Belhaven University Dance Clinic Policies and Procedures Handbook

Table of Contents

• Mission/Vision of Belhaven University
• Statement of Faith
• Preface

• Hours of Operation
• Personnel
• Qualifications
• Responsibilities
• Ethical Codes of Conduct

• Policies
• Campus Safety Requirements
• Free Test Facilities

• Safety Procedures
• EAP/Medical Services
• Building Operations

• Participation Agreements and Documentation
• Dance Clinic Policies and Procedures
• Other Policies and Information

• Mental Health Policies and Procedures

• Description
• Signs and Symptoms
• General Guidelines

• Introduction
• Concussion Management
• References

• Appendix A: Concussion Take Home Care
• Appendix B: Return to Learn Protocol
• Appendix C: Return to Dance Protocol
  
   

MISSION & VISION STATEMENT

Belhaven University prepares students academically and spiritually to serve Christ Jesus in their careers, in human relationships, and in the world of ideas.

Belhaven University affirms the Lordship of Christ over all aspects of life, acknowledges the Bible as the foundational authority for the development of a personal worldview, and recognizes each individual’s career as a calling from God.  Each academic department is committed to high academic goals for its students and clarifies the implications of biblical truth for its discipline. Belhaven upholds these commitments in offering undergraduate and graduate programs, by conventional or technological delivery modes, and in local, national, and international venues. The University requires a liberal arts foundation in each undergraduate degree program, in order to best prepare students to contribute to a diverse, complex and fast-changing world.
 

By developing servant leaders who value integrity, compassion, and justice in all aspects of their lives, the University prepares people to serve, not to be served.
 

STATEMENT OF FAITH

We believe that there is only one God, eternally existent in three persons: Father, Son, and Holy Spirit.

We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His personal return in power and glory.

We believe the Bible to be the inspired, inerrant, and only infallible, authoritative Word of God, which exercises ultimate authority over the individual, the Church, and human reason.

We believe that justification through Christ is received by repentant sinners through faith alone, without works.

We believe that God, by his Spirit, progressively transforms the lives of those who are justified by God.

We believe in the resurrection of both the saved and the lost; they that are saved unto the resurrection of life and they that are lost unto the resurrection of damnation.
 

PREFACE

The purpose of this manual is to inform the Belhaven University staff, faculty, and students about the policies and procedures of the Belhaven University Dance Clinic.

 

HOURS OF OPERATION

Clinic Hours: Monday-Friday | 8:30 a.m. - 4:30 p.m.

All school holidays will be observed and the dance clinic will be closed during those times. The dance clinic will also be closed during Dance Department Soul Days. 

These hours are subject to change based on the Dance Athletic Trainer’s (AT) availability. 

The Dance Clinic is located in Room 129 of the Bitsy Irby Visual Arts and Dance Center. The number for the clinic is 601-965-7003, or campus ext 8134.
 

PERSONNEL

Victoria Fauntroy, MS, LAT, ATC.
 

QUALIFICATIONS

• BOC certified and member of the National Athletic Trainers’ Association (NATA)
• Licensed by the State of Mississippi
• CPR/First aid/AED certified
   

RESPONSIBILITIES

The dance athletic trainer (AT) is in charge of running the dance clinic and all its entities. The AT covers dance department classes, rehearsals, and performances.
 

JOB DESCRIPTION

The Belhaven University Dance Department has established the need for an athletic trainer to be on-site during class times, rehearsals, and performances to provide the dancers and staff with the correct care needed in prevention, evaluation, treatment, conditioning, and rehabilitation of dance-related injuries. The athletic trainer is responsible for providing medical coverage of all dancers with dance-related injuries at Belhaven University. The athletic trainer must maintain and adhere to the regulations of the Board of Certification, State of Mississippi Licensure Laws, and all Belhaven University policies and procedures, like those of regular staff/faculty.
 

ETHICAL CODES OF CONDUCT

PERSONAL/ SOCIAL CONDUCT

The dance athletic trainer should conduct herself with professionalism. She is a representative of the Belhaven University Dance Department and should present herself in good standing and respect for herself and the university.


SERVICE EQUALITY

Every Dance Department student, faculty, and/or staff member that comes into the dance clinic at Belhaven University will be treated no matter their race, gender, ethnicity, way of living, and/or disability.


SEXUAL HARASSMENT

Any unwanted sexual advances, jokes, remarks, gestures, etc., will not be permitted in the dance clinic. If such actions occur by any employee, immediate expulsion and investigation will occur.


CONFIDENTIALITY

All paper work and patient information is to be kept confidential and is only to be used within the Dance Department for student care purposes. 

 

COVID-19 POLICIES

The Dance Department at Belhaven University is committed to the health and safety of students, faculty, staff, and campus guests. In response to the ever-changing status of the Covid-19 pandemic, this policy has been developed using guidelines from the city, state, and federal government as well as The Task Force on Dance Health and NCAA.

Dance students are expected to follow the Campus Safety Requirements outlined by the University. These additional guidelines must also be adhered to in order to participate in dance.  It is important to remember that everyone is responsible for their own personal health and safety.

Any vulnerable dance student or personnel should consult with their primary care physician to determine the safety of return to work, campus, and dance.  Vulnerable populations include individuals with underlying health conditions such as high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised.

DANCE DEPARTMENT PROTOCOLS

• Proper handwashing/sanitizing should be practiced in the studios and off-campus.
• Consider wearing a mask around others if you contract a respiratory illness.
• Daily cleaning protocols are in place for high-touch surfaces and floors.
• If you do not feel comfortable with dance partnering or tactile correction, please inform the Chair of Dance Department via email.
   

