CONCUSSION POLICY POLICY

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1 CONCUSSION POLICY POLICY The NCAA has created guidelines stating the course of action to be followed in the event of a sports related concussion to student-athletes. Treatment of sports-related concussions will follow these guidelines, and include additional steps put in place by the UHealth Sports Medicine Concussion Team. Student-athletes will receive concussion education materials and sign an injury reporting acknowledgement stating their understanding of the responsibility they have to inform the Athletic Training Staff of concussion signs or symptoms. Each coaching staff member will sign an injury reporting acknowledgement form, and receive concussion education materials. Return to activity following concussion will follow the steps outlined in the University of Miami Department of Athletics Concussion Guidelines. PURPOSE To allow safe return to play for any student-athlete who has experienced concussion signs or symptoms. To follow the NCAA s guidelines for safe management and return to activity following concussion related episodes. PROCEDURE See the attached University of Miami Department of Athletics Concussion Guidelines document for all concussion procedures.

2 UNIVERSITY OF MIAMI DEPARTMENT OF ATHLETICS CONCUSSION GUIDELINES (Updated June 1, 2015) I. Baseline Testing and Concussion Education The University of Miami Department of Athletics will follow the below guidelines with regard to concussion and concussion management of student-athletes. A. Baseline testing will include ImPACT, a neurocognitive computerized baseline test, the Balance Error Scoring System (BESS), and the King-Devick remove-from-play sideline concussion screening test. These baseline tests will be conducted prior to the first practice or contact activity of the student-athlete s first semester of school at UM. 1. Per NCAA Guidelines, institutions should record a baseline assessment for ALL studentathletes prior to the first practice. The same baseline assessment tools should be used postinjury at appropriate time intervals. The baseline assessment should consider one or more of the following areas of assessment. a. The baseline assessment should consist of the use of a symptoms checklist and standardized cognitive and balance assessments (Balance Error Scoring System (BESS)). b. Additionally, neuropsychological testing (ImPact computerized test) has been shown to be effective in the evaluation and management of concussion. The development and implementation of a neuropsychological testing program should be performed in consultation with a neuropsychologist. Ideally, post injury neuropsychological test data should be interpreted by a neuropsychologist. B. All student-athletes will fill out a medical history including brain injury and concussion history which will be reviewed by the medical staff prior to their pre-participation physicals. C. All student-athletes will be examined by a general medical physician as well as an orthopedic physician as a part of their pre-participation examination. The physician will review each student-athlete s concussion history and will determine their participation clearance. D. During the returning physical examination process each year, student-athletes must read and sign a statement acknowledging that they accept the responsibility for reporting their injuries and illnesses to the institutional medical staff, including signs and symptoms of concussions. During the review and signing process, student-athletes will be presented with NCAA Concussion educational materials. a. Each student-athlete will repeat the Impact computerized exam and the King-Devick sideline assessment annually with their returning student-athlete physical, and will sign the acknowledgement annually. E. All UM coaches must read and sign the attached coaches statement acknowledging that they have read and understand the NCAA Concussion Fact Sheet, will encourage their student-athletes to report any suspected injuries and illnesses related to concussions, and that they accept the

