5141.7 - Student Sports - Concussions

Policy 5141.7

Students

Student Sports – Concussions 


The Board of Education recognizes that concussions and head injuries are commonly reported injuries in children and adolescents who participate in sports and other recreational activities. The Board acknowledges the risk of catastrophic injuries or deaths are significant when a concussion or head injury is not properly evaluated and managed.

Commencing July 1, 2010, and each school year thereafter, any coach of intramural or interscholastic athletics employed by the District shall complete an initial training course, approved by the State Board of Education, regarding concussions which are a type of brain injury prior to commencing the coaching assignment for the season. Such training course shall include, but not be limited to (1) the recognition of the signs and symptoms of a concussion; (2) the means of obtaining proper medical treatment for a person suspected of having a concussion; (3) the nature and risk of concussions, including the danger of continuing to engage in athletic activity after sustaining a concussion; and (4) the proper method of allowing a student athlete who has sustained a concussion to return to athletic activity.

Each school year any coach who has completed the initial training course regarding concussions shall annually review current and relevant information, developed or approved by the State Board of Education, regarding concussions prior to the start of the coaching assignment.  This annual review is not required in any year the coach is required to complete a refresher course. Beginning July 1, 2015, and each school year thereafter, a coach must complete an approved refresher course not later than five years after the initial training course in order to maintain his/her coaching permit and to coach in the District.

Annually the District will distribute a head injury and concussion information sheet to all parents/guardians of student participants in competitive sport activities.  The parent/guardian and student must return a signed acknowledgement indicating that they have reviewed and understand the information provided before the student participates in any covered activity. This acknowledgement form must be returned and be on file with the District in order for the student to be allowed to practice or compete in the sports activity.

All coaches will complete training pertaining to the District’s procedures.

The required refresher course regarding concussions shall include, but not be limited to, an overview of key recognition and safety practices, an update of medical developments, current best practices in the field of concussion research, and prevention and treatment. Said refresher course shall also contain an update on new relevant federal, state and local laws and regulations, and for football coaches, current best practices regarding coaching the sport of football, including, but not limited to, frequency of games and full contact practices and scrimmages as identified by the governing authority for intramural and interscholastic athletics (CIAC).

The District, after January 1, 2015, shall implement the “Concussion Education Plan and Guidelines for Connecticut Schools,” developed by the State Board of Education per the stipulations of P.A. 14-66. Written materials, online training or videos, or in person training shall address, at a minimum, the recognition of signs or symptoms of concussion, means of obtaining proper medical treatment for a person suspected of sustaining a concussion, the nature and risks of concussions, including the danger of continuing to engage in athletic activity after sustaining a concussion, proper procedures for return to athletic activity and current best practices in the prevention and treatment of a concussion.

The District, commencing July 1, 2015, will utilize the consent form developed or approved by the State Board of Education with parent/guardians of student athletes in intramural or interscholastic activities regarding concussions. This form shall provide a summary of the concussion education plan developed or approved by the State Board of Education and a summary of the Board’s policy regarding concussions.  The consent form shall be returned to the appropriate school authorities, signed by the parent/guardian, attesting to the receipt of such form and authorizing the student athlete to participate in the athletic activity.

Further, in compliance with applicable state statutes, the coach of any intramural or interscholastic athletics shall immediately remove any student athlete participating in intramural or interscholastic athletics who (1) is observed to exhibit signs, symptoms or behaviors consistent with a concussion following an observed or suspected blow to the head or body during a practice, game or competition, (2) is diagnosed with a concussion, or (3) is otherwise suspected of having sustained a concussion because such student athlete is observed to exhibit signs, symptoms or behaviors consistent with a concussion regardless of when such concussion or head injury may have occurred. Upon such removal, the coach or other qualified school employee defined in Connecticut General Statutes 10-212a, shall notify the student athlete’s parent/guardian that the student athlete has exhibited such signs, symptoms, or behaviors consistent with a concussion or has been diagnosed with a concussion. Such notification shall be provided not later than twenty-four hours after such removal. However, a reasonable effort shall be made to provide such notification immediately after such removal.

The coach shall not permit such student athlete to participate in any supervised athletic activities involving physical exertion, including, but not limited to, practices, games or competitions, until such student athlete receives written clearance to participate in such supervised athletic activities involving physical exertion from a licensed health care professional* trained in the evaluation and management of concussions.

*“licensed health care professional” means a physician licensed pursuant to Chapter 370 of the General Statutes, a physician assistant licensed pursuant to Chapter 370 of the General Statutes, an advanced practice registered nurse licensed pursuant to Chapter 378 of the General Statutes or an athletic trainer licensed pursuant to Chapter 375a of the General Statutes.

Following medical clearance, the coach shall not permit such student athlete to participate in any full, unrestricted supervised athletic activities without limitations on contact or physical exertion, including, but not limited to, practices, games or competitions and such student athlete (1) no longer exhibits signs, symptoms or behaviors consistent with a concussion at rest or with exertion, and (2) receives written clearance to participate in such full, unrestricted supervised athletic activities from a licensed health care professional trained in the evaluation and management of concussions.

The Board believes that at the forefront of concussion management is the implementation of baseline testing, through the implementation of the ImPACT (Immediate Post–concussion Assessment and Cognitive Testing) Program.* Subject to the availability of financial resources, District athletes will receive “baseline” testing prior to the start of the sports season and should be done for individual athletes at least every other year.

*ImPACT is a 20 minute computerized concussion evaluation system that has been scientifically validated and has become a standard tool used in comprehensive clinical management of concussions for athletes of all ages.  Information is available at http://www.impacttest.com/. This computerized neurocognitive testing program is available online.

Legal Reference:    Connecticut General Statutes
PA 10-62 An Act Concerning Student Athletes and Concussions

P.A. 14-66 An Act Concerning Youth Athletics and Concussions

“Concussion Education Plan and Guidelines for Connecticut Schools” adopted by the State Board of Education, January 7, 2015.