GENERAL GUIDELINES FOR THE DANCE CLINIC

• The dance athletic trainer will determine the number of individuals that can safely be in the dance clinic at one time. Please do not enter the clinic without permission.
• The dance AT will be responsible for sanitizing equipment in the Dance Clinic.
• Dance students may be in the clinic only during appointments, office hours, or an emergency situation.

COVID-19 Symptoms may be experienced by people of all age groups, yet many people who have the virus do not exhibit symptoms.

SYMPTOMS MAY INCLUDE

1. Fever
2. Cough
3. Shortness of breath or difficulty breathing
4. Headache
5. Sore Throat
6. Fatigue
7. Congestion or Runny nose
8. Nausea or Vomiting
9. Changes to smell or taste
    

COVID-19 CAMPUS SAFETY REQUIREMENTS

COVID SYMPTOMS

1. Students who experience COVID-19 symptoms should not come to campus or leave their residence hall room until you have been tested and received your test results.
2. If you are experiencing symptoms, complete the COVID-19 Symptomatic Form on Blazenet under “Quick Links”.
3. If you select that a test appointment should be made for you, a member of the Office of Student Development will contact you with an appointment time at the MEA Clinic (5606 Old Canton Rd.).
4. Please remain in your residence hall room/home until you receive your test results

These guidelines are subject to change as additional information becomes available.


COVID POSITIVE

1. If found positive, you may be required to quarantine off campus. Those testing positive must quarantine for at least 5 days from the onset of symptoms and may only return on Day 6 if fever-free for the previous 24 hours (without the use of fever-reducing medication) and if symptoms are resolving
2. Upon returning to campus, a mask must be worn at all times for an additional 5 days.
3. Please send the results of your positive test to covidtesting@belhaven.edu so professors can be notified of your COVID absences.
4. Contact your professors about assignments as soon as you are able.

FREE COVID-19 TEST FACILITIES

The Families First Coronavirus Response Act ensures that free COVID-19 testing is available to anyone in the US, including the uninsured. 

The US Department of Health & Human Services has provided a listing of Free Testing Facilities by State. Please visit this website to look up free testing facilities by state: https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html.

Health Centers are a vital component of the national response to COVID-19.  To find a health center near you available for COVID-19 screening and testing, see the link: https://findahealthcenter.hrsa.gov/.

Pharmacies are coordinating with state and local governments to provide testing to communities around the United States. The following pharmacies are providing free testing to individuals. Please check each company’s website because all pharmacy locations are not offering testing and you have to schedule an online appointment.  

• CVS: here
• Rite Aid: here
• Walgreens: here
• Walmart (in partnership with Quest Diagnostics): here.
  
   

SAFETY PROCEDURES

BLOOD BORNE PATHOGENS (BBP)

By OSHA standards, all fluids considered to have BBP should be managed and disposed of with caution. Procedures include:

1. Non-Latex or surgical gloves should be worn anytime contact with blood, mucous membranes or non-intact skin takes place (for example: abrasion, bloody noses or lacerations). Gloves should be changed immediately after use on each individual and placed in the biohazard containers in the first aid room or in the individual biohazard bag in the dance clinic.
2. Hands should be washed after gloves are removed.
3. Existing wounds, abrasions or cuts which may begin to bleed during a class, rehearsal, or performance should be covered with a protective dressing to avoid the wound from reopening, and require removal from the practice or competition to care for the wound.
4. Sharp items such as needles, scalpels, or syringes must be disposed of after use in the SHARPS containers in the dance clinic.
5. Wounds that are bleeding must be covered by a dressing that will prevent blood from oozing through the Band-Aid or gauze that is applied.
   
    

BODILY FLUID CLEANUP

Small Spills

Surfaces contaminated with blood should be cleaned using the solution in the spray/foam can or sanitizing wipe located in each studio’s blood kit. Wipe up the blood with the sanitizing wipe and place it in the biohazard waste bag or trash bag. Make sure gloves are worn.


Large Spills

1. Put on gloves
2. Deposit all waste in the biohazard containers or trash can

EAP/MEDICAL SERVICES

EMERGENCY ACTION PLAN

Each facility on campus has their own Emergency Action Plan. Injury-related emergencies will be managed by the dance AT in collaboration with the Chair of Dance. The University Emergency Action Plan can be accessed at http://www.belhaven.edu/pdfs/campus-operations/Security-Report.pdf.

SAFETY EQUIPMENT

The Belhaven University Dance Department will provide and maintain all necessary personal protective equipment (PPE), engineering controls (e.g., sharps containers), and labels as required.

Biohazard Equipment

Sharps containers:

• Needles
• Scalpels
• Syringes
   

Personal Protective Equipment

• Gloves
• Disinfectant spray & sanitizing wipes
   

Spine Boards/ AED

In case of emergencies, a spine board and AED are on site with easy access. This equipment will be tested periodically to ensure proper function.


AED Location

The AED is located in the First Aid room on the second floor of the Bitsy Irby Visual Arts and Dance Center.


EMS Services

EMS may be contacted in an emergency situation by request of the dance athletic trainer or staff/faculty member in charge. If an ambulance is required, Campus Security will also be notified.
 

BUILDING OPERATIONS

EAP/MEDICAL SERVICES

Emergency Action Plan

The Dance Department has an Emergency Action Plan that is posted and available to all students and faculty. Injury-related emergencies will be managed by the dance AT in collaboration with the Chair of Dance. The University Emergency Action Plan can be accessed at http://www.belhaven.edu/pdfs/campus-operations/Security-Report.pdf.

