DCS Sport-Related Concussion Procedures & Guidelines

Dublin City Schools

Management of Sports-Related Concussions

Procedures & Guidelines

 

Dublin City School District, (DCS), has developed this protocol to educate coaches, school personnel, parents, and athletes about appropriate concussion management.  This protocol outlines procedures for staff to follow in managing concussions and outlines school policy as it pertains to return to learn and return to play issues following a concussion.

 

A safe return to activity protocol is important for both academic activity and physical activity, for all athletes following any injury, but it is essential after a concussion.  The following procedures have been developed to ensure that concussed athletes are identified, referred, and treated appropriately.  Consistent application of this protocol will ensure the athlete receives appropriate follow-up medical care and /or academic accommodations and ensures the athlete is fully recovered prior to returning to activity.

 

This protocol will be reviewed annually by DCS concussion management team.  Changes or modifications will be reviewed, and written notification will be provided to the athletic department staff, including coaches and other appropriate school personnel.

 

All athletic department administrative and coaching staff will be required to attend education programming to review and update procedures for managing sports-related concussions.

 

Recognition of Concussion

These signs and symptoms – following a witnessed or suspected blow or mechanical force to the head or body – are indicative of probable concussion.

 

Signs (observed by others):             Symptoms (reported by athlete)

Appears dazed or stunned                               Headache

Exhibits confusion                                          Fatigue

Forgets plays                                                   Nausea or vomiting

Unsure about game, score, opponent              Double vision, blurry vision

Moves clumsily (altered coordination)            Sensitive to light or noise

Balance problems                                            Feels sluggish

Personality change                                          Feels “foggy”

Responds slowly to questions                         Problems concentrating

Forgets events prior to hit                               Problems remembering

Forgets events after the hit

Loss of consciousness (any duration)

Slurred Speech

Any Abnormal Behavior

 

Any athlete who exhibits “a” sign(s), or behavior(s) or “any” symptom(s) consistent with a concussion must be removed immediately from the competition or practice and will not be allowed to return to play that day.  The athlete must be cleared by a physician or an appropriate licensed health care professional (per Ohio law, approved by Ohio Legislature in 2013) with knowledge in concussion management to reenter practice or play. *See Note.

 

 

 

 

 

 

 

Management and Referral Guidelines for All Staff

  1. The following situations indicate a medical emergency and require activation of the Emergency Medical System:
    1. Any athlete with a witnessed loss of consciousness (LOC) of any duration and is not stable (i.e. high symptom cascade or condition is worsening), should be transported immediately to nearest emergency department via emergency vehicle.
    2. Any athlete who has symptoms of a concussion and who is not stable (i.e., high symptom cascade or condition is worsening) is to be transported immediately to the nearest emergency department via emergency vehicle.
    3. An athlete who exhibits any of the following symptoms should be transported immediately to the nearest emergency department, via emergency vehicle:
      1. Deterioration of neurological function
      2. Decreased level of consciousness
  • Decrease or irregularity in respirations
  1. Any signs or symptoms of associated injuries, spine or skull fracture, or bleeding
  2. Mental status changes: lethargy, difficulty maintaining arousal, confusion, or agitation
  3. Seizure activity
  1. An athlete who is symptomatic but stable (not worsening) may be transported by his/her parents. The parents should be advised to contact the athlete’s primary care provider and/or seek care at the nearest emergency department on the day of the injury.

 

 

Guidelines and Procedures for Coaches/Athletic Trainer:

 

Recognize concussion

  1. All coaches/athletic trainers should become familiar with the signs and symptoms of concussion that are described above.
  2. All coaches/athletic trainers should become familiar with Ohio Law Guidelines for concussions.
  3. Training will occur for coaches of every sport.

