Shrewsbury High School · Shrewsbury High School Concussion Manual Table of Contents Pages 1-3 Section I: Development of Policy and Procedures Adopted by School Committee – February

ShrewsburyHighSchool

ConcussionManual

ShrewsburyHighSchoolConcussionManual

TableofContentsPages1-3 SectionI:DevelopmentofPolicyandProcedures AdoptedbySchoolCommittee–February20124-6 SectionII:ShrewsburyPublicSchools:AthleticConcussionPolicy AdoptedbySchoolCommittee–February20127-16 SectionIII:ShrewsburyPublicSchools:AthleticConcussionRegulations AdoptedbySchoolCommittee–February201217-20SectionIV:ShrewsburyHighSchool:ConcussionProtocol AdoptedbyDirectorofAthletics,AthleticTrainerandSchoolNurses–August2011

ShrewsburyPublicSchools_________________________________________________

ShrewsburyPublicSchools

ProceduresforHeadInjuriesandConcussioninExtracurricularAthletics

DevelopmentofPolicyandProceduresTheConcussionPolicyandProceduresforHeadInjuriesandConcussionweredevelopedaccordingto105CMR201.000byateamofShrewsburyPublicSchoolstaffconsistingof:CertifiedAthleticTrainer;AthleticDirector;DirectorofHealth,NursingandSafety;HighSchoolNurses;andDirectorofGuidance.ThedocumentswerereviewedbytheHPSschoolPhysician,HighSchoolandMiddleSchoolPrincipals,DirectorofPupilServices,teachers,andothermembersoftheSchoolHealth&SafetyAdvisoryCouncil.ThepersonresponsibleforimplementingpoliciesandprotocolsrelatedtoreturntoathleticsistheAthleticDirector.AConcussionteam,includingathletictrainer,schoolnurse,andguidancecounselor,willreviewstudentincidentsofconcussionanddevelopstudents’reentryplans,whichincluderesumptionofacademicsandathletics.Theseindividualswillmaintainregularcommunicationofinformationregardingstudentstatus,limitations,andprogressionwithinreentryplanafterconcussion.Theprocedureswillbereviewedandupdatedannuallyorasneeded.Trainingofindividualsinpreventionandmanagementofheadinjuriesandconcussion:Eachyear,theShrewsburyPublicSchools(AthleticDepartment)willprovidecurrenttrainingapprovedbytheMDPH,writtenmaterialsoralistandinternetlinksforDepartment-approvedon-linecoursestoallstudentswhoplantoparticipateinextracurricularathleticactivitiesandtheirparentspriortothestudents’participation.Annualtraininginthepreventionandrecognitionofsports-relatedheadinjury,andassociatedhealthrisksincludingsecondimpactsyndromewillalsobecompletedbySPSstaffandassociatedindividuals,includingcoaches,certifiedathletictrainers,trainers,volunteers,schoolsandteamphysicians,schoolnurses,AthleticDirectors,andDirectorofschoolmarchingband.DocumentationofcompletionofthisDPH-approvedannualtrainingwillbemaintainedbytheAthleticDirectorTeachertrainingrelatedtoimpactofconcussiononlearningandreentryplansforreturntoacademicswillbeprovidedonaone-timebasisandofferedasneededwhenrequestedandaslaws,regulationsorprotocolschange.

ShrewsburyPublicSchools_________________________________________________Requirementsforstudentsparticipatinginextracurricularathleticactivities:Documentationofaphysicalexaminationpriortoastudent’sparticipationinextracurricularathleticactivities(onePE/yearsufficientformultiplesportsseasons)willbereviewedbyHPSnurseorathletictrainerforeligibility(consistentwith105CMR200.100(B)(3):PhysicalExaminationofSchoolChildren).Priortostudentstartofathleticactivities,theAthleticDirectorwilldistributetoparentstheShrewsburyHighSchoolAthleticParticipationFormandwillmaintainarecordofcompletedforms.Studentsandtheirparents/guardiansmustsignthisformpriortostartingextracurricularathleticactivities.Reportingheadinjuriesorsuspectedconcussion:Athletictrainerand/orcoacheswillreportheadinjuriesand/orsuspectedheadinjuriestotheschoolnurseandcounselorassoonaspossibleafterinjury.Forheadinjuriesandsuspectedconcussionsoccurringduringtheschooldayandnonschool-sponsoredactivities,schoolnurse,guidancecounselorandotherschoolstaffwillreporttoeachotheraswellastoinformtheathletictrainer.Teacherswillbenotifiedwhenmedicaldiagnosisofconcussionisconfirmed.Stepswhenstudentsuffersheadinjuryandsuspectedconcussionduringpracticeorcompetition:Thecoachorathletictrainerremovesstudentfromplanandperformsassessmentforsignsandsymptomsofconcussion.Dependingontheseverityofsymptoms,thecoachorathletictrainerwillactivateEMS(forseveresymptoms),keepthestudentoutofplayandnotifyparents/guardians(mildtomoderatesymptoms),orreturntoplay(nosignorsymptomspresent).Thecoachorathletictrainerwillnotifyparentsimmediatelyinpersonorbyphoneifstudenthassignsorsymptomsofconcussion;followedbyinformationtoparentinwriting,paperorelectronically,bythenextbusinessday.(201.010C).Parentisprovidedtwoforms:1)ReportofHeadInjuryDuringSportsSeasonFormtobecompletedandsignedbythecoach,marchingbanddirector,orparent/guardian;and2)PostSports-RelatedHeadInjuryMedicalClearanceandAuthorizationFormtobecompletedandsignedbyadulylicensedphysician;acertifiedathletictrainerinconsultationwithalicensedphysician;adulylicensednursepractitionerinconsultationwithalicensedphysician;adulylicensedneuropsychologistincoordinationwiththephysicianmanagingthestudent’srecovery(105CMR201.011).

