Transcript
2016 SRVLL TEAM BINDERS To All Managers, Thank you for your support and volunteering with the San Ramon Valley Little League Baseball Program. The SRVLL volunteer Board is there to help make a successful program by providing you with all the support tools. The Team Binder is MANDATORY to have at all Games and Practices. To help organize your required information needed by Little League Baseball, District 57 and SRVLL while managing your team. Please follow the instructions below: NOTE: Print ATTACHMENT “001 Team Binder Part 1 & Part 2”. These files contain all pdf files. The Word and Excel files were left opened for your customization. ALL ITEMS IN “RED” ARE REQUIRED. The other information is there for your convenience. Especially if this is your first year Coaching or Managing. PLEASE TEXT JOHN BRYAN 925-518-7050 IMMEDIATELY IN THE EVENT OF AN ACCIDENT. Suggestion is to ask your Team Parent for assistance in putting the binder together and maintaining the information. 1) TEAM BINDER – Must be available at all team events-games, practices, etc… Keep this with you at all times. I would recommend creating at least two binders or one for each Manager and Coach. You’re Team Mom or another team volunteer would be a great resource to help create and maintain the information. a. MATERIALS NEEDED – (Per Binder) i. Three Ring Binder - 1 inch: $3.99 each http://www.amazon.com/Wilson-Jones-D-Ring-Customizable-38614W/dp/B000FD53RW/ref=sr_1_7?s=officeproducts&ie=UTF8&qid=1421523791&sr=17&keywords=binders+3+ring ii. 2 Sets (10 Tabs) Index Marker Presentation Dividers – 5 Tabs: $5.89 each http://www.amazon.com/Avery-Translucent-Dividers-Multi-Color11452/dp/B00006IBXN/ref=sr_1_1?s=officeproducts&ie=UTF8&qid=1421522176&sr=1-1&keywords=11452 b. INSTRUCTIONS ASSEMBLY ATTACHMENT “001 TEAM BINDER-INSTRUCTIONS” c. BINDER COVER - Sample ATTACHMENT “002 TEAM BINDER-COVER-SAMPLE” d. TABS ATTACHMENT “003 TEAM BINDER TABS” i. PLAYER LINE-UPS 1. Pre-Game and Post Line-ups. Updated line-up sheet during the game to track player’s position. 2. Helpful Hints
Contact: John Bryan – Safety Director
[email protected]
2016 SRVLL TEAM BINDERS
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a. Divisions: T-Ball, Rookies, Farm, Single A = To help create a team line-up try using website: http://freebaseballlineups.com SCHEDULES (Games-Practices) 1. Game and Practice Schedule = Division Director will send the schedule to each team. 2. TRAINING a. Schedule APPENDIX A 3. WEBSITE: http://www.srvll.org/page/show/2132691-calendar 4. TRAINING – Team Schedule a. WEBSITE: http://www.srvll.org/page/show/2132691calendar 5. Helpful Hints a. Communication System that can be used to help with team communication, email, player contact information, tracking, monitor, etc… b. www.teamsnap.com c. www.rosterbot.com PRE-GAME CHECKLIST 1. REQUIRED - Before each game and practice check off each item on the checklist. Ensure a phone communication is available. ATTACHMENT “300 PREGAME-Checklist” 2. Equipment Checklist ATTACHMENT “302 PREGAME-EquipmentChecklist” SAFETY INFORMATION 1. REQUIRED - SRVLL 2016 Safety Plan ATTACHMENT “TO FOLLOW AT LATER DATE” 2. REQUIRED – Top Safety Rules a. ATTACHMENT “ 400 Top Safety Rules” 3. Reporting Child Abuse-California ATTACHMENT “403 SAFETY-Reporting Child AbuseCalifornia” 4. Get a Heads Up on Concussion in Sports Policies a. ATTACHMENT “405 SAFETYHeadsUpOnConcussionInSportsPolicies” 5. REQUIRED – Concussion Information Sheet for each player. a. ATTACHMENT “406 SAFETY-ParentConcussionInfoSheetParentsSignature” 6. REQUIRED – Concussion Information Sheet with John Muir and San Ramon Medical Center Phone Numbers. ATTACHMENT “406 SAFETY -ConcussionClipBoard-FillIn” PITCH COUNT – Divisions Single A and Above 1. Game Pitch Log ATTACHMENT “501 PitchingLogBlank” 2. Game Pitch Log ATTACHMENT “501 PitchingLogSRVLL” 3. Pitch Count Data Sheet ATTACHMENT “502 PitchCountDataSheet” 4. Pitcher Eligibility Tracking Form
Contact: John Bryan – Safety Director
[email protected]
2016 SRVLL TEAM BINDERS
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ATTACHMENT “503 PitcherEligibilityTrackingForm” 5. Pitching Rules ATTACHMENT “505 PitchingRules” CONTACT INFORMATION 1. RECOMMEND - Team Contact List – This can be made from the list given to you by the Division Director. 2. REQUIRED - SRVLL Board of Directors – APPENDIX B MEDICAL RELEASE – PLEASE TEXT JOHN BRYAN 925-518-7050 IMMEDIATELY IN THE EVENT OF AN ACCIDENT. 1. REQUIRED - Medical Release Form for each player ATTACHMENT “700 MEDICAL-ReleaseForm2015” 2. Accident Claim Form ATTACHMENT “707 MEDICAL-AccidentClaimForm” 3. Accident Claim Form Instructions ATTACHMENT “707 MEDICALAccidentClaimFormInstructions” TRACKING PROJECTS 1. MANDATORY – All volunteers must be Background Check approved prior to being around any child. a. REQUIRED - Tracking Parent Volunteer Approval Sheet ATTACHMENT “800 DOCUMENTATION-Team Requirements” b. New Volunteer Application – i. “800 NewVolunteerApplication2015” c. Returning Volunteer Application – i. “800 ReturningVolunteerApplication2015” 2. MANDATORY – Keep latest “Approved Volunteer List” 3. Parent Code-of-Conduct a. ATTACHMENT “805 FORM-Parent_Code-of-Conduct” LOCAL RULES 1. ATTACHMENT “900 SRVLLLocalRules-2016” 2. BAT APPROVAL LIST a. ATTACHMENT “901 2016Licensed-BatList” MISC INFORMATION 1. Team Meetings, Agenda, Notes, Other Items 2. Little League Insurance = what parents should know about Little League Insurance. 3. Helpful Hints a. Communication System that can be used to help communication, track, monitor, etc… b. www.teamsnap.com c. www.rosterbot.com – FREE SERVICE d. www.leagueathletics.com 4. League Athletics Mobile App = Access Player information, view RSVPs to practices/games, and enter game results you’re your phone. http://www.leagueathletics.com/guest/mobile.shtml 5. American Red Cross First-Aid App = Information you need to know to handle the most common first aid emergencies http://www.redcross.org/mobile-apps/first-aid-app
Contact: John Bryan – Safety Director
[email protected]
2016 SRVLL TEAM BINDERS
Suggestion to use your Team Parent to create the binder and to maintain the information. If you have any questions or need help. Please contact the League John Bryan –
[email protected]. Thank you for your help and support of SRVLL Program,
Contact: John Bryan – Safety Director
[email protected]
2016 SRVLL TEAM BINDERS APPENDIX A SRVLL CALENDAR http://www.srvll.org/page/show/2132691-calendar
Contact: John Bryan – Safety Director
[email protected]
2016 SRVLL TEAM BINDERS APPENDIX B
SRVLL Board of Directors 2014-2015 President
Scott Tinetti
[email protected]
VP, Baseball Operations
Matt Dublin
[email protected]
Secretary
Kevin Waters
[email protected]
Treasurer
Dave Borrelli
[email protected]
League Player Agent
Jeffrey Heuer
[email protected]
League Umpire-in-Chief
Steve Edgren
[email protected]
Director, Safety
John Bryan
[email protected]
Administrative Board Director, League Information
[email protected]
Director, Uniforms
Chuck Scheneck
[email protected]
Director, Equipment
Chip Congdon
[email protected]
Director, Fields
Michael Rothschild
[email protected]
Director, Marketing
Orlando Frasca
[email protected]
Director, Merchandising
Kirsten Hazard
[email protected]
Director, League Training
Jeffrey Heuer
[email protected]
Director, Tryouts
Ernie Schlitt
[email protected]
Director, Volunteers
Krissy Sherwood
[email protected]
Director, Big Leagues
Charley Luckhardt
[email protected]
Director, Junior/Senior Program
Tom Afdahl
[email protected]
Director, All-Stars
Damon Bowers
[email protected]
Director, Majors
Matt Green
[email protected]
Director, AAA
Dave Tripaldi
[email protected]
Director, AA
Todd Carter
[email protected]
Director, A
Carl Peterson
[email protected]
Director, Rookie
Preston Smalley
[email protected]
Director, Farm
Bob McNamara
[email protected]
Director, T-Ball
Josh Roden
[email protected]
Director, Postseason (Summer/Fall)
John Threleid
[email protected]
Director, Challenger Program
Mike Giosso
[email protected]
Contact: John Bryan – Safety Director
[email protected]
2016 SRVLL TEAM BINDERS
Town of Danville Rain Hotline (925) 314-3484 Usually updated by 7:00am and then again at 12:00pm. Mailing Address: San Ramon Valley Little League P.O. Box 161 Danville, CA 94526 e-mail:
[email protected]
Contact: John Bryan – Safety Director
[email protected]
PLAYER LINE-UP’S SCHEDULES
PLAYER LINE-UP’S SCHEDULES
PLAYER LINE-UP’S SCHEDULES
PLAYER LINE-UP’S SCHEDULES
GAMES-PRACTICES
GAMES-PRACTICES
GAMES-PRACTICES
GAMES-PRACTICES
PRE-GAME CHECKLIST SAFETY INFORMATION PITCH COUNT CONTACT INFORMATION MEDICAL RELEASE TRACKING PROJECTS LOCAL RULES MISC INFORMATION PLAYER LINE-UP’S SCHEDULES
PRE-GAME CHECKLIST SAFETY INFORMATION PITCH COUNT CONTACT INFORMATION MEDICAL RELEASE TRACKING PROJECTS LOCAL RULES MISC INFORMATION PLAYER LINE-UP’S SCHEDULES