A.    Return to Play after Concussions 
1.    A student athlete who has been removed from play may not participate in any supervised team activities involving physical exertion, including, but not limited to practices, games, or competitions, sooner than twenty-four hours* after such athlete was removed from play until the athlete is evaluated by a licensed health care provider trained in the evaluation and management of concussions and receives a written clearance to return to play from that health care provider. [or: Any athlete removed from play because of a concussion must have written medical clearance from an appropriate health care professional before he/she can resume practice or competition and not until the student athlete and his/her parent/guardian completes the State Board of Education concussion education plan.] (Refer to Appendix E: “The Proper Procedures for Allowing a Student Athlete Who Has Sustained a Concussion to Return to Athletic Activity.”)
Note:    CIAC requirements indicate that no athlete shall return to participation on the same day of concussion.
*P.A. 10-62 does not require a 24 hour waiting period before an athlete may return to participate in team activities. However, the law does require written clearance from a licensed health care professional.
2.    After medical clearance, the return to play by the athlete should follow a step-wise protocol with provisions for delayed return to play based on return of any signs or symptoms.
3.    The medical clearance return to play protocol is as follows:
a.    No exertional activity until asymptomatic.
b.    When the athlete appears clear, begin low-impact activity such as walking, stationary bike, etc.
c.    Initiate aerobic activity fundamental to the specific sport such as skating, or running and may also begin progressive strength training activities.
d.    Begin non-contact skill drills specific to sport such as dribbling, fielding, batting, etc.
e.    Full contact in practice setting.
f.    If athlete remains asymptomatic, he/she may return to game/play

4.    Once all academic requirements are made up and/or there is a plan in place to complete all academic assignments, the student/athlete may return to his or her athletic team. 


Regulation approved:    July 9, 2019    
NEWTOWN PUBLIC SCHOOLS, Newtown, Connecticut 
 
 
HEADS UP: CONCUSSION IN YOUTH SPORTS
A Fact Sheet for COACHES
 
To download the coaches fact sheet in Spanish, please visit:
http://www.cdc.gov/concussion/HeadsUp/youth.html 

THE FACTS

•    A concussion is a brain injury.
•    All concussions are serious.
•    Concussions can occur without loss of consciousness.
•    Concussions can occur in any sport.
•    Recognition and proper management of concussions when they first occur can help prevent further injury or even death.
 
WHAT IS A CONCUSSION?

A concussion is an injury that changes how the cells in the brain normally work.  A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull.  Even a ding, getting your bell rung, or what seems to be a mild bump or blow to the head can be serious.  Concussions can also result from a fall or from players colliding with each other or with obstacles, such as a goalpost.

The potential for concussions is greatest in athletic environments where collisions are common.1 Concussions can occur, however, in any organized or unorganized sport or recreational activity. As many as 3.8 million sports- and recreation-related concussions occur in the United States each year.2
 
RECOGNIZING A POSSIBLE CONCUSSION

To help recognize a concussion, you should watch for the following two things among your athletes:

1.    A forceful blow to the head or body that results in rapid movement of the head.
-and-
2.    Any change in the athlete’s behavior, thinking, or physical functioning. (See the signs and symptoms of concussion.) 
 

SIGNS AND SYMPTOMS
SIGNS OBSERVED BY COACHING STAFF
  • Appears dazed or stunned
  • Is confused about assignment or position
  • Forgets sports plays
  • Is unsure of game, score, or opponent
  • Moves clumsily
  • Answers questions slowly
  • Loses consciousness (even briefly)
  • Shows behavior or personality changes
  • Can't recall events prior to hit or fall
  • Can't recall events after hit or fall
SYMPTOMS REPORTED BY ATHLETE
  • Headache or pressure in head
  • Nausea or vomiting
  • Balance problems or diziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems
  • Confusion
  • Does not feel right

Adapted from Lovell et al. 2004

Athletes who experience any of these signs or symptoms after a bump or blow to the head should be kept from play until given permission to return to play by a health care professional with experience in evaluating for concussion. Signs and symptoms of concussion can last from several minutes to days, weeks, months, or even longer in some cases.

Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. If you have any suspicion that your athlete has a concussion, you should keep the athlete out of the game or practice.
 
PREVENTION AND PREPARATION

As a coach, you can play a key role in preventing concussions and responding to them properly when they occur. Here are some steps you can take to ensure the best outcome for your athletes and the team:
 
•    Educate athletes and parents about concussion. Talk with athletes and their parents about the dangers and potential long-term consequences of concussion. For more information on long-term effects of concussion, view the following online video clip: http://www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.htm#Video.  Explain your concerns about concussion and your expectations of safe play to athletes, parents, and assistant coaches. Pass out the concussion fact sheets for athletes and for parents at the beginning of the season and again if a concussion occurs.

•    Insist that safety comes first.
 
•    Teach athletes safe playing techniques and encourage them to follow the rules of play.
•    Encourage athletes to practice good sportsmanship at all times.
•    Make sure athletes wear the right protective equipment for their activity (such as helmets, padding, shin guards, and eye and mouth guards). Protective equipment should fit properly, be well maintained, and be worn consistently and correctly.
•    Review the athlete fact sheet with your team to help them recognize the signs and symptoms of a concussion.

Check with your youth sports league or administrator about concussion policies. Concussion policy statements can be developed to include the leagues commitment to safety, a brief description of concussion, and information on when athletes can safely return to play following a concussion (i.e., an athlete with known or suspected concussion should be kept from play until evaluated and given permission to return by a health care professional). Parents and athletes should sign the concussion policy statement at the beginning of the sports season.

•    Teach athletes and parents that it’s not smart to play with a concussion. Sometimes players and parents wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play.  Don’t let athletes persuade you that they’re just fine after they have sustained any bump or blow to the head.  Ask if players have ever had a concussion.

•    Prevent long-term problems. A repeat concussion that occurs before the brain recovers from the first usually within a short period of time (hours, days, or weeks) can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in brain swelling, permanent brain damage, and even death. This more serious condition is called second impact syndrome.4, 5 Keep athletes with known or suspected concussion from play until they have been evaluated and given permission to return to play by a health care professional with experience in evaluating for concussion. Remind your athletes: It’s better to miss one game than the whole season.
 