EMERGENCY PROCEDURES

Emergency Situations

1. Locate a responsible person to stay with the injured patient.
2. Contact the Dance Athletic Trainer and/or EMS (911).
3. If EMS is called, notify Campus Security (601-968-5900).
4. Once the dance athletic trainer or EMS has responded, they can make the appropriate decisions regarding patient care.
    

Emergency Communication

1. The dance athletic trainer, student, faculty, or staff will designate an individual to call EMS.
2. If a dancer is injured during class time or faculty-led rehearsal, the faculty member/teacher should send someone into the dance clinic or call the dance clinic. If the athletic trainer is not available, the faculty should call EMS at 911.
3. The individual who calls the EMS unit will provide the following information:
   1. Primary survey status (i.e. conscious or unconscious; extensive and/or uncontrolled bleeding; fractured bone or dislocated joint)
   2. Detailed information of the emergency
   3. EXACT location of the injured person
   4. EXACT location of where EMS should arrive
4. The staff or dance athletic trainer will designate an individual to wait for the EMS unit at the entrance to the Bitsy Irby Building.
5. The dance athletic trainer should be called immediately if not present.
6. The emergency contact of the injured/ill student-athlete will be called and notified of the injury/illness.
    

Emergency Equipment

1. An EMS unit will be called if needed according to the plan under Emergency Communication.
2. An AED and spine board are located in the first aid room on the second floor of the Bitsy Irby building. 
   
    

NON-EMERGENCY SITUATION

In the event of a non-emergent situation, the dance athletic trainer will be notified and provide all necessary medical coverage either upon the day of injury or next working day in the clinic. If the dance athletic trainer is not present, the staff/faculty present will make the proper decision for treatment and care to the best of their knowledge and will contact the dance athletic trainer. 

 

PARTICIPATION AGREEMENTS

CONSENT, ASSUMPTION OF RISK, AND MEDICAL RELEASE FORM

The consent to treat, assumption of risk, and medical release form is to provide awareness to the individual and his/her parents about the role of the dance athletic trainer, risks of dance, and confidentiality policy.


MEDICAL HISTORY AND EMERGENCY CONTACT

Prior to participation, a medical history and emergency contact form must be completed with the dance student’s current information. This form will stay in the dance clinic or with the dance athletic trainer at all times.


PRE-PARTICIPATION EXAMS

A complete physical exam by a Licensed Physician (MD, DO, NP, PA-C) with the completed abovementioned forms must be completed prior to participation in any classroom, rehearsal, or performance. These forms will be kept in the dance clinic in a file cabinet.


DANCE SCREENINGS

All new, incoming students must participate in a dance screening completed by the Dance Athletic Trainer during the first couple of weeks of the fall semester. A sign-up sheet will be sent to dancers to make an appointment for the screening. This screening is an assessment of the dancer’s movement, alignment, strength, and flexibility.
 

DOCUMENTATION

All medical care provided by the dance AT will be documented each day. The AT manages records of supplies, treatment, SOAP notes, referrals, and injury reports.


DANCE INJURY FORMS

Injury information will be kept with each dancer’s file using an electronic injury database system. 


INJURY AND PROGRESS NOTES

Injury and progress notes will be completed daily. Rehabilitation logs will be kept in an online database.


NON-DANCERS

Due to liability issues, the dance athletic trainer only provides treatment to Belhaven University Dance Department majors, minors, apprentices, staff, and faculty. They will make appropriate referrals as necessary.

 

The Belhaven University Dance Clinic policies and procedures are designed to encourage students to become active participants in the care and, in the case of injury, rehabilitation of their bodies when working with healthcare practitioners and dance faculty. The dance athletic trainer and dance faculty equip students to make wise decisions about the well-being of their bodies when injured. We endeavor to be good stewards of the students’ bodies and encourage students to be good stewards as well.

1. All dance majors, minors, and apprentices are required to have a physical evaluation by a licensed physician (MD, DO, NP, PA-C) and complete the necessary Pre-Participation Medical History Evaluation, Consent/Assumption of Risk/Medical Release forms prior to arriving on campus. The forms can be found on the BU Dance Department website. The dance athletic trainer cannot provide evaluation or treatment until all forms are completed and submitted. Additionally, the dance student may not participate in dance classes or rehearsals until all forms are completed and submitted.
2. Incoming dance majors, minors, and apprentices will meet with the dance athletic trainer during the first couple of weeks in the semester for a dance screening to discuss and review physical health records and any concerns related to injury care and prevention in preparation for the upcoming school year. A sign-up sheet will be sent to dancers to make an appointment for the screening.
3. Dance faculty and staff take preventative measures for students’ physical well-being throughout the dance curriculum at Belhaven University. However, as a dance major/minor/apprentice in a physically demanding discipline, injuries may occur. It is highly recommended that students have reliable health insurance coverage in the event of emergency.
4. Injuries sustained within the Dance Department must be reported by the student to dance faculty, and seen by the dance athletic trainer for evaluation and treatment. An appointment should be scheduled with the dance AT in a timely manner following injury. Clinic appointments can be made using the online scheduling system, Setmore, under the individual student’s account. Injuries sustained outside of the Dance Department should be reported to the dance AT in case of modifications needed in dance classes and rehearsals. The dance AT will work with the student to find appropriate outside medical care for the injury.
5. After initial evaluation by the dance AT, the student will be given an appropriate care regimen and follow-up instructions. At each follow-up clinic visit, the student will be given further treatment, rehabilitation instructions, and necessary limitations as determined by the dance AT. As part of treatment, the student may be required to either participate with restrictions or refrain from participation in classes and rehearsals. In any case, the student must attend dance classes and rehearsals, and/or report to the clinic when necessary for treatments. If class activity is limited, the dance AT will give the student a red slip (no activity) or a yellow slip (restricted activity) to present to dance faculty at the beginning of each class period. Students who are restricted from full activity in a dance class will also be restricted from participation in rehearsals.
6. If a dance student is under a red or yellow slip, the dance AT will determine the time frame in which to return to activity.  If a student receives a red slip from the dance AT, the AT in collaboration with the dance faculty will direct the student to either observe class or to use class time to work toward rehabilitation. If a student with a red slip observes class, she/he will not be counted absent if:
   1. The student follows rehabilitation instructions provided by the athletic trainer.
   2. The student uses class time as instructed by the faculty member. This could include required observation, note-taking, conditioning exercises, appointment(s) with the AT, etc.
   3. The student sends an email to their dance technique instructor(s) and cc’s the dance athletic trainer at the end of each week of missed classes (by Friday at 4:30pm) which includes:
      1. The course name and the dates of classes when the student was unable to physically participate
      2. The dates of appointments with the athletic trainer
      3. A summary of  activities to be considered as a substitution for participation in class.

