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The state of Kerala has declared Corona Virus impact as State Calamity (A State of Health Emergency ) by invoking the provisions of Sec 2(d) of the National Disaster Management Act 2005.With this the state has many executive powers to coordinate and work upon with this calamity. As reclarified by State CM and Health Minister, the decree is NOT MADE TO MAKE PEOPLE PANIC, rather to ensure effective coordination of state resources to fight against the deadly viral attack.Isolation wards set up in major hospitals of the state with WHO protocols of personal protection being observed.So far, only 3 cases are reported which is still minimal, but Kerala expects more cases as nearly 2400+ people are under medical surveillance and 84 quarantined across the state, due to their case history of visiting China and likely chances of being affected.With this official decree, the state administration has sweeping powers to do anything to control this disaster.The entire leaves and holidays of medical staff and doctors has been cancelled and all being asked to report to duty.Private hospitals, clinics and diagnosis centers were instructed to feed all data they have into DHS Central Surveillance system to moinitor any remote chancesCollectors, Subcollectors and other administrative officials who were about to go on annual training at Civil Service Academy in Mussoorie has been recalled and asked to report back to dutiesThe entire medico fraternity has to attend all mandatory training in handling and treating NCoV viruses as per WHO protocols.It now became mandatory for all people to cooperate with State Health Inspectorate. Hiding any information from Health Inspectors or Social Medicine Doctors on visit, is a criminal offence.The Health Inspectors now have powers to inspect all private premises even without a warrant.The govt has notified Police department to arrest any one and forcibly admit in authorized NCoV treating hospitals, in event the person showing symptoms and refraining modern treatments.The police also been ordered to arrest anyone under Non-Bailable charges in event of spreading misinformation about Corona Virus, that can create panic or misguides public.The State Medical University can legally mobilize 1 Lakh (100,000) medical student fraternity for mandatory NCoV public surveillance and treatment support areas. The university has now ordered for so which will be part of their mandatory duty.Collectors now have powers to restrict movement or close any area, if deemed unsafe by DMOs, in event of any chance of epidemic. Using these provisions, movement into Kerala from Wayanad border has been limited by Wayanad collector and blanket ban has imposed for any sort of group activities like picnics, excursions, study holidays etc by educational institutions.Collectors to daily chair District Medical Committee meetings and DMOs are required to update the progress of surveillance and details of observations to the collectors. This will be evaluated at State High Power Committee for Healthcare affairs on weekly basisDistrict Education Offices are now advised to conduct regular programs in schools across each district to train students, teachers and parents in sanitizing their environment, body and use of masks etc, apart from general medical awareness of NCoV.LSGs are now legally mandated to conduct regular clean ups and public sanitation programs to avoid any remote chance of epidemic. Fogging has been started in many cities of Kerala.Health Inspectorate started thermal scanning even in domestic airports across the state and NCoV desks opened across all bus stations, railway stations etc to monitor passengers.Every district is now mandatory to have minimum 10 well sanitized NCoV protocol following ambulances with PPT kits for its staff. Such ambulance staff are trained with NCoV protocols.Advisories has been issued to reduce the number of larger social gatherings across the state until Feb 14th.Tourism authorities have issued orders evict any Chinese travellers quickly (as their visas are now cancelled by Central Govt) and a temporary ban over Japanese, HK, Korean, Vietnamese, Nepal and Sri Lankan guests in home-stays facilities in the state. They can live only in hotels/resorts now. Homestays and home aggregrators like AirBnB etc are asked to report the nationalities of their guests again to Kerala Tourism directly.The state will observe an incubation period of 28 days instead of WHO’s 14 day incubation period to avoid any chance of epidemic. Its now a legal offence for anyone on surveillance or quarantine to discard the incubation period. Out of 60 who came directly from Wuhan to Kerala and kept under surveillance, 2 have escaped and fled to Saudi Arabia. The DHS has informed Immigration Bureau and Ministry of Foreign affairs to reciprocate the matter with Saudi counterparts on the same.These are the current implications of declaring this as State Calamity. The government also activated the SOP to prevent outbreak and coordinating well with NCDC of Indian government.The state has deployed nearly 200 Health Inspectors and 171 Social Community doctors as part of surveillance and social counselling. As of now, 1043 people were counselled by the special task force.The DHS also started regular Corona awareness video in many social media channels and in mainstream channels to keep people prepare about it.The official awareness video released by IPRD and DHS.Coronavirus: Other states can learn from KeralaWhy all 3 coronovirus cases in India now are from KeralaCoronavirus in Kerala: Why all novel coronavirus cases so far are from Kerala | Kochi News - Times of India3 patients, 2,155 persons under quarantine: Why Kerala could have a lesson on how to contain coronavirusWith coronavirus case confirmed, Kerala requests travellers from China to report inCoronavirus in Kerala: Several coronavirus carriers still undetected in Kerala? | Kochi News - Times of IndiaCoronavirus: Health dept prepares action plans; state all set to fightCoronavirus: What is the Kerala-Wuhan connect?How Kerala is fighting coronavirus

