Concussion Management and Awareness Act
A concussion is defined as a type of traumatic brain injury, caused by a bump, blow or jolt to the head that can change the way the brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious.
Most people who suffer a concussion do recover quickly. However, in more severe cases, a concussion can be fatal. Unlike a broken bone or a laceration, outward signs of a concussion can’t be seen. By learning to identify the symptoms and danger signs of concussions coaches, teachers and parents can help keep children safe.
The state’s Concussion Management and Awareness Act requires that students with a possible concussion or brain injury are removed from athletic activities, including physical education classes, interscholastic sports and other extracurricular activities. Students will not be allowed to resume athletic activity until they have been symptom-free for 24 hours, and have been evaluated by and received written and signed authorization from a licensed physician. For interscholastic athletics, clearance must come from the school’s medical director.
Florida UFSD Concussion Guidelines and Procedures
The Florida Union Free School District recognizes that protecting students from head injuries is one of the most important ways of preventing a concussion. Although the risk of a concussion is present with certain types of sports, education, proper athletic equipment and supervision will help minimize the risk(s) of injuries. The district’s Athletic Coaches, Athletic Trainer and/or School Nurse(s) will inform student athletes and parents of the signs and symptoms of concussions, how these types of injuries occur, possible long term effects resulting from such injuries, and guidelines for return to school and athletic participation after suffering a concussion. The district’s Athletic Trainer/Nurses Office will provide a supporting written informational hand-out entitled “Concussions: The Invisible Injury.”
It is imperative that students recognize symptoms of a concussion and 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. Emphasis must be placed on the need for medical evaluation should such an injury occur to prevent persisting symptoms. Student athletes must follow the guidelines for return to school and activities. Even if a student does not report any symptoms, if a student is suspected of having sustained a concussion, he/she will be immediately removed from athletic, cognitive or other activity, and monitored.
The Florida Union Free School District’s Athlete Contract and Parent/Guardian Consent form will provide information on concussions at the start of each athletic season.
Concussion education will be provided for the Athletic Director, all coaches and assistant coaches (paid or volunteer), school nurses and athletic trainers. Parents will learn about concussions during preseason sports meetings and information sheets will be provided to them. Education should include, but not be limited to, the definition of concussion, signs and symptoms, how concussions may occur, why concussions are not detected with CT Scans or MRIs, management of the injury and the protocol for return to school, activity or interscholastic athletics. The protocols will cover all students returning to school after suffering a concussion, regardless of whether the accident occurred outside of school or while participating in a school activity.
The Concussion Management and Awareness Act of 2011, 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. NYSED has approved the course Heads Up, Concussion in Youth Sports for physical education teachers and coaches. It is a free web-based course developed by the CDC and is available at http://www.cdc.gov/concussion/HeadsUp/online training.html This is not a NYS specific training video; therefore, the scope of practice of certified athletic trainers and school nurses in NYS may differ from what is described in the training. Registered professional nurses and certified athletic trainers practicing in NYS must follow NYS laws in regards to licensing and scope of practice.
Concussion Management Team
The District has established a concussion management team (CMT). The CMT includes the Athletic Director, school nurse, athletic trainer and school physician. Additional school staff such as administrators, guidance counselors, teachers, physical education teachers and coaches may participate with the CMT on an as needed basis. The CMT will collaborate with the student’s private medical provider, the student and the student’s family to assist with the student’s recovery.
The Athletic Director will coordinate training for all coaches. Training is mandatory for all physical education teachers, coaches, assistant coaches and volunteer coaches who work with student athletes. Training is also mandatory for all school nurses and certified athletic trainers. Parents need to be aware of the school district’s policy and procedures, how these injuries will ultimately be managed by school officials and what information the school must receive from a student’s medical provider. Students also need to be educated as a concussion is primarily diagnosed by reported and/or observed signs and symptoms. These guide the members of the team in transitioning the student back to activities. Students will be educated about the following topics:
- Preventing head injuries
- Reporting signs and symptoms of a concussion to a coach, athletic trainer, school nurse, parent/guardian, or other staff
- Risk of concussion
- The importance of informing the coach, parent/guardian, athletic trainer, school nurse or other staff members about injuries and the symptoms
- Risk of severe injury, permanent disability, and even death that can occur with re-injury by resuming normal activities before recovering from a concussion
- Following the instructions from their private medical provider
- Asking for help and informing teachers of difficulties they experience in class and when completing assignments
- Encouraging classmates and teammates to report injuries
- Promoting an environment where reporting signs and symptoms of a concussion is considered acceptable
Training also includes: signs and symptoms of concussions, post-concussion and second impact syndromes, return to play and school protocols, and available area resources for concussion management and treatment. Particular emphasis should be placed on the fact that no athlete will be allowed to return to play the day of injury and also that all athletes must obtain appropriate medical clearance prior to returning to practice, play or school. The CMT will act as a liaison for any student returning to school and/or play following a concussion. The CMT will review and/or design an appropriate plan for the student while the student is recovering.
