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Concussion Management Plan

Introduction

This document will outline the school district policies, protocols, and programs for prevention, identification, and management of sports-related concussion/mild traumatic brain injury (mTBI).

Background

A concussion is a traumatic brain injury (TBI) caused by a direct or indirect blow to the head or body. The Center for Disease Control and Prevention estimates that as many as 3.8 million sports and recreational relate concussions occur in the United States each year. In mid-November of 2011, Pennsylvania Governor Tom Corbett signed the Act of Nov. 9, 2011, P.L. 411, No. 101, known as the Safety in Youth Sports Act, into law. This law makes certain requirements of Pennsylvania schools and the personnel who supervise the student athletes who represent these schools, as well as the medical personnel who support them when there is an injury.

Policies

1.  Once each year, all coaches shall complete the concussion management certification training course offered by the Centers for Disease Control and Prevention, the National Federation of State High Schools Association (NFHS), or other provider posted on the website by the Pennsylvania Departments of Education and Health.

  1. A coach shall not coach an athletic activity until he/she completes the training course required.
  2. All coaches shall provide documentation of course completion to the school district.
  3. Any coach who violates this policy will be suspended from coaching any athletic activity for the remainder of that season. For a second violation, the coach will be suspended from coaching any athletic activity for the remainder of that school year. For a third violation, the coach will be permanently suspended form coaching any athletic activity (see Safety in youth Sports Safety Act).

2.  The school will hold an informational meeting prior to the start of each athletic season for all competitors regarding concussion management and demonstrate how pre-season baseline assessments can aid in the evaluation, management, and recovery process. These meetings will also include parents/guardians and coaches.

  1. Student athletes and parents will sign and return a statement acknowledging receipt, review, and understanding of information.
  2. Information includes a fact sheet, video, question and answer session with a trained medical professional, and other media as determined.

3.  All student athletes who participate in sports with a high risk of concussions will complete the ImPACT baseline neuropsychological testing prior to participation in any athletic activity. All other student athletes may elect to take the ImPACT baseline test if desired.

  1. High-risk sports
  2. Baseball
  3. Basketball
  4. Cheerleading
  5. Field events (shot put, discus, high jump, triple jump, long jump, pole vault)
  6. Football
  7. Softball
  8. Wrestling

4.  Authority is granted to game officials, coaches, athletic trainer, licensed physician, or other individuals trained in the recognition of the signs and symptoms of a concussion and designated by the school to determine if the student athletes exhibits signs or symptoms of a concussion or TBI.

5.  Once a student athlete has exhibited signs or symptoms of a concussion/TBI, he/she must be removed from participation. The student athlete cannot return to practice or play until he/she is evaluated and cleared for return to participation in writing by an appropriate medical professional (as defined in the Safety in Youth Sports Act) with training in the evaluation and management of concussions.

6.  All medical personnel authorized to make decisions on when the student athlete can return to play must complete, or have completed, training in evaluation and management of concussion.

Procedures

1.  Any student athlete who exhibits any of the signs or symptoms of a sports-related concussion or other head injury during practice or competition shall be removed from play immediately and may not return to play until he/she is evaluated and cleared for return to participation in writing by an appropriate medical professional (as defined by the Safety in Youth Sports Act).

  1. Signs of concussion (can be observed) include, but are not limited to:
  2. Appears dazed, stunned, or disoriented; demonstrates decreased alertness
  3. Forgets plays or demonstrates short term memory difficulty
  4. Slurs words
  5. Exhibits difficulties with balance or coordination
  6. Answers questions slowly or incorrectly
  7. Exhibits seizures or vomiting
  8. Changes in level of consciousness (estimates are that <10% of concussions result in a loss of consciousness)
  9. Symptoms of concussion (are reported by injured athlete) include, but are not limited to:
  10. Headache
  11. Nausea
  12. Balance problems or dizziness
  13. Double vision or changes in vision
  14. Sensitivity to light/noise
  15. Feeling sluggish or foggy
  16. Difficulty with concentration and short term memory
  17. Sleep disturbances
  18. Irritability of changes in personality and behavior
  19. Student athletes may exhibit or experience any combination of these signs and symptoms. These lists are not exhaustive of all signs and symptoms that may be experienced by an injured student athlete. No two injured student athletes may experience the same symptoms. A mechanism of injury must occur for suspicion of a concussion.

2.  Once a student athlete has been removed from competition or practices because of signs or symptoms of a concussion, the following Concussion Management Protocol must be followed:

