Medina Valley Independent School District

MEDINA VALLEY INDEPENDENT SCHOOL DISTRICT

DEPARTMENT OF ATHLETICS

CONCUSSION MANAGEMENT PROTOCOL

APPROVED BY:

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James Stansberry

Superintendent of Schools, Medina Valley Independent School District

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Richard Russell

School Board President, Medina Valley Independent School District

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Steve Hale

Athletic Director, Medina Valley Independent School District

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Randy Neuman ATC, LAT

Athletic Trainer, Medina Valley Independent School District

MEDINA VALLEY INDEPENDENT SCHOOL DISTRICT

ATHLETIC DEPARTMENT

CONCUSSION MANAGEMENT PROTOCOL

PURPOSE:

This Concussion Protocol is to help the Medina Valley High School sports medicine staff treat suspected concussed student-athletes in an efficient and objective manner. By following this protocol, the high school will be able to provide efficient treatment to keep the student-athlete’s health primary and safe while also being able to assist the student-athlete to return to competition as quickly as possible following a concussion episode.

DESCRIPTION:

By utilizing the Consensus Statement on Concussion in Sport 3rd International Conference on Concussion in Sport Held in Zurich November 2008, along with the NCAA Executive Committee policy statement on April 30, 2010, and the UIL’s Health and Safety guidelines regarding concussions, Medina Valley High School will continue to keep the health, safety and welfare of its student-athletes foremost.

According to this protocol, the athletic training staff at Medina Valley High School will:

• Present educational materials to each student-athlete through the UIL required student safety training

• Educate the coaching staff of the concussion protocol and the coaches’ role within the protocol.

• Offer baseline ImPACT™ testing to student-athletes.

• Remove a student-athlete from a practice/competition if the student-athlete shows any signs, symptoms, or behaviors consistent with a concussion and evaluate by an athletic trainer or other qualified healthcare provider.

• Remove a student-athlete from a practice/competition for the remainder of the day if they are diagnosed with a concussion or, after evaluation and assessment, are suspected to have suffered a concussion.

• Provide written instructions for monitoring a student-athlete diagnosed with (or suspected of having sustained) a concussion to a parent or guardian, or another responsible person who is able to stay with the student-athlete and follow the instructions via the MVISD Concussion Release Form.

• Recommend that the student-athlete be evaluated by a physician and return-to-play following the medically supervised process as outlined in this program, or after a physician gives final authority for return-to-play as required by UIL

According to this protocol, the coaching staff at Medina Valley High School will:

• Complete all UIL-required training regarding concussion management.

• Remove a student-athlete from a practice/competition if they show any signs, symptoms, or behaviors consistent with a concussion and refer the student-athlete for evaluation by a qualified healthcare provider.

• Follow all participation restrictions that are placed on a student-athlete by a licensed athletic trainer, physician, or other qualified healthcare provider who has evaluated that student-athlete.

EVOLUTION:

This protocol as well as the issue of sports concussion management should be continually updated following established guidelines and new standards of care as they become available.

DEFINITION OF A CONCUSSION:

There are numerous definitions of a concussion available in medical literature. The universally expressed definition is that a concussion 1) is the result of a physical, traumatic force to the head and 2) that force is sufficient to produce altered brain function which may last for a variable duration of time. Chapter 38, Sub Chapter D of the Texas Education Code considers the following as appropriate to define a concussion:

“Concussion” means a complex pathophysiological process affecting the brain caused by a traumatic physical force or impact to the head or body, which may:

(A) Include temporary or prolonged altered brain function resulting in physical, cognitive, or emotional symptoms or altered sleep patterns; and

(B) Involve loss of consciousness.

CONCUSSION OVERSIGHT TEAM (COT):

The purpose of the concussion oversight team is to establish a return-to-play protocol, based on peer-reviewed scientific evidence, for a student’s return to interscholastic athletic practice or competition following the force or impact believed to have caused a concussion. The adopted protocol, at a minimum, shall adhere to the UIL Concussion Management Protocol, based on guidelines from the National Federation of State High School Associations, which have been mandated by the UIL Legislative Council and the UIL Medical Advisory Committee.

The Concussion Oversight Team for Medina Valley I.S.D. consists of the following members:

1) Jesse DeLee MD, Nix Health Foundation and Orthopedic surgeon specializing in knee and hip

2) Dr. Zack Stinson MD, Orthopedic Surgeon

3) Randy Neuman ATC, LAT; Athletic Trainer for Medina Valley I.S.D.

RESPONSIBLE INDIVIDUALS:

At every activity under the jurisdiction of the UIL in which the activity involved carries a potential risk for concussion in the participants, there should be a designated individual who is responsible for identifying student-athletes with symptoms of a concussion.

This will include the following:

A physician (will pertain to a Physician, on-site during Varsity home football games, when available, arranged by the MVISD Athletic Trainer), and a Licensed Athletic Trainer, employed by MVISD, with the appropriate training in the recognition and management of concussion in athletes.

In the event a designated physician or MVISD Athletic Trainer is not available, an MVISD coach, supervising the student-athlete, with appropriate training in the recognition of the signs and symptoms of a concussion in athletes.

When a Licensed Athletic Trainer is available, the Licensed Athletic Trainer will be the appropriate designated person.