The above Red Slip Attendance Policy applies to students taking dance technique classes for credit, audit, and zero credit. Students with a Red Slip will be marked absent if they do not follow the above protocol.

If a student is unable to participate in class for more than two weeks due to an injury/red slip, the student will need a medical drop for all affected courses. If limitations in class through a yellow slip reach a total of four weeks, the student will also need a medical drop for those corresponding courses. Dance faculty will be in close communication with the dance AT and the injured student throughout this process to determine the best possible plan of action.

7. The dance AT works with specific medical professionals in the Jackson area. These relationships give the AT critical involvement in the outside care of the dancer, which is imperative in decision-making regarding class participation. Please consult the dance AT before seeking outside medical assistance. If the dance AT deems an injury severe or is not responding well to treatment, then she will make referral to necessary outside medical professionals: orthopedics, general practitioners, chiropractors, counselors, etc. The dance AT will either arrange or give the student specific details to set up outside appointments.
8. The dance AT will maintain communication with the Dance Chair and Dance faculty regarding care and injury status of each dancer.
   
    

STUDENTS CHOOSING TO SEEK OUTSIDE MEDICAL CARE

• If a student chooses to seek outside medical care, the student must stay in communication with the dance athletic trainer about:
  • Any/all injury restrictions and updates on these restrictions  
  • Treatment being received
  • Injury timeline and physician clearance
• Following injury, if the student is restricted from participation in dance classes and rehearsals per the guidelines of a physician, the student must present a doctor’s note to the dance athletic trainer with the following information:
  • Date of appointment
  • Doctor’s signature
  • Specific restrictions in dance classes and rehearsals
  • Time frame for specific restrictions
  • Follow-up appointment date
• Students should have weekly appointment(s) for rehabilitation and/or treatment.
• Students must submit any follow-up visit reports and a signed doctor’s release letter for full participation to the dance athletic trainer and Chair of the Dance Department.

STUDENTS WHO DO NOT COMPLY WITH THESE GUIDELINES MAY BE ASKED TO WITHDRAW FROM DANCE COURSES.
 

ILLNESS

Please refer to the University’s list of suggested local medical clinics for care of illness or other medical issues.
 

STUDENT HEALTH INSURANCE

All students should be insured with accident and/or health insurance at all times during attendance at Belhaven University. Belhaven does not automatically provide student health insurance. For international students, a medical insurance plan is required. As part of your acceptance to Belhaven University, you have agreed either to purchase student insurance to provide proof that you are already covered by an adequate insurance policy. Insurance is available at registration or in the Office of Student Development.

OVERVIEW

The Belhaven University Dance Department and Dance Athletic Trainer assist in the overall healthcare of the dance majors, minors, and apprentices. The purpose of this mental health guideline is to define mental health, identify specific members of the healthcare team who will oversee potential incidences, and to outline the necessary steps to manage an acute or chronic mental/behavioral health situation.
Guidelines for the identification, management, and treatment of mental health issues of students have been provided through the Best Practices for Understanding and Supporting Student-Athlete Mental Health Best Practices derived from the NATA and NCAA.
 

MENTAL HEALTH

Mental health is defined as the emotional, psychological, and social well-being of a person.  For the purpose of these guidelines, mental health issues will be categorized as acute or chronic. Acute emergencies are defined as sudden changes in mental conditions (i.e. perceived suicide attempt or changes in mental status). These conditions may require hospitalization. Chronic conditions include: depression, anxiety disorders, or other previously diagnosed mental conditions.

MENTAL HEALTHCARE TEAM

• BU Dance Athletic Trainer
  Victoria Fauntroy, MS, LAT, ATC
  vfauntroy@belhaven.edu
• BU Assistant Vice President of Student Development
  Dr. Shelley Smith
  sasmith@belhaven.edu
• Office of Student Development
  sdevelopment@belhaven.edu
• BU Counselor
  counselor@belhaven.edu
   

MENTAL HEALTH PREVENTION

The BU Dance Department takes a proactive approach to mental health concerns by adding the mental health questionnaire to the new and returning dancers’ pre-participation documentation.  At risk dance students identified through the PPE MH screening may be provided an additionally detailed questionnaire. The dance athletic trainer will determine the need for further evaluation by a member of the Mental Healthcare Team.


