1 Medical management of sports-related concussion continues to evolve. Recently, there has been a significant amount of new research regarding sports-related concussions in high school athletes, including the July 19, 2010 Massachusetts General Law regarding interscholastic athletic head injury safety training program. The Athletic Department has established this protocol to provide education about concussion for coaches, parents and athletes. This protocol outlines procedures for staff to follow in managing concussions, and outlines school policy as it pertains to return to play issues following a concussion. The Athol-Royalston Regional School District seeks to provide a safe return to activity for all athletes following any injury, but particularly after a concussion. In order to effectively and consistently manage these injuries, procedures have been developed to aid in insuring that concussed athletes are identified, treated and referred appropriately. The athletic department shall review this protocol annually. Any changes or modifications will be reviewed and given to athletic department staff, including coaches and other appropriate school personnel in writing. All athletic department staff shall attend a yearly in-service meeting in which procedures for managing sports-related concussion are discussed. Concussion Information: Additional to the Massachusetts General Law regarding Head Injuries, the Massachusetts Interscholastic Athletic Administration (MIAA) Board of Directors adopted a policy concerning concussions. This policy applies to all member schools including Athol High School and Athol-Royalston Middle School. The MIAA policy reads, ANY ATHLETE WHO EXHIBITS SIGNS, SYMPTOMS,OR BEHAVIORS CONSISTENT WITH A CONCUSSION (SUCH AS LOSS OF CONSCIOUSNESS,HEADACHE, CONFUSION, OR BALANCE PROBLEMS) SHALL BE IMMEDIATELY REMOVEDFROM THE CONTEST OR PRACTICE AND SHALL NOT RETURN TO PLAY UNTIL CLEARED BY ANAPPROPRIATE HEALTH CARE PROFESSIONAL. Any head injury can be a serious life threatening condition. It is important that the athlete and parent/guardian, pay careful attention to these symptoms: Recognition of Concussion Signs (observed by others): Athlete appears dazed or stunned Confusion Forgets plays Unsure about game, score, opponent Moves clumsily (altered coordination) Balance problems Personality change Responds slowly to questions Forgets events prior to hit Forgets events after the hit Loss of consciousness (any duration) Symptoms (reported by athlete): Headache Fatigue Nausea or vomiting Double vision, blurry vision Sensitive to light or noise Feels sluggish Feels foggy Problems concentrating Problems remembering These signs and symptoms following a witnessed or suspected blow to the head or body are indicative of probable concussion. Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest or practice and shall not return to play until cleared by an appropriate health care professional. (per MIAA rule, approved by MA Legislature in 2010).
2 Guidelines and Procedures for Coaches, Parents and Athletes RECOGNIZE REMOVE REFER Before season actions for coaches 1. Should become familiar with the signs and symptoms of concussion that are described above. 2. Must complete NIAAA Course: Concussion in Sports - What You Need To Know Certification must be renewed annually Before season actions for parents and athletes 1. Required to annually attend a Pre-Season Sports Parent-Athlete Meeting to be refreshed on Head Injury related policies, protocol and procedures information. 2. Complete the Pre-Participation Head Injury/Concussion Reporting Form Remove from activity Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional. When in doubt, sit em out Refer the athlete for medical evaluation 1. The coach is responsible to begin the Head Injury Procedures and Return to Play Protocol. 2. In the event that an athlete s parents cannot be reached, and the athlete is able to be sent home (rather than directly to MD): The coach should insure that the athlete will be with a responsible individual, who is capable of monitoring the athlete. The coach should continue efforts to reach a parent. If there is any question about the status of the athlete, or if the athlete is not able to be monitored appropriately, the athlete should be referred to an Emergency Department for evaluation. An adult should accompany the athlete and remain with the athlete until a parent arrives. Athletes with suspected head injuries should not be permitted to drive home. 3. Coaches should seek assistance from the host site certified athletic trainer (ATC) or team physician, if available at an away contest. P
3 Head Injury and Return to Play Protocol If any symptoms of concussions or head injuries occur during any phase of the recovery process, whether in school, practice, or at home, the coach, nurse, or health care provider needs to be notified. Athletes who have not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences from a second concussion injury. Such difficulties are prevented if the athlete is allowed time to recover from the concussion and return to play decisions are carefully made. No athlete should return to sport or other high risk activities when symptoms of concussion are present and recovery is ongoing. Don t Hide It! It is better to miss a few games than a whole season. The following procedures will be followed in the event an athlete receives a head injury *Athlete is removed from the contest or practice immediately. *The coach will notify parent/guardian and require follow up with athlete s health care provider. *The coach will notify the Athletic Director. *The Athletic Director will notify school nurse. *School nurse will contact athlete s teachers and guidance counselor. Any athlete exhibiting signs and or symptoms of a concussion will follow the Return to Play Protocol. Return to Play Protocol: Return to play will occur only after the following steps have been completed, in the order listed below: 1. Athlete may not participate in practice, play or Gradual Return to Play Plan until written clearance by an appropriate health care professional: physician (MD, DO), physicians assistant (PA), or nurse practitioner (NP). See form: ARRSD Head Injury Incident Form 2. If concussion is diagnosed by health care professional; athlete must complete Gradual Return to Play Plan. 3. Coach and Athletic Director meet to discuss the athletes Gradual Return to Play Plan. 4. Athlete returns to health care professional for Post Sports-Related Head Injury Clearance and Authorization Form 5. Athletic Director notifies coach of clearance and gives copies of the completed Head Injury Incident Form and Post Sports-Related Head Injury Clearance and Authorization Form to the School Nurse and Superintendants Office.