ShrewsburyPublicSchools_________________________________________________ThecoachordesigneecommunicatesbytheendofthenextbusinessdaywiththeAthleticDirectorandschoolnursethatstudenthasbeenremovedfrompracticeorcompetitionforaheadinjury,suspectedconcussion,signsandsymptomsofaconcussion,orlossofconsciousness.(201.010D).Stepsforstudentreturningtoacademicsafterconcussion:Thestudentwillbereturnedtoschoolandacademicspriortoresumingathletics.HPSnurseassessesstudentforpost-concussionsignsandsymptomsandcompletesreturntoacademicsprotocolchecklist(seesamplesfromOregon–tobemodified),includingcompletionofplanwithinstructionsformodificationsneeded.Thenursewillprovidethestudentwithacopyofthechecklisttogivetoteachersandwillcommunicatethisinformationtothecounselor,athletictrainerandteachers.Stepsforstudentreturningtoathleticsafterconcussion:Thestudentwillprovidetwoformstothecoach,athletictrainer,schoolnurseorcounselor:1)ReportofHeadInjuryDuringSportsSeasonFormcompletedandsignedbythecoach,marchingbanddirector,orparent/guardian;and2)PostSports-RelatedHeadInjuryMedicalClearanceandAuthorizationFormsignedbyadulylicensedphysician;acertifiedathletictrainerinconsultationwithalicensedphysician;adulylicensednursepractitionerinconsultationwithalicensedphysician;adulylicensedneuropsychologistincoordinationwiththephysicianmanagingthestudent’srecovery(105CMR201.011).Thereturntoplaydecisionmayalsoinvolvetheparents,schoolnurse,counselorsandteachersasappropriate.Uponreturntoacademicsinschool,theathletictrainerprovidesthestudent(andparent)asneededwritteninstructions,whichoutlineaprogressivesteppedapproachforgradualreturntoactivityandstepstotakeifsymptomsrecur(ConcussionProtocolReturn-To-PlayChecklist).


ATHLETICCONCUSSIONPOLICY

PURPOSEOFPOLICY&MASSACHUSETTSLAW:Thepurposeofthispolicyistoprovideinformationandstandardizedproceduresforpersonsinvolvedintheprevention,trainingmanagementandreturntoactivitydecisionsregardingstudentswhoincurheadinjurieswhileinvolvedinextracurricularathleticactivities(1)including,butnotlimitedto,interscholasticsports,inordertoprotecttheirhealthandsafetyasrequiredbyMassachusettslawandregulations.Therequirementsofthelawapplytoallpublicmiddleandhighschools,howeverconfigured,servinggradesixthroughhighschoolgraduation.Inadditiontoanytrainingrequiredbylaw,thefollowingpersonsshallcompleteoneoftheheadinjurysafetytrainingprogramsapprovedbytheMassachusettsDepartmentofPublicHealth(DPH)asfoundonitswebsite:

• Coaches;• Certifiedathletictrainers;• Trainers;• Volunteers;• Schoolandteamphysicians;• Schoolnurses;• Athleticdirectors;• Directorsresponsibleforaschoolmarchingband;• Employees• Studentswhoparticipateinanextracurricularactivityandtheirparents

Volunteersshallnotbeliableforcivildamagesarisingoutofanyactoromissionrelatedtotherequirementsoflaw,unlesssuchvolunteeriswillfullyorintentionallynegligentinhisactoromission.CONCUSSION:Moststudentathleteswhosustainaconcussioncanfullyrecoveraslongastheirbrainhastimetohealbeforesustaininganotherhit;however,relyingonlyonan_______________________(1)ExtracurricularAthleticActivitymeansanorganizedschoolsponsoredathleticactivitygenerallyoccurringoutsideofschoolinstructionalhoursunderthedirectionofacoach,athleticdirectorormarchingbandleader,butnotlimitedtoAlpineandNordicskiingandsnowboarding,baseball,basketball,cheerleading,crosscountrytrack,fencing,fieldhockey,football,golf,gymnastics,horsebackriding,icehockey,lacrosse,marchingband,rifle,rugby,soccer,skating,softball,squash,swimminganddiving,tennis,track(indoorandoutdoor),ultimateFrisbee,volleyball,waterpolo,andwrestling.Allinterscholasticathleticsaredeemedtobeextracurricularathleticactivities.