PRE-GAME CHECKLIST SAFETY INFORMATION PITCH COUNT CONTACT INFORMATION MEDICAL RELEASE TRACKING PROJECTS LOCAL RULES MISC INFORMATION PLAYER LINE-UP’S SCHEDULES
PRE-GAME CHECKLIST SAFETY INFORMATION PITCH COUNT CONTACT INFORMATION MEDICAL RELEASE TRACKING PROJECTS LOCAL RULES MISC INFORMATION PLAYER LINE-UP’S SCHEDULES
GAMES-PRACTICES
GAMES-PRACTICES
GAMES-PRACTICES
GAMES-PRACTICES
PRE-GAME CHECKLIST SAFETY INFORMATION PITCH COUNT CONTACT INFORMATION MEDICAL RELEASE TRACKING PROJECTS LOCAL RULES MISC INFORMATION
PRE-GAME CHECKLIST SAFETY INFORMATION PITCH COUNT CONTACT INFORMATION MEDICAL RELEASE TRACKING PROJECTS LOCAL RULES MISC INFORMATION
PRE-GAME CHECKLIST SAFETY INFORMATION PITCH COUNT CONTACT INFORMATION MEDICAL RELEASE TRACKING PROJECTS LOCAL RULES MISC INFORMATION
PRE-GAME CHECKLIST SAFETY INFORMATION PITCH COUNT CONTACT INFORMATION MEDICAL RELEASE TRACKING PROJECTS LOCAL RULES MISC INFORMATION
SAN RAMON VALLEY LITTLE LEAGUE TEAM 6 SAN FRANCISCO GIANTS
Manager:
(Name)
(Phone Number)
Head Coach:
(Name)
(Phone Number)
Coach:
(Name)
(Phone Number)
Coach: Ryan
(Name)
(Phone Number)
Team Mom:
(Name)
(Phone Number)
President: Todd Sanders Vice-President: Matt Dublin Safety: John Bryan Division Director: (Name) www.SRVLL.org
SRVLL PRE-GAME CHECKLIST DATE
TIME
FIELD NUMBER
RESPONSIBLE PERSONS
Place a check in the box after each item is completed
First-Aid/AED/CPR Station - Verify availability Equipment Inspection - helmets, bats, catcher gear, proper game balls Field Inspection - Walk the field for debris/foreign objects Check Condition - fences, backstops, bases, dugouts, and warning track Communications - Available - mobile phone, pay phone, etc.. Warm-Up - Players Completed TOP SAFETY REMINDERS - SAFETY IS EVERYONES RESPONSIBILITY Warm-Up's - Cautions of batters swinging & handling of bats, balls thrown, endangering others, protective gear is worn-helmets, catchers gear, players have enough distance from each other NO SWINGING OF BATS - NO ON DECK CIRCLE or BATTER - No bats in hands until player is up to bat REQUIRED SAFETY EQUIPMENT IS USED - Helmets, Catchers Gear, Males-Athletic Supporters Only Catchers are allowed to receive balls from pitchers - No Managers or Coaches Managers & Coaches shall NEVER leave a child unattended at a practice or game, NO EXCEPTIONS Only Managers, Coaches, & Umpires are permitted on the field. No unauthorized person is allowed around the players at any time - All persons must be background check approved before being allowed players. NO EXCEPTIONS Offensive & extra players must remain in dugout during play.
HYDRATION - Ensure all player maintain hydration at ALL TIMES especially during hot days.
PRINT NAME
SRVLL-201501
SIGNATURE
DATE
Lastest Revision: 2015-01-18
Equipment Checklist Keep Your Players Safer
safety on the field? Do you know which optional items can help keep players safer? Check out the following list for ideas and reminders. REQUIRED PLAYER EQUIPMENT Defense ❑ Athletic supporter – all male players ❑ Metal, fiber, or plastic type cup – all male catchers ❑ Catcher’s helmet and mask, with “dangling” throat guard; NO skull caps – all catchers; must be worn during pitcher warm-up, infield practice, while batter is in box ❑ Catcher’s mitt – all baseball catchers ❑ Chest protector and leg protectors – all catchers; must be worn while batter is in box; long model chest protector required for Little League (Majors) and younger catchers Offense ❑ Helmet meeting NOCSAE standards – all batters, base runners, and players in coaches boxes ❑ Helmet chinstrap – all helmets made to have chinstrap (with snap buttons, etc.) ❑ Regulation-sized ball for the game and division being played; marked RS for regular season or RS-T for regular season and tournament in baseball ❑ Regulation-sized bat – all batters; Little League (Majors) and younger baseball divisions must have bat marked with BPF 1.15 beginning in 2009 ❑ Non-wood bats must have a grip of cork, tape, or composite material, and must extend a minimum of 10 inches from the small end. Slippery tape is prohibited. REQUIRED FIELD EQUIPMENT ❑ 1st, 2nd and 3rd bases that disengage from their anchors ❑ Pitcher’s plate and home plate ❑ Players’ benches behind protective fences ❑ Protective backstop and sideline fences OPTIONAL PLAYER EQUIPMENT Defense ❑ Metal, fiber, or plastic type cup – any player, esp. infielders ❑ Pelvic protector – any female, esp. catchers ❑ Heart Guard/XO Heart Shield/Female Rib Guard – any defensive player, esp. pitchers, infielders ❑ Game-Face Safety Mask – any player, esp. infielders ❑ Goggles/shatterproof glasses – any player, esp. infielders or those with vision limitations
Offense ❑ Helmet – adults in coaches boxes ❑ Helmet with Face Guards or C-Flap meeting NOCSAE standards – all batters, esp. in younger divisions ❑ Mouth guard – batters, defensive players ❑ Goggles/Shatterproof glasses – any player, esp. those with vision limitations ❑ Batters vest/Heart Guard/Heart Shield/Female Rib Guard – any batter ❑ Regulation-sized reduced impact ball OPTIONAL FIELD EQUIPMENT ❑ Double 1st base that disengages from its anchor ❑ Baseball mound for pitcher’s plate ❑ Portable pitchers baseball mound with pitcher’s plate ❑ Protective/padded cover for fence tops ❑ Foul ball return in backstop fencing
IMPORTANT:
Do you know what equipment is required for player
BPF RULE GOES INTO EFFECT FOR BASEBALL DIVISIONS
Buying bats for your league’s baseball divisions? If it is composite metal, make sure it has the BPF 1.15 label. Bats in use in Little League Baseball (Majors Division and younger) must have the new bat performance factor listed on the bat. Unless this marking is present, the bat will be removed from games. Little League officials are aware some bats do not have the required markings but are Little League approved. And some of the bats on the approved bat list may not carry the required BPF 1.15 marking, depending on when they were manufactured and licensed. Little League is building a list of bats that are approved but do not have the BPF marking due to special circumstances. For these bats, the eligibility for play will be extended until December 31, 2009. As Little League is made aware of bats that meet the BPF rule for this extension, the bats will be added to the list. ONLY bats with a BPF 1.15 marking or that are listed below will be allowed for use in the Little League (Majors) Baseball and younger divisions in 2009. Non-BPF-marked bats approved until Dec. 31, 2009: Adidas – Vanquish (blue design) A newer model of this bat, also named Vanquish with copper and black markings, has the proper labeling, so is therefore not subject to the one-year rule. DeMarini – Black Coyote, Rogue, Distance, Rumble, Tengu, Mach 10, Patriot Easton – LZ-810, LZ-800, Stealth Optiflex LST 1, Louisville Slugger – YB31 NIKE – Areo
Spring 2009
5
LITTLE LEAGUE TOP INJURIES Pitcher's elbow . This condition, an inflammation of the bony joint of the elbow, occurs with repeated hard-slamming throws. Leg sprains and breaks. Baseball doesn't just involve the top part of an athlete's body. Every time a person throws a ball, the lower extremities get into the act. don't forget those “sliding into base” moves. Shoulder pull. Another injury of the upper body, shoulder pulls occur from catching high balls, from throwing a ball to base with all you're worth or from hitting so hard with a bat, it cracks. Concussion. Unfortunately, baseball players don't wear headgear (caps don't count), and sometimes baseballs land where they shouldn't …on vulnerable heads. Cracked teeth. Baseball players don't wear mouthguards either, and the ball that misses the top of the head can get the teeth. Broken jaw. The jaw, too, is exposed to flying baseballs during a game. A ball might hit a child on the outside of the jaw or face forward. Even a mouthguard can't protect against that. Heat Prostration. When an inning lasts forever in the hot sun. Foot Injury. Sneakers are not always the best shoe to protect toes from getting stubbed or broken. Making a run to a base or getting hit in the foot from a bat or a ball is all it takes. Back Injury. Picking up foul balls, bending to catch a low-flying ball, jumping at an angle to get a curving ball—all of these cause back injury. Commotio cordis. Some of the sports which have a risk for this cause of trauma in baseball. Children are especially vulnerable, possibly due to the mechanical properties of their thoracic skeleton.
Danville
Walnut Creek
Megan's Law - State of California Crime Report
Alamo
The importance of Volunteer Background Checks. NO ONE IS ALLOWED AROUND A PLAYER WHO HAS NOT PASSED SRVLL BACKGROUND CHECK. ________ Initial
Contra Costa County
CHILD/SEX OFFENDERS
1028
1 3
8 5
19 27
SRVLL TOP SAFETY RULES AND RECOMMENDATIONS
T-BALL
ROOKIE
FARM
A
AA
AAA
The rules and recommendations are not a guarantee that a person will not get hurt.