As written by the NFL:NFL Head, Neck and Spine Committee’s Protocols Regarding Diagnosis and Management of ConcussionIntroductionConcussion is an important injury for the professional football player, and the diagnosis, prevention, and management of concussion is important to the National Football League, its players and member Clubs, and the National Football League Players Association. The NFL’s Head, Neck and Spine Committee has developed a comprehensive set of protocols with regard to the diagnosis and management of concussions in NFL players.The diagnosis and management of concussion is complicated by the difficulty in identifying the injury as well as the complex and individual nature of managing this injury. Ongoing education of players, NFL team physicians and athletic trainers regarding concussion is important, recognizing the evolving advances in concussion assessment and management. The objective of these protocols is to provide medical staffs responsible for the health care of NFL players with a process for diagnosing and managing concussion.Concussion Defined: For purposes of these protocols, the term concussion is defined as (reference McCrory et al BJSM '13): A complex pathophysiological process affecting the brain induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:1. Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head.2. Concussion typically results in the rapid onset of transient impairment of neurologic function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hours.3. Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course; however, it is important to note that, in some percentage of cases, post- concussive symptoms may be prolonged.Potential Concussion Signs (Observable)Any loss of consciousness;Slow to get up following a hit to the head (“hit to the head” may include secondary contact with the playing surface);Motor coordination/balance problems (stumbles, trips/falls, slow/labored movement);Blank or vacant look;Disorientation (e.g., unsure of where he is on the field or location of bench);Clutching of head after contact;Visible facial injury in combination with any of the above.Potential Concussion Symptoms (Player reported, following direct or indirect contact)Headache;Dizziness;Balance or coordination difficulties;Nausea;Amnesia for the circumstances surrounding the injury (i.e., retrograde/anterograde amnesia);Cognitive slowness;Light/sound sensitivity;Disorientation;Visual disturbance;Tinnitus.NFL Sideline Concussion Assessment:The NFL Sideline Concussion Assessment is the standardized acute evaluation that has been developed by the NFL’s Head Neck and Spine Committee to be used by team’s medical staffs to evaluate potential concussions during practices and on game day. This evaluation is based on the Standardized Concussion Assessment Tool (SCAT2) published by the Concussion in Sport Group (McCrory ‘09), modified for use in the NFL in 2011, and consistent with the SCAT3 published in 2013 by the same international Concussion in Sport Group (McCrory ‘13) (Attachment A). The NFL Sideline Concussion Assessment can be used to aide in the diagnosis of concussion even if there is a delayed onset of symptoms. The NFL Sideline Concussion Assessment is also designed for serial testing, which allows it to be used across multiple occasions to track player recovery. Clubs shall maintain all NFL Sideline Concussion Assessment exams and a copy of the same shall be given to both the player and the team medical staff.Being able to compare the results from the Sideline Concussion Assessment to the baseline information obtained in the preseason improves the value of this instrument. In all circumstances, the Team Physician or other physician designated by the Team Physician (e.g. neurosurgeon or Neurotrauma Consultant) shall assess the player in person. The Team Physician shall be responsible for determining whether the player is diagnosed as having a concussionThe athlete may have a concussion despite being able to complete the NFL Sideline Concussion Assessment “within normal limits” compared to their baseline, due to the limitations of a brief sideline assessment. Such limitations underscore the importance of knowing the athlete and the subtle deficits in their personality and behaviors that can occur with concussive injury.The signs and symptoms of concussion listed above, although frequently observed or reported, are not an exhaustive list. The NFL Sideline Concussion Assessment is intended to capture these elements in a standardized format. The neurocognitive