3 responsibility for referring any student-athlete to the medical staff suspected of sustaining a concussion. Furthermore, the coach acknowledges they have read and understand the UM Concussion Guidelines. F. All UM Team Physicians (Primary care and Orthopedic), Athletic Trainers, Graduate Assistant Athletic Trainers and Undergraduate Athletic Training Students must read and sign the attached medical provider statement acknowledging that they will provide the UM student-athletes with the NCAA Concussion Fact Sheet and encourage their student-athletes to report any suspected injuries and illnesses to the medical staff, including signs and symptoms of concussions. Furthermore, the staff acknowledges they have read and understand the UM Concussion Guidelines. G. The Director of Athletics and all UM administrators must read and sign the attached administrators statement acknowledging that they have read and understand the NCAA Concussion Fact Sheet, will encourage their student-athletes to report any suspected injuries and illnesses related to concussions, and that they accept the responsibility for referring any studentathlete to the medical staff suspected of sustaining a concussion. Furthermore, the administrator acknowledges they have read and understand the UM Concussion Guidelines. II. NCAA Recommendations The NCAA Safeguards committee reaffirms its recommendation from December 2009 that an athlete exhibiting an injury that involves significant symptoms, long duration of symptoms or difficulty with memory function should not be allowed to return to play during the same day of competition and expands upon it by stating a student-athlete diagnosed with a concussion should not return to activity for the remainder of that day. Student-athletes that sustain a concussion outside of their sport should be managed in the same manner as those sustained during sport activity. The student-athlete should be monitored for recurrence of symptoms both from physical exertion and also mental exertion, such as reading, phone texting, computer games, working on a computer, classroom work, or taking a test. Healthcare professionals should assume a concussion when unsure and waiting for final diagnosis. When in doubt, sit the athlete out. Institutions should ensure healthcare professionals attain continuing education on concussion evaluation and management annually. Structured and documented education of student-athletes and coaches is also recommended to improve the success of the recognition and referral components of a consistent concussion management program. III. University of Miami Concussion Treatment and Return to Play Guidelines A. Concussions and other brain injuries can be serious and potentially life threatening injuries in sports. Research indicates that these injuries can also have serious consequences later in life if not managed properly. In an effort to combat this injury the following concussion management guidelines will be used for student-athletes suspected of sustaining a concussion. B. In the event a suspected concussion occurs, UM Athletic Trainers will: 1. Rule out cervical spine, skull fracture, intracranial bleed, or any other immediate lifethreatening injuries.

4 a. In the case any of these life-threatening injuries are suspected, the Athletic Trainer will immediately activate the Emergency Action Plan. The Athletic Training Staff will stabilize the student-athlete and monitor vital signs until Emergency Personnel arrives at the scene. b. Emergency Personnel will stabilize the student-athlete will transport the studentathlete to the nearest medical facility for further evaluation and treatment. 2. Perform a symptom assessment. a. If the student-athlete displays any of the following symptoms, the Emergency Action Plan should be activated: i. Glasgow Coma Scale <13 ii. Prolonged loss of consciousness iii. Focal neurological deficit iv. Repetitive emesis v. Persistently diminishing mental status 3. Administer the King-Devick test on the sideline or locker room. 4. The student-athlete shall be withheld from the competition or practice and not return to activity for the remainder of that day. 5. Have the student-athlete see the UM Team Physician for evaluation. 6. The student-athlete will receive serial monitoring for deterioration. Student-athletes will be provided with written instructions upon discharge; preferably with a roommate, guardian, or someone that can follow the instructions. 7. Complete a repeat ImPACT and BESS Test for the student-athlete (within hours of suspected concussion), as per the Team Physician s instructions. 8. Notify UM Department of Athletics Academics Services that the student-athlete has sustained a possible head injury. Academic Services will arrange daily meetings with the studentathlete to assess accommodations that may be necessary. 9. Refer the student-athlete, upon the recommendation by the UM Team Physicians, for further neurological evaluation to Dr. Kester Nedd and Dr. Gillian Hotz Ph.D. at UMH. 10. Follow the recommendations of Dr. Nedd and Dr. Hotz for return-to-play guidelines, along with any academic accommodations that may be necessary. 11. Monitor the student-athlete for recurrence of symptoms both from physical exertion and also mental exertion, such as reading, phone texting, computer games, working on a computer, classroom work, or taking a test. 12. The University of Miami will document the incident, evaluation, continued management, and clearance of the student-athlete with a concussion in the NExtt Solutions Injury Database.

