Pre-season coach survey

Attachment C

Pre-Season Coach Survey

Form Approved
OMB No: 0920-XXXX
Exp. Date:

Public Reporting burden of this collection of information is estimated at 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-XXXX).

Date __ __ / __ __ / __ __

Coach Concussion Survey

Thank you for taking the time to complete this survey. We hope this study will help us understand more about concussion laws and how they can help improve the safety of sports. This survey contains 38 questions and should take about 10 to 15 minutes to complete.

1. This section covers general background information.

1. What is your gender?

1. Male

2. Female

2. In what state do you coach?

3. How old are you? __________

4. How many years have you been coaching soccer? _____________

5. What is the highest degree of education that you completed?

   1. Some high school

   2. High school graduate or equivalent

   3. Some college or 2-year degree

   4. Bachelor’s degree

   5. Master’s or professional degree

   6. Ph.D., Ed.D., or equivalent

   7. Other:

2. This section covers COACH concussion education requirements.

6. Were you required to complete any concussion education in order to coach either alone or as part of other training:

6a. within the past 3 years?

1. Yes

2. No

(If No, skip to #7)

6b. within the past 12 months?

1. Yes

2. No

(If No to both 6a and 6b, skip to #7)

6c. How often do you have to complete concussion education in order to coach?

1. Once a year

2. Every other year

3. Every 3 years

4. Less often than every 3 years

6d. Which types of education were you required to complete? Check all that apply.

1. Review written materials

2. Watch a video

3. View a PowerPoint slide presentation

4. Take a test

5. Attend an in-person concussion training

6. Other:

6e. What happened if you did not complete this required education?

1. I was not allowed to coach until it was completed.

2. I was allowed to coach, but had to complete the training when there was time.

3. Nothing happened.

4. I don’t know.

7. Did you take the online concussion course offered by the CDC “Heads up: concussion in youth sports” (click HERE to view)

7a. within the past 3 years?

1. Yes, I was required to take this course.

2. Yes, I took this course because I was interested in it.

3. No.

4. Not sure.

(If No or Not sure, skip to #8)

7b. within the past 12 months?

1. Yes, I was required to take this course.

2. Yes, I took this course because I was interested in it.

3. No.

4. Not sure.

8. Did you take the online concussion course offered by the National Federation for High School Sports (NFHS) “Concussion in sports: what you need to know” (click HERE to view)

8a. within the past 3 years?

1. Yes, I was required to take this course.

2. Yes, I took this course because I was interested in it.

3. No.

4. Not sure.

(If No or Not sure, skip to #9)

8b. within the past 12 months?

1. Yes, I was required to take this course.

2. Yes, I took this course because I was interested in it.

3. No.

4. Not sure.

9. Have you obtained concussion information from any other source? Check all that apply.

1. Online video Past 3 years Past 12 months

2. Online news Past 3 years Past 12 months

3. Online blog Past 3 years Past 12 months

4. Online medical website

(Web MD, Medline plus,

Mayo clinic) Past 3 years Past 12 months

5. ESPN/Sports center Past 3 years Past 12 months

6. TV or radio Past 3 years Past 12 months

7. Went to a talk Past 3 years Past 12 months

8. Discussion with physician Past 3 years Past 12 months

9. Printed material (newspaper,

magazine, etc) Past 3 years Past 12 months

10. “Heads Up” from the Centers

for Disease Control and

Prevention (CDC) Past 3 years Past 12 months

11. State athletic association Past 3 years Past 12 months

website

12. Other______________ Past 3 years Past 12 months

3. This section covers ATHLETE concussion education requirements.

10. Are athletes in your soccer association required to complete any concussion education? Check all that apply.

    1. They sign a concussion information form

    2. They review written materials

    3. They watch a video

    4. They are given an in-person talk about concussion by the coach

    5. They are given an in-person talk about concussion by the athletic trainer

    6. We hang a poster about concussion

    7. They are given CDC’s Heads Up materials

    8. Other:

    9. No, we don’t have any education requirements (If No, skip to #11)

10a. How are your education requirements enforced?

1. Athletes can’t play until they complete the education/sign the form.

2. If athletes don’t complete the education/sign the form, they are allowed to play but must complete it when they have time

3. They are not enforced.

4. I don’t know.

4. This section covers PARENT concussion education requirements.

11. Are parents in your soccer association required to complete any concussion education? Check all that apply.

    1. They sign a concussion information form

    2. They review reading materials

    3. They watch a video

    4. They are given an in-person talk about concussion by the coach

    5. They are given an in-person talk about concussion by the athletic trainer

    6. We hang a poster about concussion

    7. They are given CDC’s Heads Up materials

    8. Other:

    9. No, we don’t have any education requirements (If No, skip to #12)

11a. How are your education requirements enforced?

1. Athletes can’t play until their parents complete the education/sign the form.

2. If the parents of athletes don’t complete the education/sign the form, the athletes are allowed to play but their parents must complete it when they have time.

3. They are not enforced.

4. I don’t know.

5. This section covers your personal experience with athlete concussions.

12. How many athletes did you coach last year? ______ Approximately how many of your athletes had a concussion last year ______

13. How comfortable are you in deciding that an athlete needs evaluation for a concussion?

    1. Very comfortable

    2. Somewhat comfortable

    3. A little comfortable

    4. Somewhat uncomfortable

    5. Very uncomfortable

14. Does your soccer association employ an athletic trainer?

    1. Yes

    2. No

(If No, skip to #15)

14a. How often does the athletic trainer attend the soccer games that you coach?

