CONCUSSIONS PROCEDURES



The following procedures are necessary for the prevention, training, management and return to activity decisions regarding students who incur head injuries while involved in extracurricular athletic activities in order to protect their health and safety. These procedures specifically addresses sports-related head injuries occurring in extracurricular athletic activities but may be applied to all head injuries in students.

The person overseeing the policy for Leicester High School will be the Director of Athletics. The Athletic Director, members of the Middle and High School administration, a school nurse, a guidance counselor, and a teacher shall participate in bi-annual review of the policies and procedures required by 105 CMR 201.006 for the prevention and management of sports-related head injuries within the Leicester schools.

The Athletic Director will provide the Department of Public Health an affirmation on school district letterhead, that it has developed these policies in accordance with 105 C.M.R. 201.00 by September 30, 2013 and every two years thereafter upon review or revision of the policy.

Concussion Overview:

A concussion is a brain injury which results in a temporary disruption of normal brain function. A concussion occurs when the brain is violently rocked back and forth or twisted inside the skull as a result of a blow to the head or body. An athlete does not have to lose consciousness to suffer a concussion. A concussion may cause an immediate and typically short-lived impairment of neurologic function. A concussion may cause neuropathologic changes; however, the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. A concussion may cause a gradient of clinical syndromes that may or may not involve the loss of consciousness. Resolution of the clinical and cognitive symptoms typically follow a sequential course.

Second impact Syndrome: A rare phenomenon of diffuse brain swelling with delayed catastrophic deterioration has been labeled “second impact syndrome” due to the belief held by some that it occurs as the result of a second concussion before the effects of the initial concussion have been resolved. While rare, it is catastrophic and a major concern.

Definition of “Extracurricular Athletic Activity”: As defined by the State of Massachusetts law 105 CMR 201.000 Head Injuries and Concussions in Extracurricular Athletic Activities means an organized school sponsored athletic activity generally occurring outside of school instructional hours under the direction of a coach, athletic director or band leader including but not limited to Alpine and Nordic skiing and snowboarding, baseball, basketball, cheerleading, cross country track, fencing, field hockey, football, golf, gymnastics, horseback riding, ice hockey, lacrosse, marching band, rifle, rugby, soccer, skating, softball, squash, swimming and diving, tennis, track (indoor and outdoor), ultimate Frisbee, volleyball, water polo, and wrestling. All interscholastic athletics are deemed to be extracurricular athletic activities.

“Parent” means the parent or guardian or foster parent of a student.

Training

The following persons shall annually complete one of the head injury safety training programs approved by the Department of Public Health: all coaches, trainers, volunteers, school and team physicians, school nurses, athletic directors, directors Responsible for a school marching band, parents of students who participate in extracurricular activities; and students who participate in an extracurricular activity.

The required training applies to the above individuals for one school year and must be repeated for every subsequent school year.

In accordance with this requirement of training in the prevention and recognition of a sports-related head injury, and associated health risks including second impact syndrome, each school district employee or volunteer identified above, will complete the following training online: http://www.nfhslearn.com/electiveDetail.aspx?courseID=15000.

Additionally, game officials shall also complete one of the training programs offered by the Department of Public Health annually, and shall provide independent verification of completion of the training request upon request from a school or school district.

Annually, on or after July 1st of each school year, the persons identified above must supply a certificate of completion to the high school athletic director for relevant high school personnel and to the appropriate middle school principal for grades six (6) through eight (8) for relevant middle school personnel.

Concussion Education for Student-Athletes and Parents/Guardians:

Each year, student athletes shall be presented with a discussion about concussion at either an athletes’ sports night, team discussion or through paperwork requirements and given a copy of the Center for Disease Control’s (CDC) “Heads Up: Concussion in High School Sports – A Fact Sheet for Athletes” (www.cdc.gov/concussion). This handout will also be available in the athletic training room and nurse’s office at school.

At the beginning of each sports season, parent shall be presented with a copy of the CDC’s “Heads Up: Concussion in High School Sports – A Fact Sheet for Parents” (www.cdc.gov/concussion) at a parents sports night or through paperwork requirements. This handout will also be available in the athletic training room and the nurse’s office at the school.

All student-athletes and their parents will sign a statement in which the student-athlete accepts the responsibility for reporting head injuries or concussions during the season to the athletic trainer, coach if the athletic trainer is not present, parents or other health care personnel including signs and symptoms of concussion. This statement will also acknowledge having received, read and understand the above mentioned educational handouts.