ShrewsburyPublicSchools_________________________________________________Athlete’sself-reportofsymptomstodetermineinjuryrecoveryisinadequateasmanyhighschoolathletesarenotawareofthesignsandsymptomsortheseverityconcussiveinjuriespose,ortheymayfeelpressurefromcoaches,parents,and/orteammatestoreturntoplayasquicklyaspossible.Oneormoreofthesefactorswilllikelyresultinunder-diagnosingtheinjuryandaprematurereturntoplay.MassachusettslawandMassachusettsDepartmentofPublicHealthregulationsmakeitimperativetoaccuratelyassessandtreatstudentathletewhenconcussionsaresuspected.Studentathleteswhoreceiveconcussionsmayappeartobe“fine”ontheoutside,wheninactualitytheyhaveabraininjuryandarenotabletoreturntoplay.Incurringasecondconcussioncanprovetobedevastatingtoastudentathlete.Researchhasshownthatyoungconcussedathleteswhoreturntoplaybeforethebrainhashealedarehighlyvulnerabletomoreprolongedpost-concussionsyndromeor,inrarecases,acatastrophicneurologicalinjuryknownasSecondImpactSyndrome.SCHOOLPROTOCOLS:ASchoolDepartmentprotocolwilldiscussandoutlinewhataconcussionis,themechanismofinjury,signsandsymptoms,managementandreturntoplayrequirements,aswellasinformationonSecondImpactSyndromeandpost-concussionsyndrome.Lastly,thisprotocolwilldiscusstheimportanceofeducationforourathletes,coachesandparentsandotherpersonsasrequiredbylaw.Thisprotocolwillbereviewedonayearlybasiswithallpertinentstafftoinformthemoftheprocedurestobefollowedtomanagesports-relatedconcussions.ThisprotocolwillalsobereviewedonayearlybasisbytheAthleticDepartmentaswellasbynursingstaff.AnnuallytheSchoolDepartmentwillreporttotheSchoolCommitteethenumberofconcussionsmonitored,generaloutcomesandarationaleforanychangesintheprotocol.RECORDKEEPINGBYDISTRICT:TheSuperintendentshallmaintainorcausetobemaintainedcompleteandaccuraterecordsofthedistrict’scompliancewiththerequirementsoftheConcussionLaw,andshallmaintainthefollowingrecordsforsevenyearsor,ataminimum,untilthestudentgraduates,unlessstateorfederallawrequiresalongerretentionperiod:


1. Verificationofcompletionofannualtrainingandreceiptofmaterials;2. DPHPre-participationformsandreceiptofmaterials;3. DPHReportofHeadInjuryForms,orschoolbasedequivalents;4. DPHMedicalClearanceandAuthorizationForms,orschoolbased

equivalents;and5. Graduatedreentryplansforreturntofullacademicandextracurricular

athleticactivities.AnychangesinthispolicywillbeapprovedbytheSchoolCommitteeandgiventoathleticstaff,includingcoachesandotherschoolpersonnel,inwriting.Anaccuratesynopsisofthispolicyshallbeplacedinstudentandfacultyhandbooks.UpontheadoptionofthispolicybytheShrewsburySchoolCommittee,theSuperintendentshallensurethatDPHreceivesanaffirmationonschooldistrictletterheadthatthedistricthasdevelopedpoliciesandtheSchoolCommitteehadadoptedafinalpolicyinaccordancewithlaw.ThisaffirmationshallbeupdatedbySeptember30,2013andeverytwoyearsthereafteruponrevieworrevisionofitspolicies.


ATHLETICCONCUSSIONREGULATIONS

SectionI.WhatisaConcussion?Aconcussionisdefinedasatransientalterationinbrainfunctionwithoutstructuraldamage,butwithotherpotentiallyseriouslong-termramifications.Intheeventofaconcussion,thebrainsustainsdamageatamicroscopiclevelinwhichcellsandcellmembranesaretornandstretched.Thedamagetothesecellsalsodisruptthebrainatachemicallevel,aswellascausingrestrictedbloodflowtothedamagedareaofthebrain,therebydisruptingbrainfunction.Aconcussiontherefore,isadisruptioninhowthebrainworks;itisnotastructuralinjury.Concussionsaredifficulttodiagnosebecausethedamagecannotbeseen.AnMRIorCTScancannotdiagnoseaconcussion,buttheycanhelpruleoutamoreseriousbraininjurytoastudentathlete.Becauseconcussionsaredifficulttodetect,studentathletesmustobtainmedicalapprovalbeforereturningtoathleticsfollowingaconcussion.SectionII.MechanismofInjury:Aconcussioniscausedbyabump,bloworjolttotheheadorbody.Anyforcethatcausesthebraintobouncearoundortwistwithintheskullcancauseaconcussion.Abump,bloworjolttotheheadorbodycanbecausebyeitherindirectoredirecttrauma.Thetwodirectmechanismsofinjuryarecoup-typeandcountercoup-type.Coup-typeinjuryiswhentheheadisstationaryandstruckbyamovingobjectsuchasanotherplayer’shelmet,aball,orsportimplement,causingbraininjuryatthelocationofimpact.Countercoup-typeinjuryoccurswhentheheadismovingandmakescontactwithanimmovableorslowlymovingobjectasaresultofdeceleration,causingbraininjuryawayfromthesightofimpact.Indirectforcesaretransmittedthroughthespineandjaworblowstothethoraxthatwhiptheheadwhiletheneckmusclesarerelaxed.Understandingthewayinwhichaninjuryoccurredinvitalinunderstandingandhavingawatchfuleyeforathleteswhomayexhibitsymptomsofaconcussionsothesestudentathletescanreceivetheappropriatecare.SectionIII.SignsandSymptoms:Signs(whatyousee):

• Confusion• Forgetsplays• Unsureaboutgame,score,opponent• Alteredcoordination• Balanceproblems• Personalitychange• Slowresponsetoquestions


• Forgetseventspriortoinjury(retrogradeamnesia• Forgetseventsafterinjury(anterogradeamnesia)• Lossofconsciousness(anyduration)