ACTION PLAN

WHAT SHOULD A COACH DO WHEN A CONCUSSION IS SUSPECTED?

1.    Remove the athlete from play. Look for the signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head. Athletes who experience signs or symptoms of concussion should not be allowed to return to play. When in doubt, keep the athlete out of play.

2.    Ensure that the athlete is evaluated right away by an appropriate health care professional. Do not try to judge the severity of the injury yourself. Health care professionals have a number of methods that they can use to assess the severity of concussions. As a coach, recording the following information can help health care professionals in assessing the athlete after the injury:
•    Cause of the injury and force of the hit or blow to the head
•    Any loss of consciousness (passed out/knocked out) and if so, for how long
•    Any memory loss immediately following the injury
•    Any seizures immediately following the injury
•    Number of previous concussions (if any)

3.    Inform the athlete’s parents or guardians about the possible concussion and give them the fact sheet on concussion.  Make sure they know that the athlete should be seen by a health care professional experienced in evaluating for concussion.

4.    Allow the athlete to return to play only with permission from a health care professional with experience in evaluating for concussion.  A repeat concussion that occurs before the brain recovers from the first can slow recovery or increase the likelihood of having long-term problems. Prevent common long-term problems and the rare second impact syndrome by delaying the athletes return to the activity until the player receives appropriate medical evaluation and approval for return to play.

If you think your athlete has sustained a concussion take him/her out of play, and seek the advice of a health care professional experienced in evaluating for concussion.

For more information and to order additional materials free-of-charge, visit: 
https://www.cdc.gov/headsup/youthsports/index.html

For more detailed information on concussion and traumatic brain injury, visit:
https://www.cdc.gov/TraumaticBrainInjury/index.html

REFERENCES

1.    Powell JW. Cerebral concussion: causes, effects, and risks in sports. Journal of Athletic Training 2001; 36(3):307-311. 
2.    Langlois JA, Rutland-Brown W, Wald M. The epidemiology and impact of traumatic brain injury: a brief overview. Journal of Head Trauma Rehabilitation 2006; 21(5):375-378. 
3.    Lovell MR, Collins MW, Iverson GL, Johnston KM, Bradley JP. Grade 1 or ding concussions in high school athletes. The American Journal of Sports Medicine 2004; 32(1):47-54. 
4.    Institute of Medicine (US). Is soccer bad for children’s heads? Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer. Washington (DC): National Academy Press; 2002. 
5.    Centers for Disease Control and Prevention (CDC). Sports-related recurrent brain injuries-United States. Morbidity and Mortality Weekly Report 1997; 46(10):224-227. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00046702.htm

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION

Content Source: National Center for Injury Prevention and Control, Division of Injury Response

Page Located on the Web at http://www.cdc.gov/concussion/index.html
 

Appendix B
Fact Sheet for Student Athletes
What is a concussion?

A concussion is a brain injury that:
•    Is caused by a bump, blow, or jolt to the head.
•    Can change the way your brain normally works.
•    Can range from mild to severe.
•    Can occur during practices or games in any sport.
•    Can happen even if you haven’t been knocked out.
•    Can be serious even if you’ve just been “dinged” or had your “bell rung.”

How can I prevent a concussion?

It’s different for every sport. But there are steps you can take to protect yourself from concussion.
•    Follow your coach’s rules for safety and the rules of the sport.
•    Practice good sportsmanship at all times.
•    Use the proper sports equipment, including personal protective equipment (such as helmets)
•    In order for equipment to protect you, it must be:
•    Appropriate for the game, position, and activity
•    Well maintained
•    Properly fitted
•    Used every time you play

How do I know if I’ve had a concussion?

You can’t see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up days or weeks after the injury. It’s best to see a health care professional if you think you might have a concussion. An undiagnosed concussion can affect your ability to do schoolwork and other everyday activities. It also raises your risk for additional serious injury.

What are the symptoms of a concussion?
•    Nausea (feeling that you might vomit)
•    Balance problems or dizziness
•    Double or fuzzy vision
•    Sensitivity to light or noise
•    Headache
•    Feeling sluggish
•    Feeling foggy or groggy
•    Concentration or memory problems (forgetting game plays)
•    Confusion

What should I do if I think I have a concussion?
•    Tell your coaches and your parents. Never ignore a bump, blow, or jolt to the head. Also tell your coach if one of your teammates might have a concussion.
•    Get a medical checkup. A health care professional can tell you if you have had a concussion and when you are OK to return to play.
•    Give yourself time to recover. If you have had a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to suffer another concussion.
Concussion Symptoms

Common symptoms in concussions are generally divided into physical/somatic, cognitive/thinking/remembering, sleep and emotional/mood disruption categories.

1.    Physical
•    Headache
•    Nausea
•    Vomiting
•    Imbalance
•    Slowed reaction time
•    Dizziness
•    Sensitivity to light
•    Sensitivity to  sound
•    Fuzzy or blurred vision

2.    Sleep
•    Sleeping more or less than usual
•    Drowsiness
•    Trouble falling asleep
•    Trouble maintaining sleep

3.    Cognitive (Thinking/Remembering)
•    Difficulty thinking or concentrating
•    Difficulty remembering
•    Confusion
•    Feeling mentally foggy
•    Feeling slowed down
•    Decreased attention
•    Decreased retention
•    Distractibility
•    Amnesia

4.    Mood Disruption
•    More emotional
•    Irritable
•    Sad
•    Nervous
•    Depressed

Source: Adapted from Pardini et al 2004.

Athletes who experience any of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating concussions, provides written clearance that they are symptom-free and can to return to play. It is important to note that some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. For some people, however, signs and symptoms of concussion can last for days, weeks, or longer. 