MAJORS
Safety Rules are the most important rules to follow. SRVLL has Zero Tollerance for any rule violation. Rules must be apply for both games and practices. We greatly appreciate all Coaches volunteering and need your help to keep all players safe. Safety is everyone's responsibility. Thank you! _________ Initial
HELMET - REQ-Must be Worn - REC-Recommended BATS- in Hand, Base Runners, If a Player is Base Coach REQ REQ REQ REQ REQ REQ REQ PITCHERS - OPTIONAL Full Face for Single A REC REC REC REC REC REC REC FIRST BASE REC REC REC REC REC REC REC BATS - NO SWINGING - HIGHLY RECOMMEND CAUTION WHILE PRACTICING LL does not allow a warm-up circle or swinging a bat outside of the batters box. CAGES - BULL PIN - Players must remain behind the door opening during play and back. One Coach must be in the cages with players at all times. Do not allow players to wrap or expose figures outside of fencing. NAMES ON UNIFORMS - Players cannot have any name or nick name on uniform WARM-UP PITCHER - Catchers must wear all gear to warm-up Pitchers. No adults can warm-up Pitchers per LL Rule. COACHES GEAR - Recommend wear Catchers helmet if behind home plate. TO DARK - Hard stoppage of play 15 minutes prior to sunset. Use Little League WeatherBug App to find out Sunset. HOT DAYS - Keep players hydrated. Little League WeatherBug App is available for weather temperature Under 95 Degrees - GREEN 95 to 99 Degress - CAUTION - Coaches decision to reschedule - KEEP PLAYERS HYDRATED 100 to 104 - RED FLAG - Reschedule Play HIGHLY RECOMMENDED EQUIPMENT - This is not a guarantee that someone wil not be hurt. Chest Protection - EvoShield Mouth Guard - Protective Eye Wear Face Guard - Helmets - Especially Pitchers or Soft Helmet
REPORTING CHILD ABUSE - CALIFORNIA Under the California statute, certain individuals (including teachers and school officials, day care or child care employees, employees of day camps or youth organizations or recreation programs or centers, directors, coaches, assistant coaches or athletic personnel at public or private sports organizations, public assistance workers, district attorneys, case workers, doctors or medical professionals or health care workers, counselors and therapists (including candidates), coroners, commercial film developers, animal control officers, clergy, law enforcement officers or employees of a police department, alcohol and drug counselors, among others) are required to report suspected child abuse to any police department, sheriff’s department, county probation department, or the county welfare department, but not including school district police or security. These agencies will also accept reports from persons not named above as mandatory reporters. The statutes define child abuse or neglect as physical injury or death inflicted upon a child through nonaccidental means, the willful harming or endangering of a child, or unlawful corporal punishment. The statutes also define neglect, sexual abuse, and willful endangerment of a child. Links to the specific sections of the official California Penal Code are not available. The mandatory reporting statute is found in Part 4 (PREVENTION OF CRIMES AND APPREHENSION OF CRIMINALS), Title 1 (INVESTIGATION AND CONTROL OF CRIMES AND CRIMINALS), Chapter 2 (Control of Crimes and Criminals), Article 2.5 (Child Abuse and Neglect Reporting Act), Sections 11164 through 11174.3. To access the entire California Penal Code, follow: http://www.leginfo.ca.gov/cgi-bin/calawquery?codesection=pen&codebody=&hits=20 Links to the specific sections summarized above, including definitions, in an unofficial version of the Code online, are available as follows: http://codes.lp.findlaw.com/cacode/PEN/3/4/1/2/2.5/s11165.9 http://codes.lp.findlaw.com/cacode/HSC/1/d10/4/1/s11165.1 http://codes.lp.findlaw.com/cacode/PEN/3/4/1/2/2.5/s11165.6 http://codes.lp.findlaw.com/cacode/PEN/3/4/1/2/2.5/s11165.2 http://codes.lp.findlaw.com/cacode/PEN/3/4/1/2/2.5/s11165.3 http://codes.lp.findlaw.com/cacode/PEN/3/4/1/2/2.5/s11165.7 Below is a link to a list of California county welfare offices and their contact information: http://www.calfresh.ca.gov/PG839.htm Below are a link to and a web address for a PDF of the child abuse reporting hotlines for all counties: Child Protective Services (CPS) Hotlines: http://www.childsworld.ca.gov/res/pdf/CPSEmergNumbers.pdf Below are links provided by the Department of Social Services regarding reporting child abuse: http://www.cdss.ca.gov/cdssweb/PG20.htm http://www.dss.cahwnet.gov/cdssweb/pg93.htm Latest Version 2015-01-18
Adult First Aid/CPR/AED READY REFERENCE
CHECKING AN INJURED OR ILL ADULT APPEARS TO BE UNCONSCIOUS TIP: Use disposable gloves and other personal protective equipment and obtain consent whenever giving care.
AFTER CHECKING THE SCENE FOR SAFETY, CHECK THE PERSON:
CHECK FOR RESPONSIVENESS Tap the shoulder and shout, “Are you OK?”
CALL 9-1-1 If no response, CALL 9-1-1 or the local emergency number. ■■
If an unconscious person is face-down, roll face-up, supporting the head, neck and back in a straight line.
If the person responds, obtain consent and CALL 9-1-1 or the local emergency number for any life-threatening conditions. CHECK the person from head to toe and ask questions to find out what happened.
OPEN THE AIRWAY Tilt head, lift chin.
PANEL
2
CHECK FOR BREATHING CHECK quickly for breathing for no more than 10 seconds. ■■
Occasional gasps are not breathing.
QUICKLY SCAN FOR SEVERE BLEEDING
WHAT TO DO NEXT ■■
Give CARE based on conditions found.
■■
IF NO BREATHING—Go to PANEL 6 or PANEL 7 (if an AED is immediately available).
■■
IF BREATHING—Maintain an open airway and monitor for any changes in condition.
PANEL
3
CONSCIOUS CHOKING CANNOT COUGH, SPEAK OR BREATHE AFTER CHECKING THE SCENE AND THE INJURED OR ILL PERSON, HAVE SOMEONE CALL 9-1-1 AND GET CONSENT.
GIVE 5 BACK BLOWS Give 5 back blows. ■■
Bend the person forward at the waist and give 5 back blows between the shoulder blades with the heel of one hand.
GIVE 5 ABDOMINAL THRUSTS ■■
Place a fist with the thumb side against the middle of the person’s abdomen, just above the navel.
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Cover your fist with your other hand.
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Give 5 quick, upward abdominal thrusts.
CONTINUE CARE Continue sets of 5 back blows and 5 abdominal thrusts until the: ■■
Object is forced■out.
■■
Person can cough forcefully or breathe.
■■
Person becomes unconscious.
WHAT TO DO NEXT ■■
IF THE PERSON BECOMES UNCONSCIOUS—CALL 9-1-1, if not already done, and give care for an unconscious choking adult, beginning with looking for an object (PANEL 5, Step 3).
PANEL
4
UNCONSCIOUS CHOKING CHEST DOES NOT RISE WITH RESCUE BREATHS AFTER CHECKING THE SCENE AND THE INJURED OR ILL PERSON:
GIVE RESCUE BREATHS Retilt the head and give another rescue breath.
GIVE 30 CHEST COMPRESSIONS If the chest still does not rise, give 30 chest compressions. TIP: Person must be on firm, flat surface.
Remove CPR breathing barrier when giving chest compressions.
LOOK FOR AND REMOVE OBJECT IF SEEN
GIVE 2 RESCUE BREATHS WHAT TO DO NEXT ■■
IF BREATHS DO NOT MAKE THE CHEST RISE—Repeat steps 2 through 4.
■■
IF THE CHEST CLEARLY RISES—CHECK for breathing. Give CARE based on conditions found. PANEL
5
CPR NO BREATHING AFTER CHECKING THE SCENE AND THE INJURED OR ILL PERSON:
GIVE 30 CHEST COMPRESSIONS Push hard, push fast in the middle of the chest at least 2 inches deep and at least 100 compressions per minute TIP: Person must be on firm, flat surface.
GIVE 2 RESCUE BREATHS ■■
Tilt the head back and lift the chin up.
■■
Pinch the nose shut then make a complete seal over the person’s mouth.
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Blow in for about 1 second to make the chest clearly rise.
■■
Give rescue breaths, one after the other.
Note: If chest does not rise with rescue breaths, retilt the head and give another rescue breath.
DO NOT STOP Continue cycles of CPR. Do not stop CPR except in one of these situations: ■■
You find an obvious sign of life, such as breathing.
■■
An AED is ready to use.
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Another trained responder or EMS personnel take over.
■■
You are too exhausted to continue.
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The scene becomes unsafe.
WHAT TO DO NEXT ■■
IF AN AED BECOMES AVAILABLE—Go to AED, PANEL 7.
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IF BREATHS DO NOT MAKE THE CHEST RISE— AFTER RETILTING HEAD—Go to Unconscious choking, PANEL 5.
TIP: If at any time you notice an obvious sign of life, stop
CPR and monitor breathing and for any changes in condition. PANEL
6
AED—ADULT OR CHILD OLDER THAN 8 YEARS OR WEIGHING MORE THAN 55 POUNDS NO BREATHING AFTER CHECKING THE SCENE AND THE INJURED OR ILL PERSON:
TIP: Do not use pediatric AED pads or equipment on an adult or child older than 8 years or weighing more than 55 pounds.
TURN ON AED Follow the voice and/or visual prompts.
WIPE BARE CHEST DRY TIP: Remove any medication patches with a gloved hand.