COUNSELING

Belhaven University and the Dance Department seek to meet the needs of students by fostering a warm environment of personal connection between students, faculty, and staff members. Students should feel free to visit the Dance Office, the Dance Clinic, the Campus Counselor, the Office of Student Development, or the Think Center to discuss concerns. A qualified, professional counselor is on-campus and visits are free for traditional, undergraduate students.

Appointments may be scheduled directly with the Campus Counselor by emailing counselor@belhaven.edu.
.

MENTAL HEALTH PROTOCOLS

If a student reports a mental health emergency (including but not limited to harming him/herself or others, obvious severe changes in mental status, or other destructive behaviors), the dance AT or supervising staff/faculty will notify the Dean of Students to develop a plan of care.
Should any student exhibit any symptoms of depression, anxiety, sleep disturbances, or substance abuse, an additional survey from the Mental Health Best Practices Manual may need to be completed by the student and then followed up with the dance athletic trainer.  At which point, the AT will make the recommendation for follow-up with the appropriate mental healthcare provider.
Upon a student seeking treatment in a mental healthcare crisis, the dance AT will follow-up with involved mental healthcare providers to ensure proper treatment and smooth transition upon return to classes and rehearsals. Dance faculty will be notified of any and all updates.
In the event a student reports any disturbances to the dance AT or if the AT becomes concerned, an appointment will be set up between the student and the athletic trainer.  The dance athletic trainer will then contact the appropriate member of the Mental Healthcare Team to establish the best plan of care for the involved student.
In the event of a student’s teacher or friend becoming seriously concerned of a mental health condition or crisis, the concerned person should make immediate referral to the dance athletic trainer.  From there, the appropriate member of the Mental Healthcare Team will be contacted to establish the best plan of care for the involved dancer.
 

CLASS ABSENCES DUE TO MENTAL HEALTH CONDITION

Class participation is important, and students missing more than 20% of classes will fail the course and receive an F (except in the case of unique medical or family extenuating circumstances to be considered in consultation with the Registrar).

• 8 absences for a class that meets 3 times a week
• 6 absences for a class that meets 2 times a week
• 3 absences for a class that meets once per week
• Persistently arriving late or leaving early may impact a student’s grade.

Mental health conditions that result in missed classes need to be communicated to dance professors. Students should demonstrate that they are receiving appropriate treatment and report consistent follow-up care to the dance department by the mental healthcare professional. Mental health issues resulting in more than 20% of missed classes will be addressed on a case-by-cases basis, to be considered in consultation with any treating health care professionals, Department Chair, Provost, and Registrar.

 

PANIC ATTACK DESCRIPTION

A panic attack is often a reaction to fear (either conscious or unconscious), and some of the strange physical reactions you experience during one are the result of your body reacting to this fear. Common catalysts of panic attacks include:

• Anticipatory anxiety. You become mentally anxious over a past, traumatic event, and your body responds as if it will happen again right away. Catalysts can include photographs, conversations, or anything that triggers the bad memory.
• Self-defeating visualization. You may not only picture yourself re-experiencing a traumatic event, but you may also fear losing control of a current situation and not being able to handle it. You interpret the situation as potentially dangerous, and your body secretes adrenaline to prepare for crisis.
   

SIGNS AND SYMPTOMS

Because anxiety appears in so many different conditions, it can look very different from person to person. Some people express their anxiety emotionally, while others show signs of physical distress. The unifying factor, however, is a sense of overwhelming, irrational fear. Here are some signs that someone is experiencing anxiety:

• Excessive worry with an inability to control it
• Intense episodes of fear or panic
• Difficulty concentrating
• Physical symptoms such as nausea, stomach pain, rapid heart rate, muscle tension, sweating, shaking, dizziness, numbness, or difficulty breathing

IN THE CASE OF A PANIC ATTACK DURING CLASS OR REHEARSAL

1. Designate a student that will notify the dance athletic trainer.
2. Upon arrival, the dance athletic trainer will take the dancer outside of class and escort the student to the first aid room to calm him/her down and tend to the situation.
   1. Following the recovery of the dancer, the dance athletic trainer will document the situation
3. If necessary, the dance athletic trainer will measure the dancer’s oxygen saturation using a pulse oximeter.
   1. If the dancer’s oxygen saturation is below 90% or continues to drop, the dance athletic trainer will call EMS (911) for further evaluation
   2. After EMS is called, Campus Security will be notified
4. If the dancer loses consciousness, the dance athletic trainer will.
   1. Check the dancer’s ABCs (airway, breathing, circulation) and will call for someone to retrieve the AED
   2. Call EMS (911) and notify Campus Security
   3. Document the situation
5. If the dance athletic trainer is not present, the staff/faculty will work to calm the dancer and de-escalate the situation.
   1. Following the situation, the dance athletic trainer should be notified of the situation
6. If the dancer loses consciousness and the dance athletic trainer is not present, the staff/faculty will.
   1. Check ABCs and retrieve the AED
   2. Call EMS (911) and notify Campus Security
   3. Call the dance athletic trainer and
   4. Report the situation
7. If a dancer continues to experience panic attacks over the semester, s/he will be referred to a member of the Mental Healthcare Team for further evaluation and treatment.
    

