APW Board of Education Policy No. 7521

Adopted: January 10, 2013

Last Revised:  March 9, 2017

SUBJECT:   Concussion Management

The Board of Education of the Altmar-Parish-Williamstown Central School District recognizes that concussions and head injuries are commonly reported injuries in children and adolescents who participate in sports and recreational activities and can have serious consequences if not managed carefully.  Therefore, the District adopts the following policy to support the proper evaluation and management of head injuries.

A concussion is a mild traumatic brain injury.  Concussions occur when normal brain functioning is disrupted by a blow or jolt to the head.  Signs and symptoms of a concussion include, but are not limited to:  amnesia, confusion, dizziness, headache, loss of consciousness, nausea, poor attention, poor coordination, slurred speech, visual disturbance, and vomiting.  Recovery from a concussion will vary.  Avoiding re-injury and over-exertion until fully recovered are the cornerstones of proper concussion management.

While District staff will exercise reasonable care to protect students, head injuries may still occur.  Physical education teachers, coaches, school nurses, athletic trainers, and other appropriate staff will receive training to recognize the signs, symptoms and behaviors consistent with a concussion.  Any student exhibiting those signs, symptoms or behaviors while participating in a school sponsored class, extracurricular activity, or interscholastic athletic activity shall be removed from the game or activity and be evaluated as soon as possible by an appropriate health care professional.  In the event that there is any doubt as to whether a pupil has sustained a concussion, it shall be presumed that he or she has been so injured until proven otherwise.  The school nurse will notify the student’s parents or guardians and recommend appropriate monitoring to parents or guardians.  If the school nurse is not available at the time signs, symptoms, or behaviors consistent with a concussion are exhibited, the coach, athletic trainer, or staff member in charge of supervising the student will notify the student’s parents or guardians and recommend appropriate monitoring to them.

If a student sustains a concussion at a time other than when engaged in a school-sponsored activity, the District expects the parent/legal guardian to report the condition to the school nurse so that the District can support the appropriate management of the condition.

The student shall not return to athletic activity until authorized to do so by an appropriate health care professional. During the post-concussion period, a procedure for a coordinated communication plan among appropriate staff will be enacted to ensure that the private provider orders for post-concussion management are implemented and followed. 

Once authorized for return, the authorization will be kept on file in the pupil’s permanent health records. Absent a written recommendation by the student’s treating physician, the school’s physician will make the final decision on return to activity including recess, physical education class, and after-school sports.  Any student who continues to have signs or symptoms upon return to activity must be removed from play and reevaluated by their health care provider.

The Board further recognizes the importance of ensuring that a student who has suffered a concussion be provided time for cognitive rest as necessary.  As a result, a student who has sustained a concussion will be provided with appropriate safeguards and educational accommodations during the healing phase of their recovery.  Because of the short-term nature of concussion, a student may require significant short-term program modifications without the benefit of an IEP or 504 Plan already in place.  The District will ensure that any orders for cognitive rest during school hours or graduated return to classroom activity specified by such student’s physician are followed.

Education

Concussion education should be provided for all physical education teachers, coaches, school nurses, athletic trainers, and other relevant staff members on a biennial basis. Education of parents should be accomplished through preseason meetings for sports and/or information sheets provided to parents. Education should include, but not be limited to, the definition of concussion, signs and symptoms of concussion, how concussions may occur, practices regarding prevention of concussions, management of the injury and the protocol for return to school and return to activity or interscholastic athletics. The protocols will cover all students returning to school after suffering a concussion regardless if the accident occurred outside of school or while participating in a school activity.

Concussion Management Team

The District will assemble a concussion management team ( CMT ). The CMT may consist of an administrator, school physician, a school nurse, the athletic director, a physical education teacher, and at least one board appointed coach. The District’s CMT should oversee the training for all administrators, teachers, coaches and parents. Training should be mandatory for all coaches, assistant coaches and volunteers that work with student-athletes regularly. In addition, the CMT is responsible for reviewing and providing all the information related to concussions provided to student-athletes, parents and coaches. 

Parents must be made aware of the schools district’s policy and how these injuries will ultimately be managed by school officials.

Further, the Concussion Management Team will be integral in the periodic review of the Concussion Management policy and make recommendations for revisions as needed.

Training should include, but not be limited to, the definition of concussion, signs and symptoms of concussion, how concussions may occur, practices regarding prevention of concussions, management of the injury and the protocol for return to school and return to activity or interscholastic athletics. Particular emphasis should be placed on the fact that no student-athlete will be allowed to return to play the day of injury and also that all student-athletes must obtain appropriate medical clearance prior to returning to play or school. The CMT will serve as an as needed support for any student returning to school and/or play following a concussion. The CMT may review and/or design an appropriate plan for the student while the student is recovering. 

Return to Play Protocol Following a Concussion

The following protocol has been established in accordance to the National Federation of State High School Associations and the Third International Conference on Concussion in Sport, Zurich 2008.  The information contained herein serves as a guide to be implemented following a suspected concussion.  The Altmar-Parish-Williamstown Central School District reserves the right to develop more stringent protections at any time, and to act in a manner that is more cautious in protecting the health and well-being of its students.

When a student shows ANY signs or symptoms of a concussion:

1. The student will not be allowed to return to play in the current athletic activity, game, or practice.
2. The student’s general cognitive status should be determined by the school nurse, athletic trainer, or, if appropriate medical personnel are not available, the coach or District personnel responsible for supervising the student.
3.  The student should not be left alone, and regular monitoring for deterioration is essential over the initial few hours following injury.
4. Following the injury, the student shall be instructed to see his/her primary care physician or an emergency department physician within 24 hours.
5. Return to play must follow a medically supervised stepwise process.

The cornerstone of proper concussion management is rest until resolution of all symptoms. The decision to return to play should only be made by a qualified professional.  In general, athletes should not return to play after concussion until they are completely symptom free for a specific period of time.  The length of time depends on the athlete’s history, the severity of the injury and other factors. 

Return to participation shall be permitted upon completion of the following protocol or the student’s treating physician releases the student, in writing, to return to sports activity without restriction.

Pending clearance by the student’s treating physician and/or school physician and absent a recommendation to return to sports activity without restriction by the student’s treating physician, a graded program of exertion shall be completed before a return to sport.  The program is broken down into six steps in which only one step is covered a day.  The six steps involve the following:

•  Low impact, non-strenuous, light aerobic activity such as walking or riding a stationary bike. If tolerated without return of symptoms over a 24 hour period proceed to;
• Higher impact, higher exertion, and moderate aerobic activity such as running or jumping rope. No resistance training. If tolerated without return of symptoms over a 24 hour period proceed to;
• Sport specific non-contact activity. Low resistance weight training with a spotter. If tolerated without return of symptoms over a 24 hour period proceed to;
• Sport specific activity, non-contact drills. Higher resistance weight training with a spotter. If tolerated without return of symptoms over a 24 hour period proceed to;
• Full contact training drills and intense aerobic activity. If tolerated without return of symptoms over a 24 hour period proceed to;
• Return to full activities without restrictions.

If any symptoms recur, the student shall submit to an examination by his or her treating physician, receive written authorization from such physician to resume activity, rest for 24 hours, drop back to the previous step, and then resume the protocol.  In addition, the student should be monitored for recurrence of systems due to physical activity and/or mental exertion, such as reading, working on a computer, or taking a test.  Return to participation shall be permitted upon completion of the protocol.  Absent a recommendation by the student’s treating physician, the school’s physician will make the final decision on return to activity including recess, physical education class, and after-school sports.

Adopted: January 10, 2013

Amended: March 9, 2017