ATTACH PADS
PANEL
7
PLUG IN CONNECTOR, IF NECESSARY
STAND CLEAR Make sure no one, including you, is touching the person. ■■
Say, “EVERYONE, STAND CLEAR.”
ANALYZE HEART RHYTHM Push the “analyze” button, if necessary. Let AED analyze the heart rhythm.
DELIVER SHOCK If SHOCK IS ADVISED: ■■
Make sure no one, including you, is touching the person.
■■
Say, “EVERYONE, STAND CLEAR.”
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Push the “shock” button, if necessary.
PERFORM CPR After delivering the shock, or if no shock is advised: ■■
Perform about 2 minutes (or 5 cycles) of CPR.
■■
Continue to follow the prompts of the AED.
TIPS: s
)F AT ANY TIME YOU NOTICE AN OBVIOUS SIGN OF LIFE STOP #02 AND MONITOR breathing and for any changes in condition.
s
)F TWO TRAINED RESPONDERS ARE PRESENT ONE SHOULD PERFORM #02 WHILE THE second responder operates the AED. PANEL
8
CONTROLLING EXTERNAL BLEEDING AFTER CHECKING THE SCENE AND THE INJURED OR ILL PERSON:
COVER THE WOUND Cover the wound with a sterile dressing.
APPLY DIRECT PRESSURE UNTIL BLEEDING STOPS
COVER THE DRESSING WITH BANDAGE Check for circulation beyond the injury (check for feeling, warmth and color).
APPLY MORE PRESSURE AND CALL 9-1-1 If the bleeding does not stop: ■■
Apply more dressings and bandages.
■■
Continue to apply additional pressure.
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Take steps to minimize shock.
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CALL 9-1-1 or the local emergency number if not already done.
TIP: Wash hands with soap and water after giving care.
PANEL
9
BURNS AFTER CHECKING THE SCENE AND THE INJURED OR ILL PERSON:
REMOVE FROM SOURCE OF BURN
COOL THE BURN Cool the burn with cold running water at least until pain is relieved.
COVER LOOSELY WITH STERILE DRESSING
CALL 9-1-1 CALL 9-1-1 or the local emergency number if the burn is severe or other life-threatening conditions are found.
CARE FOR SHOCK
PANEL
10
POISONING AFTER CHECKING THE SCENE AND THE INJURED OR ILL PERSON:
CALL 9-1-1 OR POISON CONTROL HOTLINE For life-threatening conditions (such as if the person is unconscious or is not breathing, or if a change in the level of consciousness occurs), CALL 9-1-1 or the local emergency number. OR
If the person is conscious and alert, CALL the National Poison Control Center (PCC) hotline at 1-800-222-1222 and follow the advice given.
PROVIDE CARE Give CARE based on the conditions found.
HEAD, NECK OR SPINAL INJURIES AFTER CHECKING THE SCENE AND THE INJURED OR ILL PERSON:
CALL 9-1-1 OR THE LOCAL EMERGENCY NUMBER MINIMIZE MOVEMENT Minimize movement of the head, neck and spine.
STABILIZE HEAD Manually stabilize the head in the position in which it was found. ■■
Provide support by placing your hands on both sides of the person’s head.
■■
If head is sharply turned to one side, DO NOT move it. PANEL
11
STROKE FOR A STROKE, THINK F.A.S.T. AFTER CHECKING THE SCENE AND THE INJURED OR ILL PERSON:
THINK F.A.S.T. Face—
Ask the person to smile. Does one side of face droop?
Arm—
Ask the person to raise both arms. Does one arm drift downward?
Speech— Ask the person to repeat a simple sentence (such as, “The sky is blue.”). Is the speech slurred? Can the person repeat the sentence correctly? Time—
CALL 9-1-1 immediately if you see any signals of a stroke. Try to determine the time when signals first appeared. Note the time of onset of signals and report it to the call taker or EMS personnel when they arrive.
PROVIDE CARE Give CARE based on the conditions found.
PANEL
12
Copyright © 2011 by The American National Red Cross Stock No. 656732
Get a Heads Up on Concussion in Sports Policies Information for Parents, Coaches, and School & Sports Professionals
National Center for Injury Prevention and Control Division of Unintentional Injury Prevention
What Do We Know? A concussion is a type of traumatic brain injury that can have a serious effect on a young, developing brain.1,2 While most children and teens with a concussion recover quickly and fully, some will have concussion symptoms that last for days, weeks, or even months. Not giving the brain enough time to heal after a concussion can be dangerous. A repeat concussion that occurs before the brain heals from the first, usually within a short amount of time (hours, days, weeks), can slow recovery or increase the chances for long-term health problems. These may include changes in how the child or teen thinks, feels, and acts, as well as their ability to learn and remember. While rare, a repeat concussion can result in brain swelling or permanent brain damage. It can even be fatal.6-10
The Facts • Athletes who have had a concussion, at any point in their lives, have a greater chance of getting another concussion. • Young children and teens are more likely to get a concussion and can take longer to recover than adults.3-5 • Recognizing and responding properly to concussions when they first occur can help prevent further injury or even death.6-10
What Can We Do? A concussion can happen at home, school, or play. So everyone from parents and coaches, to sports leagues officials and school professionals, can play an important role in learning how to spot a concussion, and knowing what to do if they think a child or teen has a concussion.
Policy Efforts Recently many states, schools, and sports leagues and organizations have created policies or action plans on concussion in youth and high school sports. While these policy efforts show some promise, more research is needed to learn if these strategies can help educate coaches and parents about this issue and help protect children and teens from concussion and other serious brain injuries.12,13
Check out a CDC report that includes lessons learned from Washington and Massachusetts on implementing their states’ concussion in sports laws. Learn more at: www.cdc.gov/ concussion/policies.html.
State Laws: Beginning in 2009, the state of Washington passed the first concussion in sports law, called the Zackery Lystedt Law.14 One month later, Max’s law15 passed in Oregon. In total, between 2009 and 2012, 43 states, and the District of Columbia, passed laws on concussion in sports for youth and/or high school athletes, often called Return to Play Laws. So far in 2013, four additional states have also passed Return to Play Laws. Some organizations, such as the National Conference of State Legislatures, have created online maps to track and update concussion in sports laws by state.
Source: National Conference of State Legislatures, 2013.16
Most Concussion in Sports Laws Include Three Action Steps:
1
Educate Coaches, Parents, and Athletes: Inform and educate coaches, athletes, and their parents and guardians about concussion through training and/or a concussion information sheet.
2
Remove Athlete from Play: An athlete who is believed to have a concussion is to be removed from play right away.
3
Obtain Permission to Return to Play: An athlete can only return to play or practice after at least 24 hours and with permission from a health care professional.
These action steps are based on recommendations presented in the International Concussion Consensus Statement.17 First created in 2002 and most recently updated in 2008, the Consensus Statement was developed by experts in the field and includes the latest science available on concussion in sports.
Local Policies and Action Plans: Along with the three action steps listed on the previous page, some school and league concussion policies include additional strategies in their policies or implementation plans. Research is needed to learn if including these additional strategies can help protect children and teens from concussion and other serious brain injuries. Based on interviews by CDC with nine states, below is a list of some examples of additional strategies in local policies and action plans. Be Ready for an Emergency by: • Creating a concussion emergency medical action plan. These plans often include contact information for local emergency medical responders and the location of trauma centers, if available. • Identifying appropriate health care professional(s) for games and practices to help assess and manage concussion among their athletes. Ensure Safer Play by: • Limiting contact during sports practices (when appropriate for the sport). • Putting in place rule changes and/or banning or limiting the use of certain drills or techniques to help reduce the chances of injury. • Checking sports equipment often.This includes making sure the equipment fits the athletes well, is in good condition, stored properly, and is repaired and replaced based on instructions from the equipment companies.
CDC Heads Up educational materials (available at no cost) can help state and local organizations meet many of the requirements in concussion in sports policies. Materials include online courses for: • Youth coaches and parents • High school coaches (developed in partnership with the National Federation of State High School Associations) • Health care professionals (developed with support from the NFL and CDC Foundation)
Build the Science by: • Collecting data from schools on the number of concussions reported by athletes during the season. • Studying changes in concussion knowledge and awareness among coaches and parents before and after the policy is put in place. Focus on Education by: • Posting information for parents, coaches, and athletes at schools and on the field or sidelines. Posted information often includes concussion signs and symptoms, as well as what to do if a concussion occurs. • Hosting or requiring regular trainings for athletes, parents, coaches, and school and health care professionals about concussion. Manage Return to School by: • Providing information on returning to school. This includes creating: - A concussion management team to check on students with a concussion for any changes in behavior or increased problems with school work. - A plan that includes special support or help for students during the school day to help with their recovery.