*School district CMTs will utilize the NYSPHSAA website as well for information related to the signs and symptoms of concussions and the appropriate return to play protocols.
A handout describing the Concussion Management team is also available on the NYSPHSAA website. A Concussion Management Checklist that has been approved and recommended by CDC will be utilized.
Concussion Management Protocol
- If a student sustains a possible head injury during school hours, the student is to be seen by the school nurse. It is the responsibility of the supervising adult to ensure that the school nurse is summoned or the student is taken to the nurse.
- The school nurse will follow the first aid protocols for a suspected head injury. The school nurse will also provide parents/guardians with oral and/or written instructions on observing the student for concussive complications that warrant immediate emergency care.
- If the student sustains a possible head injury during an activity after school hours, the coach, athletic trainer or supervising adult will remove the student from the activity, follow the first aid protocols and follow the notification protocol. The supervising adult will notify the school nurse on the next school day and complete the accident report.
- The school nurse will be responsible for follow-up and coordination between the student, parents, physical education teachers, coaches, athletic trainer, school physician and student’s health care provider.
- In keeping with the law, if the student is suspected of having a concussion, either based on the disclosure of a head injury, observed or reported symptoms, or by observing or learning that the student sustained a significant blow to the head, neck or body, the student must be removed from athletic activity and/or physical activities (e.g. PE class, recess) and may not be returned to athletic and other activities until he/she has been symptom-free for a minimum of 24 hours and has been evaluated by and receives written and signed authorization to return to activities by a licensed physician, nurse practitioner or physician assistant. This authorization will be maintained in the student’s file.
- When the student’s parent has provided the physician authorization to return to activities, the school nurse will review the medical provider’s written clearance for the student to begin graduated physical activity. If the student is still experiencing symptoms, or if the medical history, concussion severity etc., concern the nurse, she will consult with the medical director to determine if the student is ready to return. The District Medical Director will make the final decision regarding when a student will be allowed to return to physical activities.
- When the medical director determines it is safe for the student to return to play, the Athletic Director and athletic trainer will be notified that the athlete can begin the return to play protocol.
- If the student sustains a head injury other than in a school activity, the parents should notify the school nurse immediately and the student will not return to physical activity until the nurse receives written and signed authorization to return to activities by the student’s health care provider (licensed physician, nurse practitioner or physician assistant).
- Elementary students and secondary students who are not involved in sports must have written authorization from their health care provider before returning to physical education, recess or any other physical activity at school. The school nurse will notify the physical education teacher that the student has sustained a concussion and when he/she is ready to return to physical activity. The physical education teacher will remove the student from play if there are any complaints of headaches, dizziness or any other adverse reactions. The nurse will then notify the parents that the student is being removed from physical activity and discuss follow-up care with the medical provider.
Return to play – Athletes
The law requires that students who sustain, or are suspected of having sustained a concussion during athletic activities be immediately removed from such activities. A student may NOT return to athletic activities until they have been symptom-free for a minimum of 24 hours and have been evaluated/diagnosed by, and receive written and signed authorization to return to activities from a licensed physician (M.D. or D.O.). The District’s Medical Director will make the final decision when an athlete will be allowed to return to practice/play. Return to play following a concussion involves a step-wise progression once the individual is symptom free for at least 24 hours. There are many risks to premature return to play including: a greater risk for a second concussion because of a lower concussion threshold, second impact syndrome (abnormal brain blood flow that can result in death), exacerbation of any current symptoms, and possibly increased risk for additional injury due to alteration in balance. No student athlete should return to play while symptomatic. Students are prohibited from returning to play the day the concussion is sustained. If there is any doubt as to whether a student has sustained a concussion, it should be treated as a concussion. Once the student athlete is symptom free at rest for 24 hours without pain medication and has a signed release by the treating M.D or D.O., and has been cleared by the District’s Medical Director, she/he may begin the return to play progression below (provided there are no other mitigating circumstances). The return to play will be supervised by the athletic trainer for student athletes.