 

Remove from activity

Any athlete who exhibits any signs, symptoms, or behaviors consistent with a concussion (such as LOC, headache, dizziness, confusion, or balance problems) must be removed immediately from the competition or practice and not allowed to return to play that day.  The athlete must be cleared by an appropriate licensed health care professional (LHCP) or physician that has completed and signed the OHSAA Medical Authorization for Concussion Return to Play form or other appropriate medical “release form”.

 

When in doubt, sit them out!

 

 

 

 

 

 

 

 

 

Refer the athlete for medical evaluation

  1. The coach/athletic trainer is responsible for notifying the athlete’s parents of the injury in a timely manner.
    1. Contact the parents to inform them of the injury. Depending on the injury, an emergency vehicle or the parents will transport the athlete from the event.  An assistant coach or adult designee will go with the athlete to the hospital if a parent is unavailable.
    2. In the event an athlete’s parents cannot be reached, and the athlete is able to be sent home (rather than transported directly to a medical facility):
      1. The coach/athletic trainer should ensure the athlete would be with a responsible adult, who is capable of monitoring the athlete and understanding the home care instructions, before allowing the athlete to leave.
      2. The coach/athletic trainer should continue efforts to reach a parent and also initiate contact with the parent’s emergency designee as listed on the athlete’s Emergency Medical Authorization form.
  • If there is any question about the athlete being monitored appropriately, a coach/athletic trainer or designated adult should remain with the athlete until a parent or parent’s emergency designee arrives.
  1. If at an away competition, the coach may seek assistance from the host site certified athletic trainer (ATC) or team physician.

 

 

Athletes with a suspected head injury should not be permitted to drive.

 

 

 

Follow Up Care of the Athlete during the School Day

 

Student Academic Support

 

Responsibilities of the Response to Intervention Team (RTI) after notification of student’s concussion:

 

School Nurse

  1. The student will be supported by school clinic staff as described below upon his/her return to school.
    1. The school nurse will follow a health support plan based on the athlete’s physician orders and parent directive.
    2. The school nurse or clinic aide may advise the student to come to the clinic should symptoms escalate or student require rest during the day.
    3. The school nurse will notify the Student Support Team Leader or designee so teacher notification and guidance notification can be initiated to provide student support.
    4. If warranted, a Parent Consent for Record Release Form (8330 F4a) will be provided to the parent for completion so a plan of care can be created by the physician and shared with the school.
    5. If an athlete is concussed during an activity not related to their assigned school sport, the nurse/clinic aide will share the information with the Athletic Trainer and Athletic Director when notified by the student/parent of the concussion.

 

 

 

 

 

 

School Counselor/Academic Skills teacher/RTI leader/IEP Chair/Attendance

  1. Notify student’s teachers and school counselor of the concussion injury upon notification of injury by medical documentation or athletic trainers documentation.
  2. Notify student’s Physical Education teacher and all teachers engaged in physical activity (Band, Theatre, Club advisors) any restrictions the student’s physician/athletic trainer has recommended for the student.
  3. Monitor the student’s progress and accompanying physician adaptations to the care plan. Updates will be sent by the athletic trainer after weekly physician evaluation.
  4. Continue communication with the student’s teachers, parents/guardians, etc. of any significant changes in the students plan to assure in school health care and academic accommodations stay current with the students evolving and changing concussion condition.

 

RETURN to LEARN (RTL) Procedures during and after Concussion

Return to Learn is an individualized process involving progressive reintroduction to cognitive function and academic schoolwork.  The process may include complete cognitive rest, relative cognitive rest, progressive academic engagement, full academic engagement and an academic recovery plan.