References: 1. Ewing-Cobbs L, Barnes M, Fletcher JM, et al. Modeling of longitudinal academic achievements scores after pediatric traumatic brain injury. Dev Neuropsychol 2004; 25(1-2): 107-33. 2. Ewing-Cobbs L, Prasad MR, Kramer L, et al. Late intellectual and academic outcomes following traumatic brain injury sustained during early childhood. J Neurosurg 2006; 105(4 Suppl): 287-96. 3. Gilchrist J, Thomas KE, Xu L, McGuire LC, Coronado VG. Nonfatal sports and recreation related traumatic brain injuries among children and adolescents treated in emergency departments in the United States, 2001-2009. MMWR 2011: 60(39); 1337-1342. 4. Halstead ME, Walter KD, The Council on Sports Medicine and Fitness. Sport-related concussion in children and adolescents. Pediatrics. 2010; 126: 597-615. 5. Datalys Center. Home page. Datalys Center Website. Available from: http://www. datalyscenter.org/. Accessed October 27, 2011. 6. Yang J, Peek-Asa C, Allareddy V, Phillips G, Zang Y, Cheng G. Patient and hospital characteristics associated with length of stay and hospital charges for pediatric sportsrelated injury hospitalizations in the United States, 2000-2003. Pediatrics. 2007; 119: e813-e820. 7. Cantu R. Second impact syndrome: Immediate management. Physician and Sports Medicine. 1992;20:55-66. 8. Cantu R. Second-impact syndrome. Clinical Sports Medicine. 1998;17:37-44. 9. Cantu R, Voy R. Second impact syndrome. Physician and Sports medicine. 1995;23(6):27-34. 10. McCrory P, Berkovic S. Second impact syndrome. Neurology. 1998;50:677-683. 11. Saunders R, Harbaugh R. The second impact in catastrophic contact-sports head trauma. JAMA. 1984;252(4):538-539. 12. Shenouda C, Hendrickson P, Davenport K, Barber J, Bell KR. The effects of concussion legislation one year later--what have we learned: a descriptive pilot survey of youth soccer player associates. The Journal of Injury, Function, and Rehabilitation. Jun;4(6):427-35.2012. 13. Murphy A, Kaufman MS, Molton I, Coppel DB, Benson J, Herring SA. Concussion evaluation methods among Washington State high school football coaches and athletic trainers. The Journal of Injury, Function, and Rehabilitation. Jun;4(6):419-26. 2012. 14. Washington State. Engrossed House Bill 1824, Chapter 475, Laws of 2009, 61st Legislature, 2009 Regular Session. Effective: July 26, 2009. Available from: http:// apps.leg.wa.gov/documents/billdocs/2009-10/Pdf/Bills/Session%20Law%202009/1824. SL.pdf. Accessed January 3, 2011. 15. Oregon state. Senate Bill 348. 75th Oregon Legislative Assemble--2009 Regular Session. Available from: http://www.leg.state.or.us/09reg/measures/sb0300.dir/sb0348. en.html. Accessed July 3, 2011. 16. Map of Concussion in Sports Legislation. National Conference of State Legislatures. http://www.ncsl.org/issues-research/health/traumatic-brain-injury-legislation.aspx. Accessed May 13, 2013. 17. McCrory, Meeuwisse, Johnston, Dvorak, Aubry, Molloy, Cantu. Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008, Journal of Clinical Neuroscience 16 (2009) 755–763.
Additional Resources: For more information and resources on concussion and CDC’s Heads Up program, visit www.cdc.gov/ Concussion or contact CDC at
[email protected] or 1-800-CDC-INFO (232-4643) TTY 1-888-232-6348.
For more information and resources on concussion and the CDC’s Heads Up program, visit: www.cdc.gov/Concussion.
o SIGNS AND SYMPTOMS
ACTION PLAN
These signs and symptoms may indicate that a concussion has occurred.
If you suspect that a player has a concussion,
SIGNS OBSERVED BY COACHING STAFF
SYMPTOMS REPORTED BY ATHLETE
Appears dazed or stunned
Headache or "pressure" in head
Is confused about assignment or position
Nausea or vomiting
Forgets sports plays
Balance problems or dizziness
Is unsure of game, score, or opponent Moves clumsily
Double or blurry vision Sensitivity to light
you should take the following steps: 1. Remove at hlete from play. 2. Ensure ath lete is evaluated by an appropriate health care professional . Do not try to j udge the seriousness of the injury yourself. 3. Inform athlete 's parents or guard ians about the known or possible concussion and give them the fact sheet on concussion.
4. Allow athlete to return to play only with permission from an appropriate health care professional .
Answers questions slowly Sensitivity to noise Loses consciousness (even briefly) Shows behavior or personal ity changes Can't recall events prior to hit or fall Can't recall events after hit or fall
Feeling sluggish, hazy, foggy, or groggy
IMPORTANT PHONE NUMBERS FILL I N T HE NAM E A ND NU MBE R OF YOUR LOCAL HOSPITA U S) BEL OW :
Concentration or memory problems Confusion Does not "feel right"
John Muir Medical Center _ (925) 939-3000 Hospit al Phone: _ Hospital Name: San Ramon Regional Medical _ (925) 275-9200 Hospital Phone: _ Hospit al Name:
For immediate attention, CALL 911 If you think your athlete has sustained a concussion.. . tske him/her out of play, and seelc the advice of a health care professional experienced in evaluating for concussion. o o
N
free-of-ch arge, visit : www.cdc.gov/ConcussionInYouthSports
For more information and to order additiona l materials
A Fact Sheet for COACHES
To download the coaches fact sheet in Spanish, please visit www.cdc.gov/ConcussionInYouthSports Para descargar la hoja informativa para los entrenadores en español, por favor visite www.cdc.gov/ConcussionInYouthSports
THE FACTS tA concussion is a brain injury. t All concussions are serious. t Concussions can occur without loss of consciousness. t Concussions can occur in any sport. t Recognition and proper management of concussions when they first occur can help prevent further injury or even death. WHAT IS A CONCUSSION? Concussion, a type of traumatic brain injury, is caused by a bump, blow, or jolt to the head. Concussions can also occur from a blow to the body that causes the head and brain to move quickly back and forth— causing the brain to bounce around or twist within the skull. This sudden movement of the brain can cause stretching and tearing of brain cells, damaging the cells and creating chemical changes in the brain. HOW CAN I RECOGNIZE A POSSIBLE CONCUSSION?
2. Any concussion signs or symptoms, such as a change in the athlete’s behavior, thinking, or physical functioning. Signs and symptoms of concussion generally show up soon after the injury. But the full effect of the injury may not be noticeable at first. For example, in the first few minutes the athlete might be slightly confused or appear a little bit dazed, but an hour later he or she can’t recall coming to the practice or game. You should repeatedly check for signs of concussion and also tell parents what to watch out for at home. Any worsening of concussion signs or symptoms indicates a medical emergency.
April 2013
To help spot a concussion, you should watch for and ask others to report the following two things:
1. A forceful bump, blow, or jolt to the head or body that results in rapid movement of the head.
It’s better to miss one game than the whole season.
SIGNS AND SYMPTOMS 1
SIGNS OBSERVED BY COACHING STAFF
tAppears dazed or stunned tIs confused about assignment or position tForgets an instruction tIs unsure of game, score, or opponent tMoves clumsily tA nswers questions slowly tLoses consciousness (even briefly) tS hows mood, behavior, or personality changes tCan’t recall events prior to hit or fall tCan’t recall events after hit or fall
SYMPTOMS REPORTED BY ATHLETE tHeadache or “pressure” in head tNausea or vomiting tBalance problems or dizziness tDouble or blurry vision tSensitivity to light tSensitivity to noise tFeeling sluggish, hazy, foggy, or groggy tConcentration or memory problems tConfusion tJust “not feeling right” or “feeling down”
Adapted from Lovell et al. 2004
WHAT ARE CONCUSSION DANGER SIGNS?
WHY SHOULD I BE CONCERNED ABOUT CONCUSSIONS?
In rare cases, a dangerous blood clot may form on the brain in an athlete with a concussion and crowd the brain against the skull. Call 9-1-1 or take the athlete to the emergency department right away if after a bump, blow, or jolt to the head or body the athlete exhibits one or more of the following danger signs:
Most athletes with a concussion will recover quickly and fully. But for some athletes, signs and symptoms of concussion can last for days, weeks, or longer.
t t t t t t t t t t t
One pupil larger than the other Is drowsy or cannot be awakened A headache that gets worse Weakness, numbness, or decreased coordination Repeated vomiting or nausea Slurred speech Convulsions or seizures Cannot recognize people or places Becomes increasingly confused, restless, or agitated Has unusual behavior Loses consciousness (even a brief loss of consciousness should be taken seriously)
If an athlete has a concussion, his or her brain needs time to heal. A repeat concussion that occurs before the brain recovers from the first—usually within a short time period (hours, days, weeks)—can slow recovery or increase the chances for long-term problems. In rare cases, repeat concussions can result in brain swelling or permanent brain damage. It can even be fatal.2,3 HOW CAN I HELP ATHLETES TO RETURN TO PLAY GRADUALLY? An athlete should return to sports practices under the supervision of an appropriate health care professional. When available, be sure to work closely with your team’s certified athletic trainer.
Below are five gradual steps that you and the health care professional should follow to help safely return an athlete to play. Remember, this is a gradual process. These steps should not be completed in one day, but instead over days, weeks, or months. BASELINE: Athletes should not have any concussion symptoms. Athletes should only progress to the next step if they do not have any symptoms at the current step. STEP 1: Begin with light aerobic exercise only to increase an athlete’s heart rate. This means about 5 to 10 minutes on an exercise bike, walking, or light jogging. No weight lifting at this point. STEP 2: Continue with activities to increase an athlete’s heart rate with body or head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking, moderate-intensity weightlifting (reduced time and/or reduced weight from your typical routine). STEP 3: Add heavy non-contact physical activity, such as sprinting/running, highintensity stationary biking, regular weightlifting routine, non-contact sportspecific drills (in 3 planes of movement). STEP 4: Athlete may return to practice and full contact (if appropriate for the sport) in controlled practice. STEP 5: Athlete may return to competition. If an athlete’s symptoms come back or she or he gets new symptoms when becoming more active at any step, this is a sign that the athlete is pushing him or herself too hard.
The athlete should stop these activities and the athlete’s health care provider should be contacted. After more rest and no concussion symptoms, the athlete should begin at the previous step. PREVENTION AND PREPARATION Insist that safety comes first. To help minimize the risks for concussion or other serious brain injuries: t Ensure that athletes follow the rules for safety and the rules of the sport. t Encourage them to practice good sportsmanship at all times. t Wearing a helmet is a must to reduce the risk of severe brain injury and skull fracture. – However, helmets are not designed to prevent concussions. There is no “concussion-proof” helmet. So, even with a helmet, it is important for kids and teens to avoid hits to the head. Check with your league, school, or district about concussion policies. Concussion policy statements can be developed to include: t The school or league’s commitment to safety t A brief description of concussion t Information on when athletes can safely return to school and play. Parents and athletes should sign the concussion policy statement at the beginning of the season.