5 13. Although sports currently have rules in place; athletics staff, student-athletes and officials should continue to emphasize that purposeful or flagrant head or neck contact in any sport should not be permitted and current rules of play should be strictly enforced. C. Return-To-Play Guidelines In order to be considered for return to play, the student-athlete must: 1. Follow the outlined guidelines by the Team Physician for management of his/her injury; 2. Be fully asymptomatic at rest, with exertional testing, and with supervised non-contact and contact sports-specific activities: Exertional guidelines allow for a gradual increase in volume and intensity during the return to play process. The student-athlete will be monitored for any concussion-like signs/symptoms during and after each exertional activity. If at any point during the process the student-athlete becomes symptomatic, the student-athlete should be re-assessed daily until asymptomatic. Once asymptomatic, the student- athlete should then begin the gradual increase in exertional exercise again. Each step should take approximately 24 hours. Graduated Return to Play from ZURICH Consensus Statement: a. No Activity: Complete and cognitive rest until asymptomatic. Objective is rest and recovery. b. Light aerobic exercise: Walking, stationary bike at >70% intensity. Objective is to increase heart rate. Example: 20 minute stationary bike ride evaluate for symptoms. c. Sport-specific exercise: Running, soccer/football drills etc. Objective is to add movement. Examples: Interval bike ride: 30 sec sprints 30 sec rest x 10 sprints - evaluate for symptoms; Bodyweight circuit: Squats, Push Ups, Sit-ups x 20sec x 3 - evaluate for symptoms. d. Non-contact training drills: More advance drills like passing drills, etc. May add resistance training. Objective is to add coordination and cognitive load with exercise. Examples: 60 yard shuttle run x 10 (40sec rest) and plyometric workout: 10 yard bounding, 10 medicine ball throws, 10 vertical jumps x 3, non-contact sport specific drills for approximately 15 minutes evaluate for symptoms. e. Full contact practice: Participate in normal training activities. Objective is to restore confidence and allow assessment of functional skills by coaching staff. Example: Limited, controlled return to full contact practice and monitoring for symptoms. f. Return-To-Play: No student-athlete can return to full practice activity or competitions until the student-athlete is asymptomatic in limited, controlled, and full-contact activities, and cleared by the Team Physician. Example: Full sport participation in a practice.

6 3. Be within normal baseline limits on all post-exertion assessments as determined by the team physicians; AND 4. Be cleared for participation by a University of Miami Team Physician. D. Return-to-Learn Guidelines 1. Once a student-athlete has sustained a concussion or head injury, the Athletic Trainer will notify the student-athlete s Academic Advisor in Academic Services, who will be the point person in notifying the student-athlete s professors 2. The student-athlete will be excused from all classroom activity the same day as the initial concussion, and may remain at home/dorm if light cognitive activity cannot be tolerated. 3. The Team Physicians, along with Dr. Hotz and Dr. Nedd at UMH Sports Medicine will determine what classroom accommodations may be necessary based on their evaluation and the student-athlete s symptoms. They will provide this information in writing, which will be sent to the Academic Advisor. 4. The Academic Advisor will notify all professors and will contact any other resources that may be necessary (e.g., learning specialists, office of disability services) in a manner that is compliant with ADAAA. 5. The student-athlete will follow-up with Team Physicians to progress the gradual return into classroom/studying. If the student-athlete is continuing to experience symptoms with academic work, the Team Physician will re-evaluate the accommodations necessary.. E. Student-Athlete With Prolonged Symptoms: 1. If a student-athlete is not able to complete the graduated return-to-play criteria, or if they have a recurrence of symptoms during the process, the student-athlete will follow-up with Dr. Hotz and Dr. Nedd at University of Miami Sports Medicine. a. Dr. Hotz and Dr. Nedd will consider other possible diagnosis, including but not limited to post-concussion syndrome, sleep dysfunction, migraines, mood disorders, or ocular or vestibular dysfunction. b. The student-athlete will perform all necessary testing and will follow-up per Dr. Hotz and Dr. Nedd s orders 2. The Athletic Trainer will notify Academic Services, and if necessary a note will be obtained from the physicians if any accommodations need to be made academically. 3. If a student-athlete has returned-to-play and develops recurrent symptoms or sustains any other head trauma, he/she will follow-up with the Team Physicians.