Potential Signs Observed by Coaches, Athletic Trainers, Parents or Others: 
•     Appears dazed or stunned 
•     Is confused about assignment or position
•     Forgets an instruction 
•     Is unsure of game, score, or opponent 
•     Moves clumsily 
•     Answers questions slowly
•     Loses consciousness (even briefly) 
•     Shows mood, behavior, or personality changes 
•     Can’t recall events prior to hit or fall 
•     Can’t recall events after hit or fall 

Potential Symptoms Reported by Athlete: 
•     Headache or “pressure” in head 
•     Nausea or vomiting
•     Balance problems or dizziness
•     Double or blurry vision 
•     Sensitivity to light 
•     Sensitivity to noise 
•     Feeling sluggish, hazy, foggy, or groggy 
•     Concentration or memory problems 
•     Confusion 
•     Does not “feel right” or is “feeling down” 
Source: CDC, How Can I Recognize a Possible Concussion? 

Athletes who experience any of the signs and symptoms listed above after a bump, blow, or jolt to the head or body should be kept out of play the day of the injury and until a health care professional, experienced in evaluating concussions, provides written clearance that they are symptom-free and can to return to play. It is important to note that some athletes may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. For some people, however, signs and symptoms of concussion can last for days, weeks, or longer. 
 
The Proper Procedures for Allowing a Student Athlete Who Has Sustained a Concussion to Return to Athletic Activity

When managing an athlete with a concussion, the management plan should cover both returning to school and to play, and should:
•    include monitoring both physical and cognitive activities; 
•    consider concussion history; and
•    be individualized to the athlete. 

An athlete should be referred for follow-up care from a health care professional who can help him or her gradually return to school and to play when fully recovered. An athlete who has been diagnosed with a concussion should not return to practice or play the same day. In addition, Public Act No. 14-66, An Act Concerning Youth Athletics and Concussions requires that:
…coaches shall not permit such student athlete to participate in any supervised team activities involving physical exertion, including, but not limited to, practices, games or competitions, until such student athlete receives written clearance to participate in such supervised team activities involving physical exertion from a licensed health care professional trained in the evaluation and management of concussions. Following clearance, the coach shall not permit such student athlete to participate in any full, unrestricted supervised team activities without limitations on contact or physical exertion, including, but not limited to, practices, games or competitions, until such student athlete no longer exhibits signs, symptoms or behaviors consistent with a concussion at rest or with exertion, and receives written clearance to participate in such full, unrestricted supervised team activities from a licensed health care professional trained in the evaluation and management of concussions. 

There are five gradual steps to help safely return an athlete to play, adapted from the International Concussion Consensus Guidelines located at:
http://www.cdc.gov/concussion/headsup/return_to_play.html

Suggested Return-to-Play Progression

Baseline (Step 0): As the baseline step of the Return-to-Play Progression, the athlete needs to have completed physical and cognitive rest and not be experiencing concussion symptoms for a minimum of 24 hours. Keep in mind, the younger the athlete, the more conservative the treatment. There should be a minimum of 24 hours before progressing to the next step.

Step 1: Light Aerobic Exercise 
Goal: only to increase an athlete’s heart rate 
Time: 5 to 10 minutes 
Activities: exercise bike, walking, or light jogging 
No weight lifting or resistance training, jumping, or hard running 

Step 2: Moderate Exercise 
Goal: limited body and head movement 
Time: reduced from typical routine 
Activities: moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting and resistance training 
No head impact activities 

Step 3: Non-contact Exercise 
Goal: more intense, but non-contact movement 
Time: close to typical routine 
Activities: running, high-intensity stationary biking, the player’s regular weightlifting routine, and non-contact sport-specific drills 
This stage may add some cognitive component to practice in addition to the aerobic and movement components introduced in Steps 1 and 2. 

Step 4: Practice 
Goal: reintegrate in full contact practice with vigilant observation by the coach and/or athletic trainer 

Step 5: Return to Play 
Goal: return to competition 

It is important to monitor symptoms and cognitive function carefully during each increase of exertion. Athletes should only progress to the next level of exertion if they are not experiencing symptoms at the current level. If symptoms return at any step an athlete should stop these activities as this may be a sign that the athlete is pushing too hard. Only after additional rest, when the athlete is once again not experiencing symptoms for a minimum of 24 hours, should he or she start again at the step during which symptoms were experienced. 

The Return-to-Play Progression process is best conducted through a team approach and by a health care professional who knows the athlete’s physical abilities and endurance, such as the school’s athletic trainer in collaboration with the school nurse. By gauging the athlete’s performance on each individual step, a health care professional will be able to determine how far to progress the athlete on a given day. In some cases, the athlete may be able to work through one step in a single day, while in other cases it may take several days to work through an individual step. It may take several weeks to months to work through the entire 5-step progression. 

While most athletes will recover quickly and fully following a concussion, some will have symptoms for weeks or longer. Athletes should be referred to a concussion specialist if: 
1.    Symptoms worsen at any time.
2.    Symptoms have not gone away after 10-14 days. 
3.    The athlete has a history of multiple concussions or risk factors for prolonged recovery. This may include a history of migraines, depression, mood disorders, or anxiety, as well as developmental disorders such as learning disabilities and Attention Deficit Hyperactivity Disorder (CDC, A “Heads Up” on Managing Return to Play). 
School Concussion Management Team
(Adapted from the Oregon Concussion Awareness and Management Program)

School concussion management teams may be formed to create and implement a concussion management plan with sound procedures that support a concussed student. Suggestions for team members are as follows:

Student Athlete
Empowering students to self-assess symptoms and report may be a challenge. Consider inviting an influential student-athlete to the team. Help create an atmosphere of acceptance for reporting suspected and diagnosed concussions, and encourage athletes to report a fellow athlete’s symptoms. 

Parent(s)/Guardian(s) 
Invite a parent leader to the team who could be influential with parent organizations that support athletics and gaining parental and community support for district policies. 

School Administrator 
Administrator support is needed to change the culture surrounding sports concussions, put systems in place to manage concussions effectively, and provide the programs necessary to return students to full activity (athletics and academics) safely. 

School Medical Advisor 
It is important that the school medical advisor is appropriately trained in the current knowledge about concussion. 

