CONCUSSION PROTOCOL

        A concussion is a reaction by the brain to a jolt or force that can be transmitted to the head by an impact or blow occurring anywhere on the body. Essentially, a concussion results from the brain moving back and forth or twisting rapidly inside the skull. The symptoms of a concussion result from a temporary change in the brain’s function. In most cases, the symptoms of a concussion generally resolve over a short period of time; however in some cases symptoms can last for weeks or longer. In a small number of cases, or in cases of re-injury during the recovery phase, permanent brain injury is possible. Children and adolescents are more susceptible to concussions and take longer than adults to fully recover. Therefore, it is imperative that any student who is suspected of having sustained a concussion be immediately removed from athletic activity (e.g., recess, PE class, sports) and remain out of athletic activities until evaluated and cleared to return to athletic activity by a physician.

IDENTIFICATION OF A CONCUSSION

        Any student who is observed to, or is suspected of, suffering a significant blow to the head, has fallen from any height, or collides hard with another person or object, may have sustained a concussion. Symptoms of a concussion may appear immediately, may become evident in a few hours, or evolve and worsen over a few days. Concussions may occur at places other than school. Therefore, district staff members who observe a student displaying signs and/or symptoms of a concussion, or learn of a head injury from the student, should have the student accompanied to the school nurse. If there isn’t a school nurse, or he/she is unavailable, the school should contact the parent/guardian. In accordance with the Concussion Management and Awareness Act, any student suspected of having a concussion either based on the disclosure of a head injury, observed or reported symptoms, or by sustaining a significant blow to the head or body must be removed from athletic activity and/or physical activities (e.g., PE class, recess), and observed until an evaluation can be completed by a medical provider. Symptoms of a concussion include, but are not necessarily limited to: 

  • Amnesia (e.g. decreased or absent memory of events prior to or immediately after the injury, or difficulty retaining new information)

  • Confusion or appearing dazed

  • Headache or head pressure

  • Loss of consciousness

  • Balance difficulty or dizziness, or clumsy movements

  • Double or blurry vision

  • Sensitivity to light and/or sound

  • Nausea, vomiting, and/or loss of appetite

  • Irritability, sadness or other changes in personality

  • Feeling sluggish, foggy, groggy, or lightheaded

  • Concentration or focusing problems

  • Slowed reaction times, drowsiness

  • Fatigue and/or sleep issues (e.g. sleeping more or less than usual)

       

        Students who develop any of the following signs, or if the above listed symptoms worsen, must be seen and evaluated immediately at the nearest hospital emergency room:

  • Headaches that worsen

  • Seizures

  • Looks drowsy and/or cannot be awakened

  • Repeated vomiting

  • Slurred speech

  • Unable to recognize people or places

  • Weakness or numbing in arms or legs, facial drooping

  • Unsteady gait

  • Dilated or pinpoint pupils, or change in pupil size of one eye

  • Significant irritability

  • Any loss of consciousness

  • Suspicion of skull fracture: blood draining from ear, or clear fluid from nose

RETURN TO PLAY

        There are many risks to premature return to play including: a greater risk for a second concussion because of a lower concussion threshold, second impact syndrome (abnormal brain blood flow that can result in death), exacerbation of any current symptoms, and possibly increased risk for additional injury due to alteration in balance. Return to physical activities following a concussion will involve a stepwise progression once the individual is symptom free. While the athlete is symptomatic, he or she will be medically excused from physical education classes, recess, and interscholastic athletics other recreational activities until the student is cleared to participate.

        These return to physical activities recommendations are based on the most recent international expert opinion (Consensus Statement on Concussion in Sport – The 3rd International Conference on Concussion in Sport, Zurich, and November 2008) and will remain in effect until new medically recognized guidelines have been established. The Return to Physical Activities Protocol (RTPAP) are as follows:

  • No student will be allowed to return to play without clearance from a medical professional and is cleared by the Chief Medical Officer.

  • The athlete must have a signed release by the treating clinician before she/he may begin the return to physical activities progression (RTPAP) (provided there are no other mitigating circumstances).

  • If any symptoms return during the RTPAP, the student will stop the protocol, wait until the symptoms subside and return to the previous level. The Certified Athletic Trainer and/or School Nurse along with the Chief Medical Officer will be notified if the student develops symptoms during the RTPAP.

  • The RTPAP will be performed by the Athletic Trainer; or a Physical Education teacher in cooperation with the School Nurse.

  • The Certified Athletic Trainer and/or School Nurse along with the Chief Medical Officer will be notified when the student successfully completes the RTPAP.

  • Any loss of consciousness, signs/symptoms lasting 7 days or longer or repeat concussions will require a minimum 7 day asymptomatic period and medical clearance before beginning the RTPAP and will be managed on an individual basis as approved by the CMO. The asymptomatic period for any concussion may be extended at the discretion of the CMO.

 

        The return to physical activities steps for interscholastic sports are as follows:

  •  Level I low impact, non-strenuous, light aerobic activity such as walking 

  • Level II higher impact, higher exertion, and moderate aerobic activity such as running or jumping rope; no resistance training

  • Level III sport-specific non-contact activity; low resistance weight training with a spotter

  • Level IV sport specific activity, non-contact drills; higher resistance weight training with a spotter

  • Level V full contact training skills and intense aerobic activity;

  • Level VI return to full activities without restrictions 

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