assessment in the NFL Sideline Concussion Assessment is brief and does not replace more formal neuropsychological test data. A balance assessment is an important component of the NFL Sideline Concussion Assessment, and has been validated as a useful adjunct in assessing concussive injury.In the pre-season and post-injury, more formal neuropsychological test data may be very useful in assessing the neurocognitive sequel of concussion. However, it should be noted that there are limitations to neuropsychological testing, and neuropsychological testing should not be used in isolation to make the diagnosis of concussion or as the sole determinant for return to play. Instead, neuropsychological testing should be considered as one component of the assessment.Emergency Medical Action PlanningAn Emergency Medical Action Plan (EAP) must be developed, written, discussed, practiced and reviewed by the medical staff for all practice and game venues, as well as conditioning and training sites. The EAP is availableto the visiting team.Preseason1. Education: Players and Club personnel must be provided with, and must review, educational materials regarding concussion, including the importance of identifying and reporting signs and symptoms to the medical staff. These educational materials provide basic facts about concussion, including signs and symptoms, as well as why it is important to report symptoms promptly. Additionally, players must be educated and encouraged to report to the medical staffs concussion signs and symptoms that their teammates may experience.2. Pre-Season Assessment:Physical Examination. The preseason physical examination allows the team physician and athletic trainer the opportunity to review and answer questions about a player’s previous concussions, discuss the importance of reporting any concussive signs or symptoms, and explain the specifics regarding the concussion diagnosis and management protocol. The baseline physical examination to be conducted as part of the preseason physical examination shall include a traditional neurological examination and Baseline NFL Sideline Assessment (Attachment B). This information is helpful if a player subsequently sustains a concussion during the season.Neuropsychological testing. Each player is required to have a baseline neuropsychological test. Computerized forms of neuropsychological testing are used, but it is also acceptable to perform standard paper and pencil testing or to utilize a combination of the two.Practice and Game Day Concussion Management1. Emergency Medical Action Plan. As referenced above, the EAP is available at, and specific to, each venue (practice, conditioning, training and/or game venue). The EAP is to be reviewed with the visiting team prior to each game.2. The Player Presenting Signs/Symptoms of Concussion. If a player exhibits or reports signs or symptoms of concussion on the field and does not require emergent transport for more serious brain injury and/or cervical spine injury, he must be removed and evaluated by the Club medical team. This evaluation shall include a sideline and/or locker room examination utilizing the NFL Sideline Concussion Assessment Tool. The entire assessment is to be completed, compared to the baseline assessment and subsequently entered into the player’s medical record. Same-day return to practice or play in a case of a diagnosed concussion is strictly prohibited.3. Unaffiliated Neurotrauma Consultant. During games, each team will be assigned an Unaffiliated Neurotrauma Consultant. Each Unaffiliated Neurotrauma Consultant shall be a physician who is impartial and independent from any Club, is board certified or board eligible in neurology, neurological surgery, emergency medicine, physical medicine and rehabilitation physician, or any primary care CAQ sports medicine certified physician and has documented competence and experience in the treatment of acute head injuries. An Unaffiliated Neurotrauma Consultant shall be present on each sideline during every game and shall be (i) focused on identifying symptoms of concussion and mechanisms of injury that warrant concussion evaluation, (ii) working in consultation with the Head Team Physician or designated TBI team physicians to implement the Club’s concussion evaluation and management protocol (including the Sideline Concussion Assessment Exam) during the games, and (iii) present to observe (and collaborate when appropriate with the Team Physician) the Sideline Concussion Assessment Exams performed by Club medical staff. These unaffiliated consultants also will be available to assist in transportation to an appropriate facility for more advanced evaluation and/or treatment as needed based on the EAP. These consulting physicians will work with the team’s medical staff and will assist in the diagnosis and care of the concussed player. The responsibility for the diagnosis of concussion and the decision to return a player to a game remains exclusively within the professional judgment of the Head Team Physician or the Team physician assigned to managing TBI.4. Booth ATC. An athletic trainer serving as a “spotter” for both teams will be present in the stadium booth with access to multiple views of video and replay in order to aid in the recognition of injury. The ATC “spotter” will introduce him/herself to the