Symptoms(reportedbyathlete):

• Headache• Fatigue• Nauseaorvomiting• Doublevision/blurryvision• Sensitivitytolight(photophobia)• Sensitivitytonoise(tinnitus)• Feelssluggish• Feelsfoggy• Problemsconcentrating• Problemsremembering• Troublewithsleeping/excesssleep• Dizziness• Sadness• Seeingstars• Vacantstare/glassyeyed• Nervousness• Irritability• Inappropriateemotions

Ifanyoftheabovesignsorsymptomsareobservedafterasuspectedblowtothehead,jaw,spineorboy,theymaybeindicativeofaconcussionandthestudentathletemustberemovedfromplayimmediatelyandnotallowedtoreturnuntilclearedbyanappropriatealliedhealthprofessional.SectionIV.ManagementandReferralGuidelines:

1. Whenanathletelosesconsciousnessforanyreason,theathletictrainerordesigneewillstarttheEAP(EmergencyActionPlan)includingactivatingEMS;ABC’s(airway,breathing,circulation);stabilizethecervicalspine;andtransporttheinjuredathletetotheappropriatehospitalviaambulanceifrequired.Iftheathletictrainerisnotavailable,thecoachshouldimmediatelycallEMS,checkABC’sandnotmovetheathleteuntilhelparrives.

2. AnyathletewhoisremovedfromthecompetitionoreventandbeginstodevelopsignsandsymptomsofaworseningbraininjurywillbetransportedtothehospitalimmediatelyinaccordancewiththeEAP.Worseningsignsandsymptomsrequiringimmediatephysicianreferralinclude:


A. Amnesialastinglongerthan15minutesB. DeteriorationinneurologicalfunctionC. DecreasinglevelofconsciousnessD. DecreaseorirregularityofrespirationE. DecreaseorirregularityinpulseF. IncreaseinbloodpressureG. Unequal,dilated,orun-reactivepupilsH. CranialnervedeficitsI. Anysignsorsymptomsofassociatedinjuries,spineorskullfracture,or

bleedingJ. Mental-statuschanges:lethargy,difficultymaintainingarousal,confusion,

agitation.K. SeizureactivityL. Vomiting/worseningheadacheM. Motordeficitssubsequenttoinitialon-fieldassessmentN. Sensorydeficitssubsequenttoinitialon-fieldassessmentO. Balancedeficitssubsequenttoinitialon-fieldassessmentP. Cranialnervedeficitssubsequenttoinitialon-fieldassessmentQ. PostConcussionsymptomsworsenR. Athleteisstillsymptomaticattheendofthegame

3. Afterastudentathletesustainsaconcussion,theathletictrainerwillusethe

StandardizedAssessmentforConcussion(SAC)toassessanddocumentthestudentathlete’sconcussion.Theathletictrainerwillalsoreportonthestudentathlete’ssignsandsymptomsbyusingtheSignsandSymptomsCheck-List.Onthesignsandsymptomschecklist,theathletictrainerwillalsocheckpulseandbloodpressureofeachstudentathletewithasuspectedconcussion.

4. Anyathletewhoissymptomaticbutstableisallowedtogohomewith

his/herparent(s)/guardian(s)followingtheheadinjury.A. Iftheheadinjuryoccursatpractice,parent(s)/guardian(s)will

Immediatelybenotifiedandmustcomeandpickupthestudentathleteandtalktothecertifiedathletictrainerinperson.

B. Iftheinjuryoccursatagameoreventthestudentathletemaygohomewiththeparent(s)/guardian(s)aftertalkingwiththecertifiedathletictrainer.

C. Parent(s)/guardian(s)willreceiveimportantinformationregardingsignsAndsymptomsofdeterioratingbraininjury/functionpromotingimmediatereferraltoalocalemergencyroomaswellasreturntoplayrequirements.Parent(s)/guardian(s),aswellasstudentathletes,must


readandsigntheConcussionInformationandgradualReturntoPlayformandbringitbacktothecertifiedathletictrainerbeforestartingwiththereturntoplayprotocol.

SectionV.GradualReturntoPlayProtocol:

1. Atthebeginningofeverysportseason,studentathletesarerequiredtocompleteaconcussionhistoryformandreturnitotheathleticdepartment.Thisinformationwillberecordedinthestudentinformationsystemfortrackingpurposes.

2. Followinganyconcussiontheathletictrainermustnotifytheathleticdirectorandschoolnursewithin24hours.

3. Onceastudentathletehasbeenidentifiedwithaconcussiveinjury,aphysician’sevaluationisrequiredanddeliveredtotheschoolnurseorathletictrainer.

4. Thecertifiedathletictrainerwillalsodocumentthedateonwhichtheathleteisasymptomaticfor48hoursandbeginReturntoPlayProtocol.

5. Studentathleteswhocontinuetoexhibitconcussionsymptomsforaweekormoremustbere-evaluatedbyaphysicianbeforereturningtoplay.

ExertionalPostConcussionTests: Day1:LightAerobicExercise:walkingorstationarycycling,lightjogging. Noresistancetraining.Noheavyexertion.Limit30minutes. Day2:SportSpecificTraining:stretchingroutine,agilitydrills,change ofdirection,sprinting.Noextendedexertion.Nocontact.Nohelmetor equipment. Day3:LightContactTraining;resumebodycontactdrills,limitdirect headcontact(tackledrillsinfootball,headinginsoccer,checkingin hockey),lightresistancetraining(weightlifting). Day4:FullContactPRACTICE:participationinallareasofpractice, Ccntactisallowed(tackledrills,heading,checking),resistancetraining infull Day5:GamePlay.


