NFCSD Concussion Protocol

  • Pre-Season: 

    • Prior to all sports seasons, a baseline test using the ImPACT neurocognitive computer test is performed.
    • Test is administered by Certified Athletic Trainer (ATC) or the NFCSD Athletic Director.
    • Each student is required to complete this test prior to the season starting.
    • If any student has not completed the Impact Test, he/she is ineligible to participate until a test has been given.
    • The test is administered in conjunction with student athletes receiving a pre-participation (PPE) examination.
    • Baseline tests are repeated every other year prior to PPE’s.
    • ImPACT tests are done on ALL contact sport athletes in their Freshman and Junior years of High School in addition to those student athletes that will be participating in Modified football and/ or wrestling for the NFCSD. ImPACT testing will also be done on ALL boys and girls basketball players as well as cheerleaders.
    • When ImPACT test is completed, the student athlete will bring a confirmation printout from the ImPACT program back to the school nurse for notification of completion and clearance to receive PPE.

    In-Season: 

    • In the event that an athlete suffers a mechanism of injury and/or signs and symptoms of concussion, a sideline evaluation is performed.
    • SCAT5 will be utilized
    • If it is determined that any athlete is positive for signs and symptoms of concussion, he/she is to be immediately removed from that day’s contest and/or practice.
    • Student athletes are ineligible to return on the day of injury.
    • Parents/guardians are immediately contacted regarding injury.
    • Parents/guardians are given a head injury warning sheet of instructions to follow until the athlete is seen by primary care physician and/or emergency room.
    • Injury report is sent to school nurse, athletic office and guidance counselor/principal.
    • Within return to school, or ASAP, a post injury ImPACT test is performed (24-48 hours post-injury is optimal time frame).
    • Prior to the test, the list of signs and symptoms is reviewed by the medical professional.
    • This is done during each evaluation / re-evaluation during the recovery process. 

    Reports:  

    • Once the Post injury test has been completed, NFCSD school physician, school nurse, nurse practitioner and guidance counselor/principal are informed of the injured student athlete.
    • NFCSD school policy states that final release of a student to return to play is determined by the NFCSD school physician.
    • Student athletes MUST be evaluated by their Primary Care Physician and report the injury, but the NFCSD school Physician is the one to release students for return to play.
    • Once student athletes have returned to baseline level on the ImPACT test and are symptom free based on the SCAT5 evaluation, they may begin the return to play exercise progression initiated/approved by the NFCSD school physician.
    • The final ImPACT post-injury report will be sent to the school physician along with completed RTP exercise progression form for interpretation and possible clearance.

    Return To Play:

    • NFCSD follows the 2012 Zurich guidelines/concussion policy for return to play. (see Return to Play progression protocol form) (see 2012 Zurich guidelines)

    The return to play following a concussion incorporates a step-by-step process:

    1. No activity, complete rest.  Once asymptomatic for 24 hours, proceed to levels using the following steps:
    2. Light aerobic exercise such as walking or stationary cycling, no resistance training.
    3. Sport specific exercise (Skating in hockey, running in soccer, etc.) progressive addition of resistance training at steps 3 or 4.
    4. Non-contact training drills.
    5. Full contact training and/or exertional testing after medical clearance.
    6. Return to FULL Game play.
    7. This progression should be over 5 days for RTP without return of symptoms.
    • If a student suffers any return of symptoms during the RTP protocol, he/she must immediately stop the RTP protocol until he/she is once again symptom free.
    • Once the athlete is symptom free for 24 hours, he/she can continue with RTP process where he/she previously ended.
    • When a student completes the RTP, he/she is eligible for full release to game activity.
    • Completed RTP protocol form signed off by ATC is then sent to school physician for final approval and RTP (See Attachment A)

    Return to Learn:

    Stage 1-no activity: complete cognitive rest, no school attendance no homework, reading, texting, video/computer games or computer work for recovery of the injury.

    Stage 2-gradual re-introduction of cognitive activity: short 5-15 minutes at a time then relax to the restrictions of stage one. This gradual controlled increases the sub-symptom threshold of cognitive activities.

    Stage 3- catch up: the student can start to catch up on some school work by completing it at home in longer increments of 20-30 minutes at a time, the increase of cognitive endurance by repetition of short periods of self-paced cognitive activity.

    Stage 4-limited re-entry to school: finally re-entry to school for part of the day, this stage is initiated once 1-2 cumulative hours of homework has been achieved. The re-entry into school with accommodations to allow rest or a shorted day will assist in the controlled sub-symptom threshold and increased cognitive load.

    Stage 5- full day: starts a gradual reintegration into school increasing to a full day of school and classes, accommodations decrease as cognitive endurance improves.

    Stage 6- return to regular school activity: attendance of a full cognitive workload such as taking test and exams that were missed or currently expected, catch up with missed essential work, this is full recovery into the academic day and at this point a return to play protocol maybe initiated.

    The above policy will be followed by the healthcare professionals (school physician, nurse practitioners, school nurses, athletic trainer, athletic department) who manage the return to play of student athletes at local high schools and colleges that are under contract for athletic training services with NFMMC.  This concussion management/RTP protocol will be followed despite the athlete presenting a prescription note to RTP sooner from his/her primary care physician or Emergency Room.  If an athlete presents a prescription from his/her primary care physician to their school nurse for the appropriate time frame in regards to RTP, then the exertional progressive steps will be followed by the athletic trainer when given approval to start from the NFCSD Nurse practitioners using the RTP protocol from the SCAT5 form protocol.  The student athlete MUST see their school nurse after the injury has occurred and RTP progression MUST be initiated and approved by the District Nurse Practitioners prior to beginning.  See attached SCAT5 form (Attachment C).  NFCSD school physician MUST approve initiation of RTP protocol completed by school district’s athletic trainer.  The completed RTP protocol form (Attachment B) MUST be approved upon completion by the NFCSD school physician.