7 Concussion and Injury Reporting Acknowledgement Student-Athlete Concussion Statement I understand that it is my responsibility to report all injuries and illnesses to my athletic trainer and/or team physician. I have read and understand the NCAA Concussion Fact Sheet. After reading the NCAA Concussion Fact Sheet, I am aware of the following information (please initial beside each statement): A concussion is a brain injury, which I am responsible for reporting to my team physician or athletic trainer. A concussion can affect my ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. If I suspect a teammate has a concussion, I am responsible for reporting the injury to my team physician or athletic trainer. I will not return to play in a game or practice if I have received a blow to the head or body that results in concussion-related symptoms. Following concussion the brain needs time to heal. You are much more likely to have a repeat concussion if you return to play before your symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage, and even death. Signature of Student-Athlete _ Date Printed name of Student-Athlete Date of Most Recent Impact Test ATC Signature

8 Concussion and Injury Reporting Acknowledgement Coaches Concussion Statement I have read and understand the UM Concussion Guidelines. I have read and understand the NCAA Concussion Fact Sheet. After reading the NCAA Concussion Fact Sheet and reviewing the UM Concussion Guidelines, I am aware of the following information (please initial beside each statement): A concussion is a brain injury, which student-athletes should report to the medical staff. A concussion can affect the student-athlete s ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. I will not knowingly allow the student-athlete to return to play in a game or practice if he/she has received a blow to the head or body that results in concussion-related symptoms. Student-athletes shall not return to play in a game or practice on the same day that they are suspected of having a concussion. If I suspect one of my student-athletes has a concussion, it is my responsibility to have that student-athlete see the medical staff. I will encourage my student- athletes to report any suspected injuries and illness to the medical staff, including signs and symptoms of concussions. Following concussion the brain needs time to heal. Concussed student-athletes are much more likely to have a repeat concussion if they return to play before your symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage, and even death. I am aware that every first-year student-athlete participating on specified UM teams must be baseline tested prior to participation in sport. These tests allow for comparison of symptoms, neurocognition and balance if the student-athlete were to become injured. I am aware that student-athletes diagnosed with a concussion will be assessed by the medical staff. Once symptoms have resolved the student-athlete will begin a graduated return to play guideline, following full recovery of neurocognition and balance. Signature of Coach Date Printed name of Coach

9 Concussion and Injury Reporting Acknowledgement Medical Provider Concussion Statement I have read and understand the UM Concussion Guidelines. I have read and understand the NCAA Concussion Fact Sheet. After reading the NCAA Concussion Fact Sheet and reviewing the UM Concussion Guidelines, I am aware of the following information (please initial beside each statement): A concussion is a brain injury, which student- athletes should report to the medical staff. A concussion can affect the student-athlete s ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. I will not knowingly allow the student-athlete to return to play in a game or practice if he/she has received a blow to the head or body that results in concussion-related symptoms. If I suspect one of my student-athletes has a concussion, it is my responsibility to have that student-athlete see the medical staff. I will encourage my student-athletes to report any suspected injuries and illness to the medical staff, including signs and symptoms of concussions. Following a concussion the brain needs time to heal. Concussed student-athletes are much more likely to have a repeat concussion if they return to play before your symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage, and even death. I am aware that every first-year student-athlete participating on specified UM teams must be baseline tested prior to participation in sport. These tests allow for comparison of symptoms, neurocognition and balance if the student-athlete were to become injured. I am aware that student-athletes diagnosed with a concussion will be assessed by the medical staff. Once symptoms have resolved the student-athlete will begin a graduated return to play guideline, following full recovery of neurocognition and balance. Signature of Medical Provider Date Printed name of Medical Provider

10 Concussion and Injury Reporting Acknowledgement Administrators Concussion Statement I have read and understand the UM Concussion Guidelines. I have read and understand the NCAA Concussion Fact Sheet. After reading the NCAA Concussion Fact Sheet and reviewing the UM Concussion Guidelines, I am aware of the following information (please initial beside each statement): A concussion is a brain injury, which student-athletes should report to the medical staff. A concussion can affect the student-athlete s ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. I will not knowingly allow the student-athlete to return to play in a game or practice if he/she has received a blow to the head or body that results in concussion-related symptoms. Student-athletes shall not return to play in a game or practice on the same day that they are suspected of having a concussion. If I suspect a student-athletes has a concussion, it is my responsibility to have that studentathlete see the medical staff. I will encourage student- athletes to report any suspected injuries and illness to the medical staff, including signs and symptoms of concussions. Following a concussion the brain needs time to heal. Concussed student-athletes are much more likely to have a repeat concussion if they return to play before your symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage, and even death. I am aware that every first-year student-athlete participating on specified UM teams must be baseline tested prior to participation in sport. These tests allow for comparison of symptoms, neurocognition and balance if the student-athlete were to become injured. I am aware that student-athletes diagnosed with a concussion will be assessed by the medical staff. Once symptoms have resolved the student-athlete will begin a graduated return to play guideline, following full recovery of neurocognition and balance. Signature of Administrator Date Printed name of Administrator