medical staff for both teams prior to the game to discuss protocol. Communication between the athletic trainer and the medical personnel on the sideline is available so that the athletic trainer in the booth can report any plays that appear to involve possible injury. The teams’ medical personnel may also initiate communication with the spotter to clarify the manner of injury. The sideline medical staff will be able to review the instant replay on the sidelines so that particular plays involving injury can be reviewed.5. Madden Rule. On game day, per the Madden Rule, a player diagnosed with a concussion must be removed from the field of play and observed in the locker room by qualified medical personnel. The Madden Rule is intended to protect the players by providing a quiet environment, with appropriate medical supervision, to permit the player time to recover without distraction. Once a player is diagnosed with a suspected concussion, he is not permitted to meet or talk to the press until his is medically cleared.6. Performing the NFL Sideline Concussion Assessment. A player diagnosed with concussion should have the entire sideline exam performed on the day of injury. The components of the NFL Sideline Concussion Assessment may be performed at different times on the day of the injury depending on the individual situation (e.g., exceptions for a player who is transported to the ER), and an assessment should be repeated prior to discharge home or prior to transportation home following an away game.7. Additional Triggers for Medical Evaluation. As set forth above, in situations in which the player exhibits or reports signs/symptoms of concussion, the full NFL Sideline Concussion Assessment examination is mandatory. In the event the occurrence of a concussion is unclear, or a player sustains a mechanism of injury (“big hit”) that is reasonably expected to give rise to a concussion, and/or a concern is raised by another player, coach, game official, ATC spotter, or Unaffiliated Neurotrauma Consultant, the player shall be removed immediately from the field by Club medical personal. The Team Physician best qualified to evaluate concussion shall assess the player by, at a minimum, performing a focused neurological examination that includes, asking what happened, reviewing the “Go-No-Go” signs and symptoms and asking the Maddock’s questions to discern the status of the player and whether a more thorough evaluation is required. If the medical staff concludes that the player did not sustain a concussion, then the video replay must be reviewed prior to the player returning to play. If after performing the above evaluations and reviewing the video there remains any doubt as to whether a concussion has occurred, then the full NFL Sideline Concussion Assessment must be performed.8. Additional Best Practicesa. Performing serial concussion evaluations (e.g., every 20 minutes for 60 minutes; every hour for 3 hours) is useful because concussive injury can evolve and may not be apparent for several minutes or hours. Even if a player passes an initial concussion assessment and is returned to practice or play, he must be checked periodically during practice or play and again before leaving the venue. Components of the NFL Sideline Concussion Assessment may be utilized in the performance of such evaluations.b. It is important to recognize that players may be able to equal or exceed their performance under the Sideline Concussion Assessment compared to their baseline level yet still have a concussion; underscoring the importance of the physicians’ knowledge of the player. If there is any doubt about the presence of a concussion, regardless of the Sideline Concussion Assessment results, the player is to be removed from practice or play.c. A player diagnosed with concussion will be given “take home” information (e.g. signs and symptoms to watch for, emergency phone numbers) as well as follow up instructions.Return-to-Participation ProcessAfter a concussion has occurred in practice or play, the concussed player must be examined and monitored in the training room on a daily basis or as decided by the medical staff. Components of the NFL Sideline Concussion Assessment can be utilizedto check for symptomsas well as continue to monitor the other aspects of the examination. The following measures must occur in order for a player to return to play:a. A player returns to baseline status of symptoms and neurologic exam, including cognitive and balance functions.i. Repeat neuropsychological evaluation is performed before return to practice or play with interpretation of the data by the team neuropsychology consultant. The team neuropsychology consultant reports the findings back to the team physician.b. A graduated exercise challenge, followed by a gradual return to practice and play, is initiated when the player returns to baseline status. The RTP protocol following a concussion follows a stepwise process to be outlined in the NFL Head, Neck and Spine Committee’s Return to Participation Protocol.c. Prior to return to practice or play, not only must the team physician clear the player, but the Independent Neurological Consultant with expertise in concussion must also evaluate and clear the player for return to practice and play.d. A player may be considered for return to practice and play only after the player has returned to baseline status with rest and exertion, has repeat neuropsychological testing which is interpreted by the team neuropsychology consultant as back to baseline levels of functioning, and has completed the Return to Participation Protocol referenced above and is cleared by the Team Physician and the Independent Neurological Consultant.SummaryIn summary, these protocols for the diagnosis and management of concussion including pre-season education and assessment, practice and game management protocols, and return to play requirements, provide a comprehensive approach to concussion diagnosis and management for the NFL player.[1][1][1][1]Footnotes[1] Page on nflplayers.com[1] Page on nflplayers.com[1] Page on nflplayers.com[1] Page on nflplayers.com