ACTION PLAN WHAT SHOULD I DO WHEN A CONCUSSION IS SUSPECTED? No matter whether the athlete is a key member of the team or the game is about to end, an athlete with a suspected concussion should be immediately removed from play. To help you know how to respond, follow the Heads Up four-step action plan: 1. REMOVE THE ATHLETE FROM PLAY. Look for signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head or body. When in doubt, sit them out! 2. ENSURE THAT THE ATHLETE IS EVALUATED BY AN APPROPRIATE HEALTH CARE PROFESSIONAL. Do not try to judge the severity of the injury yourself. Health care professionals have a number of methods that they can use to assess the severity of concussions. As a coach, recording the following information can help health care professionals in assessing the athlete after the injury: t Cause of the injury and force of the hit or blow to the head or body t Any loss of consciousness (passed out/ knocked out) and if so, for how long t Any memory loss immediately following the injury
t Any seizures immediately following the injury t Number of previous concussions (if any) 3. INFORM THE ATHLETE’S PARENTS OR GUARDIANS. Let them know about the possible concussion and give them the Heads Up fact sheet for parents. This fact sheet can help parents monitor the athlete for signs or symptoms that appear or get worse once the athlete is at home or returns to school. 4. KEEP THE ATHLETE OUT OF PLAY. An athlete should be removed from play the day of the injury and until an appropriate health care professional says they are symptom-free and it’s OK to return to play. After you remove an athlete with a suspected concussion from practice or play, the decision about return to practice or play is a medical decision. REFERENCES 1. Lovell MR, Collins MW, Iverson GL, Johnston KM, Bradley JP. Grade 1 or “ding” concussions in high school athletes. The American Journal of Sports Medicine 2004; 32(1):47-54. 2. Institute of Medicine (US). Is soccer bad for children’s heads? Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer. Washington (DC): National Academies Press; 2002. 3. Centers for Disease Control and Prevention (CDC). Sports-related recurrent brain injuries-United States. Morbidity and Mortality Weekly Report 1997; 46(10):224-227. Available at: www.cdc.gov/mmwr/ preview/mmwrhtml/00046702.htm.
If you think your athlete has a concussion… take him/her out of play and seek the advice of a health care professional experienced in evaluating for concussion. For more information, visit www.cdc.gov/Concussion.
SIGNS AND SYMPTOMS These signs and symptoms may indicate that a concussion has occurred. SIGNS OBSERVED BY COACHING STAFF
SYMPTOMS REPORTED BY ATHLETE
Appears dazed or stunned
Headache or “pressure” in head
Is confused about assignment or position
Nausea or vomiting
Forgets sports plays
Balance problems or dizziness
Is unsure of game, score, or opponent
Double or blurry vision
Moves clumsily
Sensitivity to light
Answers questions slowly
Sensitivity to noise
Loses consciousness (even briefly)
Feeling sluggish, hazy, foggy, or groggy
Shows behavior or personality changes
Concentration or memory problems
Can’t recall events prior to hit or fall
Confusion
Can’t recall events after hit or fall
Does not “feel right”
ACTION PLAN If you suspect that a player has a concussion, you should take the following steps:
1. Remove athlete from play. 2. Ensure athlete is evaluated by an appropriate health care professional. Do not try to judge the seriousness of the injury yourself. 3. Inform athlete’s parents or guardians about the known or possible concussion and give them the fact sheet on concussion. 4. Allow athlete to return to play only with permission from an appropriate health care professional.
July 2007
It’s better to miss one game than the whole season.
U.S. D EPARTMENT
OF H EALTH AND H UMAN S ERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION
U .S .
DEPARTMENT OF
HEALTH ANO
HUMAN
SERVICES
CENTERS FOR DISEASE CONTROL AN D PREVENTION
A QUIZ FOR COACHES, ATHLETES, AND PARENTS Review the "Heads Up: Concussion in Youth Sports" materials and test your knowLedge of concussion.
Marl< each of the following statements as True (T) or False (F) 1. A concussion is a brain injury.
2. Concussions can occur in any organized or unorganized recreational sport or activity. 3. You can't see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. 4. Following a coach's rules for safety and the rules of the sport, practicing good sportsmanship at all times, and using the proper sports equipment are all ways that athletes can prevent a concussion. 5. Concussions can be caused by a fall or by a bump or blow to the head or body. 6. Concussion can happen even if the athlete hasn't been knocked out or lost consciousness. 7. Nausea, headaches, sensitivity to light or noise, and difficulty concentrating are some of the symptoms of a concussion . 8. Athletes who have a concussion should not return to play until they are symptom-free and have received approval from a doctor or health care professional. 9. A repeat concussion that occurs before the brain recovers from the first can slow recovery or increase the likelihood of having long-term problems.
Parent/Athlete Concussion Information Sheet A concussion is a type of traumatic brain injury that changes the way the brain normally works. A concussion is caused by bump, blow, or jolt to the head or body that causes the head and brain to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow
Did You Know? s Most concussions occur without loss of consciousness.
to the head can be serious.
s Athletes who have, at any point in their lives, had a concussion have an increased risk for another concussion.
WHAT ARE THE SIGNS AND SYMPTOMS OF CONCUSSION?
s Young children and teens are more likely to get a concussion and take longer to recover than adults.
Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days or weeks after the injury. If an athlete reports one or more symptoms of concussion listed below after a bump, blow, or jolt to
the head or body, s/he should be kept out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says s/he is symptom-free and it’s OK to return to play.
SIGNS OBSERVED BY COACHING STAFF
SYMPTOMS REPORTED BY ATHLETES
Appears dazed or stunned
Headache or “pressure” in head
Is confused about assignment or position
Nausea or vomiting
Forgets an instruction
Balance problems or dizziness
Is unsure of game, score, or opponent
Double or blurry vision
Moves clumsily
Sensitivity to light
Answers questions slowly
Sensitivity to noise
Loses consciousness (even briefly)
Feeling sluggish, hazy, foggy, or groggy
Shows mood, behavior, or personality changes
Concentration or memory problems
Can’t recall events prior to hit or fall
Confusion
Can’t recall events after hit or fall
Just not “feeling right” or “feeling down”
CONCUSSION DANGER SIGNS In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. An athlete should receive immediate medical attention if after a bump, blow, or jolt to the head or body s/he exhibits any of the following danger signs:
Remember Concussions affect people differently. While most athletes with a concussion recover quickly and fully, some will have symptoms that last for days, or even weeks. A more serious concussion can last for months or longer.
s One pupil larger than the other s Is drowsy or cannot be awakened s A headache that not only does not diminish, but gets worse s Weakness, numbness, or decreased coordination s Repeated vomiting or nausea s Slurred speech s Convulsions or seizures s Cannot recognize people or places s Becomes increasingly confused, restless, or agitated s Has unusual behavior s Loses consciousness (even a brief loss of consciousness should be taken seriously)
WHY SHOULD AN ATHLETE REPORT THEIR SYMPTOMS? If an athlete has a concussion, his/her brain needs time to heal. While an athlete’s brain is still healing, s/he is much more likely to have another concussion. Repeat concussions can increase the time it takes to recover. In rare cases, repeat concussions in young athletes can result in brain swelling or permanent damage to their brain. They can even be fatal.
WHAT SHOULD YOU DO IF YOU THINK YOUR ATHLETE HAS A CONCUSSION? If you suspect that an athlete has a concussion, remove the athlete from play and seek medical attention. Do not try to judge the severity of the injury yourself. Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says s/he is symptom-free and it’s OK to return to play. Rest is key to helping an athlete recover from a concussion. Exercising or activities that involve a lot of concentration, such as studying, working on the computer, or playing video games, may cause concussion symptoms to reappear or get worse. After a concussion, returning to sports and school is a gradual process that should be carefully managed and monitored by a health care professional.
It’s better to miss one game than the whole season. For more information on concussions, visit: www.cdc.gov/Concussion.
Student-Athlete Name Printed
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Date
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Date
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IUUQ XXXDEDHPW IFBETVQ
Pitches Thrown
Pitcher's Name
Unif. No.
League Age
Tm. Manager's Signature *
Opp. Manager's Signature *
Scorekeeper/Ump Signature *
Team _____________________ again on (date)
Eligible to pitch
* Note: These signatures may be optional as determined by the local league.
Regulation VI (see current rule book for details). An electronic version of this form is available for free download at www.LittleLeague.org.
Pitching eligibility varies by the league age of the pitcher, which is the pitcher's age as of May 1 of the current year. The pitching eligibility regulation is
Date of Game
Division ___________________
____________________ Little League -- Baseball Pitcher Eligibility Tracking Form
____________________________ Little League -- Baseball Game Pitch Log Team ___________________ Pitcher's Name
Opponent ___________________
Uniform League Age Number
Date _________________
X Cross out the number as that pitch is thrown. O Circle the number for the last pitch thrown in each half-inning. 1
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Pitching eligibility varies by the league age of the pitcher, which is the pitcher's age as of May 1 of the current year. The pitching eligibility regulation is Regulation VI (see current rule book for details). A blank electronic version of this form is available for free download at www.littleleague.org.
San Ramon Valley Little League - Baseball Game Pitch Log Team ___________________ Pitcher's _________________ Name
Opponent ___________________
Uniform League Age Number
Date _______________
X Cross out the number as that pitch is thrown. O Circle the number for the last pitch thrown in each half-inning. 1
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Pitching eligibility varies by the league age of the pitcher, which is the pitcher's age as of May 1 of the current year. The pitching eligibility regulation is Regulation VI (see current rule book for details). A blank electronic version of this form is available for free download at www.littleleague.org.