The MVISD Licensed Athletic Trainer and all MVISD Coaches are provided the required training through the UIL and NFHS.

RESPONSE TO A SUSPECTED CONCUSSION:

A student shall be removed from an interscholastic athletic practice or competition immediately if one of the following persons believes the student might have sustained a concussion during the practice or competition:

A coach

A physician

A licensed health care professional (i.e. Licensed Athletic Trainer)

The student’s parent or guardian of another person with legal authority to make medical decisions for the student

Concussions can produce a wide variety of signs and symptoms. Signs and symptoms include the following, but are not limited to:

Signs Observed / Symptoms Reported by the Athlete
Appears dazed or stunned / Headache or “pressure” in the head
Is confused about assignments or position / Nausea or vomiting
Forgets and instruction / Balance problems or dizziness
Is unsure of game, score, or opponent / Double or blurry vision
Moves clumsily / Sensitivity to light
Answers questions slowly / Sensitivity to noise
Any loss of consciousness / Feeling sluggish, hazy, foggy, or groggy
Shows behavior or personality changes / Concentration or memory problems
Cannot recall events prior to hit or fall / Confusion
Cannot recall events after hit or fall / Does not “feel right”

In addition to undergoing questioning as whether or not the athlete is exhibiting the above mentioned signs and symptoms the athlete will also undergo:

Mental status testing:

Orientation – Example: anything the student athlete should know: Place, person, day of the week, situation (circumstances of injury), jersey number, cell phone number, home address, etc

Concentration – months of the year or days of the week in reverse order.

Memory – Ability to recall words, numbers, or letters.

Neurological Testing:

Manual strength testing

Checking for equal pupil size

Checking for nystagmus (uncontrolled, quick, or jittery eye movement)

Coordination Testing (finger to nose with eyes open and closed)

Balance – double leg stance with eyes closed, single leg stance with eyes closed

Exertional proactive testing:

40 yard sprint or repeat 20 yard sprints

Push ups

Sit ups

If a student athlete demonstrates signs or symptoms consistent with a concussion, the following plan will be implemented:

The student athlete shall be immediately removed from the game or practice (to include any weight training or conditioning sessions).
The student athlete will be evaluated by the MVISD Athletic Trainer or on-site Licensed Athletic Trainer, if available.
The parent or guardian of the student athlete will be notified and provided information about the possible concussion.
The MVISD Athletic Trainer will arrange, with the parent or another person with legal authority to make medical decisions for the student, appropriate evaluation by a physician.
If it is determined that a concussion has occurred, the student athlete shall not be allowed to return to participation that day regardless of how quick the signs or symptoms of the concussion resolve and shall be kept from activity until the following requirements have been met:
The treating physician has provided the parent/guardian of the student athlete and the athletic trainer a written statement indicating that, in the physicians professional judgment, it is safe for the student to return to play.
All steps of the Return to Play Protocol have been met.
The high school student athlete shall be symptom free for 24 hours prior to initiating the return to play progression. (Symptom free for 120 hours for middle school student athletes).
Progression continues at 24-hour intervals as long as the high school student athlete remains symptom free at each level. (Progression will be at 48-hour intervals for middle school student athletes).
If the student athlete experiences any post concussion symptoms during any stages of the return to play protocol, activity is discontinued and the student athlete must be re-evaluated by a licensed health care professional.
A coach of an interscholastic athletics team may not authorize a student’s return to play.

Return to Play Progression:

The Return to Play Protocol is a supervised progression of activities, based on a standardized protocol, following compliance with the above information. Progression will be initiated by the MVISD Athletic Trainer.

High school student athletes shall be symptom free for 24 hours prior to initiating the return to play progression. (120 hours for middle school student athletes)

Progress continues at 24-hour intervals as long as the high school student athlete is symptom free at each level. (48-hour intervals for middle school student athletes.)

If the student athlete experiences any post concussion symptoms during the return to activity progression, activity is discontinued and the student athlete must be re-evaluated by a licensed health care professional.

Phase 1: No exertional physical activity until the high school student athlete is symptom free for 24 hours (120 hours for middle school student athletes) and receives written clearance from a physician and submission of the required documentation following the concussion injury to the MVISD Athletic Trainer.

Phase 2:

Step 1: When the athlete completes Phase 1, begin supervised light aerobic exercise (5-10 minutes on an exercise bike, or light jog); no weight lifting, resistance training, or any other exercise.
Step 2: Supervised moderate aerobic exercise (15-20 minutes of running at moderate intensity in the gym or on the field without a helmet or other equipment).
Step 3: Non-contact training drills in full uniform. May begin supervised weight lifting, resistance training, and other exercises.
Step 4: Full contact practice or training.
Step 5: Full game play.

Full Return to Activity/Play:

In order for the student/athlete to be allowed to return to full practice/competition, the following criteria must be met:

All phases and steps of the above mentioned Return to Play Protocol must be completed with no recurrence of any signs or symptoms consistent with concussion.

All medical documentation must be on file in the athletic department including a note from the treating physician that states in his/her opinion the athlete is cleared to return to full activity with no restrictions.

Has filled out and returned the UIL Concussion Return to Play form with parent/guardian signature.

Has taken the ImPACT concussion post test. This applies to high school student/athletes only.