• Ifanypost-concussionsymptomsdevelopatanystage,thestudentathletemustbegintheReturn-to-PlayProtocolstartingwithDay1andtrytoprogressagainafter48symptom-freehours.

• Nomedicationsmaybetakenatanystepoftheprogression.Thisistopreventmaskingamoreseriousunderlyingcondition!

• YoumustcheckindailywiththeathletictrainereverydayPRIORtopracticetoreviewthesestepsaswellasforaminimumof1weekafterbeingclearedforfullparticipation.

SectionVI.SchoolNurseResponsibilities:

1. ParticipateandcompletetheNFHSon-linetrainingcourseonconcussions.Acertificateofcompletionwillberecordedbythenurseleaderyearly.

2. CompletesymptomassessmentwhenstudentathleteentersHealthOffice(HO)withquestionableconcussionduringschoolhours.Repeatin15minutes.

3. Observestudentswithaconcussionforaminimumof30minutes.4. Ifsymptomsarepresent,notifyparent(s)/guardian(s)andinstruct

parent(s)/guardian(s)thatstudentmustbeevaluatedbyanMD.(a) Ifsymptomsarenotpresent,thestudentmayreturntoclass.

5. Ifsymptomsappearafteranegativeassessment,MDreferralisnecessary.6. AllowstudentwhoareinrecoverytorestinHOwhenneeded.7. Developplanforstudentsregardingpainmanagement.8. Schoolnursewillnotifyteachersandguidancecounselorsofanystudentsor

studentathleteswhohaveacademicrestrictionsormodificationsrelatedtotheirconcussion.

9. Educateparentsandteachersabouttheeffectsofconcussionandreturningtoschoolandactivity.

10. Ifinjuryoccursduringtheschoolday,informadministratorandcompleteaccident/incidentform.

11. Enterphysicalexamdatesandconcussiondatesintothestudentinformationsystemandmaintainforthemandatory7yearsorgiventothestudentupongraduation.

SectionVII.SchoolResponsibilities:

1. Reviewand,ifnecessary,revisetheconcussionpolicyevery2years.2. Oncetheschoolisinformedofthestudent’sconcussion,acontactor“point

person”shouldbeidentified(e.g.theguidancecounselor,athleticdirector,schoolnurse,schoolpsychologistorteacher).


3. Pointpersontoworkwiththestudentandteachersonorganizingworkassignments,makingupworkandgivingextratimeforassignmentsandtests/quizzes.

4. Assistteachersinfollowingtherecoverystageforstudents.5. Includeconcussioninformationinstudentandfacultyhandbooks.

SectionVIII.AthleticDirectorResponsibilities:

1. Provideparents,athletes,coaches,andvolunteerswitheducationaltrainingandconcussionmaterialsyearly.

2. Ensurethatalleducationaltrainingprogramsarecompletedandrecorded.3. Ensurethatallstudentsmeetthephysicalexamrequirementsconsistent

with105CMR200.000priortoparticipationinanyextracurricularathleticactivity.

4. Ensurethatallstudentparticipatinginextracurricularathleticactivityhavecompletedandsubmittedtheirpre-participationforms,whichincludehealthhistoryform,concussionhistoryformandMIAAform.

5. Ensurethatathletesareprohibitedfromengaginginanyunreasonablydangerousathletictechniquethatendangersthehealthandsafetyofanathlete,includingusingahelmetoranyothersportsequipmentasaweapon.

6. Ensurethatallheadinjuryformsarecompletedbyaparent(s)/guardian(s)orcoachesandreviewedbythecoach,athletictrainer,schoolnurseandschoolphysician.

7. Informparent(s)/guardian(s)that,ifallnecessaryformsarenotcompleted,theirchildwillnotparticipateinathleticextracurricularactivities.

SectionIX.Parent/GuardianResponsibilities:

1. Completeandreturnconcussionhistoryformtotheathleticdepartment.2. Informtheschoolifyourstudentsustainsaconcussionoutsideofschool

hours.Completenewconcussionhistoryformfollowingnewinjury.3. Ifastudentsuffersaconcussionoutsideofschool,completeheadinjuryform

andreturnittotheschoolnurse.4. Completeatrainingprovidedbytheschoolonconcussionsandreturn

certificateofcompletiontotheathleticdepartment.5. Watchforchangesinyourchildthatmayindicatethatyourchilddoeshavea

concussionorthatyourchild’sconcussionmaybeworsening.Reporttoaphysician:

A. LossofconsciousnessB. Headache


C. DizzinessD. LethargyE. DifficultyconcentrationF. BalanceproblemG. AnsweringquestionsslowlyH. DifficultyrecallingeventsI. RepeatingquestionsJ. IrritabilityK. SadnessL. EmotionalityM. NervousnessN. Difficultywithsleeping

6. Supportyourchildwhilefollowingconcussionprotocol.Enforce

restrictionsonrest,electronicsandscreentime.7. Reinforcerecoveryplan.8. Contacttheidentifiedpointpersonfromtheschoolwithwhomyoumay

communicateaboutyourchild’sprogressandacademicneeds.9. Observeandmonitoryourchildforanyphysicaloremotionalchanges.10. Recognizethatyourchildwillbeexcludedfromparticipationinany

extracurricularathleticeventifallformsarenotcompletedandonfilewiththeathleticdepartment.