Little League® Pitch Count Data Sheet
Use Additional Sheets If Necessary League: ________________________________________ Date: Visiting Team Name: Pitcher(s) Name
League Inning Inning Pitches Reason for Removal Score Age started removed thrown in opinion of Official Pitch Count Scorer when removed Reached limit, tired, ineffective, end of game, strategic change, other ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ Home Team Name: Pitcher(s) Name
League Inning Inning Pitches Reason for Removal Score in opinion of Official Pitch Count Scorer when removed Age started removed thrown Reached limit, tired, ineffective, end of game, strategic change, other ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________
____________________ Little League -- Baseball Pitcher Eligibility Tracking Form Division ___________________ Date of Game
Pitches Thrown
Pitcher's Name
Unif. No.
League Age
Tm. Manager's Signature *
Team _____________________
Eligible to pitch
Opp. Manager's Signature *
again on (date) if requirement for game rest is met
Scorekeeper/Ump Signature *
Game of rest required?
Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Pitching eligibility varies by the league age of the pitcher, which is the pitcher's age as of May 1 of the current year. The pitching eligibility regulation is Regulation VI (see current rule book for details). An electronic version of this form is available for free download at www.LittleLeague.org.
* Note: These signatures may be optional as determined by the local league.
Regular Season Pitching Rules - Baseball VI - PITCHERS (a) Any player on a regular season team may pitch. (NOTE: There is no limit to the number of pitchers a team may use in a game.) (b) A pitcher once removed from the mound cannot return as a pitcher. Junior, Senior, and Big League Divisions only: A pitcher remaining in the game, but moving to a different position, can return as a pitcher anytime in the remainder of the game, but only once per game. (c) The manager must remove the pitcher when said pitcher reaches the limit for his/her age group as noted below, but the pitcher may remain in the game at another position: League Age 1 7-18 105 pitches per day 13 -16 95 pitches per day 11 -12 85 pitches per day 9-10 75 pitches per day 7-8 50 pitches per day Exception: Exception: If a pitcher reaches the limit imposed in Regulation VI (c) for his/her league age while facing a batter, the pitcher may continue to pitch until any one of the following conditions occurs: 1. That batter reaches base; 2. That batter is put out; 3. The third out is made to complete the half-inning. Note 1: A pitcher who delivers 41 or more pitches in a game cannot play the position of catcher for the remainder of that day. (d) Pitchers league age 14 and under must adhere to the following rest requirements: • If a player pitches 66 or more pitches in a day, four (4) calendar days of rest must be observed. • If a player pitches 51 - 65 pitches in a day, three (3) calendar days of rest must be observed. • If a player pitches 36 - 50 pitches in a day, two (2) calendar days of rest must be observed. • If a player pitches 21 - 35 pitches in a day, one (1) calendar days of rest must be observed. • If a player pitches 1-20 pitches in a day, no (0) calendar day of rest is required. Pitchers league age 15-18 must adhere to the following rest requirements: • If a player pitches 76 or more pitches in a day, four (4) calendar days of rest must be observed. • If a player pitches 61 - 75 pitches in a day, three (3) calendar days of rest must be observed. • If a player pitches 46 - 60 pitches in a day, two (2) calendar days of rest must be observed. • If a player pitches 31 -45 pitches in a day, one (1) calendar days of rest must be observed. • If a player pitches 1-30 pitches in a day, no (0) calendar day of rest is required.
(e) Each league must designate the scorekeeper or another game official as the official pitch count recorder.
(f) The pitch count recorder must provide the current pitch count for any pitcher when requested by either manager or any umpire. However, the manager is responsible for knowing when his/her pitcher must be removed. (g) The official pitch count recorder should inform the umpire-in-chief when a pitcher has delivered his/her maximum limit of pitches for the game, as noted in Regulation VI (c). The umpire-in-chief will inform the pitcher’s manager that the pitcher must be removed in accordance with Regulation VI (c). However, the failure by the pitch count recorder to notify the umpire-in-chief, and/or the failure of the umpire-in-chief to notify the manager, does not relieve the manager of his/her responsibility to remove a pitcher when that pitcher is no longer eligible. (h) Violation of any section of this regulation can result in protest of the game in which it occurs. Protest shall be made in accordance with Playing Rule 4.19. (j) A player who has attained the league age of twelve (12) is not eligible to pitch in the Minor League. (See Regulation V – Selection of Players) (k) A player may not pitch in more than one game in a day. (Exception: In the Big League Division, a player may be used as a pitcher in up to two games in a day.) NOTES : 1. The withdrawal of an ineligible pitcher after that pitcher is announced, or after a warm-up pitch is delivered, but before that player has pitched a ball to a batter, shall not be considered a violation. Little League officials are urged to take precautions to prevent protests. When a protest situation is imminent, the potential offender should be notified immediately. 2. Pitches delivered in games declared “Regulation Tie Games” or “Suspended Games” shall be charged against pitcher’s eligibility. 3. In suspended games resumed on another day, the pitchers of record at the time the game was halted may continue to pitch to the extent of their eligibility for that day, provided said pitcher has observed the required days of rest. Example 1: A league age 12 pitcher delivers 70 pitches in a game on Monday when the game is suspended. The game resumes on the following Thursday. The pitcher is not eligible to pitch in the resumption of the game because he/she has not observed the required days of rest. Example 2: A league age 12 pitcher delivers 70 pitches in a game on Monday when the game is suspended. The game resumes on Saturday. The pitcher is eligible to pitch up to 85 more pitches in the resumption of the game because he/she has observed the required days of rest. Example 3: A league age 12 pitcher delivers 70 pitches in a game on Monday when the game is suspended. The game resumes two weeks later. The pitcher is eligible to pitch up to 85 more pitches in the resumption of the game, provided he/she is eligible based on his/her pitching record during the previous four days. Note: The use of this regulation negates the concept of the “calendar week” with regard to pitching eligibility.
Little League Baseball and Softball ®
M E D I C A L
R E L E A S E
NOTE: To be carried by any Regular Season or Tournament Team Manager together with team roster or International Tournament affidavit. Player: _____________________________________
Date of Birth: ____________ Gender (M/F):_________________
Parent (s)/Guardian Name:_____________________________________ Relationship:____________________________ Parent (s)/Guardian Name:_____________________________________ Relationship:____________________________ Player’s Address:____________________________________ City:_______________ State/Country:________ Zip:______ Home Phone:_____________________ Work Phone:______________________ Mobile Phone:_____________________ PARENT OR LEGAL GUARDIAN AUTHORIZATION:
Email: ____________________________
In case of emergency, if family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician) Family Physician: ____________________________________________ Phone: _________________________________ Address: __________________________________________ City:________________ State/Country:_________________ Hospital Preference: __________________________________________________________________________________ Parent Insurance Co:_________________________ Policy No.:__________________Group ID#:_____________________ League Insurance Co:_________________________ Policy No.:__________________League/Group ID#:______________ If parent(s)/legal guardian cannot be reached in case of emergency, contact: ___________________________________________________________________________________________________ Name Phone Relationship to Player ___________________________________________________________________________________________________ Name Phone Relationship to Player Please list any allergies/medical problems, including those requiring maintenance medication. (i.e. Diabetic, Asthma, Seizure Disorder)
Medical Diagnosis
Medication
Dosage
Frequency of Dosage
Date of last Tetanus Toxoid Booster: ______________________________________________________________________ The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.
Mr./Mrs./Ms. ________________________________________________________________________________________ Authorized Parent/Guardian Signature Date: FOR LEAGUE USE ONLY: League Name:_______________________________________________ League ID:________________________________ Division:_________________________________Team:______________________________ Date:____________________ WARNING: PROTECTIVE EQUIPMENT CANNOT PREVENT ALL INJURIES A PLAYER MIGHT RECEIVE WHILE PARTICIPATING IN BASEBALL/SOFTBALL. Little League does not limit participation in its activities on the basis of disability, race, color, creed, national origin, gender, sexual preference or religious preference.
LITTLE LEAGUE® BASEBALL AND SOFTBALL ACCIDENT NOTIFICATION FORM INSTRUCTIONS
Send Completed Form To: Little League® International 539 US Route 15 Hwy, PO Box 3485 Williamsport PA 17701-0485 Accident Claim Contact Numbers: Phone: 570-327-1674 Fax: 570-326-9280
1. This form must be completed by parents (if claimant is under 19 years of age) and a league official and forwarded to Little League Headquarters within 20 days after the accident. A photocopy of this form should be made and kept by the claimant/parent. Initial medical/ dental treatment must be rendered within 30 days of the Little League accident. 2. Itemized bills including description of service, date of service, procedure and diagnosis codes for medical services/supplies and/or other documentation related to claim for benefits are to be provided within 90 days after the accident date. In no event shall such proof be furnished later than 12 months from the date the medical expense was incurred. 3. When other insurance is present, parents or claimant must forward copies of the Explanation of Benefits or Notice/Letter of Denial for each charge directly to Little League Headquarters, even if the charges do not exceed the deductible of the primary insurance program. 4. Policy provides benefits for eligible medical expenses incurred within 52 weeks of the accident, subject to Excess Coverage and Exclusion provisions of the plan. 5. Limited deferred medical/dental benefits may be available for necessary treatment incurred after 52 weeks. Refer to insurance brochure provided to the league president, or contact Little League Headquarters within the year of injury. 6. Accident Claim Form must be fully completed - including Social Security Number (SSN) - for processing. League Name
League I.D.
