CONCUSSION CHECKLIST FOR COACHES

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1 Sports Medicine CONCUSSION CHECKLIST FOR COACHES 1. Read through the material included in the Concussion Packet for Coaches 2. Know the signs and symptoms of a concussion 3. Send the following forms home to parents: a. Heads Up - Concussion in High School Sports A Fact Sheet for Parents b. Concussion Acknowledgment and Signature Form for Parents and Student Athletes 4. Hand out and discuss the Heads Up Concussion in High School Sports A Fact Sheet for Athletes with your student athletes 5. Ensure that parents and student athletes sign and return the Concussion Acknowledgement and Signature Form for Parents and Student Athletes 6. Ensure that a student athlete does not begin practice for an interscholastic or intramural sport until the Concussion Acknowledgement and Signature Form for Parents and Student Athletes is signed and on file with the coaching staff 7. Have a plan in place to identify and properly handle students that are suspected of having a concussion or head injury 8. Send all students for evaluation by a licensed health care provider trained in the evaluation and management of concussions and head injuries when a concussion or head injury is suspected 9. Require that the Concussion Evaluation and Release to Play Form for Licensed Health Care Providers is signed and on file with the coaching staff before the athlete can return to play 10. Ensure that the return to play schedule is followed per the guidelines outlined by the licensed health care provider trained in the evaluation and management of concussion and head injuries

2 Sports Medicine Coaches Education for Concussions 1. Log onto the Centers for Disease Control web site: 2. Click on the Take the free online concussion training for coaches button 3. Watch training video (approx. 30 minutes) 4. Take the post test 5. Type your name on the certificate, print it, and give to your athletic director by July 1st. ecommunity.com/sports

3 Sports Medicine CONCUSSION AND HEAD INJURY FACT SHEET FOR COACHES New Law A new law Student Athletes: Concussions and Head Injuries (IC ) will take effect on July 1, This law requires that schools distribute information sheets to inform and educate coaches, student athletes, and parents of student athletes concerning the nature and risk of concussion and head injury to student athletes, including the risks of continuing to play after concussion or head injury. The law requires that each year, before beginning practice for an interscholastic or intramural sport, a high school student athlete and the student athlete s parents must be given an information sheet, and both must sign and return a form acknowledging receipt of the information to the student athlete s coach. The law further states that a high school athlete who is suspected of sustaining a concussion or head injury in a practice or game, shall be removed from play at the time of injury and may not return to play until the student athlete has received a written clearance from a licensed health care provider trained in the evaluation and management of concussions and head injuries. Definition and Statistics A concussion is a type of brain injury that changes the way the brain normally works. A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. As many as 3.8 million sports- and recreation-related concussions occur in the United States each year. Common Causes The potential for concussions is greatest in athletic environments where collisions are common, but can occur with 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. Concussions can also result from a fall, or from players colliding with each other or with obstacles, such as goalposts. Examples of situations where a concussion could occur include a knock to the head from a fall, a jolt to the torso from a collision, a hit to the head from a stick or ball. Signs and Symptoms It is important to note that concussions can occur without loss of consciousness. If a student exhibits even one of the following signs or symptoms after a blow or bump to the head, a concussion should be suspected and the student should be removed from play and allowed to return to play only after a written release has been obtained by the licensed health care provider who evaluated the student. The signs of a concussion include that the student: 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

4 to hit or fall, or can t recall events after hit or fall. The symptoms of a concussion include the following complaints by the student: headache or pressure in the head, nausea or vomiting, balance problems or dizziness, double or blurry vision, sensitivity to light, feeling sluggish, hazy, foggy or groggy, concentration or memory problems, confusion or does not feel right. Danger Signs If even one of the following signs or symptoms are observed in a student, it should be considered a medical emergency and 911 should be called: one pupil larger than the other, drowsiness or inability to wake up, a headache that gets worse and does not go away, weakness, numbness, or decreased coordination, repeated vomiting or nausea, slurred speech, convulsions or seizures, inability to recognize people or places, increasing confusion, restlessness, or agitation, unusual behavior, or loss of consciousness (even a brief loss of consciousness should be taken seriously). Treatment Since all concussions can be serious, recognition and proper management of concussions when they first occur can help prevent further injury or even death. If you or your staff recognize any (even one) of the above symptoms, the player should be removed from play and assessed by a health care professional (athletic trainer or school nurse) if available. The parents or guardians of the athlete should be informed and the Heads Up parent fact sheet should be given. If the student continues to exhibit any (even one) of the signs or symptoms listed above, the athlete must be seen by a licensed health care provider trained in the evaluation and management of concussions and head injuries, and must receive a written clearance from the health care provider who evaluated the student in order to return to play. Rest is the usual treatment after a concussion or head injury has occurred. The student should return to play based on the treatment plan written by the licensed health care provider. Each student s treatment plan will be individually tailored based on the student s severity of head injury, underlying health condition and ability to resume activities. Typically after a concussion, activity is resumed slowly and gradually increased over time. The timing and speed with which each student returns to normal activity is individual, but follows the progression of beginning with light activity and increasing the activity slowly as the student can tolerate each step without experiencing any signs or symptoms of a concussion. While most athletes with a concussion recover quickly and fully, some will have symptoms that last for days, or even weeks. A more serious concussion can take months before the student is fully recovered. After a concussion, the brain needs time to rest and heal. That is why it is important that students not resume normal activities, especially athletic competition, too soon. If the student returns before his/her brain is healed, they are at increased risk for a second concussion or a longer recovery due to a reoccurrence of concussion signs and symptoms. A repeat concussion that occurs before the brain recovers from the first usually within a short time period (hours, days, or weeks) can slow recovery or increase the chances for long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage, and even death.

