Department of Athletics and Department of Sports Medicine: Sickle Cell Trait Policy

Title

Department of Athletics and Department of Sports Medicine: Sickle Cell Trait Policy

UNC Department of Athletics Policy Number: 00093165

A. Definitions

The definitions below shall have their respective meanings ascribed.

1. “Campus Health Services” or “CHS” shall mean the University’s Campus Health Services unit.
2. “Department of Athletics” shall mean the Department of Athletics of the University.
3. “Department of Sports Medicine” shall mean the Department of Sports Medicine within Campus Health Services.
4. “Policy” shall mean this Department of Athletics and Department of Sports Medicine Sickle Cell Trait Policy.
5. “Sickle Cell Disease” shall mean a medical issue in which a mutation in hemoglobin affects the shape of red blood cells and alters some such cells from a rounded to a sickle shape.
6. “Sickle Cell Trait” shall mean a benign carrier condition where one gene carries the sickle hemoglobin mutation and the other gene is normal.
7. “Sickle Cell-Related Risks” shall mean risks associated with Sickle Cell Trait or Sickle Cell Disease.
8. “UNC” or “University” shall mean the University of North Carolina at Chapel Hill.

B. Overview

1. As required by the National Collegiate Athletic Association, this Policy is intended to provide protocols to help determine UNC student-athletes who have Sickle Cell Trait. It also sets forth subsequent measures to be taken in the event a UNC student-athlete is determined to have Sickle Cell Trait.
2. Individuals with Sickle Cell Trait have only one anomalous gene from one of their parents and usually have normal red blood cells. When individuals with Sickle Cell Trait are involved in intense exertion or extreme conditions, the shape of their red blood cells can change to a “sickle shape.” This change, known as “sickling,” can pose a grave risk, as the cells can cause a blockage of blood vessels. These blockages can result in damage to organs and muscle, causing rhabdomyolysis. Exertional sickling is a medical emergency that can lead to various medical issues, collapse and, in some cases, death.
3. Sickling can begin within two to three minutes of any intense exertion. Heat, dehydration, altitude, and asthma can increase the risk of sickling and can also make an occurrence of sickling more severe.

C. Education

The Director of Sports Medicine or other appropriate Department of Sports Medicine staff member shall annually discuss with UNC Head Coaches basic information related to Sickle Cell Trait and management of student-athletes who have tested positive for Sickle Cell Trait. Additionally, the Director of Sports Medicine should instruct coaches to promptly refer to Department of Sports Medicine staff any health concerns about any student-athlete who has tested positive for Sickle Cell Trait.

D. Testing

1. Each UNC varsity student-athlete must be afforded an opportunity to be tested for Sickle Cell Trait before participation in any athletic activity as a student-athlete at the University. Current UNC students trying out for a varsity team or practicing with a varsity team must also be afforded an opportunity to be tested. Such individuals who are trying out for a varsity team shall be responsible for payment for their own test.
   1. Notwithstanding the foregoing, a student-athlete or individual trying out for a UNC varsity team may submit previous test results as evidence of whether or not they have Sickle Cell Trait. If able to provide results of previous Sickle Cell Trait testing deemed adequate by the Director of Sports Medicine, such an individual may not need to undergo additional diagnostic testing.
2. Any student-athlete who refuses testing for Sickle Cell Trait yet wishes to participate in athletic activities of a UNC varsity sport program must first meet with and be approved for participation in such activities by:
   1. The Team Physician for the student-athlete’s varsity sport program;
   2. The Director of Sports Medicine; and
   3. The Department of Athletics Compliance Office.
3. Any student-athlete who declines testing must have a legitimate reason for doing so. Excuses of convenience will not be allowed. In addition, any such individual must also complete the Sickle Cell Trait Information and Student-Athlete Testing Waiver and Release form attached to this Policy as Appendix A.
4. Individuals being tested for Sickle Cell Trait should report to CHS no later than 48 hours prior to participation in their first athletic activity as a UNC student-athlete. Initial testing is usually conducted using a rapid screen. If the screen produces a positive result, such test will typically be verified with hemoglobin electrophoresis. A positive test result does not automatically disqualify an individual from athletic participation.