Licensed Health Care Professional 
Student athletes who are suspected of or have a concussion must receive written clearance from a licensed health care professional trained in the evaluation and management of concussions in order to participate in supervised team activities. 

School Nurse 
The school nurse is the lead health and medical school staff who works in conjunction with the athletic trainer (when available), athletic director, coaches, school faculty, counselors, and administrators, as well as the student-athlete’s health care provider and family, in order to provide the best healing environment possible. In the case of a concussion, school nurses need to be able to recognize signs and symptoms, be aware of risks associated with recurrent injury, and make recommendations to student-athletes, parents, and school officials on proper care and recovery. 

Physical Education Director/Athletic Director (AD)
The physical education or athletic director’s leadership is a crucial component of good concussion management. They can support coach/athlete/parent training, promote a culture of awareness, ensure the teaching of safe techniques and sportsmanship, ensure proper and well maintained equipment, monitor appropriate incident protocols, promote good officiating, and encourage effective tracking of injuries. 

Certified Athletic Trainer (ATC) 
Certified athletic trainers (ATCs) are medical experts in preventing, recognizing, managing and rehabilitating injuries that result from physical activity. The ATC in a school environment works under the direction of a licensed physician, in collaboration with the school nurse and in cooperation with other health care professionals, athletic or physical education directors, coaches and parents. 

Coach 
Coaches play a key role in concussion management. They are responsible for pulling an athlete from competition or practice immediately after suspecting a concussion, Securing buy-in from the coaching staff is crucial to the safety of the athlete and to the success of the return to play protocol. Having a coach serve as the liaison between the school concussion management team and the other coaching staff can help ensure effective communication and understanding. 

Teachers 
Teachers are critical to student success post-concussion. Teachers need to have a strong understanding of the potential cognitive, behavioral, emotional, and physical symptoms of a concussion. A school concussion management team representative from the teaching staff can work with the student’s teachers to ensure appropriate classroom accommodations. 

School Counselor 
The school counselor is the ideal lead staff person to inform teachers of needed learning accommodations while the student is symptomatic. They can provide information needed for making decisions about return to activity, can work with the student’s teachers to ensure appropriate classroom accommodations, and can refer the student to more formalized supports such as 504 plans or Individualized Education Programs (IEP). 

School Psychologist 
School psychologists can help with assessment and test results interpretation. 
 
Reference: Oregon Concussion Awareness and Management Program. Max‘s Law.
Concussion Management Implementation Guide for School Administrators
http://www.ohsu.edu/xd/outreach/programs/thinkfirst/upload/ocampguide.pdf
 
 
Suggested Roles and Responsibilities of the School Concussion Management Team and School Personnel

(Adapted from the University of the State of New York, State Education Department, Office of Student Support Services Guidelines for Concussion Management in the School Setting [Last updated January 2014]) 

Student Athlete 

Students should be encouraged to communicate any symptoms promptly to district staff and/or parents/guardians, as a concussion is primarily diagnosed by reported and/or observed signs and symptoms. It is the information provided by students about their signs and symptoms that guide the other members of the team in transitioning them back to activities. The amount and type of feedback reported by the student will be dependent on age and other factors. Therefore it is recommended that students: 
•    Be educated about the prevention of head injuries.
•    Be familiar with signs and symptoms that must be reported to the coach, certified athletic trainer, school nurse, parent/guardian, or other staff. 
•    Be made aware of the risk of concussion and be encouraged to tell their coach, parent/guardian, certified athletic trainer, school nurse or other staff members about injuries and symptoms they are experiencing.
•    Be educated about the risk of severe injury, permanent disability, and even death that can occur with re-injury by resuming normal activities before recovering from a concussion. 
•    Follow instructions from their private medical/health care provider. 
•    Be encouraged to ask for help and to inform teachers of difficulties they experience in class and when completing assignments.
•    Encourage classmates and teammates to report injuries.
•    Promote an environment where reporting signs and symptoms of a concussion is considered acceptable and is encouraged. 

Parent(s)/Guardian(s) 

When students are diagnosed with a concussion, it is important that the parent/guardian communicates with both the health care professional and the school. Therefore, it is recommended that parents/guardians: 
•    Be familiar with the signs and symptoms of concussions. This may be accomplished by reading pamphlets, Web based resources, and attending meetings and education sessions prior to their child’s involvement in athletic activities. 
•    Be familiar with the requirement that any students suspected of having a concussion must immediately be removed from athletic activities. 
•    Be familiar with any concussion policies or protocols implemented by the local or regional board of education.
•    Be made aware that concussion symptoms that are not addressed can prolong concussion recovery. 
•    Provide any forms and written orders from the health care professional to the school nurse and the athletic trainer or coach in a timely manner.
 
•    Monitor their child’s physical and mental health as they transition back to full activity after sustaining a concussion. 
•    Report concerns to their child’s health care professional and the school as necessary. 
•    Communicate with the school to assist in transitioning their child back to school after sustaining a concussion. 
•    Communicate with school staff if their child is experiencing significant fatigue or other symptoms during or at the end of the school day.
•    Follow the health care professional’s orders at home regarding return to activities. 

School Administrator

School administrators and/or their designees, should ensure that the district’s policies on concussion management are communicated and implemented. Administrators may choose to designate a school concussion management team to oversee that district policies are enforced and protocols are implemented. Therefore, administrators should: 
•    Review the district’s concussion education plan with all staff. 
•    Arrange for the mandatory professional development regarding concussion management for staff and/or parents. 
•    Provide guidance to district staff on district wide policies and protocols for emergency care and transport of students suspected of sustaining a concussion.
•    Ensure that plans are developed and implemented to meet the needs of individual students diagnosed with a concussion and consult with the school medical advisor, school nurse, and (if any) a certified athletic trainer. 
•    Enforce district concussion management policies and protocols. 
•    Encourage parents/guardians to communicate with the school nurse and teachers if their child is experiencing significant fatigue or other symptoms during or at the end of the school day. 
•    Invite parent/guardian participation in determining their child’s needs at school. 
•    Encourage parents/guardians to communicate with the health care professional on the status of their child and their progress with return to school activity. 
•    Ensure that coaches, athletic directors and athletic trainers inform the school nurse or medical advisor of any student who is suspected of or has been diagnosed with a concussion. 