5 Action Plan for a Suspected Concussion 1. Remove the athlete from play. 2. Ensure that the athlete is assessed by a health care professional (athletic trainer or school nurse), if available. Do not try to judge the seriousness of the injury yourself. 3. Inform the athlete s parents or guardians about the possible concussion and give them the Heads Up Concussion in High School Sports A Fact Sheet for Parents. 4. Keep the athlete out of play the day of the injury and until a licensed health care provider trained in the evaluation and management of concussions and head injuries signs and returns the Concussion Evaluation and Release to Play Form for Licensed Health Care Providers. List of Forms Packet for Coaches Fact Sheet for Coaches (this sheet), Checklist for Coaches, Quick Reference Guide for Coaches, Q and A Sheet, List of Resources Heads Up Concussion in High School Sports A Fact Sheet for Parents Heads Up Concussion in High School Sports A Fact Sheet for Athletes Concussion Acknowledgement and Signature Form for Parents and Student Athletes Concussion Evaluation and Release to Play Form for Licensed Health Care Providers

6 Sports Medicine CONCUSSION QUICK REFERENCE GUIDE FOR COACHES Athletes who experience one or more of the signs and symptoms listed below after a bump, blow or jolt to the head or body may have a concussion. Symptoms Reported by Athlete Headache or pressure in head Nausea or vomiting Balance problems or dizziness Double or blurred vision Sensitivity to light Sensitivity to noise Feeling sluggish, hazy, foggy, or groggy Concentration or memory problems Confusion Just not feeling right or is feeling down Signs Observed by Coaching Staff 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 Action Plan for Coaches to Follow If you suspect that an athlete has a concussion, you should take the following steps: 1. Remove the athlete from play. 2. Ensure that the athlete is assessed by a health care professional, athletic trainer or school nurse, if available. Do not try to judge the seriousness of the injury yourself. 3. Inform the athlete s parents or guardians about the possible concussion and give them the Heads Up Concussion in High School Sports A Fact Sheet for Parents. 4. Keep the athlete out of play the day of the injury and until a licensed health care provider trained in the evaluation and management of concussions and head injuries signs a written clearance allowing the student to return to play. An athlete should receive immediate medical attention if s/he exhibits any of the following signs: One pupil larger than the other Convulsions or seizures Is drowsy or cannot be awakened Becomes increasingly confused, Repeated vomiting or nausea restless or agitated A headache that does not diminish, Has unusual behavior but gets worse Cannot recognize people or places Slurred speech Loses consciousness (a brief loss of Weakness, numbness, or decreased consciousness should be taken coordination seriously)

7 Sports Medicine CONCUSSION QUESTION AND ANSWER SHEET 1. Where can I find a copy of the new Concussion Law? The law is titled Student Athletes: Concussions and Head Injuries. It is listed under Indiana Code as IC and can be found at the following site: 2. Where can I find the forms and more information regarding this new law? The forms and information regarding this law can be found on the Indiana Department of Education Learning Connection under the community entitled IDOE Concussion and Head Injury in Student Athletes. 3. Does this law apply to all students? No, this law does not apply to all students. The law only applies to students that are in grades 9-12, who are participating in an interscholastic or intramural sport. 4. What is the definition of an interscholastic sport? An interscholastic sport is defined as one that is sanctioned by the Indiana High School Athletic Association (IHSAA). These include the following for boys: baseball, basketball, cross country, football, golf, soccer, swimming, tennis, track and wrestling; and for girls: basketball, cross country, golf, gymnastics, soccer, softball, swimming, tennis, track and volleyball. 5. What is the definition of an intramural sport? IHSAA states an intramural contest occurs when all participants on both teams are members of one school. 6. With regard to the Concussion Law, what other types of teams could be considered as an intramural sport? Any team, comprised of student athletes in grades 9-12, that is considered a schoolsponsored team or whose coach is paid, compensated or officially recognized by the school administrator would be considered as an intramural sport.