4 GRADUAL RETURN TO PLAY PLAN Return to play should occur in gradual steps beginning with light aerobic exercise only to increase your heart rate (e.g. stationary cycle); moving to increasing your heart rate with movement (e.g. running); then adding controlled contact if appropriate; and finally return to sports competition. Pay careful attention to your symptoms and your thinking and concentration skills at each stage or activity. After completion of each step without recurrence of symptoms, you can move to the next level of activity the next day. Move to the next level of activity only if you do not experience any symptoms at the present level. If your symptoms return, let your health care provider know, return to the first level and restart the program gradually. Day 1: Low levels of physical activity (i.e. symptoms do not come back during or after the activity). This includes walking, light jogging, light stationary biking, and light weight lifting (low weight, moderate reps, no bench, no squats). Day 2: Moderate levels of physical activity with body/head movement. This includes moderate jogging, brief running, moderate intensity on the stationary cycle, moderate intensity weight lifting (reduce time and or reduced weight from your typical routine). Day 3: Heavy non-contact physical activity. This includes sprinting/running, high intensity stationary cycling, completing the regular lifting routine, non-contact sport specific drills (agility with 3 planes of movement). Day 4: Sports specific practice. Day 5: Full contact in a controlled drill or practice. Day 6: Return to competition.
5 PRE-PARTICIPATION HEAD INJURY/CONCUSSION REPORTING FORM FOR EXTRACURRICULAR ACTIVITIES This form should be completed by the student s parent(s) or legal guardian(s). It must submitted to the Athletic Director, or official designated by the school, prior to the start of each season a student plans to participate in an extracurricular athletic activity. Student s Name Sex Date of Birth Grade School Sport(s) Home Address Telephone Has student ever experienced a traumatic head injury (a blow to the head)? Yes No If yes, when? Dates (month/year): Has student ever received medical attention for a head injury? Yes No If yes, when? Dates (month/year): If yes, please describe the circumstances: Was student diagnosed with a concussion? Yes No If yes, when? Dates (month/year): Duration of Symptoms (such as headache, difficulty concentrating, fatigue) for most recent concussion: AUTHORIZATION TO SHARE MEDICAL INFORMATION TO APPROPRIATE SCHOOL STAFF Parent/Guardian: Name: Signature/Date (Please print) Student Athlete: Signature/Date
6 HEAD INJURY INCIDENT FORM PART A: Part A of this incident form should be completed by the supervising coach of the athlete and then given to Parent/Guardian for initial visit to health care professional. Student s Name Sex Date of Birth Grade School Sport(s) Home Address Telephone Date of injury: Did the incident take place during an extracurricular activity? Yes No If so, where did the incident take place? Please describe nature and extent of injuries to student: I HEREBY STATE THAT TO THE BEST OF MY KNOWLEDGE, MY ANSWERS TO THE ABOVE QUESTIONS ARE COMPLETE AND CORRECT. Please circle one: Coach or Marching Band Director Parent/Guardian Name of Person Completing Form (please print): Signature Date PART B: Part B of this incident form to be completed by health care professional. Name of Physician or Practitioner: Physician Certified Athletic Trainer Nurse Practitioner Neuropsychologist Address: Phone number: Diagnosis: Concussion: Grade Level Other: The following are the return to sport recommendations at the present time: May not return to practice or competition at this time. Return to office in day(s). May return to practice and begin Gradual Return to Play Plan with the following restriction: May begin Gradual Return to Play Plan when clear of all symptoms for consecutive day(s). May return to full participation in practice and competition immediately without restrictions. Signature: Date:
7 POST SPORTS-RELATED HEAD INJURY MEDICAL CLEARANCE AND AUTHORIZATION FORM This medical clearance should be only be provided after a graduated return to play plan has been completed and student has been symptom free at all stages. The student must be completely symptom free at rest and during exertion prior to returning to full participation in extracurricular athletic activities. Student s Name Sex Date of Birth Grade Date of injury: Nature and extent of injury: Duration of Symptom(s): Diagnosis: Concussion Other: If concussion diagnosed, date student completed graduated return to play plan without recurrent symptoms: Prior concussions (number, approximate dates): TEST COMPLETION DATES FOR GRADUAL RETURN TO PLAY Test 1 Test 2 Test 3 Test 4 Test 5 I verify that has completed the five physical post-concussion tests and said Athlete s Name athlete was asymptomatic for all tests. Coach/Supervisor Signature Date HEALTH CARE PROFESSIONAL CLEARANCE Name of Physician or Practitioner: Physician Certified Athletic Trainer Nurse Practitioner Neuropsychologist Address: Phone number: Physician providing consultation/coordination (if not person completing this form): Will allow him/her to return to full sports/extracurricular activity. Will allow him/her to return to full sports/extracurricular activity with the following restrictions: Will NOT allow him/her to return to full sports/extracurricular activity until: Signature: Date: Note: This form may only be completed by: a duly licensed physician; a certified athletic trainer in consultation with a licensed physician; a duly licensed nurse practitioner in consultation with a licensed physician; a duly licensed neuropsychologist in coordination with the physician managing the student s recovery.
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