Name of Injured Person/Claimant
PART 1
SSN
Date of Birth (MM/DD/YY)
Age
Sex
Female Male Home Phone (Inc. Area Code) Bus. Phone (Inc. Area Code) ( ) ( )
Name of Parent/Guardian, if Claimant is a Minor Address of Claimant
Address of Parent/Guardian, if different
The Little League Master Accident Policy provides benefits in excess of benefits from other insurance programs subject to a 50 deductible per injury. Other insurance programs include family’s personal insurance, student insurance through a school or insurance through an employer for employees and family members. Please CHECK the appropriate boxes below. If YES, follow instruction 3 above. Does the insured Person/Parent/Guardian have any insurance through: Date of Accident
Time of Accident AM
Employer Plan Individual Plan
Yes Yes
No No
School Plan Dental Plan
Yes Yes
No No
Type of Injury PM
Describe exactly how accident happened, including playing position at the time of accident:
Check all applicable responses in each column: BASEBALL CHALLENGER (4-18) (5-18) SOFTBALL T-BALL (5-8) (4-7) CHALLENGER MINOR (7-12) (6-12) TAD (2ND SEASON) LITTLE LEAGUE (9-12) INTERMEDIATE (50/70) (11-13) JUNIOR (13-14) SENIOR(12-14)(14-16) JUNIOR BIG LEAGUE SENIOR (13-16)(16-18)
PLAYER MANAGER, COACH VOLUNTEER UMPIRE PLAYER AGENT OFFICIAL SCOREKEEPER SAFETY OFFICER VOLUNTEER WORKER
TRYOUTS PRACTICE SCHEDULED GAME TRAVEL TO TRAVEL FROM TOURNAMENT OTHER (Describe)
SPECIAL EVENT (NOT GAMES) SPECIAL GAME(S) (Submit a copy of your approval from Little League Incorporated)
BIG (14-18)
I hereby certify that I have read the answers to all parts of this form and to the best of my knowledge and belief the information contained is complete and correct as herein given. I understand that it is a crime for any person to intentionally attempt to defraud or knowingly facilitate a fraud against an insurer by submitting an application or filing a claim containing a false or deceptive statement(s). See Remarks section on reverse side of form. I hereby authorize any physician, hospital or other medically related facility, insurance company or other organization, institution or person that has any records or knowledge of me, and/or the above named claimant, or our health, to disclose, whenever requested to do so by Little League and/or National Union Fire Insurance Company of Pittsburgh, Pa. A photostatic copy of this authorization shall be considered as effective and valid as the original. Date
Claimant/Parent/Guardian Signature (In a two parent household, both parents must sign this form.)
Date
Claimant/Parent/Guardian Signature
For Residents of California: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. For Residents of New York: Any person who knowingly and with the intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. For Residents of Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. For Residents of All Other States: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
PART 2 - LEAGUE STATEMENT (Other than Parent or Claimant) Name of Injured Person/Claimant League I.D. Number
Name of League Name of League Official
Position in League
Address of League Official
Telephone Numbers (Inc. Area Codes) Residence: ( ) Business: ( ) Fax: ( )
Were you a witness to the accident Yes No Provide names and addresses of any known witnesses to the reported accident. Check the boxes for all appropriate items below. At least one item in each column must be selected. CAUSE OF INJURY PART OF BODY INJURY POSITION WHEN INJURED 01 BATTED BALL 01 ABDOMEN 01 ABRASION 01 1ST 02 BATTING 02 ANKLE 02 BITES 02 2ND 03 CATCHING 03 ARM 03 CONCUSSION 03 3RD 04 COLLIDING 04 BACK 04 CONTUSION 04 BATTER 05 COLLIDING WITH FENCE 05 CHEST 05 DENTAL 05 BENCH 06 FALLING 06 EAR 06 DISLOCATION 06 BULLPEN 07 HIT BY BAT 07 ELBOW 07 DISMEMBERMENT 07 CATCHER 08 HORSEPLAY 08 EYE 08 EPIPHYSES 08 COACH 09 PITCHED BALL 09 FACE 09 FATALITY 09 COACHING BOX 10 RUNNING 10 FATALITY 10 FRACTURE 10 DUGOUT 11 SHARP OBJECT 11 FOOT 11 HEMATOMA 11 MANAGER 12 SLIDING 12 HAND 12 HEMORRHAGE 12 ON DECK 13 TAGGING 13 HEAD 13 LACERATION 13 OUTFIELD 14 THROWING 14 HIP 14 PUNCTURE 14 PITCHER 15 THROWN BALL 15 KNEE 15 RUPTURE 15 RUNNER 16 OTHER 16 LEG 16 SPRAIN 16 SCOREKEEPER 17 UNKNOWN 17 LIPS 17 SUNSTROKE 17 SHORTSTOP 18 MOUTH 18 OTHER 18 TO/FROM GAME 19 NECK 19 UNKNOWN 19 UMPIRE 20 NOSE 20 PARALYSIS/ 20 OTHER 21 SHOULDER PARAPLEGIC 21 UNKNOWN 22 SIDE 22 WARMING UP 23 TEETH 24 TESTICLE 25 WRIST 26 UNKNOWN 27 FINGER Does your league use breakaway bases on: ALL SOME NONE of your fields Does your league use batting helmets with attached face guards YES NO If YES, are they Mandatory or Optional At what levels are they used I hereby certify that the above named claimant was injured while covered by the Little League Baseball Accident Insurance Policy at the time of the reported accident. I also certify that the information contained in the Claimant’s Notification is true and correct as stated, to the best of my knowledge. Date
League Official Signature
Little League Baseball & Softball ®
CLAIM FORM INSTRUCTIONS
WARNING — It is important that parents/guardians and players note that: Protective equipment cannot prevent all injuries a player might receive while participating in baseball/softball. To expedite league personnel’s reporting of injuries, we have prepared guidelines to use as a checklist in completing reports. It will save time -- and speed your payment of claims. The National Union Fire Insurance Company of Pittsburgh, Pa. (NUFIC) Accident Master Policy acquired through Little League® contains an “Excess Coverage Provision” whereby all personal and/or group insurance shall be used first. The Accident Claim Form must be fully completed, including a Social Security Number, for processing. To help explain insurance coverage to parents/guardians refer to What Parents Should Know on the internet that should be reproduced on your league’s letterhead and distributed to parents/guardians of all participants at registration time. If injuries occur, initially it is necessary to determine whether claimant’s parents/guardians or the claimant has other insurance such as group, employer, Blue Cross and Blue Shield, etc., which pays benefits. (This information should be obtained at the time of registration prior to tryouts.) If such coverage is provided, the claim must be filed first with the primary company under which the parent/guardian or claimant is insured. When filing a claim, all medical costs should be fully itemized and forwarded to Little League International. If no other insurance is in effect, a letter from the parent/guardian or claimant’s employer explaining the lack of group or employer insurance should accompany the claim form. The NUFIC Accident Policy is acquired by leagues, not parents, and provides comprehensive coverage at an affordable cost. Accident coverage is underwritten by National Union Fire Insurance Company of Pittsburgh, a Pennsylvania Insurance company, with its principal place of business at 175 Water Street, 18th Floor, New York, NY 10038. It is currently authorized to transact business in all states and the District of Columbia. NAIC Number 19445.This is a brief description of the coverage available under the policy. The policy will contain limitations, exclusions, and termination provisions. Full details of the coverage are contained in the Policy. If there are any conflicts between this document and the Policy, the Policy shall govern. The current insurance rates would not be possible without your help in stressing safety programs at the local level. The ASAP manual, League Safety Officer Program Kit, is recommended for use by your Safety Officer.
TREATMENT OF DENTAL INJURIES Deferred Dental Treatment for claims or injuries occurring in 2002 and beyond: If the insured incurs injury to sound, natural teeth and necessary treatment requires that dental treatment for that injury must be postponed to a date more than 52 weeks after the date of the injury due to, but not limited to, the physiological changes occurring to an insured who is a growing child, we will pay the lesser of the maximum benefit of $1,500.00 or the reasonable expense incurred for the deferred dental treatment. Reasonable expenses incurred for deferred dental treatment are only covered if they are incurred on or before the insured’s 23rd birthday. Reasonable Expenses incurred for deferred root canal therapy are only covered if they are incurred within 104 weeks after the date the Injury is sustained.
CHECKLIST FOR PREPARING CLAIM FORM 1.
Print or type all information.
2.
Complete all portions of the claim form before mailing to our office.
3.
Be sure to include league name and league ID number.
PART I - CLAIMANT, OR PARENT(S)/GUARDIAN(S), IF CLAIMANT IS A MINOR 1.
The adult claimant or parent(s)/guardians(s) must sign this section, if the claimant is a minor.
2.
Give the name and address of the injured person, along with the name and address of the parent(s)/guardian(s), if claimant is a minor.
3.
Fill out all sections, including check marks in the appropriate boxes for all categories. Do not leave any section blank. This will cause a delay in processing your claim and a copy of the claim form will be returned to you for completion.
4.
It is mandatory to forward information on other insurance. Without that information there will be a delay in processing your claim. If no insurance, written verification from each parent/spouse employer must be submitted.
5.
Be certain all necessary papers are attached to the claim form. (See instruction 3.) Only itemized bills are acceptable.
6.
On dental claims, it is necessary to submit charges to the major medical and dental insurance company of the claimant, or parent(s)/guardian(s) if claimant is a minor. “Accident-related treatment to whole, sound, natural teeth as a direct and independent result of an accident” must be stated on the form and bills. Please forward a copy of the insurance company’s response to Little League International. Include the claimant’s name, league ID, and year of the injury on the form.
PART II - LEAGUE STATEMENT 1.
This section must be filled out, signed and dated by the league official.
2.
Fill out all sections, including check marks in the appropriate boxes for all categories. Do not leave any section blank. This will cause a delay in processing your claim and a copy of the claim form will be returned to you for completion.
IMPORTANT: Notification of a claim should be filed with Little League International within 20 days of the incident for the current season.