  1. Emergency medical treatment should be pursued if the following occur:
  1. Requires immediate transport to nearest emergency department via EMS:
  2. Deterioration of neurologic function
  3. Decreasing level of consciousness
  4. Decrease or irregularity of respirations
  5. Decrease or irregularity of pulse
  6. Unequal, dilated, or un-reactive pupils
  7. Cranial nerve abnormalities
  8. Any signs or symptoms of associated injuries to the spine, skull fracture, or bleeding
  9. Mental status changes: lethargy, difficulty maintaining arousal, confusion, or agitation
  10. Seizure activity
  11. Vomiting
  12. Transport disposition is dependent at the athletic trainer’s assessment:
  13. Loss of consciousness on the field
  14. Amnesia lasting longer than 15 minutes
  15. Increase in blood pressure
  16. Motor deficits subsequent to initial on-field assessment
  17. Sensory deficits subsequent to initial on-field assessment
  18. Balance deficits subsequent to initial on-field assessment
  19. Cranial nerve abnormalities subsequent to initial on-field assessment
  20. Post-concussion symptoms that worsen
  21. Additional post-concussion symptoms as compared with those on the field
  22. Athlete is still symptomatic at the end of the game
  23. All appropriate school officials should be notified of the event, including the school physician, athletic trainer, athletic director, school nurse, school psychologist, school counselor, and student’s teachers.
  24. School officials must make contact with the student athlete’s parent/guardian to inform him/her of the suspected sports-related concussion or head injury.
  25. School officials shall provide the student athlete and the parent/guardian with information on the continuing care of a person with a concussion.
  26. The student athlete must be evaluated by an appropriate medical professional who is trained in the evaluation and management of concussions (as defined by the Safety in Youth Sports Act).
  27. The student athlete must receive written clearance from an appropriate medical professional trained in the evaluation and management of concussions that states the student athlete is asymptomatic at rest and may begin a graduated return-to-play protocol.
  28. When appropriate, a referral should be made to the regional BrainSTEPS Team. This team will consult with school teams and families in the development and delivery of educational services for the student who ahs suffered a concussion.

3.  Physical, cognitive, emotional, and social rest is advised while the student athlete is experiencing symptoms and signs of a concussion/TBI. This includes minimal mental exertion, limiting overstimulation, limit cell phone and computer usage, testing, video gaming, multi-tasking, physical exertion, etc.

4.  Return to play

  1. After written medical clearance is given by an appropriate medical professional, the student athlete may begin a graduated, individualized return-to-play protocol supervised by an athletic trainer, school/team physician, or, in cases where the aforementioned medical professionals are not available, a physician or licensed health care provider trained in the evaluation and management of sports-related concussions.
  2. Graduated return-to-play protocol to be followed:
  3. Completion of a full day of normal cognitive activities (school day, studying for tests, watching practice, interacting with peers, etc.) without re-emergence of any signs or symptoms. If no return of symptoms, next day progress to:
  4. Light aerobic exercise, which includes walking, swimming, or stationary cycling, keeping the intensity < 70% maximum predicted heart rate: no resistance training. The objective of this step is increased heart rate. If no return of symptoms, the next day advance to:
  5. Sport-specific exercise including running; no head impact activities. The objective of this step is to add movement and continue to increase heart rate. If no return of symptoms, next day advance to:
  6. Non-contact training drills (e.g. passing drills). The student athlete may initiate progressive resistance training. If no return of symptoms, next day advance to:
  7. Participation in normal training activities. The objective of this step is to restore confidence and to assess functional skills by the coaching staff. If no return of symptoms, next day advance to:
  8. Return to play involving normal exertion or game activity.
  9. If concussion symptoms recur during the graduated return-to-play protocol, the student athlete will return, at a minimum, to the previous level of activity that caused no symptoms, and the attending physician should be notified.
  10. Utilization of standardized tools, such as symptoms checklists, and comparison of post-injury performance to preseason baseline cognitive and balance testing are suggested.

5.  Return to Classroom

  1. Temporary learning support accommodations as directed by a physician or licensed health care provider trained in the evaluation and management of sports related concussions may be needed for a student athlete with a sports-related head injury to return to the classroom
  2. Students who return to school after a concussion may need to:
  3. Take rest breaks as needed.
  4. Spend fewer hours at school (shortened school day, as directed by physician).
  5. Be given more time to take tests or complete assignments.
  6. Receive help with schoolwork.
  7. Reduce time spent on the computer, reading, and writing.
  8. Be granted early dismissal from each class to avoid crowded hallways.
  9. No standardized testing (PSSA, SAT, etc.) during the initial recovery window of 2-4 weeks, if still experiencing signs and symptoms of a sports-related concussion.

Resources on Interscholastic Sports-Related Concussions and Head Injuries

I.  Internet resources

Centers for Disease Control and Prevention – Concussion Toolkit

http://www.cdc.gov/concussion/HeadsUp/physicians_tool_kit.html

http://www.cdc.gov/concussion/headsup/pdf/ACE-a.pdf

http://www.cdc.gov/concussion/headsup/pdf/ACE_care_plan_school_version_a.pdf

http://www.cdc.gov/concussion/headsup/pdf/Concussion_in_Sports_palm_card-a.pdf

National Federation of State High Schools Association – Online “Concussion in Sports” training program

www.nfhslearn.com

Brain Injury Association of Pennsylvania (BIAPA)

www.biapa.org

Pennsylvania Athletic Trainers’ Society (PATS)

www.gopats.org

National Collegiate Athletic Association (NCAA)

www.NCAA.org/health-safety

Pennsylvania Interscholastic Athletic Association (PIAA)

www.piaa.org

II.  Articles

“Consensus Statement on Concussion in Sport: 3rd International Conference on Concussion in Sport held in Zurich, November 2008”. Clinical Journal of Sports Medicine, Volume 19, May 2009, pp.185-200.

Halstead ME, Walter, KD and the Council on Sports Medicine and Fitness. “Clinical Report: Sport-related Concussion in Children and Adolescents.” Pediatrics, Volume 126, September 2010, pp.597-615.

McGrath, N. Supporting the student/athlete’s return to the classroom after a sport-related concussion. Journal of Athletic Training. 2010;45(5):492-498.

Kutcher, J, Eckner, J (2010). At-risk population in sports-related concussion. Current Sports Medicine Reports, 9(1), 16-20.

Grady, M (2010). Concussion in the Adolescent Athlete. Current Problems in Pediatric and Adolescent Health Care. 40(7), 1540169.