E. Protocol in the Event of a Student-Athlete Testing Positive for Sickle Cell Trait

1. Communication to Appropriate University Personnel

1. When a student-athlete tests positive for Sickle Cell Trait, a written notification shall be communicated by the Team Physician for the student-athlete’s varsity sport program to:
   1. The Athletic Trainers for the student-athlete’s varsity sport program;
   2. The Director of Sports Medicine; and
   3. The Associate Director(s) of Sports Medicine.
2. The Head Athletic Trainer for the student-athlete’s varsity sport program shall then communicate the positive result of the Sickle Cell Trait test to other appropriate personnel including, but not necessarily limited to:
   1. The coaching staff of the student-athlete’s varsity sport program, including the Head Coach, each appropriate Assistant Coach, each appropriate Graduate Assistant Coach, each appropriate Volunteer Coach, and each appropriate Strength and Conditioning coach;
   2. Graduate Student Athletic Trainers for the student-athlete’s varsity sport program; and
   3. The Department of Athletics Compliance Office.
3. The communication referenced above in this Section shall occur at the time of the diagnosis and annually thereafter for the duration of the time during which an applicable individual is an enrolled student-athlete at the University

2. Communication to Individuals Outside of the University

1. If a student-athlete who tests positive for Sickle Cell Trait is under the age of 18, the Team Physician for the student-athlete’s varsity sport program shall call the parent(s) or guardian(s) of the student-athlete to discuss the condition and this Policy. Such parent(s) or guardian(s) of the student-athlete must then sign the Voluntary Assumption of Sickle Cell-Related Risks form (attached to this Policy as Appendix B) to acknowledge that this Policy was explained, all questions were answered, and all Sickle Cell-Related Risks associated with continued participation as a varsity student-athlete at UNC are assumed.
2. If a student-athlete who tests positive for Sickle Cell Trait is over the age of 18, he or she must sign the Voluntary Assumption of Sickle Cell-Related Risks form (attached to this Policy as Appendix B) to acknowledge that this Policy was explained, all questions were answered, and all Sickle Cell-Related Risks associated with continued participation as a varsity student-athlete at UNC are assumed. The Team Physician for the student-athlete’s varsity sport program will highly recommend to the student-athlete that such student-athlete permit the Team Physician to communicate with the student-athlete’s parent(s) or guardian(s) regarding the condition and this Policy.
   1. If a student-athlete is unwilling to provide consent for his or her varsity sport program’s Team Physician to discuss his or her positive Sickle Cell Trait test with such student-athlete’s parent(s) or guardian(s), such student-athlete shall be required to acknowledge such refusal of consent in writing using the Positive Sickle Cell Trait Test Acknowledgement form (attached to this Policy as Appendix C).
   2. If a student-athlete is willing to provide consent for his or her varsity sport program’s Team Physician to discuss his or her positive Sickle Cell Trait test with such student-athlete’s parent(s) or guardian(s), such student-athlete should provide consent in writing using the Positive Sickle Cell Trait Test Acknowledgement form (attached to this Policy as Appendix C).

3. Waivers to Participate

No UNC student who has tested positive for Sickle Cell Trait at any time shall be permitted to participate in any activity of a UNC varsity sport program without completing and submitting to the Department of Sports Medicine the Voluntary Assumption of Sickle Cell-Related Risks form (attached to this Policy as Appendix B).

F. Guidelines for Participation in Athletic Activities for Student-Athletes who have Tested Positive for Sickle Cell Trait