GENERAL GUIDELINES WHEN TREATING SOMEONE EXPERIENCING A PANIC ATTACK

1. Be calm
2. Be patient
3. Don’t be condescending
4. Remind the student that they’re not crazy
5. Sit with the dancer
6. Ask the dancer to tighten and relax their muscles one by one
7. Remind the dancer that they are breathing
8. Engage the dancer in a discussion (if they can talk, then they can breathe)
9. If the dancer is having trouble breathing, try getting them to exhale slowly or have them breathe through their nose
10. Put their hands their stomach to feel each breath
    
     

INTRODUCTION

A sports-related concussion is a traumatic brain injury caused by a direct blow to the head, neck, or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities.1 This initiate a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change, and inflammation affecting the brain. Symptoms and signs may present immediately, or evolve over minutes or hours, and commonly resolve within days, but may be prolonged.1

Sport-related concussions may result in a range of clinical symptoms and signs that may or may not involve loss of consciousness. The clinical signs and symptoms of a concussion cannot be explained soley by (but may occur concomitantly with) medication use or other injuries (such as cervical injuries, peripheral vestibular dysfunction) or other comorbidities (such as psychological factors or coexisting medical conditions).

Because concussions can vary widely in their severity, clinical trajectory, and duration, each case should be evaluated and treated on an individual basis; however, this document will provide general guidelines for concussion management best practices.2

This policy has been formulated according to the best available evidence and adheres to all guidelines set by the NCAA and NATA. This policy will be reviewed and updated annually by the dance athletic trainer.
 

CONCUSSION MANAGEMENT

1. Pre-Participation Assessment
   • Within the first week of school, all dance students will complete a pre-participation symptom evaluation. Additionally, as part of the required health history form, dance students will also complete a previous history of concussion or brain injury, neurologic disorder, and mental health symptoms and disorders. Both forms will be reviewed by the dance athletic trainer. If there is anything that warrants possible referral and/or additional follow-up, the dance athletic trainer will communicate with the student. The pre-participation symptom evaluation and health history, along with other factors may inform post-injury evaluation
2. Recognition and Diagnosis of a Concussion
   1. Any dancer who is suspected of having a concussion should be immediately removed from participation. Suspicion may be based on a blow to the head, whiplash type mechanism, any signs and symptoms of concussion, or other reasonable evidence. If the dance athletic trainer or overseeing physician is present, the dancer will be assessed immediately on site. If the dance athletic trainer is not present, the faculty or staff member is responsible for holding the dancer from participation for the remainder of that day and contacting the dance athletic trainer to ensure the dancer is evaluated as soon as possible.^1,2
   2. If the head injury is deemed an emergency, the emergency action plan should be activated immediately. All of the following will constitute an emergency^1,2:
      • Observable red flags:
        • Neck pain or tenderness
        • ii. Seizure or convulsion
        • iii. Double vision
        • iv. Loss of consciousness
        • v. Weakness or tingling/burning in more than one arm or in the legs
        • vi. Deteriorating conscious state
        • vii. Vomiting
        • viii. Severe or increasing headache
        • ix. Increasingly restless, agitated, or combative (Glascow Coma Score less than 15)
        • x. Visible deformity of the skull
      • Persistently diminished or worsening mental status or other neurological signs or symptoms
   3. Signs that warrant immediate removal from dance class, rehearsal, or performance include: actual or suspected loss of consciousness, seizure, tonic posturing, ataxia, poor balance, confusion, behavioral changes, and amnesia.²
   4. Ample time (up 10-15 minutes) will be taken to conduct a screening (e.g. SCAT6) to evaluate a potential concussion.
   5. Dancers who are diagnosed with or suspected of having a concussion by the dance athletic trainer will be held from participation for the remainder of that day.1 A dancer may only return to play the same day if a concussion is no longer suspected after a thorough evaluation.
   6. Diagnosis of concussions will be the result of a clinical evaluation and supported with assessment tools including, but not limited to the SCAT6.
   7. Dancers that sustain a concussion during non-dance related activities will be managed in the same manner as those that sustain them during dance-related activities.
3. Initial Suspected Concussion Evaluation
   1. The initial assessment will be performed by the dance athletic trainer and will evaluate for possible concussion while ruling out more serious brain injury, skull fracture, or cervical spine injury that may warrant activation of the emergency action plan and/or referral to the hospital.¹
      • ^​If the dance athletic trainer is not present, faculty/staff will need to observe any of the abovementioned red flags. If any of the red flags are present, the faculty/staff should activate the emergency action plan and alert emergency medical services (911).​
   2. A brief initial assessment should take place that may include but is not limited to: a thorough history, symptom assessment, physical assessment of injured area, neurological assessment, cognitive assessment, and balance assessment.¹
   3. If the dancer is suspected of having a concussion after the initial assessment, they should be moved to a more controlled environment when possible to perform the SCAT6 or modified sideline SCAT6.^1,2
   4. The Belhaven University dance AT will be empowered to determine management and return to dance of any injured or ill dancer, as they deem appropriate. The dance athletic trainer will practice within the standards established by their professional practice.¹
4. Acute Concussion Evaluation (up to 72 hours post-injury

   1. The dancer will be monitored for mental deterioration. Both oral and written instructions for monitoring will be provided to the dancer and a roommate, family member, or other responsible party.^1,2 (Appendix A)

   2. The dancer should rest from physical exertion for at least 24-48 hours following diagnosis of a concussion. Upon clearance from the dance AT, the dancer can begin light physical activity/activities of daily living (i.e. walking or stationary cycling) that do not elicit more than mild symptom exacerbation (i.e. mild = activity stops with an increase of more than two points on a 0-10-point scale when compared to pre-existing resting values).^1,2