11 Balance Error Scoring System (BESS) Procedures- Athlete Name Examiner Date Athlete Position- Shoes off Roll pant legs above ankles Feet narrowly together Hands on the iliac crests Eyes closed Test Procedures / Patient Instructions- Test begins when the patient closes his/her eyes Patient is instructed to make any necessary adjustments in the event that they lost their balance and to return to the testing position as quickly as possible Test #1- Double Leg Stance (feet together) Test #2- Single Leg Stance (non-dominant foot; free leg should be bent to 90 degrees) Test #3- Tandem Stance (non-dominant foot in the rear; weight evenly distributed) 20 seconds per test Each test is performed on a firm surface (grass, turf, court, etc.) and a 10-cm-thick foam / unstable surface Balance Errors- Hands lifted off of iliac crests Opening eyes Step, stumble, or fall Moving hip into more than 30 degrees of flexion or abduction Lifting forefoot or heel Remaining out of testing position for more than five (5) seconds BESS Scoring- The number of balance errors (1 point per error) on each of the six (6) tests are added together for a total BESS Score SCORE CARD # ERRORS FIRM SURFACE FOAM SURFACE Double Leg Stance Feet together Single Leg Stance Non-Dominant foot Tandem Stance Non-Dominant foot in back Sub-Totals Total Score:

12 CO N C U S S I O A fact sheet for student-athletes N118 What is a concussion? A concussion is a brain injury that: Is caused by a blow to the head or body. From contact with another player, hitting a hard surface such as the ground, ice or floor, or being hit by a piece of equipment such as a bat, lacrosse stick or field hockey ball. Can change the way your brain normally works. Can range from mild to severe. Presents itself differently for each athlete. Can occur during practice or competition in ANY sport. Can happen even if you do not lose consciousness. how can i prevent a concussion? Basic steps you can take to protect yourself from concussion: Do not initiate contact with your head or helmet. You can still get a concussion if you are wearing a helmet. Avoid striking an opponent in the head. Undercutting, flying elbows, stepping on a head, checking an unprotected opponent, and sticks to the head all cause concussions. Follow your athletics department s rules for safety and the rules of the sport. Practice good sportsmanship at all times. Practice and perfect the skills of the sport. What are the symptoms of a concussion? You can t see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. Concussion symptoms include: Amnesia. Confusion. Headache. Loss of consciousness. Balance problems or dizziness. Double or fuzzy vision. Sensitivity to light or noise. Nausea (feeling that you might vomit). Feeling sluggish, foggy or groggy. Feeling unusually irritable. Concentration or memory problems (forgetting game plays, facts, meeting times). Slowed reaction time. Exercise or activities that involve a lot of concentration, such as studying, working on the computer, or playing video games may cause concussion symptoms (such as headache or tiredness) to reappear or get worse. What should i do if i think i have a concussion? Don t hide it. Tell your athletic trainer and coach. Never ignore a blow to the head. Also, tell your athletic trainer and coach if one of your teammates might have a concussion. Sports have injury timeouts and player substitutions so that you can get checked out. Report it. Do not return to participation in a game, practice or other activity with symptoms. The sooner you get checked out, the sooner you may be able to return to play. Get checked out. Your team physician, athletic trainer, or health care professional can tell you if you have had a concussion and when you are cleared to return to play. A concussion can affect your ability to perform everyday activities, your reaction time, balance, sleep and classroom performance. Take 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 have a repeat concussion. In rare cases, repeat concussions can cause permanent brain damage, and even death. Severe brain injury can change your whole life. it s better to miss one game than the Whole season. When in doubt, get checked out. For more information and resources, visit and Reference to any commercial entity or product or service on this page should not be construed as an endorsement by the Government of the company or its products or services.

