Concussion Information

First page of the PDF file: Head_Injury_Information-1

Sweet Home Central School District recognizes that concussion and head injuries are a leading cause of injuries in children and adolescents. Concussion is a type of traumatic brain injury that can go undetected and lead to physical and cognitive damage, if not death. We need your help in supporting our plan for prevention and detection so that your children are safe and can return to school and sport activities with optimum success.

Please take time to review the following information and visit the resource websites for further information on concussion and head injuries, signs and symptoms, and practices for prevention. Our coaches, athletic trainers and school nurses are making every effort to keep our students safe.

Students who are identified with concussion or head injury will be immediately removed from athletic/physical activities during and after the school day [for younger children this also includes playground activities], and may return to activities only after being symptom free for not less than 24 hours, undergone a medical evaluation, and submit a medical note to return to activities and resume academics. Grades 7-12 athletes will undergo a Return to Play Protocol before resuming any physical activity.

Concussion Management and Awareness Act

The Concussion Management and Awareness Act, specifically Chapter 496 of the Laws of 2011 (released last year for a 7-1-12 effective date) requires the Commissioner of Education, in conjunction with the Commissioner of Health, to promulgate rules and regulations related to students who sustain a concussion and directs school districts to adopt and implement rules and regulations for the treatment and monitoring of students who sustain a concussion, also known as a mild traumatic brain injury (MTBI) at school and at any district-sponsored event or related activity. These guidelines for return to school and certain school activities apply to all public school students who have sustained a concussion regardless of where the concussion occurred.

The law also requires that school coaches, physical education teachers, nurses, and certified athletic trainers complete a New York State Education Department (NYSED) approved course on concussions and concussion management every two years. Finally, the law requires that students who sustained, or are suspected to have sustained, a concussion during athletic activities be immediately removed from such activities. Students may not return to athletic activities until they have been symptom-free for a minimum of 24 hours and have been evaluated by, and receive written and signed authorization to return to activities from a licensed physician. Concussion Management and Awareness Act

Guidelines for Concussion Management in the School Setting

New York State Education Department Guidelines for Concussion Management in the School Setting document was released in late June 2012 and provides school district personnel, parents/guardians, students, and private health providers with information on concussion management in school settings. It explains the purpose of a concussion management program in schools and provides guidance for developing an effective program including planning, implementation, and follow-up protocols. This assists in identifying a student with a potential concussion, and insures that a student who has been diagnosed with a concussion receives the appropriate care and attention at school to aid in his/her recovery. New York State Education Department Guidelines for Concussion Management in the School Setting, June 2012

Head Injury Definition

A traumatic brain injury (TBI) is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The majority of TBIs that occur each year are concussions or other forms of mild TBI. A concussion is a type of TBI. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.

Head Injury And Concussion Policy

Any student who is observed to, or is suspected of, suffering a significant blow to the head, has fallen from any height, or collides hard with another person or object, may have sustained a concussion.

Symptoms of a concussion may appear immediately, may become evident in a few hours, or evolve and worsen over a few days. Concussions may occur at places other than school. Therefore, district staff members who observe a student displaying signs and/or symptoms of a concussion, or learn of a head injury from the student, should have the student accompanied to the school nurse. If there isn’t a school nurse, or he/she is unavailable, the school should contact the parent/guardian.

In accordance with the Concussion Management and Awareness Act, any student suspected of having a concussion either based on the disclosure of a head injury, observed or reported symptoms, or by sustaining a significant blow to the head or body must be removed from athletic activity and/or physical activities (e.g., PE class, playground activities, recess), and observed until an evaluation can be completed by a medical provider.

Head Injury Prevention

Protecting students from head injuries is one of the most important ways to prevent a concussion. Although the risk of a concussion may always be present with certain types of activities, education, proper equipment, and supervision help to minimize the risk. Instruction with school personnel, parents and students should include signs and symptoms of concussions, how such injuries occur, and possible long term effects resulting from such injury.

It is imperative that students know the symptoms of a concussion and to inform appropriate personnel, even if they believe they have sustained the mildest of concussions. This information should be reviewed periodically with student athletes throughout each season. It is extremely important that all students be made aware of the importance of reporting any symptoms of a concussion to their parent/guardian and/or appropriate district staff. District staff members must follow district emergency protocols and procedures for any student reporting signs and symptoms of injury or illness.

Emphasis must be placed on the need for medical evaluation should such an injury occur to prevent persisting symptoms of a concussion, and following the guidelines for return to school and activities.

Ways To Help Reduce The Risk Of Sustaining A Concussion:

Wear a seat belt every time you are driving or riding in a motor vehicle.
Never drive a vehicle, or ride with a driver under the influence of drugs including alcohol.
Wear appropriate safety equipment, such as properly fitted helmets when:

o Driving a bike, motorcycle, snow mobile, all-terrain vehicle (ATV);

o Using skates or a skateboard;

o Batting and running bases in baseball or softball;

o Horseback riding;

o Playing contact sports, such as football, soccer, hockey, boxing and lacrosse); or

o Skiing, snowboarding, and sledding.