   3. The dancer should also relatively rest from mental exertion for at least 24-48 hours. Examples of relative rest may include limited reading, texting, or working on a computer. These activities should only be done as tolerated by the dancer.^1,2

   4. The dancer should check-in with the dance AT each day after a concussion diagnosis. Serial re-assessment should be conducted appropriately throughout the dancer’s recovery process. This re-assessment includes daily progress notes and SCOAT6 symptom checklists. The dance AT should pay special attention to signs of depression or other emotional responses to the injury.^1,2

   5. The dance AT will appropriately document the initial injury as well as daily check-ins with the dancer following the injury. Documentation should include at minimum: mechanism of injury; initial signs and symptoms; state of consciousness; findings of the physical and neurological exam and results from neurocognitive and balance testing; instructions given to the patient and/or parent, guardian, or roommate; notes from Return to Dance progression; and any notes regarding patient’s concussion history.²

   6. The dance AT will email professors for appropriate classroom accommodations and contact the VP of Student Development. See guidelines for Return to Learn (Appendix B).

5. Subacute Management Plan (>72 hours to weeks post-injury)
   1. The dancer should check-in with the dance AT each day after a concussion diagnosis. Serial re-assessment, including daily progress notes and SCOAT6 symptom checklists, should be conducted appropriately throughout the dancer’s recovery process. SCOAT6 re-assessments will be conducted that include evaluation of immediate and delayed memory, concentration, vital signs, cervical spine and neurological assessment, balance, and modified VOMS assessment. The dance AT should pay special attention to signs of depression, anxiety, sleep disturbance, or other emotional responses to the injury.^1,2
   2. Dancers may begin symptom-limited, light physical activity within 24-48 hours (i.e. walking) of the concussion. If needed, the dancer should reduce screen use within the first 48 hours after injury.2 Dancers should return to mental and physical exertion gradually and guided by their symptoms. See guidelines for Return to Learn (Appendix B) and Return to Dance.^1,2 (Appendix C)
   3. Based on the patient’s clinical presentation, the dance AT will work to identify which pain management strategies that will be beneficial and specific to the dancer’s clinical trajectory (vestibular, oculo-motor, cognitive, fatigue, migraine, cervicogenic, and anxiety/mood). Rehab activities may include, but are not limited to: gaze stability, proprioception, postural control, dynamic gait, and other vision and vestibular therapies. Activities should be progressed as guided by the dancer’s symptoms and re-assessments.¹
6. ^​Re-evaluation Plan (>4 weeks post-injury
   1. All dancers who are diagnosed with a concussion will be seen by the dance AT for evaluation before they are allowed to return to dance.
   2. Dancers who have especially severe, persisting, or worsening symptoms over four weeks will be referred to a physician for further evaluation. This determination will be made by the dance athletic trainer.1 Additional diagnoses that should be considered include²:
      • ​Fatigue and/or sleep disorder
      • Migraine or other headache disorders
      • Mental health symptoms and disorders
      • Ocular dysfunction
      • Cervical and vestibular dysfunction
      • Cognitive impairment
      • Autonomic dysfunction, including orthostatic intolerance and postural orthostatic tachycardia syndrome
      • Pain
   3. Dancers with a history of multiple concussions, who have increasing severity of injury with lessening of injuring forces should be referred to a physician for further evaluation.²
   4. Dancers with prolonged recovery will work closely with the dance AT for long-term academic accommodations.¹
       

REFERENCES

1. Patricios JS, Schneider KJ, Dvorack J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport - Amsterdam, October 2022. British Journal of Sports Medicine. 2023; 57:695-711. https://bjsm.bmj.com/content/bjsports/57/11/695.full.pdf
2. NCAA Sport Science Institute. Concussion safety protocol checklist. September 2023.
3. Broglio SP, Cantu RC, Gioia GA, et al. National Athletic Trainers’ Association Position Statement: Management of Sport Concussion. Journal of Athletic Training. 2014;49(2):245-265. doi:10.4085/1062-6050-49.1.07
4. Sport concussion assessment tool - 6th edition. Br J Sports Med. June 2023: Sport Concussion Assessment Tool 6 (SCAT6) (bmj.com). doi:10.1136/bjsports-2023-107036

​

CONCUSSION TAKE HOME CARE

You have been diagnosed with concussion and need to be monitored closely for the next 24-48 hours. This is a guide for your caregiver (family member, roommate, teammate, etc.) to monitor for worsening symptoms. Make sure you check in daily with the dance athletic trainer after being diagnosed with a concussion.


IT IS OK TO

• Use Tylenol for headaches
• Use ice pack on head/neck as needed
• Eat a normal diet
• Go to sleep
• Rest (minimize physical or mental activity)

DO NOT

• Use alcohol or illegal drugs
• Take Ibuprofen, Aspirin, Aleve, Motrin, or Advil
• Engage in mental or physical activity that makes symptoms worse
• Drive a car or operate machinery

If any of the following symptoms develop or get worse, contact the Dance Athletic Trainer and go to the emergency room.

1. Decreased level of consciousness
2. Increased confusion
3. Increased irritability
4. Numbness or weakness in the arms or legs
5. Pupils becoming unequal in size
6. Repeated vomiting
7. Seizures
8. Slurred speech or inability to speak
9. Inability to recognize people or places
10. Worsening/severe headache
     

**When in doubt, seek medical attention IMMEDIATELY**.
 

CONTACT INFORMATION

Victoria Fauntroy - Dance Athletic Trainer - (571) 354-0853.