8 7. Is cheerleading considered an interscholastic or intramural sport? In Indiana, cheerleading is considered an intramural sport, and thus would apply under this law. In addition, cheerleading is recognized as an interscholastic sport at the federal level by the National Federation of High School Sports. 8. Are club sports considered intramural sports? Club sports would be considered as intramural sports if all the participants of both teams are members of one school, or if the coach of the club sport is paid, compensated or officially recognized by the school administrator. 9. What about other age students or those that do not fall under the legal definitions of this law? For a student athlete, of any age or sport, the recommendation would be for the adults in charge to take concussions and head injuries seriously. If a concussion or head injury is suspected for any student, the recommendation would be to remove the student from play, notify the student s parents and recommend that the student be evaluated by a licensed health care provider. 10. Does a student athlete have to lose consciousness for a concussion to be suspected? No, if a student athlete exhibits any of the signs or symptoms listed on the fact sheet, even if it is just one of the symptoms, he/she should be suspected of having a concussion. 11. What should be done if a student athlete does lose consciousness, even for a brief time, after a blow to the head or body? Losing consciousness is one of the danger signs when a concussion is suspected. A student athlete should receive immediate medical attention if after a bump, blow or jolt to the head or body he/she exhibits any of the danger signs listed on the fact sheet.

9 12. Can an athletic trainer do an initial assessment of a student athlete that has had a bump, blow or jolt to the head or body? Yes, if a student athlete has had a bump, blow or jolt to the head or body, the student may be assessed by an athletic trainer, if available. The athletic trainer can make a first assessment of the student athlete at the time of injury. If the student exhibits any of the danger signs associated with a concussion, the student athlete should receive immediate medical attention. If during this initial assessment, the student athlete does not exhibit any of the danger signs associated with a concussion, but does exhibit any (even one) of the signs or symptoms of a concussion, a concussion should be suspected. At that time, the student athlete should be removed from play, the athlete s parents should be notified, and the athlete should not return to play until he/she is evaluated by a licensed health care provider trained in the evaluation and management of concussions and head injuries, and the Concussion Evaluation and Release to Play Form for Licensed Health Care Providers is completed. 13. Can EMS personnel do an initial assessment for a student athlete that has had a bump, blow or jolt to the head or body? No, if EMS personnel are called to the scene, they will document the observed and reported signs and symptoms of the student athlete and provide care following the protocols established by their medical director. If called to the scene, EMS personnel will not determine whether a student athlete may return to play, but will transport a student athlete who is suspected of having a concussion or head injury to the nearest hospital. 14. Are there important legal considerations for the phrase licensed health care provider trained in the evaluation and management of concussions and head injuries? Yes, there are three distinct criteria a person must meet in order to qualify under this definition: Must have a license given by a governmental agency that regulates a specific profession Must be listed in Indiana Code as a health care provider Must have training in the evaluation and management of concussions and head injuries By law, for a person to be able to sign a written clearance in order for the athlete to return to play after a suspected concussion, the person must meet all three of the above criteria. 15. Can an athletic trainer write a written clearance to return to play for a student athlete who is suspected of having a concussion? No, an athletic trainer is a licensed health care professional who works under the direction of a licensed health care provider. Because an athletic trainer does not meet the criteria for the definition as a licensed health care provider, they are not allowed to write a written clearance for a student athlete to return to play following a concussion or head injury.

10 16. Can emergency medical personnel write a written clearance to return to play for a student athlete who is suspected of having a concussion? No, emergency personnel are certified not licensed health care providers. Emergency medical personnel (EMT s and Paramedics) do not meet the criteria for the definition as a licensed health care provider trained in the evaluation and management of concussions and head injuries. 17. What training is necessary for a licensed health care provider? If it requires special training how will I know who has that specialized training? The law states that the student athlete release to return to play form should be signed by a "licensed health care provider trained in the evaluation and management of concussions and head injuries". Several concussion specialists are offering training for health care providers who are interested in participating in their programs. However, there is no definition in the law of what constitutes a "trained" provider. Thus, it will be up to the individual health care provider to determine if he/she feels qualified or if he/she would rather refer the student to a specialist. Additionally, a parent could request a specialist or a second opinion if they felt this was needed. There are two programs that offer training for health care providers: Athletic Concussion Alliance - Indiana Sports Concussion Network If I have further questions regarding the Concussion Law, who could I contact? You may contact Jolene Bracale at the Indiana Department of Education. She can be reached at or