1. Each student-athlete who has tested positive for Sickle Cell Trait shall meet with the Team Physician and Head Athletic Trainer for his or her varsity sport program to discuss and document sport-specific matters related to management of such student-athlete’s participation in practices, competitions, and other athletic activities.
   1. Determinations made by such individuals about these matters shall be communicated by the applicable Team Physician or Head Athletic Trainer to the coaching staff of the student-athlete’s varsity sport program.
   2. The Team Physician or Head Athletic Trainer for the student-athlete’s varsity sport program shall also provide sport-specific management guidelines to the coaching staff and Strength and Conditioning staff for the student-athlete’s varsity sport program.
   3. The Team Physician and other appropriate members of the Department of Sports Medicine staff should then work with the coaching staff for such student-athlete’s varsity sport program to determine appropriate levels of individual progression and physical activity for such student-athlete.
2. Each student-athlete who has tested positive for Sickle Cell Trait shall be managed, limited when necessary, and monitored as appropriate by Department of Sports Medicine staff during participation in varsity sport program athletic activities:
   1. In very hot or humid conditions;
   2. When such student-athlete is exercising at an altitude to which they are unaccustomed;
   3. After any illness, especially an illness involving nausea, vomiting, diarrhea, or other symptom(s) affecting hydration levels;
   4. If such student-athlete has an asthmatic condition or is experiencing asthmatic symptoms;
   5. If atmospheric conditions present increased challenges for respiration; and
   6. After sleep loss.
3. Each student-athlete who has tested positive for Sickle Cell Trait should acclimate to the onset of conditioning or weightlifting programs by modifying his or her exercise programs as appropriate (in consultation with Department of Sports Medicine staff as necessary) over a period of one to two weeks. Additional accommodations should be made in the event of any of the conditions referenced above in this Section.
4. When a student-athlete has tested positive for Sickle Cell Trait and is unaccustomed to the existing altitude or climate conditions, his or her training level should decrease as determined to be appropriate by a Department of Sports Medicine staff member. Department of Sports Medicine staff shall ensure an oxygen tank is readily available during all conditioning sessions, practices, and games in which the student-athlete will participate.
5. Each student-athlete who has tested positive for Sickle Cell Trait shall refrain from sustained exertion without adequate rest time.
   1. Such student-athletes who participate in sports which require high-speed sprints, interval training, or other activities which induce high levels of lactic acid shall be allowed extended recovery between repetitions.
6. Student-athletes who have tested positive for Sickle Cell Trait should not be required to meet performance standards in timed conditioning tests. Notwithstanding the foregoing, any such student-athlete may participate in such conditioning activities without having to meet time requirements.
7. Student-athletes who have tested positive for Sickle Cell Trait shall not be required to participate in punitive conditioning drills.

G. Management of Symptoms

The provisions of this Section shall serve as a basic guide to management of symptoms of any student-athlete with Sickle Cell Trait. These provisions may be adjusted or supplemented as deemed appropriate in the professional judgement of Department of Sports Medicine staff.

1. Any student-athlete who has tested positive for Sickle Cell Trait shall immediately report any symptoms associated therewith to the Head Athletic Trainer for his or her varsity sport program or other appropriate Department of Sports Medicine staff member. Such symptoms may include, but are not limited to:
   1. Cramping;
   2. Muscle Pain;
   3. Swelling;
   4. Tenderness;
   5. Fatigue;
   6. Shortness of breath; and
   7. Abdominal pain.
2. Upon the occurrence of any such symptoms which are unordinary for the applicable student-athlete, such student-athlete shall discontinue exertional activity. If such symptoms are believed by Department of Sports Medicine staff or the student-athlete to be due to exertional sickling, there shall be a low threshold for removal from the physical activity. A member of the Department of Sports Medicine staff shall have the right to remove any student-athlete from any activity of a UNC varsity sport program at any time in the event of a concern about possible exertional sickling.
3. When notified of any symptoms associated with exertional sickling by a student-athlete who has tested positive for Sickle Cell Trait, the Head Athletic Trainer or other appropriate Department of Sports Medicine staff member shall immediately:
   1. Check the student-athlete’s vital signs;
   2. Help cool the student-athlete’s body temperature (if appropriate);
   3. Help rehydrate the student-athlete as appropriate and as can be tolerated by the student-athlete;
   4. Administer high-flow oxygen if such means are available, preferably with a non-breather face mask;
   5. Activate the appropriate Emergency Action Plan if the student-athlete exhibits any signs or symptoms of decreased mental capacity or unstable vital signs; and
   6. Communicate the student-athlete’s status to other appropriate physicians and medical personnel so that such information may be included in any subsequent evaluation and treatment plan for the student-athlete.

H. Return to Participation in Athletic Activities

After exhibiting signs or symptoms of exertional sickling, a student-athlete who has tested positive for Sickle Cell Trait may only return to participation in athletic activities with his or her varsity sport program after he or she has been cleared to do so by the Team Physician for his or her varsity sport program. It is advisable for a plan for a gradual return to participation in such activities to be determined and followed, with Department of Sports Medicine staff closely monitoring the student-athlete throughout the process.

Related Requirements

External Regulations and Consequences

• NCAA Sickle Cell Trait (SCT) Testing - What You Need to Know

Contact Information

Policy Contact

UNC Director of Sports Medicine
Telephone: 919-966-3655
Website: UNC Department of Athletics Staff Directory