School Medical Advisor 

The school medical advisor, who is a physician, plays a very important role in setting policies and procedures related to identifying students who may have sustained a concussion, along with post-concussion management in school. Therefore, the medical advisor should: 
•    Collaborate with district administration and the school nurse supervisor in developing concussion management policies and protocols. 
•    Assist district staff by acting as a liaison to the student’s medical provider when necessary.
 
•    Attend 504 and concussion management team meetings when necessary or requested. Clear all students returning to athletic activities. This can be done at the discretion of the medical advisor either by reviewing a private medical provider’s clearance, or personally assessing the student.
•    Work with the concussion management team to monitor the progress of individual students with protracted recovery, multiple concussions, and atypical recovery. 
•    Encourage school health personnel (such as school nurses and certified athletic trainers) to collaborate and communicate with each other about all students who are involved in athletic activities and are suspected of having or are diagnosed with a concussion. 
•    Participate in professional development activities as needed to maintain a current knowledge base. 

Licensed Health Care Professional 

Licensed health care professionals trained in the evaluation and management of concussions provide orders and guidance that determine when students are able to begin transitioning back to school and activities. Therefore, they should: 
•    Provide written orders regarding restrictions and monitoring for specific symptoms that the health care professional should be made aware of by family and/or district staff members. 
•    Provide the district with a written graduated return to activity schedule to follow, or approve use of the district’s graduated return to activity schedule, if appropriate. 
•    Readily communicate with the school nurse, certified athletic trainer, or school medical advisor to clarify orders.
•    Provide written clearance for return to full activities (coaches shall not permit such student athlete to participate in any supervised team activities involving physical exertion, including, but not limited to, practices, games or competitions, until such student athlete receives written clearance to participate in such supervised team activities involving physical exertion).

School Nurse 

The school nurse (registered nurse) is the primary health care professional in the school environment and is responsible for the coordination of care for all students. He or she communicates with the health care professional, medical director, parent/guardian, and district staff, collects written documentation and orders and assesses students’ progress in returning to school activities. Therefore, the school nurse should: 
 
•    Assess students who have suffered a significant fall or blow to the head or body for signs and symptoms of a concussion and determine if any signs and symptoms of concussion warrant emergency transport to the nearest hospital emergency room per district policy. 
•    Refer parents/guardians of students believed to have sustained a concussion to their health care professional for evaluation. 
•    Provide parents/guardians with oral and/or written instructions (best practice is to provide both) on observing the student for concussive complications that warrant immediate emergency care.
•    Use the health care professional’s orders when developing an individualized health care plan or an emergency care plan for staff to follow.
•    Ensure proper communication (as guided by FERPA and school district policies) to teachers, coaches, athletic trainers, athletic directors and other school staff that a student is suspected of or has sustained a concussion.
•    Monitor and assess the student’s return to school activities, assessing the student’s progress with each step and communicating with the health care professional, school medical advisor, certified athletic trainer, parent/guardian, and appropriate district staff when necessary. 
•    Collaborate with the concussion management team in creating accommodations if it is determined that a 504 plan is necessary. 
•    Assist in educating students and staff in concussion management and prevention. 

Director of Physical Education and/or Athletic Director (AD) 

The Director of Physical Education provides leadership and supervision for Physical Education (PE) class instruction, intramural activities, and interscholastic athletic competition within a school district’s total physical education program. In many districts there may be an athletic director solely in charge of the interscholastic athletic program. The Director of Physical Education and/or the athletic director must be fully informed about district policies regarding concussion management. They should educate physical education teachers, coaches, parents/guardians, and students about such policies. The Director of Physical Education and/or the athletic director often act as the liaison between district staff and coaches. Therefore, the Director of Physical Education and/or athletic director should: 
•    Ensure that informed consent forms are distributed to and collected from the parents and legal guardians of student athletes involved in intramural or interscholastic athletic activities. Such informed consent form shall include, at a minimum, a summary of the concussion education plan and a summary of the local or regional board of education’s policies regarding concussions.
•    Inform the school nurse, certified athletic trainer, or medical advisor of any student who is suspected of or has been diagnosed with a concussion. 
•    Ensure that any student identified as potentially having a concussion is not permitted to participate in any athletic activities until written clearance is received from a licensed health care professional trained in the evaluation and management of concussions. 
•    Ensure that game officials, coaches, physical education teachers, or parents/guardians are not permitted to determine whether a student with a suspected head injury can continue to play. 
•    Educate coaches on the school district’s policies on concussions and care of injured students during interscholastic athletics, including when to arrange for emergency medical transport. 
•    Assist in educating students, parents/guardians and staff in concussion management and prevention. 
•    Enforce district policies on concussions including training requirements for coaches and certified athletic trainers.
•    Advocate for a certified athletic trainer to be present during athletic activities.
 
Certified Athletic Trainer (ATC) 

A certified athletic trainer, under the supervision of a qualified physician, can assist the medical advisor and athletic director (or Director of Physical Education) by identifying a student with a potential concussion. The certified athletic trainer can also evaluate the concussed student’s progress in return to athletic activities and post-concussion care based on the licensed health care professional’s provider orders and/or district protocol. Therefore, in collaboration with the school nurse, certified athletic trainers should: 
•    Evaluate student athletes who may have suffered a significant fall or blow to the head or body for signs and symptoms of a concussion when present at athletic events. 
•    Observe for late onset of signs and symptoms of a concussion and refer as appropriate. 
•    Evaluate the student to determine if any signs and symptoms of concussion warrant emergency transport to the nearest hospital emergency room per district policy. 
•    Refer parents/guardians of student athletes believed to have sustained a concussion to their health care professional for evaluation. 
•    Provide parents/guardians with oral and/or written instructions (best practice is to provide both) on observing the student for concussive complications that warrant immediate emergency care. 
•    Monitor the student’s return to school activities, evaluating the student’s progress with each step.
•    Review the written statement to clear a student for return to activities.
•    Assist in educating students, parents/guardians and staff in concussion management and prevention.
•    Inform the school nurse or medical advisor of any student who is suspected of or has been diagnosed with a concussion. 