11 Sports Medicine CONCUSSION EVALUATION AND RELEASE TO PLAY FORM FOR LICENSED HEALTH CARE PROVIDERS (SECTION ONE: Completed by School Personnel) Student Name: Date: Sport s Team: Grade: Number of Past Concussions: Brief description by school personnel of how injury occurred and why concussion is suspected: (SECTION TWO: Completed by Licensed Health Care Provider) Per Indiana Code , a student athlete who is suspected of suffering a concussion may not return to play until the student athlete has been evaluated by a licensed health care provider trained in the evaluation and management of concussions and head injuries and receives a written clearance to return to play from the health care provider who evaluated the student athlete. Health Care Provider Name: License Number: Licensing Board: I have evaluated the above mentioned student athlete and the student athlete is: NOT cleared to participate in any sports-related activities (including gym class) until seen for a follow-up exam Cleared, as of today, to return to all activities, including sports, without restrictions Cleared to return to all activities, including sports, without restrictions, on the following date* - Cleared to return to sports following the schedule below: Step 1: May participate in light activity on the following date* - (10 minutes on an exercise bike, walking, or light jogging; but no weight lighting, jumping or hard running) Step 2: May participate in moderate activity on the following date* - (Moderate intensity activity on an exercise bike, jogging or weight lifting {reduced time and/or weight than normal}) Step 3: May participate in heavy; non-contact physical activity on the following date* - (Sprinting, running, high-intensity exercise bike, and weight lifting; but no contact sports) Step 4: May return to practice and full contact in a controlled practice setting on the following date* - Step 5: May return to full game play on the following date* - Other please list: * Please note that if signs and symptoms of a concussion occur, the student must return to the previous stage and parents must contact the licensed health care provider for instructions. (Signature of Health Care Provider) (Date)

12 Sports Medicine CONCUSSION - LIST OF RESOURCES INFORMATION 1. CENTERS FOR DISEASE CONTROL and PREVENTION (CDC) Concussion information Download or order free materials Information for coaches, athletes, parents, athletic trainers and school nurses Fact sheets in Spanish Free posters, fact sheets, clipboard stickers, wallet cards, magnets and tool kits Interactive media and video presentations 2. IHSAA PROTOCOL FOR IMPLEMENTATION OF NATIONAL FEDERATION OF STATE HIGH SCHOOL ASSOCIATIONS (NFHS) SPORTS PLAYING RULES FOR CONCUSSIONS Go to Quick Resources Go to Concussion Protocol 3. IHSAA CONTEST OFFICIAL S REPORT OF REMOVAL OF PARTICIPANT DUE TO POTENTIAL CONCUSSION Go to General Forms Go to Concussion Report CONCUSSION TRAINING COURSES 4. NATIONAL FEDERATION OF STATE HIGH SCHOOL ASSOCIATIONS (NFHS) CENTERS FOR DISEASE CONTROL and PREVENTION (CDC) INDIANA DEPARTMENT OF EDUCATION (IDOE) -

13 CONCUSSION ACKNOWLEDGEMENT AND SIGNATURE FORM FOR PARENTS AND STUDENT ATHLETES Sports Medicine Student Athlete s Name (Please Print): Sport Participating In (If Known): Date: Due to the new law Student Athletes: Concussions and Head Injuries (IC ), schools are now required to distribute information sheets to inform and educate student athletes and their parents of the nature and risk of concussion and head injury to student athletes, including the risks of continuing to play after concussion or head injury. The law requires that each year, before beginning practice for an interscholastic or intramural sport, a high school student athlete and the student athlete s parents must be given an information sheet, and both must sign and return a form acknowledging receipt of the information to the student athlete s coach. The law further states that a high school athlete who is suspected of sustaining a concussion or head injury in a practice or game, shall be removed from play at the time of injury and may not return to play until the student athlete has received a written clearance from a licensed health care provider trained in the evaluation and management of concussions and head injuries. Parent - please read the attached Heads Up Concussion in High School Sports A Fact Sheet for Parents and ensure that your child has also received and read Heads Up Concussion in High School Sports A Fact Sheet for Athletes. After reading these fact sheets, please sign below and ensure that your child also signs the form. Once signed, have your student athlete return this form to his/her coach. I am a student athlete participating in the above mentioned sport. I have received and read the Student Athlete Information Fact Sheet. I understand the nature and risk of concussion and head injury to student athletes, including the risks of continuing to play after concussion or head injury. (Signature of Student Athlete) (Date) I, as the parent or legal guardian of the above named student, have received and read the Parent Information Fact Sheet. I understand the nature and risk of concussion and head injury to student athletes, including the risks of continuing to play after concussion or head injury. (Signature of Parent or Guardian) (Date)