All student athletes and the parent of student athletes shall be required to participate in the above education prior to their participation in any sport.

Pre-participation Requirements

Parent and student must participate in the concussion education described above annually.

Physical Examination: All students must meet the physical examination requirements consistent with 105 CMR 200.000: Physical Examination of School Children prior to participation in any extracurricular athletic activity. Physical examinations should be turned into the high school nurses for entry into the medical records. All Middle School and High School students shall have an approved physical in place before they may try out for, practice, or participate with any extracurricular activity, as defined above. The head nurse’s office shall keep a master list of students with approved physical exams. Middle School and High school coaches must check the approved physical list before a student may try out for, practice, or participate with any interscholastic team.

Pre-Participation Form: Parents of students turn in pre-participation form that lists the athlete’s history of head injuries/concussions prior to participation each sport to the athletic director with parental permission forms. This needs to before the start of each sport season in which the student is seeking to participate. This form will be turned over to the high school or middle school nurse for any positive head injury/concussion for their review. All forms or copies are turned over to the high school or middle school nurses for insertion into the medical records, per regulations; these will be kept for three years.

Maintenance of Records

The Director of Athletics, Director of Nurses, and Director of Fine Arts shall ensure the maintenance the following records for three years or, at a minimum, until the student graduates:

a. Verifications of completion of annual training;

b. Pre-participation Forms;

c. Report of Head Injury Forms;

d. Medical Clearance and Authorization Forms; and

e. Graduated reentry plans for return to full academic and extracurricular athletic activities.

Responsibilities of Individual Personnel

The Director of Athletics will be responsible for ensuring that the training requirements for staff, parents, volunteers, coaches and students are met, recorded, and records are maintained in accord with 105 CMR 201.016 as it pertains to extracurricular activities. The Director of Athletics shall also be responsible for:

1. Ensuring that all students meet the physical examination requirements consistent with 105 C.M.R. 200.000;

2. Ensuring that all students participating in extracurricular athletic activities have completed and submitted Pre-participation Forms prior to participation each season;

3. Ensuring that the student Pre-participation Forms are completed and reviewed and shall make arrangements for:
A. Timely review of all Pre-participation and Report of Head Injury Forms by coaches so as to identify students who are at greater risk of repeated head injuries;
b. Timely review of all Pre-participation Forms which indicate a history of head injury and Report of Head Injury Forms by (i) the school nurse; and (ii) the school physician, if appropriate; and
c. Timely review of accurate, updated information regarding each athlete who has reported a history of head injury or a head injury during the sports season by (i) the team’s physician, if any, and (ii) the school’s certified athletic trainer, if any.
4. Ensuring that Report of Head Injury Forms are completed by the parent or coach and reviewed by the student’s coaches and school nurse; and

5. Ensuring that athletes are prohibited from engaging in any unreasonably dangerous technique that endangers the life or safety of an athlete, including using a helmet or any other sports equipment as a weapon.

6. Reporting annual statistics to the Department, including:
a. The total number of Department Report of Head Injury Forms received by the school; and
b. The total number of students who incur head injuries and suspected concussions when engaged in extracurricular activities.

The High School Principal will be responsible for ensuring that the training requirements for staff, parents, volunteers, coaches and students are met, recorded, and records are maintained in accord with 105 CMR 201.016 as it pertains the marching band and for winter color guard, if such activities are added to the program at Leicester High School.

The High School and Middle School School Nurses or Lead School Nurse, if this assignment is made, will be responsible for ensuring that the training requirements for school nurses, per-diem nurses, and the school physician are met, recorded, and records are maintained in accord with 105 CMR 201.016.; for ensuring all physical exams are entered in the students’ records, for ensuring that all pre-participation forms have been entered into the students’ medical record folders, for ensuring all head injury forms are entered in the students’ medical record folders.