Coach 

Coaches are typically the only district staff present at all interscholastic athletic practices and competitions. Therefore, it is essential that coaches be well informed regarding possible causes of concussions and to understand the signs and symptoms. Coaches should always put the safety of the student first. Therefore, coaches should: 
•    Remove any student who has taken a significant blow to head or body, or presents signs and symptoms of a head injury immediately from play. Public Act No. 14-66: An Act Concerning Youth Athletics and Concussions require immediate removal of any student suspected to have sustained a concussion. 
•    Contact the school nurse or certified athletic trainer for assistance with any student injury. 
•    Send any student exhibiting signs and symptoms of a more significant concussion to the nearest hospital emergency room via emergency medical services (EMS).
•    Inform the parent/guardian of the need for evaluation by their medical/health care provider.
•    Provide the parent/guardian with written educational materials on concussions along with the district’s concussion management policies.
•    Inform the school nurse, certified athletic trainer, athletic director (or physical education director) of the student’s potential concussion. This is necessary to ensure that the student does not engage in activities at school that may complicate the student’s condition prior to having written clearance by a licensed health care professional. 
•    Ensure that students diagnosed with a concussion do not participate in any athletic activities until written authorization has been received from the licensed health care professional trained in the evaluation and management of concussions.
•    Inform the school nurse or medical advisor of any student who is suspected of or has been diagnosed with a concussion. 

Teacher/School Counselor/School Psychologist 

Teachers, school counselors, and school psychologists can assist students in their recovery from a concussion by making and coordinating the implementation of accommodations that minimize aggravating symptoms so that the student has sufficient cognitive rest. They should refer to district protocols and licensed health care provider orders in determining academic accommodations. Section 504 plans may need to be considered for some students with severe symptoms requiring an extended timeframe for accommodations. The school professionals should be aware of the processing issues a student with a concussion may experience. A student who has a concussion will sometimes have short-term problems with attention and concentration, speech and language, learning and memory, reasoning, planning, and problem solving. Students transitioning into school after a concussion might need academic accommodations to allow for sufficient cognitive rest. These include, but are not limited to: 
 
•    shorter school day; 
•    rest periods; 
•    extended time for tests and assignments; 
•    provision of copies of notes;
•    alternative assignments; 
•    minimizing distractions;
•    permitting student to audiotape classes; 
•    peer note takers; 
•    providing assignments in writing; and
•    refocusing student with verbal and nonverbal cues. 
 
Reference: Guidelines for Concussion Management in the School Setting.
http://www.p12.nysed.gov/sss/schoolhealth/schoolhealthservices/ConcussionManageGuidelines.pdf
 
Current Best Practices in the Prevention and Treatment of a Concussion

Prevention 

There are many ways to reduce the chances of sustaining a concussion during participation in athletic activities. Schools should ensure that during athletic contests and practices, athletes:
•    use the correct protective equipment (should be fitted and maintained properly in order to provide the expected protection); 
•    follow all safety rules and the rules of the sport; 
•    practice good sportsmanship; and 
•    do not return to play with a known or suspected concussion until they have been evaluated and given written permission by an appropriate health care professional. 

Treatment 

Education and recognition are the best tools for improving the care of the athlete with a concussion. Students who have been diagnosed with a concussion require both physical and cognitive rest. Delay in instituting health care provider orders for such rest may prolong recovery from a concussion. The health care provider’s orders for avoidance of cognitive and physical activity and graduated return to activity should be followed and monitored both at home and at school. Districts should consult their school medical director if further discussion and/or clarification is needed regarding a private medical provider’s orders, or in the absence of a private medical provider’s orders. Additionally, children and adolescents are at increased risk of protracted recovery and severe, potentially permanent disability (e.g. early dementia, also known as chronic traumatic encephalopathy), or even death if they sustain another concussion before fully recovering from the first concussion. Therefore, it is imperative that a student is fully recovered before resuming activities that may result in another concussion. Best practice warrants that, whenever there is a question of safety, a health care professional errs on the side of caution and holds the athlete out for a game, the remainder of the season, or even a full year. 

Cognitive Rest 

Cognitive rest requires that the student avoid participation in, or exposure to, activities that require concentration or mental stimulation including, but not limited to:
•    computers and video games; 
•    television viewing; 
•    texting; 
•    cell phone use; 
•    reading or writing; 
•    studying or homework; 
•    taking a test or completing significant projects; 
•    loud music; or 
•    bright lights.

Parents/guardians, teachers, and other school staff should watch for signs of concussion symptoms such as fatigue, irritability, headaches, blurred vision, or dizziness reappearing with any type of mental activity or stimulation. If any of these signs and symptoms occur, the student should cease the activity. Return of symptoms should guide whether the student should participate in an activity. Initially a student with a concussion may only be able to attend school for a few hours per day and/or need rest periods during the day, Students may exhibit increased difficulties with focusing, memory, learning new information, and/or an increase in irritability or impulsivity. (Districts should have policies and procedures in place related to transitioning students back to school and for making accommodations for missed tests and assignments.) An Individual Health Care Plan with academic accommodations is an example of a guideline that may be used. If the student’s symptoms last longer than 7 to 14 days, a medical provider should consider referring the student for an evaluation by a neuropsychologist, neurologist, physiatrist, or other medical specialist in traumatic brain injury. 

