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Iroquois Central School District Concussion Management Policy And Protocol
Concussion in Youth Sports is a free, online course available to coaches, parents, and others helping to keep athletes safe from concussion. It features interviews with leading experts, dynamic graphics and interactive exercises, and compelling storytelling to help you recognize a concussion and know how to respond if you think that your athlete might have a concussion. Once you complete the training and quiz, you can print out a certificate, making it easy to show your league or school you are ready for the season.
The Board of Education of the Iroquois Central School district recognizes that concussions and head injuries are the most commonly reported injuries in children and adolescents who participate in sports and recreational activity. Therefore, the District adopts the following policy and protocol to assist in the proper evaluation and treatment of head injuries.
The information presented in this policy and protocol follows the American Academy of Neurology (AAN) Standards, National Federation of State High School Association (NFHS), New York State Public High School Athletic Association (NYSPHSAA) and National Athletic Trainers’ guidelines.
Concussion is a mild traumatic brain injury. Concussion occurs when normal brain functioning is disrupted by a blow or jolt to the head. Concussion, a common consequence of trauma to the head in contact sports, can also occur from collisions or falls in all forms of activity. Any sport has an inherent risk of injury. Recovery from concussion will vary. It is the goal of the Iroquois Central School District to educate and be educated on the objective assessment of the injured student and offer guidance about the safety of the students return to regular activity as indicated by professional parameters.
Any student demonstrating signs, symptoms or behaviors consistent with a concussion (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*. The student will be allowed to return to school and/or the activity ONLY when released by Iroquois School Head Physician. The Iroquois School District Chief Medical Officer will make the final decision on the students return to activity which includes Physical Education Class and any school related/sponsored sports or activities (this is in compliance with the State of New York Education Departments policy on students returning to activity after exhibiting the signs/symptoms of a concussion). A student who is diagnosed with concussion and receives medical permission to return to full activity but continues to have signs or symptoms MUST be removed from all sports/PE activity and reevaluated by an appropriate Health Care Professional.
*Appropriate Health Care Professional as per the New York State Education Department includes a NYS licensed medical doctor, Physician Assistant or Nurse Practitioner.
CONCUSSION PROTOCOL AND GUIDELINES
Concussion education will be provided for all administrators, teachers, coaches, school nurses, athletic trainers and guidance counselors. The Department of Athletics will provide parents/guardians with concussion education through preseason meetings for sports and/or printed informational packets. Education will include the definition of concussion, signs and symptoms, how concussions occur, reasons why concussions are not detected with CT or MRI scans, management of the injury and protocol for students to return to full activity in school. The protocol for students returning to school and to full activity after concussion applies to injuries sustained both during school sponsored activity and outside of school.
Concussion Management Team
The Iroquois Central School District will assemble a Concussion Management Team (CMT). This team will include the Districts Athletic Director, High School and/or Middle School Nurse, Athletic Trainer(s) and Chief Medical Officer. The CMT’s role includes concussion training coordination for all administrators, staff, coaches and parents/guardians on an annual basis, monitoring students diagnosed with concussion upon their return to school and communication between team members, parents/guardians and Health Care Professionals. Concussion training will be mandatory for all coaches, assistant coaches and volunteer coaches annually. Training coordination will include presentation of materials/information to parents/guardians at meetings prior to each sports season and on an as needed basis.
Concussion training will include the following information: signs and symptoms of concussions, post concussion and second impact syndromes, protocol for handling concussive injuries, protocol for students diagnosed with concussion returning to regular activity at school, and local area resources for concussion treatment and management.
Concussion Management Protocol
The Iroquois Central School district CMT will be responsible for training staff on proper evaluation of students suspected to exhibit signs and symptoms of concussion during the school day and/or during school sponsored activity.
Mental Status Testing
- Orientation – time, place, person and situation (circumstances of injury)
- Concentration – digits backward; Months of the year in reverse order
- Memory – recent newsworthy events; recall of 3 words and 3 objects at 0 and 5 minutes
- Tests – 40-yeard sprint; 5 pushups; 5 sit ups; 5 knee bends (observing for any appearance of associated symptoms, e.g. headaches, dizziness, nausea, unsteadiness, photophobia, blurred or double vision, emotional liability or mental status changes)
- Pupils - symmetry and reaction to light
- Coordination – finger-nose-finger, tandem gait
- Sensation – finger-nose (eyes closed) and Romberg
Guidelines for Returning To Activity Following a Concussion
These steps can be initiated once a student is cleared to return to activity by their private Health Care Practitioner.
Day 1: No exertional activity until medically cleared and asymptomatic for 24 hours.
Day 2: Begin low-impact activity such as walking, stationary bike, etc.
Day 3: Initiate aerobic activity fundamental to specific sport such as skating, running, etc.
Day 4: Begin non-contact skill drills specific to the sport the student participates in such as dribbling, ground balls, batting, etc.
Day 5: Full contact in (sport) practice setting.
Day 6: If the student remains without symptoms, he or she may return to play/PE activity.
*If the student experiences any symptoms during this stepwise process, they should drop back to the previous day’s activity and resume from there in 24 hours.
** Special note: The student must remain asymptomatic, without the use of pharmacological medicines/agents, to progress to the next day “return to activity” step.
Recovery varies from person to person. Factors that affect how quickly a person will recover include the severity of the concussion, the part of the brain that was injured, age, and the health of the person prior to the concussion.
Concussion Management and Protocol (added 2/4)
Iroquois school district follows N.Y.S. guidelines for concussion management in the school setting. We continue to monitor the advancements in testing and protocols for return to play. The district in 2011 sponsored a forum for parents and school districts in Section 6 and had Bud Carpenter head trainer for the Buffalo Bills as a speaker. The topic of concussions in sports has been thrusted into the lime light as of late, because of education and more public awareness. Currently, there are a few validated pretesting vehicles being utilized in the United States. The two most prominent are Impact and SCAT 2.
To date, neuropsychological testing has not been proven to diminish the risk of greater injury on return to play. In some studies there have been an upwards of thirty to forty percent false positive rates and almost the same comparable percentages for false negatives. What this means is that the testing is not as far along as it needs to be to have a significant impact on return to play. Even though the prevalence of such programs have increased, marketing can be a stronger component of want versus actual need. As the medical director for the district, I think it is prudent to consider moving in the direction of a pretesting program, however the ultimate question in doing so is whether or not we will improve the medical safety of our children by implementing one of the computerized pretesting systems. The major benefit of doing this would be to continue to educate and make the district more aware of traumatic brain injury and its management.
Neuropsychological pretesting can be part of the process, but all the disclaimers on these products state it shouldn’t be the sole determinant of a return to play policy. That determination should be done by a trained healthcare professional.
Dr. Robert Erickson
District Chief Medical Officer