14 HEADS UP CONCUSSION IN HIGH SCHOOL SPORTS A FACT SHEET FOR PARENTS What is a concussion? A concussion is a brain injury. Concussions are caused by a bump, blow, or jolt to the head or body. Even a ding, getting your bell rung, or what seems to be a mild bump or blow to the head can be serious. What are the signs and symptoms? You can t see a concussion. Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days after the injury. If your teen reports one or more symptoms of concussion listed below, or if you notice the symptoms yourself, keep your teen out of play and seek medical attention right away. Signs Observed by Parents or Guardians 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 Symptoms Reported by Athlete Headache or pressure in head Nausea or vomiting Balance problems or dizziness Double or blurry vision Sensitivity to light or noise Feeling sluggish, hazy, foggy, or groggy Concentration or memory problems Confusion Just not feeling right or is feeling down How can you help your teen prevent a concussion? Every sport is different, but there are steps your teens can take to protect themselves from concussion and other injuries. Make sure they wear the right protective equipment for their activity. It should fit properly, be well maintained, and be worn consistently and correctly. Ensure that they follow their coaches' rules for safety and the rules of the sport. Encourage them to practice good sportsmanship at all times. What should you do if you think your teen has a concussion? 1. Keep your teen out of play. If your teen has a concussion, her/his brain needs time to heal. Don t let your teen return to play the day of the injury and until a health care professional, experienced in evaluating for concussion, says your teen is symptom-free and it s OK to return to play. 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 edema (brain swelling), permanent brain damage, and even death. 2. Seek medical attention right away. A health care professional experienced in evaluating for concussion will be able to decide how serious the concussion is and when it is safe for your teen to return to sports. 3. Teach your teen that it s not smart to play with a concussion. Rest is key after a concussion. Sometimes athletes wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don t let your teen convince you that s/he s just fine. 4. Tell all of your teen s coaches and the student s school nurse about ANY concussion. Coaches, school nurses, and other school staff should know if your teen has ever had a concussion. Your teen may need to limit activities while s/he is recovering from a concussion. Things such as studying, driving, working on a computer, playing video games, or exercising may cause concussion symptoms to reappear or get worse. Talk to your health care professional, as well as your teen s coaches, school nurse, and teachers. If needed, they can help adjust your teen s school activities during her/his recovery. If you think your teen has a concussion: Don t assess it yourself. Take him/her out of play. Seek the advice of a health care professional. It s better to miss one game than the whole season. For more information and to order additional materials free-of-charge, visit: June 2010 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION

15 HEADS UP CONCUSSION IN HIGH SCHOOL SPORTS A FACT SHEET FOR ATHLETES What is a concussion? A concussion is a brain injury that: Is caused by a bump, blow, or jolt to the head or body. Can change the way your brain normally works. Can occur during practices or games in any sport or recreational activity. 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. All concussions are serious. A concussion can affect your ability to do schoolwork and other activities (such as playing video games, working on a computer, studying, driving, or exercising). Most people with a concussion get better, but it is important to give your brain time to heal. What are the symptoms of a concussion? You can t see a concussion, but you might notice one or more of the symptoms listed below or that you don t feel right soon after, a few days after, or even weeks after the injury. Headache or pressure in head Nausea or vomiting Balance problems or dizziness Double or blurry vision Bothered by light or noise Feeling sluggish, hazy, foggy, or groggy Difficulty paying attention Memory problems Confusion What should I do if I think I 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 right away if you think you have a concussion or if one of your teammates might have a concussion. Get a medical check-up. A doctor or other health care professional can tell if you have a concussion and when it is OK to return to play. Give yourself time to get better. If you have a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have another concussion. Repeat concussions can increase the time it takes for you to recover and may cause more damage to your brain. It is important to rest and not return to play until you get the OK from your health care professional that you are symptom-free. How can I prevent a concussion? Every sport is different, but there are steps you can take to protect yourself. Use the proper sports equipment, including personal protective equipment. In order for equipment to protect you, it must be: - The right equipment for the game, position, or activity - Worn correctly and the correct size and fit - Used every time you play or practice Follow your coach s rules for safety and the rules of the sport. Practice good sportsmanship at all times. If you think you have a concussion: Don t hide it. Report it. Take time to recover. It s better to miss one game than the whole season. For more information and to order additional materials free-of-charge, visit: June 2010 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION

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