13 CO N C U S S I O A fact sheet for coaches N216 The FacTs A concussion is a brain injury. All concussions are serious. Concussions can occur without loss of consciousness or other obvious signs. Concussions can occur from blows to the body as well as to the head. Concussions can occur in any sport. Recognition and proper response to concussions when they first occur can help prevent further injury or even death. Athletes may not report their symptoms for fear of losing playing time. Athletes can still get a concussion even if they are wearing a helmet. Data from the NCAA Injury Surveillance System suggests that concussions represent 5 to 18 percent of all reported injuries, depending on the sport. WhaT is a concussion? A concussion is a brain injury that may be caused by a blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head. Concussions can also result from hitting a hard surface such as the ground, ice or floor, from players colliding with each other or being hit by a piece of equipment such as a bat, lacrosse stick or field hockey ball. Recognizing a possible concussion To help recognize a concussion, watch for the following two events among your student-athletes during both games and practices: 1. A forceful blow to the head or body that results in rapid movement of the head; -AND- 2. Any change in the student-athlete s behavior, thinking or physical functioning (see signs and symptoms). signs and symptoms Signs Observed By Coaching Staff Appears dazed or stunned. Is confused about assignment or position. Forgets 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 before hit or fall. Can t recall events after hit or fall. Symptoms Reported By Student-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.

14 217 prevention and preparation As a coach, you 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 student-athletes: Educate student-athletes and coaching staff about concussion. Explain your concerns about concussion and your expectations of safe play to student-athletes, athletics staff and assistant coaches. Create an environment that supports reporting, access to proper evaluation and conservative return-to-play. Review and practice your emergency action plan for your facility. Know when you will have sideline medical care and when you will not, both at home and away. Emphasize that protective equipment should fit properly, be well maintained, and be worn consistently and correctly. Review the Concussion Fact Sheet for Student-Athletes with your team to help them recognize the signs of a concussion. Review with your athletics staff the NCAA Sports Medicine Handbook guideline: Concussion or Mild Traumatic Brain Injury (mtbi) in the Athlete. Insist that safety comes first. Teach student-athletes safe-play techniques and encourage them to follow the rules of play. Encourage student-athletes to practice good sportsmanship at all times. Encourage student-athletes to immediately report symptoms of concussion. Prevent long-term problems. A repeat concussion that occurs before the brain recovers from the previous one (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. if you ThinK your student-athlete has sustained a concussion: Take him/her out of play immediately and allow adequate time for evaluation by a health care professional experienced in evaluating for concussion. An athlete who exhibits signs, symptoms or behaviors consistent with a concussion, either at rest or during exertion, should be removed immediately from practice or competition and should not return to play until cleared by an appropriate health care professional. Sports have injury timeouts and player substitutions so that student-athletes can get checked out. if a concussion is suspected: 1. Remove the student-athlete from play. Look for the signs and symptoms of concussion if your student-athlete has experienced a blow to the head. Do not allow the student-athlete to just shake it off. Each individual athlete will respond to concussions differently. 2. Ensure that the student-athlete is evaluated right away by an appropriate health care professional. Do not try to judge the severity of the injury yourself. Immediately refer the studentathlete to the appropriate athletics medical staff, such as a certified athletic trainer, team physician or health care professional experienced in concussion evaluation and management. 3. Allow the student-athlete to return to play only with permission from a health care professional with experience in evaluating for concussion. Allow athletics medical staff to rely on their clinical skills and protocols in evaluating the athlete to establish the appropriate time to return to play. A return-to-play progression should occur in an individualized, step-wise fashion with gradual increments in physical exertion and risk of contact. 4. Develop a game plan. Student-athletes should not return to play until all symptoms have resolved, both at rest and during exertion. Many times, that means they will be out for the remainder of that day. In fact, as concussion management continues to evolve with new science, the care is becoming more conservative and return-to-play time frames are getting longer. Coaches should have a game plan that accounts for this change. it s better They miss one game Than The Whole season. When in doubt, sit Them out. For more information and resources, visit and Reference to any commercial entity or product or service on this page should not be construed as an endorsement by the Government of the company or its products or services.

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