 

A concussion is an injury to the brain that can lead to a number of physical and cognitive symptoms. Concussions may cause headaches, difficulty remembering, difficulty concentrating, delayed reaction time, confusion, and a number of other symptoms that may hinder academic performance.1 This Return to Learn Protocol is designed to allow the brain time to heal and return to proper cognitive functioning. It aims to give dancers with a concussion a better chance at succeeding in the classroom after an injury.

Each dancer will respond to concussions differently, and some dancers may be symptomatic for a much longer period than others. It is important to take into account each individual case when dealing with concussions. The Return to Learn Protocol is designed to be a general guide through the process. Dancers may progress through the protocol at different speeds. It is important to allow the dancer the time they need based on their symptoms.1

1. Each dancer that sustains a concussion will begin in Stage 1 for at least 24 hours.
2. Once their symptoms are “mild” to “moderate” (measured on symptom scale), the dancer will be allowed to progress to Stage 2 as tolerated.
3. In order to progress to Stage 3 and 4, the dancer must be able to complete Stage 2 with no increase in symptoms.
4. If a dancer progresses to the next level and their symptoms worsen, they should return to the previous stage until symptoms subside.
5. The dancer will go through a Return to Dance protocol around the same time as the Return to Learn Protocol. The dancer must fully return to learn before they can fully return to dance.
6. Dancers may miss a significant amount of assignments, quizzes, and tests. It is important to communicate about a reasonable timeline for them to finish all missed work in order not to overload the brain too soon after an injury.
7. The dance athletic trainer will communicate the stage the dancer should be in as well as possible accommodations with professors and the VP of Student Development, who will provide the dancer with a letter to distribute to their professors. The Dance Department Chair will also be included on all emails. If the dancer begins to exhibit symptoms of depression and anxiety, the campus counselor will be included in all communication.
    

STAGE 1 - RELATIVE COGNITIVE AND PHYSICAL REST

First 24-48 hours following injury; may progress once symptoms are “mild” and daily activities do not result in more than brief exacerbation of current symptoms.

• Daily activities that do not result in more than a mild exacerbation* of symptoms related to the current concussion
  • *Mild and brief exacerbation of symptoms is defined as an increase of no more than 2 points on a 0-10-point scale (with 0 representing no symptoms compared with the baseline value reported prior to cognitive activity).
• Typical activities during the day (i.e. reading) while minimizing screen time
  • Start with 5-15 minutes at a time and increase gradually
• Goal: gradual return to typical activities
   

STAGE 2 - SCHOOL ACTIVITIES

• homework
• Reading or other cognitive activities outside of the classroom
• Goal: increase tolerance to cognitive work
   

STAGE 3 - RETURN TO SCHOOL PART-TIME

May progress when dancer is symptom-free or at discretion of the Dance Athletic Trainer.

• Gradual introduction of schoolwork
• May need to start with a partial school day or with greater access to rest breaks during the day
  • Gradually increase assignments (allow extension, may require modifications)
  • May begin quizzes/tests with accommodations, if ready
    • Extended testing time
  • Testing in quiet room
  • Assistance with computerized quizzes/tests
• Determine plan for completing remaining assignments, quizzes, and tests
• Goal: increase academic activities
   

STAGE 4 - RETURN TO SCHOOL FULL-TIME

• Gradually progress in school activities until a full day can be tolerated without more than mild* symptom exacerbation
• Full assignment load (allow time to make-up missed assignments)
• Quizzes/tests with accommodations if necessary
  • Extended testing time
  • Testing in quiet room
• Goal: return to full academic activities and catch up on missed work

1. The Return to Dance Protocol is a supervised 6-step progression that begins only after the dancer’s symptoms have lowered to a “mild” level (i.e. as determined by the SCOAT6) and are exhibiting “mild” and brief symptom exacerbation.
2. Only one step may be performed per 24-hour period and they must be completed in order.
3. When a dancer completes a step with no return of symptoms for 24-hours, they may progress to the next step.
4. If the dancer has more than a mild exacerbation of symptoms (i.e. >2 points on SCOAT6) during a step in the protocol, they must return to the previous stage until symptoms regulate.
5. The Return to Dance Protocol must be monitored and cleared for participation by the Dance Athletic Trainer.
6. The dancer must complete the Return to Learn Protocol before they can return to full movement participation.
    

RETURN TO DANCE PROTOCOL1,2

STEP 1
Symptom-limited activity  -  Perform daily activities that do not exacerbate symptoms (i.e. walking)

STEP 2A

Light aerobic exercise  -  Stationary cycling or walking at slow to medium pace (up to 55% maxHR)

STEP 2B
Moderate aerobic exercise  -  Light aerobic activity such as stationary bike riding, light barre work (plié , relevés, etc.) for 10-15 minutes (up to 70% maxHR) in both classes and rehearsals

STEP 3
Dance-specific exercise  -  Perform moderate-intensity aerobic activity such as partial class (no turning or jumping) and quarter of rehearsal. Activity should last at least 30 minutes

STEP 4
Dance-specific exercise  -  Perform class with light to moderate jumping and limited turning. Complete half of rehearsal

STEP 5
Dance-specific exercise  -  Perform class with moderate to high-intensity jumping and turning

STEP 6
Dance-specific exercise  -  Return to full-class and rehearsal

**Final determination for return to dance shall rest with the Dance Athletic Trainer**.