 

         School Counselor/Academic Skills teacher/RTI leader/IEP Chair

  1. Interview/Assess the student and recommend appropriate academic accommodations for students who are exhibiting symptoms of concussion. The student interview may include identifying academic competency areas and areas of concussion cognitive deficiency related to their academic schedule. Findings will be incorporated with physician directed academic accommodation plan provided by the parent.
  2. Communicate with teachers the incremental Return to Learn academic accommodation and/or plan for the student and teacher guidelines if there are ongoing student difficulties.
  3. Upon request, communicate with parents to educate, support, and inform parents of their child’s plan and progress so information can be conveyed to the physician regarding problem areas. Physician concussion assessment typically occurs in weekly assessments.
  4. When needed, communicate with physician after parent has filed Release of Information form to clarify issues of concern or help guide in academic accommodations.
  5. If the student’s symptoms significantly impact school attendance, work completion, testing, academic work and continues for 15 school days or longer and there is a need for ongoing support, notify the school counselor to arrange for an RTI meeting with the student, parents, RTI members, etc. in order to create any educational plans for the student as determined by the team.
  6. Return to LEARN and engaging the student in full academic engagement and academic recovery process can be a delicate process. The parent should be notified if symptoms reappear in this process so the parent may reengage physician follow-up.  All members of the RTI team should be notified of concussion student symptom relapse at this stage.  The student should be regressed to less rigorous academic activity that does not trigger symptoms if relapse occurs upon academic reentry.
  7. Create with the student the Return to Learn Plan including academic recovery progression when physician authorizes full academic recovery.

 

RETURN to PLAY (RTP) Procedures after Concussion

 

Return to Play (RTP)Procedure after Concussion PLEASE NOTE:  return to play is a medical decision made by the attending physician and a parent.  Symptom free Return to Learn must precede Return to Play. A multitude of physician tools are utilized in Return to Play decisions.  They may include graded symptom scores, balance testing, neurological exam and abbreviated neuropsychological testing (ImPACT).  The athlete must meet all of the following criteria in order to progress to activity:

  1. Student must have established a pattern of full day school attendance
  2. Student must have an established pattern of successful full academic engagement symptom free
  3. Student must be independent of concussion medications designed to modify symptoms as directed by the physician. This includes prescribed concussion medications and parent initiated over the counter pain/other medications.

Return to Play

  1. Student must be symptom free at rest, with physical exertion and after physical exertion during the multi-step RTP progression.
  2. Student must be symptom free with the combination of full academic engagement and sport physical activity.
  3. Student must complete a documented full multi day, multi-step Return to Play progression individualized to the sport symptom free.
  4. Student must have a completed Medical Authorization to Return to Play form signed by the attending physician managing the concussion as directed by Ohio law.
  5. The student must have a “parent authorization to return to play form” signed (prior to entry into the five-step return to play protocol) confirming the parent’s knowledge the above criteria has been met and they are not aware of any symptoms or circumstances that should preclude reentry to sport.
  6. Parents will agree that if their child does not meet the above criteria or displays concussion symptoms after reentry to sport they will remove their child from sport activity and notify attending concussion physician, coach and/or athletic trainer and appropriate school personnel.
  7. Once the above criteria are met, the athlete will be progressed back to full activity following the step-wise process detailed below. A coach or Athletic Trainer must closely supervise this progression.  If you school does not have an athletic trainer, then the coach must have a detailed plan to follow as directed by the athlete’s physician.
  8. Progression is individualized and will be determined on a case-by-case basis. Factors that may affect the rate of progression include: previous history of concussion, duration and type of symptoms, age of the athlete, and sport/activity in which the athlete participates.  An athlete with a prior history of concussion, one who has had an extended duration of symptoms, or one who is participating in a collision or contact sport may be progressed at a slower rate.
  9. The stepwise progression is described below:

 

 

 

*With regards to the Dublin City Schools Management of Sports Related Concussion, a licensed health care professional (LHCP) is defined as a health care professional who has been deemed to have appropriate experience and licensure for the evaluation and treatment of concussion by the treating assigned team physician for that particular school.  The designated team physician for that school has the ultimate ability to suspend an athlete’s introduction into the return to play protocol if that particular team physician finds reason on medical grounds to do so.  As with any illness or injury, concussion is included in the Dublin City School’s conservative care approach protocol.