1. Never

2. Some of the time

3. At least half the time

4. Most of the time

5. All of the time

15. Are there other medical personnel who are usually on the sidelines of the soccer games you coach (>50% of the time)? Check all that apply.

    1. Emergency Medical Technician (EMT)

    2. Physical therapist (PT)

    3. Chiropractor

    4. Physician (MD)

    5. Nurse Practitioner (ARNP)

    6. Physician assistant (PA)

    7. There are no people with these types of training on the sideline.

    8. Other:

16. Do you (or the athletic trainer or other medical personnel) use any standardized forms when assessing an athlete for concussion? Check all that apply.

    1. Sport Concussion Assessment Tool, version 2 or 3 (SCAT-2 or 3)

    2. Standardized Assessment of Concussion (SAC)

    3. Balance Error Scoring System (BESS)

    4. Mini-Mental Status Examination (MMSE)

    5. We use a standardized form, but I am not sure of the name

    6. We do not use any standardized forms

    7. Other:

17. Do athletes in your soccer association complete any baseline testing regarding concussion before the start of the season? Check all that apply.

    1. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT)

    2. Automated Neuropsychological Assessment Metrics (ANAM)

    3. CogSport

    4. Athletes complete a computerized test, but I am unsure of the name

    5. Athletes complete pencil and paper neuropsychological testing

    6. SCAT-2 or SCAT-3 at baseline

    7. Other:

18. Are you familiar with the term “graduated return to play?”

    1. I have never heard of this term.

    2. I have heard of this term, but I am not sure what it means.

    3. I have heard of this term and I understand what it means, but I do not use this concept.

    4. I use graduated return to play with my athletes.

    5. The athletic trainer uses graduated return to play with my athletes.

E. This section covers general concussion knowledge

19. Which of these are signs or symptoms of concussion? Please answer for each symptom.

	Yes	No	Not sure
Dizziness
Headache
Nausea or vomiting
Sadness
Problems with balance
Sensitivity to light
Irritability
Problems sleeping
More emotional
Difficulty concentrating
Drowsiness
Tingling in hands or feet
Nervous or anxious
Blurry vision
Diarrhea
Seeming “in a fog”
Chest pain
Memory Problems

20. There is a possible risk of death if a second concussion occurs before the first one has healed.

    1. True

    2. False

    3. Unsure

21. People who have had one concussion are more likely to have another concussion.

    1. True

    2. False

    3. Unsure

22. In order to be diagnosed with a concussion, you have to be knocked out.

    1. True

    2. False

    3. Unsure

23. A concussion can only occur if there is a direct hit to the head.

    1. True

    2. False

    3. Unsure

24. Being knocked unconscious always causes permanent damage to the brain.

    1. True

    2. False

    3. Unsure

25. Symptoms of a concussion can last for several weeks.

    1. True

    2. False

    3. Unsure

26. Sometimes a second concussion can help a person remember things that were forgotten after the first concussion.

    1. True

    2. False

    3. Unsure

27. After a concussion occurs, brain imaging (e.g., CAT Scan, MRI, X-Ray, etc.) typically shows visible physical damage (e.g., bruise, blood clot) to the brain.

    1. True

    2. False

    3. Unsure

28. If you receive one concussion and you have never had a concussion before, you will become less intelligent.

    1. True

    2. False

    3. Unsure

29. After 10 days, symptoms of a concussion are usually completely gone.

    1. True

    2. False

    3. Unsure

30. After a concussion, people can forget who they are and not recognize others but be perfect in every other way.

    1. True

    2. False

    3. Unsure

31. Concussions can cause emotional symptoms (such as sadness or crying).

    1. True

    2. False

    3. Unsure

32. An athlete who gets knocked out after getting a concussion is experiencing a coma.

    1. True

    2. False

    3. Unsure

33. There is rarely a risk to long-term health and well-being from multiple concussions.

    1. True

    2. False

    3. Unsure

This last section covers attitudes about concussion.

34. I would continue playing a sport while also having a headache that resulted from a minor concussion.

    1. Strongly agree

    2. Agree

    3. Neither agree nor disagree

    4. Disagree

    5. Strongly disagree

35. I feel that coaches need to be extremely cautious when determining whether an athlete should return to play.

    1. Strongly agree

    2. Agree

    3. Neither agree nor disagree

    4. Disagree

    5. Strongly disagree

36. I feel that concussions are less important than other injuries.

    1. Strongly agree

    2. Agree

    3. Neither agree nor disagree

    4. Disagree

    5. Strongly disagree

37. I feel that an athlete has a responsibility to return to a game even if it means playing while still experiencing symptoms of a concussion.

    1. Strongly agree

    2. Agree

    3. Neither agree nor disagree

    4. Disagree

    5. Strongly disagree

38. I feel that an athlete who is knocked unconscious should be taken to the emergency room.

    1. Strongly agree

    2. Agree

    3. Neither agree nor disagree

    4. Disagree

    5. Strongly disagree

You are finished! Thank you for filling out this survey.

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