Always use, during any athletic participation including practices and games, the recommended protective equipment fitted appropriately and maintained according to manufacturer’s recommendations.
Learn sport safety rules and follow proper measures for safe play.
Promptly and honestly report injuries to an adult.
Any student with a head injury must be removed from participation. The student will be referred to his/her health care provider for evaluation and follow-up, and will remain out of play until proper medical documentation is submitted.
Making living areas safer for children, by:

o Installing window guards to keep young children from falling out of open windows; and

o Using safety gates at the top and bottom of stairs for young children.

Making sure the surface on children’s playgrounds is made of shock-absorbing material, such as hardwood mulch or sand.

Concussion Symptoms include, but are not necessarily limited to:

Amnesia (e.g. decreased or absent memory of events prior to or immediately after the injury, or difficulty retaining new information)
Confusion or appearing dazed
Headache or head pressure
Loss of consciousness
Balance difficulty or dizziness, or clumsy movements
Double or blurry vision
Sensitivity to light and/or sound
Nausea, vomiting, and/or loss of appetite
Irritability, sadness or other changes in personality
Feeling sluggish, foggy, groggy, or lightheaded
Concentration or focusing problems
Slowed reaction times, drowsiness
Fatigue and/or sleep issues (e.g. sleeping more or less than usual)

Concussion Symptom Severity

Students who develop any of the following signs, or if the above listed symptoms worsen, must be seen and evaluated immediately at the nearest hospital emergency room:

Headaches that worsen
Seizures
Looks drowsy and/or cannot be awakened
Repeated vomiting
Slurred speech
Unable to recognize people or places
Weakness or numbing in arms or legs, facial drooping
Unsteady gait
Dilated or pinpoint pupils, or change in pupil size of one eye
Significant irritability
Any loss of consciousness
Suspicion of skull fracture: blood draining from ear, or clear fluid from nose

Student Evaluation of Head Injury/Concussion

The protocol for any student suspected of suffering a concussion is that first (s)he must be medically evaluated. Sweet Home Central School District’s Concussion Management Policy states that a student will not be allowed to return to sports, physical education, or playground activities until asymptomatic and medically cleared by a Health Care Provider.

Requirements of Evaluation And Medical Note

A. If a student is injured during school athletics, the student must have a medical note from a physician in order to return to activities, and it must be a physician to clear to return to activity.

Additionally, the school medical director must approve the student to resume participation in strenuous athletic activity.

For example, 16 year old varsity football player tackled in an afterschool game.

B. A student who sustains a concussion any where other than school athletics may return with clearance from any appropriate health provider [physician, NP, or PA]. A medical note is also required.

For example, 8 year old boy who fell off of home bunk bed, or 12 year old girl hit to the head in gym class with a soccerball, or a fall to the floor.

Definitions:

Physician* encompasses MD and DO.

Medical provider/health care provider is any of the appropriate providers-

Physician,
Nurse Practitioner (NP), or
Physician’s Assistant (PA).

Athletics means after school organized sports.

Student Athlete

Sweet Home Central School District uses a validated neurocognitive computerized testing concussion assessment tool [ImPACT (Immediate Post Concussion Assessment & Cognitive Testing) with athletes to obtain baseline and post-concussion performance data. SHCSD will follow approved guidelines from the American Academy of Pediatrics based on the Consensus Statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008.

Any Grade 7-12 student athlete participating in a district after school sport activity must have medical clearance for a head injury by a physician. The athlete will begin Return to Play Protocol and will resume physical education activities and sports once cleared by our Medical Director or delegate.

The SHCSD Medical Director has ultimate charge and final responsibility in clearing a student for physical activity/sports participation. The Medical Director remains the final authority and any memorandum does not negate this responsibility.

The Return To Play Protocol

As recommended by the New York State Public High School Association (NYSPHAA), the athlete who sustains a head injury must complete all six phases of a Return To Play Protocol in order to return to play. An athlete may progress to the next phase of the protocol provided (s)he stays asymptomatic. If symptoms return, the athlete must stop activity. The athlete will return to the previous phase of the protocol. The athlete only advances or progresses to complete the next phase if (s)he is asymptomatic for 24 hours.

Post Concussion Management

Students who have been diagnosed with a concussion require both physical and cognitive rest. Delay in instituting medical provider orders for such rest may prolong recovery from a concussion. Private medical provider’s orders for avoidance of cognitive and physical activity and graduated return to activity should be followed and monitored both at home and at school.

The District’s medical director will be consulted if further discussion and/or clarification is needed regarding a private medical provider’s orders, or in the absence of private medical provider orders.

Children and adolescents are at increased risk of protracted recovery and severe, potential permanent disability (e.g. early dementia also known as chronic traumatic encephalopathy), or even death if they sustain another concussion before fully recovering from the first concussion. Therefore, it is imperative that a student is fully recovered before resuming activities that may result in another concussion. Best practice warrants that, whenever there is a question of safety, a medical professional err on the side of caution and hold the athlete out for a game, the remainder of the season, or even a full year.

Head Injury And The Classroom

Teachers can assist students in their recovery from a concussion by making accommodations that minimize aggravating symptoms so that the student has sufficient cognitive rest. Teachers should refer to district protocols and private medical provider orders in determining academic accommodations. Section 504 plans may need to be considered for some students with severe symptoms requiring an extended time frame for accommodations.

Teachers should be aware of the processing issues a student with a concussion may experience. A student who has a concussion will sometimes have short-term problems with attention and concentration, speech and language, learning and memory, reasoning, planning, and problem solving.