How can you be sure they are wrong? I will graciously admit my mistakes if in fact they were mistakes. But, I rarely see anything as 100 % right or wrong.I always wonder how someone is sure they are “right”. I am rarely 100% sure.For example, I may say that the color of the Quora logo is red. You may say no, no it’s actually a really dark pink , but it looks red.I would look at it again but closer and argue that I am pretty sure it’s red. Meanwhile I’m realizing that its possible that the color profile on my monitor is off or it’s possible that your color is off. I might even look at it on my phone to try to verify. But, I am still not SURE you are wrong, but I KNOW for sure I’m NOT about to say I am wrong, because I am no more sure of that than I am of you being wrong. However, If you were to argue passionately enough and persistently enough, at some point I am likely to think to myself “maybe I am wrong, maybe I need more time to evaluate this”, instead of completely dismissing it. So to you, I refused to admit I was wrong, to me, I just haven’t decided yet…I often catch my own mistakes, usually before anyone else even notices. (Well, except typos and grammatical errors, lol). I guess that is one benefit of our constant self scrutiny.I remember when I first started as a staff coordinator for a pediatric home health care agency that specializes in the care of children that rely on life supportive technologies to stay alive. I was particularly insecure and unsure of my abilities. I felt a tremendous pressure to always be 100% on top of everything. These were the lives of fragile children and the trust of their parents, that we will be there and keep their child safe and alive through the night. The nursing we provided allowed these parents the opportunity to “dare” to fall asleep and maybe even get a full 5 or 6 hours of uninterrupted sleep without being terrified that they might accidentally sleep through a life support or heart monitor alarm… It allowed them time to read a bedtime story to their other children (that often get lost in the background in these situations) and spend a few minutes with them with their undivided attention. It allowed mom and dad a few minutes to relax and enjoy each others company, maybe even have time to watch a movie or TV show together and talk about something besides medical equipment, doctors appointments and therapies.So when I made a mistake that resulted in NOT having a nurse when they NEEDED and EXPECTED one, it weighed heavy on my mind. I remember trying to divert the blame, by pushing things to a “grey area”, “a miscommunication” or “software glitch”. I remember being ashamed of myself, not for my mistake but for the way I handled it.Eventually I realized it was easier for me to deal with my mistakes than the guilt of “passing the buck”. From that point on, if I made a mistake, believe me, I would be the first one in the office in the morning, sitting in my bosses office, ready to admit what happened and accept the blame before they had a chance to hear it anywhere else.Today, my readiness to admit when I am wrong, is something I am proud of. For many reasons including: 1- It is the “right” thing to do and 2- It means that I am more able to accept that I am human and I can and will make mistakes and no one expects me to be “perfect” even the parents, even my boss and now even myself. Accepting that we don’t have to be perfect is a big step for us. It’s progress and 3 - so I can argue with people like you that when you say were “wrong”, you better be 100% sure that we are wrong. Because we are going to research and review and investigate until we know if we are in fact to blame or not and how much of the blame we are willing to accept. We are pretty literal and we’re more likely to say something along the lines of “ok so I was like 80% in the wrong but the other 20% was because of ___________and that was out of my control…And If I were you, I would make sure they you let them know how much you appreciate them for that, because as irritating as it is that it’s made into such a “big deal” you can trust that they are NOT going to just tell you what you want to hear to get you to shut up. They aren’t going to half heartedly do anything. Ever. OK, thats not entirely true… It wont happen often. Unless it’s something like folding a fitted sheet, we hate that crap. We truly don’t have time for that shit. We've got stuff to think about. You’ll find your fitted sheet in the closet rolled into a ball and us somewhere ALONE on the computer or curled up with a book.