SectionX.StudentandStudentAthleteResponsibilities:

1. Returnrequiredconcussionhistoryformpriortoparticipationinathletics.2. Participateinallconcussiontrainingandeducationandreturnall

appropriateformstotheathleticdepartmentpriortoparticipationinathletics.

3. Reportallsymptomstoathletictrainerand/orschoolnurse.4. Followrecoveryplan.5. REST6. NOATHLETICS7. BEHONEST!!8. Keepstrictlimitsonscreentimeandelectronics9. Don’tcarrybooksorbackpacksthataretooheavy10. Tellyourteachersifyouarehavingdifficultywithyourclasswork11. SeeAthleticTrainerand/orschoolnurseforpainmanagement12. Returntosportsonlywhenclearedbyphysicianandtheathletictrainer.13. FollowReturn-to-PlayGuidelines14. Reportanysymptomstotheathletictrainerand/orschoolnurseand

parent(s)/guardian(s)ifanyoccurafterreturntoplay


15. Returnmedicalclearanceformtoathletictrainerpriortoreturntoplay16. Studentswhodonotcompleteandreturnallrequiredtrainings,testingand

formswillnotbeallowedtoparticipateinsports.SectionXI.Coach&BandInstructorResponsibilities:

1. ParticipateinConcussionEducationCourseofferedbytheNationalFederationofStateHighSchoolAssociation(NFHS)onayearlybasis.Completecertificateofcompletionandreturntotheathleticdepartment.

2. Ensureallstudentathleteshavereturnedconcussionhistoryandhealthhistoryformpriortoparticipationinathletics.

3. Completeaheadinjuryformiftheirplayersuffersaheadinjuryandtheathletictrainerisnotpresentattheathleticevent.Thisformmustbesharedwiththeathletictrainerandtheschoolnurse.

4. Ensureallstudentshavecompletedaconcussioneducationaltrainingpriortoparticipationinathletics.

5. Removefromplayanystudentwhoexhibitssignsandsymptomsofaconcussion.

6. Donotallowstudentathletestoreturntoplayuntilclearedbyaphysicianandathletictrainer.

7. FollowReturn-to-PlayGuidelines8. Referanystudentathletewithreturnedsignsandsymptomsbacktoathletic

trainer.9. Anycoach,bandinstructor,orvolunteercoachforextracurricularactivities

shallnotencourageorpermitastudentparticipatingintheactivitytoengageinanyunreasonablydangerousathletictechniquethatunnecessarilyendangersthehealthofastudentathlete,includingusingamusicalinstrument,helmetoranyothersportsequipmentasaweapon.

SectionXII.PostConcussionSyndrome:PostConcussionSyndromeisapoorlyunderstoodconditionthatoccursafterastudentathletereceivesaconcussion.Studentathleteswhoreceiveconcussionscanhavesymptomsthatlastafewdaystoafewmonths,andevenuptoafullyear,untiltheirneurocognitivefunctionreturnstonormal.Therefore,allschoolpersonnelmustpayattentiontoandcloselyobserveallstudentathletesforpostconcussionsyndromeanditssymptoms.Studentathleteswhoarestillsufferingfromconcussionsymptomsarenotreadytoreturntoplay.Thesignsandsymptomsofpostconcussionsyndromare:

• Dizziness

ShrewsburyPublicSchools_________________________________________________• Headachewithexertion• Tinnitus(ringingintheears)• Fatigue• Irritability• Frustration• Difficultyincopingwithdailystress• Impairedmemoryorconcentration• Eatingandsleepingdisorders• Behavioralchanges• Alcoholintolerance• Decreasesinacademicperformance• Depression• Visualdisturbances

SectionXIII.SecondImpactSyndrome:Secondimpactsyndromeisaseriousmedicalemergencyandaresultofanathletereturningtoplayandcompetitiontoosoonfollowingaconcussion.Secondimpactsyndromeoccursbecauseofrapidbrainswellingandherniationofthebrainafterasecondheadinjurythatoccursbeforethesymptomsofapreviousheadinjuryhavebeenresolved.Thesecondimpactthatastudentathletemayreceivemayonlybeaminorblowtotheheadoritmaynoteveninvolveahittothehead.Ablowtothechestorbackmaycreateenoughforcetosnaptheathlete’sheadandsendacceleration/decelerationforcestoanalreadycompromisedbrain.Theresultingsymptomsoccurbecauseofadisruptionofthebrain’sbloodautoregulatorysystem,whichleadstoswellingofthebrain,increasingintracranialpressureandherniation.Afterasecondimpactastudentathleteusuallydoesnotbecomeunconscious,butappearstobedazed.Thestudentathletemayremainstandingandbeabletoleavethefieldunderhis/herownpower.Withinfifteensecondstoseveralminutes,theathlete’sconditionworsensrapidly,withdilatedpupils,lossofeyemovement,lossofconsciousnessleadingtocomaandrespiratoryfailure.Thebestwaytohandlesecondimpactsyndromeistopreventitfromoccurringaltogether.Allstudentathleteswhoincuraconcussionmustnotreturntoplayuntiltheyareasymptomaticandclearedbyanappropriatehealthcareprofessional.SectionXIV.ConcussionEducation:Itisextremelyimportanttoeducatecoaches,athletesandthecommunityaboutconcussions.Onayearlybasis,allcoachesmustcompletetheonlinecoursecalled