    Concussion Management Team (CMT)

    This section summarizes the responsibilities of each profession of the CMT along with the student and student-athlete as well as the parent/guardian of that student.  These responsibilities are explained in detail in the NYS Concussion Management and Awareness ACT that was enacted on July 1, 2012.  These components are to be installed by each profession within the CMT and reviewed on an annual basis.

    Student –  Review Concussion Information Sheet. Athletes must sign signature sheet.

    Parent/Guardian – Review District's Concussion Information Sheet. If child is an athlete, Concussion Information sheet must be signed.  Parent and athlete must receive and sign concussion information in order for athlete to participate

    School Administrator/Pupil Personnel Staff – Must share Concussion Information Sheet with parents and staff (this can be done via a letter to home for parents and an email to staff – Attachment A)

    Medical Director – Review and complete CDC’s Heads Up, Facts for Physicians About Mild Traumatic Brain Injury (MTBI, students with these conditions are at a higher risk for prolonged recovery from a concussion:

    http://www.cdc.gov/concussion/headsup/pdf/Facts_for_Physicians_booklet-a.pdf

    If school chooses to use ImPACT, school physician must be educated through ImPACT system to interpret ImPACT scores.

    Private Medical Provider/Specialists (Primary Care Physician) – If possible, review and complete CDC’s Heads Up, Facts for Physicians About Mild Traumatic Brain Injury (MTBI, students with these conditions are at a higher risk for prolonged recovery from a concussion:

    http://www.cdc.gov/concussion/headsup/pdf/Facts_for_Physicians_booklet-a.pdf

    We ask that notes from private medical providers that clear athletes from concussions include:  Clearance for RTP and an exercise progression.

    School Nurse – Must be knowledgeable on how to evaluate concussions – i.e. SCAT5 must complete the Department-approved course for school nurses and athletic trainers every two (2) years. NYSED has approved the course Heads Up to Clinicians for these professions, which is a free web-based course developed by the CDC. It is available at http://preventingconcussions.org/.

    Director of Physical Education And/or Athletic Director – Must implement/enforce concussion management program. Make sure everyone on the sports medical list has overseen the CMT and that all “CDC heads up education” has been completed bi-annually and tracked

    Certified Athletic Trainer - 

    - Must complete the Department-approved course for school nurses and athletic trainers every two (2) years. NYSED has approved the course Heads Up to Clinicians for these professions, which is a free web-based course developed by the CDC. It is available at http://preventingconcussions.org/.

    - In charge of bridging the concussion policy from athletics to general school population.

    Physical Education/Coach - 

    Responsible:

    • Remove any student who has taken a significant blow to head or body, or presents with signs and symptoms of a head injury immediately from play because the Concussion Awareness Management Act requires immediate removal of any student believed to have sustained a concussion.
    • Contact the school nurse or certified athletic trainer (if available) for assistance with any student injury.
    • Send any student exhibiting signs and symptoms of a more significant concussion (In red below) to the nearest hospital emergency room via emergency medical services (EMS) or as per District policy.
    • Symptoms of a concussion 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)

     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
    • Inform the parents/guardians of the need for evaluation by their medical provider. The coach should provide the parents/guardians with written educational materials on concussions along with the District’s concussion management policy.
    • Inform the PE director, certified athletic trainer, the school nurse and/or medical director of the student’s potential concussion. This is necessary to ensure that the student does not engage in activities at school that may complicate the student’s condition prior to having written clearance by a medical provider.
    • Ensure that the student diagnosed with a concussion does not participate in any athletic activities until, in conjunction with the student’s physician, the PE teacher/coach has received written authorization from the medical director or their designee that the student has been cleared to participate.
    • Ensure that the student diagnosed with a concussion does not substitute mental activities for physical activities unless medical provider clears the student to do so (e.g. Due to the need for cognitive rest, a student should not be required to write a report if he/she is not permitted to participate in PE class by their medical provider).

    Complete the Department-approved course for coaches and PE teachers every two years. NYSED has approved the course Heads Up, Concussion in Youth Sports for these professions, which is a free web-based course that has been developed by the CDC. It is available at http://www.cdc.gov/concussion/HeadsUp/online_training.html.

    Teacher –  Must review information listed below in this section.

    Students who have been diagnosed with a concussion require both physical and cognitive rest.

    Cognitive rest requires that the student avoid participation in, or exposure to, activities that require concentration or mental stimulation including, but not limited to:

    • Computers and video games
    • Television viewing
    • Texting
    • Reading or writing
    • Studying or homework
    • Taking a test or completing significant projects
    • Loud music
    • Bright lights

    Students transitioning into school after a concussion might need academic accommodations to allow for sufficient cognitive rest. These include, but are not necessarily limited to:

    • Shorter school day
    • Rest periods
    • Extended time for tests and assignments
    • Copies of notes
    • Alternative assignments
    • Minimizing distractions
    • Permitting student to audiotape classes
    • Peer note takers
    • Provide assignments in writing
    • Refocus student with verbal and nonverbal cues

     More information on classroom accommodations can be found at: http://www.upstate.edu/pmr/healthcare/programs/concussion/classroom.php http://www.nationwidechildrens.org/concussions-in-the-classroom

    http://www.cdc.gov/concussion/pdf/TBI_Returning_to_School-a.pdf

    Guidance Counselor/School Psychologist – Same as Teacher section (above)