual return to play progression. Once this complete form has been submitted to AYSA, the player pass will be returned allowing that player to return to action immediately. (If a player pass was pulled and submitted to AYSA, the player may NOT return and participate in ANY physical team activities until the actual player pass has physically been returned to the team/player by AYSA).
 
 
HOW TO BEST PREPARE FOR A POSSIBLE HEAD INJURY/CONCUSSION:
 
Baseline Testing:
Concussions occur without warning. They cannot be predicted nor can the severity of any head injury. Due to this, AYSA strongly encourages our members aged 11 and older to perform a baseline test prior to suffering a head injury. Taking this 30-minute test prior will provide qualified medical doctors with a road-map on how to best treat a concussion and to eventually return a player to competition.
 
(Note: AYSA has a partnership with Banner Concussion Center. Although Banner is our preferred provider, it is NOT required for players to attend their center or any Banner University Medical Care providers following a head injury or concussion. Please feel free to have your player meet with any qualified and licensed MD or DO that is convenient to your home and/or your health insurance plan.)
 
Banner Concussion Center (Phoenix) and Banner University Medical Center - Sports Medicine (Tucson) are the AYSA official partners for the treatment of concussion. To learn more, or to inquire on how to schedule a baseline test, please contact:
 
CENTRAL ARIZONA (PHOENIX AREA):
 
Banner Concussion Center
Office of Steven M. Erickson, MD
1320 N. 10th Street
Suite B
Phoenix, Arizona 85006
(602) 839-7285
 
SOUTHERN ARIZONA (TUCSON AREA):
 
Banner University Medical Center - Sports Medicine
Office of Holly McNulty, MD
2800 E. Ajo Way
Tucson, Arizona 85713
(520) 874-9000
 
If you live outside of the Phoenix or Tucson areas, please contact Mr. Bryce Nalepa of Banner Concussion Center at (602) 839-7285 or Bryce.Nalepa@BannerHealth.com . He will do his best to refer a baseline testing facility or a medical provider to best help treat a head injury/concussion near you.
 
Please contact AYSA with any questions regarding the content of the information contained on this page.



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