“ConcussionInSports:WhatYouNeedtoKnow”.ThiscourseisofferedbytheShrewsburyPublicSchools_________________________________________________NationalFederationofStateHighSchoolAssociations(NFHS).Studentathletesneedtounderstandtheimportanceofreportingaconcussiontotheircoaches,parents,athletictrainerandotherschoolpersonnel.Everyyearstudentathletesandparentswillparticipateineducationaltrainingonconcussions.Thistrainingmayinclude:

• CDCHeads–UpVideoTraining,or• Trainingprovidedbytheschooldistrict

Theschooldistrictmayalsoofferseminars,speakers,anddiscussionpanelsonthetopicofconcussions.Seminarsofferanopportunityforthecertifiedathletictrainer,athleticdirectorandnurseleadertospeakaboutconcussionsonthefieldatpracticesandgamesandtodiscussprotocolandpolicythatthedistricthasenacted.Providingeducationwithinthecommunitywilloffertheresidentsandparentsofathletesanopportunitytoaskquestionsandvoicetheirconcernsonthetopicofbraininjuryandconcussions.Whenitcomestoconcussions,everyoneneedstobeawareofthepotentialdangersandrememberthataconcussionisabraininjury.Wheneveranyonehasadoubtaboutastudentathletewithaconcussion,SITTHEMOUTandhavethemseetheappropriatehealthcareprofessional!

SHREWSUBYHIGHSCHOOL

CONCUSSIONPROTOCOL

Allcoaches,athleticstaff,parents,student-athletes,marchingbandmembers,volunteers,andanyotherpersonsinvolvedwithextracurricularactivitiesmusttaketheonlineconcussioninformationcourseandprovidecertificateofcompletionpriortothestartoftheseasonasmandatedbytheMIAAandtheStateofMassachusetts.Coaches:areprohibitedfromencouragingorpermittingastudent-athletetoreturntoplayaftersufferingfromapossibleheadinjury.ThecoachmustprovidedocumentationofinjuryoccurrencetotheAthleticDepartmentwithin24hoursofsuspectedinjury.Parent(s)/guardian(s)and/orStudent-Athletes:areresponsibleunderthenewMassachusettsstatelawtoprovidetheschooldistrictwithinformationregardinganypastmedicalhistoryofheadinjury/concussions.TheAthleticDepartmentmustreceivethisinformationpriortothestartofthestudent’ssportsseason.

RETURN-TO-PARTICIPATIONPROTOCOL

Thisprotocolallowsagradualincreaseinvolumeandintensityduringthereturn-to-playprocess.Theathleteismonitoredforanyconcussion-likesigns/symptomsduringandaftereachactivityperiodbytheCertifiedAthleticTrainer.Ifsymptomsreturnatanypointduringthere-exertionactivitytheathleteisexpectedtostophis/heractivityfortheday.Thefollowingday,ifasymptomatiche/shemaycontinueactivitiesatthenextstep.Oneyouaresymptom-freefor48hoursyoumaybeginthestepsforreturntoplay.Day1:LightAerobicExercise:walkingorstationarycycling,lightjogging.Noresistancetraining.Noheavyexertion.Limitto30minutes.Day2:SportSpecificTraining:Stretchingroutine,agilitydrills,changeofdirection,sprinting.Noextendedexertion.Nocontact.Nohelmetorequipment.

Day3:LightContactTraining:resumebodycontactdrills,limitdirectheadcontact(tackledrillsinfootball,headinginsoccer,checkinginhockey),lightresistancetraining(weightlifting).Day4:FullContactPRACTICE:participationinallareasofpractice,contactisallowed(tackledrills,heading,checking),resistancetraininginfull.TakePost–InjuryImPACTtestonlineifnecessary.Day5:GamePlay.*Ifanypost-Concussionsymptomsdevelopatanystage,dropbacktothepreviouslevelandtrytoprogressagainafter48symptom-freehours.

*Nomedicationsmaybetakenatanystepoftheprogression.Thisistopreventmaskingamoreseriousunderlyingcondition!

*YoumustcheckindailywithyourathletictrainereverydayPRIORtopracticetoreviewthesestepsaswellasforaminimumof1weekafterbeingclearedforfullparticipation.Themostconsensusofexpertsisthatathleteswhohavesufferedmultipleconcussion,shouldbeheldoutofplayforanextendedperiodoftime–1to2weeks–aftersymptomshavecleared,especiallyduringthesamesportsseason.Forathleteswhohavesufferedthreemild/simpleconcussionsortwomoderate-severe/complexconcussionsinthesameseason,expertsadvisethattheynotbepermittedtoreturntoplayagainthatseason.

HeadInjuryInformation

• Ablowtotheheadcandisruptthenormalfunctionofthebrain.Doctorsoftencalledthistypeofbraininjurya“concussion”ora“closedheadinjury”.Theymaydescribetheseinjuriesas“mild”becauseconcussionsareusuallynotlifethreatening.However,theeffectsofaconcussioncanbeserious.

• Afteraconcussion,somepeopleloseconsciousnessorare“knockedout”forashorttime,butnotalways–youcanhaveabraininjurywithoutlosingconsciousness.Somepeoplearesimplydazedorconfused.