Note: increased cognitive activity, as well as too little cognitive activity, is associated with longer recovery from concussion. Thus, it is desirable to pace a student’s academic load below symptom threshold. (Pediatrics 2014; 133:1-6)

Schools are permitted to authorize certain testing accommodations for students who incur an injury within a certain timeframe prior to the test administration. In some situations, a 504 plan may be appropriate for students whose concussion symptoms are significant or whose symptoms last 6 months or longer. Section 504 is part of the Rehabilitation Act of 1973 and is designed to protect the rights of individuals with disabilities in programs and activities that receive federal financial assistance from the U.S. Department of Education. Section 504 requires a school district to provide a “free appropriate public education” (FAPE) to each qualified student with a disability who is in the school district’s jurisdiction, regardless of the nature or severity of the disability. Under Section 504, FAPE consists of the provision of regular or special education and related aids and services designed to meet the student’s individual educational needs as adequately as the needs of nondisabled students are met. 

(More information is available on Section 504 law at:
http://www2.ed.gov/about/offices/list/ocr/index.html

Questions and Answers on Section 504 including information on addressing temporary impairments such as concussions is available at:
http://www2.ed.gov/about/offices/list/ocr/504faq.html

Physical Rest 

Physical rest includes getting adequate sleep, taking frequent rest periods or naps, and avoiding physical activity that requires exertion. Some activities that should be avoided include, but are not limited to:
•    activities that result in contact and collision and are high risk for re-injury; 
•    high speed and/or intense exercise and/or sports; 
•    any activity that results in an increased heart rate or increased head pressure (such as straining or strength training). 

Students may experience frustration or stress about having to limit activities or having difficulties keeping up in school. They should be supported and reassured that they will be able to resume activities as soon as it is safe, and that it is important to avoid activities which will delay their recovery. Students should be informed that the concussion will resolve more quickly when they follow their medical provider’s orders. Students will need encouragement and support at home and school until symptoms fully resolve (CDC, Heads Up: Preventing Concussion Heads Up).
 

 
Form
HEADS UP: CONCUSSION IN YOUTH SPORTS
 
A Fact Sheet for Parents and Athletes
(Requirement to Read and Signed by Parents and Athletes) 
Return This Form to Team Coach.

WHAT IS A CONCUSSION?

A concussion is a type of traumatic brain injury (TBI) that is caused by a bump, blow or jolt to the head. It can change the way your brain normally works. Concussions can also occur from a fall or blow to the body that causes the head and brain to move quickly back and forth. It can occur during practices or games in any sport. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious. A concussion can happen even if you haven’t been knocked out. You can’t see a concussion. Signs and symptoms of a concussion can show up right after the injury or may not appear or be noticed until days or weeks after the injury. If your child reports any symptoms of concussion, or if you notice the symptoms yourself, seek medical attention right away.

Parents and Guardians

What are the signs and symptoms of a concussion observed by Parents/Guardians?

If your child has experienced a bump or blow to the head during a game or practice, look for any of the following signs and symptoms of a concussion:
•    Appears dazed or stunned
•    Is confused about assignment or position
•    Forgets an instruction
•    Is unsure of game, score, or opponent
•    Moves clumsily
•    Answers questions slowly
•    Loses consciousness (even briefly)
•    Shows behavior or personality changes
•    Can’t recall events prior to being hit or falling
•    Can’t recall events after being hit or falling

How can a Parent/Guardian help their child prevent a concussion?

Every sport is different, but there are steps your children can take to protect themselves from concussion.
•    Ensure that they follow their coach’s rules for safety and the rules of the sport.
•    Encourage them to practice good sportsmanship at all times.
•    Make sure they wear the right protective equipment for their activity (such as helmets, padding, shin guards, and eye and mouth guards). Protective equipment should fit properly, be well maintained, and be worn consistently and correctly.
•    Learn the signs and symptoms of a concussion.


What should a parent/guardian do if they think their child has a concussion?
  1. Seek medical attention right away. A health care professional will be able to decide how serious the concussion is and when it is safe for your child to return to sports. Notify your child’s coach if you think your child has a concussion.
  2. Keep your child out of play. Concussions take time to heal. Don’t let your child return to play until a health care professional says it’s OK. Children who return to play too soon while the brain is still healing risk a greater chance of having a second concussion. Second or later concussions can be very serious. They can cause permanent brain damage, affecting your child for a lifetime.
  3. Tell your child’s coach about any recent concussion in ANY sport or activity. Your child’s coach may not know about a concussion your child received in another sport or activity unless you tell the coach.

Athletes

What are the symptoms of a concussion?
 
•    Headache or “pressure” in head
•    Nausea or vomiting
•    Balance problems or dizziness
•    Double or blurry vision
•    Bothered by light
•    Bothered by noise
•    Feeling sluggish, hazy, foggy, or groggy
•    Difficulty paying attention
•    Memory problems
•    Confusion
•    Does not “feel right”

What should an athlete do if they think they have a concussion?
 
•    Tell your coaches and your parents. Never ignore a bump or blow to the head even if you feel fine. Also, tell your coach if one of your teammates might have a concussion.
•    Get a medical checkup. A doctor or health care professional can tell you if you have a concussion and when you are OK to return to play.
•    Give yourself time to get better. If you have had a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have a second concussion. Second or later concussions can cause damage to your brain. It is important to rest until you get approval from a doctor or health care professional to return to play.
•    It is better to miss one game than the whole season.

How can athletes prevent a concussion?

Every sport is different, but there are steps you can take to protect yourself.
•    Follow your coach’s rules for safety and the rules of the sport.
•    Practice good sportsmanship at all times.
•    Use the proper sports equipment, including personal protective equipment (such as helmets, padding, shin guards, and eye and mouth guards). In order for equipment to protect you, it must be:
•    The right equipment for the game, position, or activity
•    Worn correctly and fit well
•    Used every time you play
•    Repaired and maintained






Student Signature: ____________________________________   Date:  ________________________________               

Parent/Guardian Signature: ___________________________________  Date:  ______________________________               


 
For more detailed information on concussion and traumatic brain injury, visit:
http://www.cdc.gov/injury or http://www.cdc.gov/concussion/HeadsUp/youth.html

IF YOU WANT TO ACCESS ALL FORMS FOR STUDENT SPORTS - CONCUSSIONS PLEASE CLICK THE PDF ICON AT THE TOP OF THIS PAGE.


















 
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