The following is the recommended return to physical activity protocol based on the Zurich Progressive Exertion Protocol:
Phase 1 – Low impact, non-strenuous, light aerobic activity such as walking or riding a stationary bike. If tolerated without return of symptoms over a 24 hour period proceed to;
Phase 2 – Higher impact, higher exertion, and moderate aerobic activity such as running or jumping rope. No resistance training. If tolerated without return of symptoms over a 24 hour period proceed to;
Phase 3 – Sport specific non-contact activity. Low resistance weight training with a spotter. If tolerated without return of symptoms over a 24 hour period proceed to;
Phase 4 – Sport specific activity, non-contact drills. Higher resistance weight training with a spotter. If tolerated without return of symptoms over a 24 hour period proceed to;
Phase 5 – Full contact training drills and intense aerobic activity. If tolerated without return of symptoms over a 24 hour period proceed to
Phase 6 – Return to full activities without restrictions.
The NYSED Guidelines for Concussion Management in Schools have been revised to reflect the current recommendations on managing concussions. Emerging research suggests that some symptoms may be acceptable during the return to activities. The updated guidelines reflect this practice along with emphasizing that schools follow the guidance of the student’s health care provider on what symptoms are acceptable for return to activities.
A gradual return to physical activity typically is done by progressing a student through levels of activity that increase in duration and/or intensity. Gradual return to activity should occur with the introduction of a new activity level every 24 hours. If any post-concussion symptoms return, the student should stop the activity and drop back to the first level of activity. Current research suggests that some level of symptoms with activity is acceptable. Therefore, schools will need to follow provider orders on return to activities. Students should be monitored by district staff daily following each progressive level of physical activity, for any return of signs and symptoms of a concussion. A gradual progression should be followed based on the student’s healthcare provider’s or other specialist’s orders and recommendations.
Return to play – Non-Athletes
The School Nurse and the Physical Education Teachers will be responsible for the return to play for non-athletes. Clearance to begin the return to play will be required from a physician, nurse practitioner or a physician assistant. The District’s Medical Director will make the final decision as to when a student will return to physical activities. When the student is cleared, the school nurse will notify in writing the physical education teacher and the return to play will be initiated. Non-athletes follow the same progression of activities as athletes.
The school nurse will notify the student’s teachers and guidance counselor that the student has sustained a concussion. Teachers should make accommodations that minimize aggravating symptoms so that the student has sufficient cognitive rest. The nurse will provide information from the student’s medical provider regarding limitations on the student during the recovery phase. Teachers can refer to the websites listed below for more information.
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 clues
With written documentation from the student’s medical provider, a 504 Plan may need to be initiated until the student has recovered from the concussion.
Information Sources and Accommodations for Classroom Teacher
Teachers should make accommodations that minimize aggravating symptoms so that the student has sufficient cognitive rest. The nurse will provide information from the student’s medical provider regarding limitations on the student during the recovery phase. Teachers can refer to the following web sites for more information:
Concussion Signs and Symptoms for Classroom Teacher
- Neck pain
- Lack of energy and constantly feeling physically and mentally tired
- Dizziness, light-headedness, and a loss of balance
- Blurred or double vision and sensitivity to light
- Increased sensitivity to sounds
- Ringing in the ears
- Loss of sense of taste and smell
- Change in sleep patterns especially waking up a lot at night
- Difficulty concentrating and paying attention
- Trouble with learning and memory
- Problems with word-finding and putting thoughts into words
- Easily confused and losing track of time and place
- Slower in thinking, acting, reading, and speaking
- Easily distracted
- Trouble doing more than one thing at a time
- Lack of organization in everyday tasks
Social and Emotional Symptoms
- Mood changes including irritability, anxiousness, and tearfulness
- Decreased motivation
- Easily overwhelmed
- More impulsive
- Withdrawn and wanting to avoid social situations especially if there is a lot of people
Adoption: July 11, 2019