• Becausethebrainisverycomplex,everybraininjuryisdifferent.Somesymptomsmayappearrightaway,whileothersmaynotshowupfordaysorweeksaftertheconcussion.Sometimestheinjurymakesithardforpeopletorecognizeoradmitthattheyarehavingproblems.

• Thesignsofconcussionaresubtle.Earlyon,problemsmaybemissed.Peoplemaylook,fineeventhoughtheyareactingorfeelingdifferently.

• Becauseallbraininjuriesaredifferent,soisrecovery.Mostpeoplewithmileinjuriesrecoverfully,butitcantaketime.Somesymptomscanlastfordays,weeks,orlonger.

• Peoplewithaconcussionneedtobeseenbyadoctor.SignsandSymptomsSomeofthesymptomsobservedbyMEDICALSTAFF:

- Appearsdazedorstunned- Isconfusedaboutassignments- Forgetssportsplays- Isunsureofgame,score,opponent- Movesclumsily- Slownessinthinking,acting,speaking,orreading- Losesconsciousness(evenbriefly)- Memoryloss- Difficultypayingattentionorconcentrating- Lackofenergy- Severemoodchanges

SomeofthesymptomsreportedbyATHLETE:

- Headacheorpressureinhead- Nausea- Balanceproblemsordizziness- Doublevisionorblurredvision- Sensitivitytolight- Sensitivitytonoise- Feelingsluggishorsloweddown- Feelinginafogorgroggy- Increasedfatigue

DangerSignsInveryrarecases,alongwithaconcussion,adangerousbloodclotmayformonthebrain.ContactyourDoctororEmergencyDepartmentrightawayifyouhaveanyofthefollowingsymptoms:

- Headachethatgetsmuchworsethanatinitialevaluation- Weakness,numbness,ordecreasedcoordination- Repeatedvomiting

ThepeoplecheckingonyoushouldtakeyoutoanEmergencyDepartmentrightawayifyou:

- Cannotbeawakened- Haveonepupil(theblackdotofyoureye)largerthantheother- Haveconvulsionsorseizures- Haveslurredspeech- Aregettingmoreconfused,restless,oragitated

Recovery

- Howfastpeoplerecoverfromaconcussionvariesfrompersontoperson.- Althoughmostpeoplehaveagoodrecovery,howquicklydependsonmany

factors.- Thesefactorsincludehowseveretheconcussionwas,whatpartofthebrain

wasinjured,theirage,andhowhealthytheywerebeforetheconcussion.- Restisveryimportantafteraconcussionbecauseithelpsthebraintoheal.

Youwillneedtobeextremelypatientbecausehealingtakestime.Asthedaysgoby,youcanexpecttograduallyfeelbetter.

- Whileyouarehealing,youshouldbeverycarefultoavoiddoinganythingthatcouldcauseablowtoyourhead.Onrareoccasions,receivinganotherblowbeforeaconcussionhashealedcanbefatal.Hereresometipsforhealing:

o Getplentyofsleepatnightandrestduringthedayo Avoiduseofelectronics/mediai.e.Ipods,videogames,computer,cell

phone/texting,televisionthatmayoverstimulatethebrain.o Returntoactivitiesgradually,notallatonceo Avoidactivitiesthatcouldleadtoa2ndbraininjuryuntilclearedby

theDoctoro TakeonlythosedrugsthatyourDoctorhasapproved

ShrewsburyHighSchoolDepartmentofAthleticsHistoryofHeadInjuryReportForm

Duetoanewlawregardingsports-relatedheadinjuryandconcussion,parentsarerequiredtoinformtheircoachesandathleticdepartmentaboutpriorheadinjuriesatthebeginningof,andthroughout,theseason.Additionally,thenewconcussionlegislationmandatesthatallstudentsandparentscompletetheConcussioninSports,WhatYouNeedtoKnowcertificationcoursethroughtheNationalFederationofHighSchoolswebsite:http://www.nfhslearn.com/.Pleasecompletethefollowinginformationasaccuratelyaspossible.Nameofstudent-athlete:__________________________________________________________________Yearofgraduation:___________________Sportandlevel:____________________________________________________________________________MysignatureverifiesthatIhavecompletedandhavereceivedacertificatefortheConcussionSports,WhatYouNeedtoKnowcertificationcoursethroughtheNationalFederationofHighSchoolswebsite:http://nfhslearn.com/.Printednameofstudent-athlete:_________________________________________________________Signatureofstudent-athlete:______________________________________________________________PrintednameofParent/guardian:_______________________________________________________SignatureofParent/guardian:___________________________________________________________HistoryofHeadInjuries(useadditionalformsifnecessary):HeadInjury#1:Date:_______________________Detailedexplanationofhowinjuryoccurred__________________________________________________________________________________________________________________________________________________________________________________________________Detailedexplanationofdiagnosis__________________________________________________________________________________________________________________________________________________________________________________________________Detailedexplanationoftreatment__________________________________________________________________________________________________________________________________________________________________________________________________

HeadInjury#2Date:_______________________Detailedexplanationofhowinjuryoccurred__________________________________________________________________________________________________________________________________________________________________________________________________Detailedexplanationofdiagnosis__________________________________________________________________________________________________________________________________________________________________________________________________Detailedexplanationoftreatment__________________________________________________________________________________________________________________________________________________________________________________________________

Documents

Shrewsbury High School · Shrewsbury High School Concussion Manual Table of Contents Pages 1-3 Section I: Development of Policy and Procedures Adopted by School Committee – February