School Nurses shall be responsible for:

1. Reviewing, or arranging for the school physician to review, completed Pre-participation Forms and following up with parents as needed prior to the student’s participation in extracurricular activities;

2. Reviewing, or arranging for the school physician to review, Report of Head Injury Forms and following up with the coach and parent as needed;

3. Reviewing forms that are completed by a parent which report a head injury during the sports season, but outside of an extracurricular activity;

4. Maintaining: (1) Pre-participation Forms and (2) Report of Head Injury Forms in the student’s health record;

5. Participating in the graduated reentry planning for students who have been diagnosed with a concussion to discuss any necessary accommodation or modifications with respect to academics, course requirements, homework, testing, scheduling and other aspects of school activities consistent with a graduated reentry plan for return to full academic and extracurricular athletic activities is being followed.

6. Providing ongoing educational materials on head injury and concussion to teachers, staff, and students.

Coaches shall be responsible for:

1. Completing the annual training identified above;

2. Reviewing the Pre-participation Forms, so as to identify those athletes who are at greater risk for repeated head injuries;

3. Completing the Head Injury Form upon identification of a student with a head injury or suspected concussion that occurs during practice or competition;

4. Transmitting promptly the Pre-participation Forms and Report of Head Injury Forms to the school nurse for review and maintenance in the student’s health record. This includes transmitting Report of Head Injury Forms that are completed by a parent which report a head injury during the sports season, but outside of an extracurricular activity;

5. Teaching techniques aimed at minimizing sports-related heading injury;

6. Discouraging and prohibiting athletes from engaging in any unreasonably dangerous athletic technique that endangers the health or safety of an athlete, including using a helmet or any other sports equipment as a weapon; and

7. Identifying athletics with head injuries or suspected concussions that occur in practice or competition and removing them from play.

Procedures for Suspected Head Injury/Concussion

Exclusion from Play:

1. Disqualifying an athlete - Any extracurricular athletic activity participant who sustains a head injury or suspected concussion, or exhibits signs and symptoms of a concussion, or loses consciousness, even briefly, while participating with any school athletic team will be removed from the remainder of the event and not allowed to return to the practice or competition that same day.

2. The student shall not return to practice or competition unless and until the student provides medical clearance and authorization, as described below.

3. The student will not return to full practice or competition before completing a graduated return to play program described below.

4. Any athlete, who shows concussion signs and/or symptoms, must have their parent/guardian notified by the coach.

5. The coach shall communicate the nature of the injury directly to the parent in person or by phone immediately after the practice or competition in which a student has been removed from play for a head injury, suspected concussion, signs and symptoms of a concussion, or loss or consciousness.

6. The coach must also provide this information to the parents in writing, whether paper or electronic format, by the next business day.

7. The student should be released only to the direct supervision of the parent unless arrangements have been made between the coach and the parent. Student-athletes should not drive if concussion is suspected. Alternative transportation should be coordinated by the injured student- athlete, parents, coaches, nurse and/or athletic director.

8. The parent/guardian will be advised to seek medical treatment for student.

9. The coach will complete the Report of Head Injury Form upon identification of a student with a head injury or suspected concussion that occurs during practice or competition;

10. The coach or his or her designee will promptly, by the end of the next business day, transmit the Report of Head Injury Forms to both the school nurse and the athletic director for review and maintenance in the student’s health record;

Procedures After Concussion

A. A student-athlete who exhibits signs or symptoms of concussion shall not be permitted to return to play on the day of the injury.

B. “WHEN IN DOUBT, HOLD THEM OUT.” Any student-athlete who denies symptoms but has abnormal sideline cognitive testing will be held out of the activity.

C. Each student who is removed from practice or competition for and subsequently diagnosed with a concussion shall have a written graduated reentry plans for return to full academic and extracurricular activities. See Section X of this policy for more information regarding graduated reentry plans.

D. Medical Clearance and Authorization to Return to Play

1. Each student who is removed from practice or competition for a head injury or suspected concussion, or loses consciousness, even briefly, or exhibits signs and symptoms of a concussion, shall obtain and present to the Athletic Director, unless another person is specified in school policy or procedure, a Post Sports-Related Head Injury Medical Clearance and Authorization Form. This form must be completed by one of the following individuals:

a. A duly licensed physician;

b. A duly licensed certified athletic trainer in consultation with a licensed physician;

c. A duly licensed nurse practitioner in consultation with a licensed physician; or

d. A duly licensed neuropsychologist in coordination with the physician managing the student's recovery.

2. Physicians, nurse practitioners, certified athletic trainers and neuropsychologists providing medical clearance for return to play shall verify that they have received Department of Health-approved training in post traumatic head injury assessment and management or have received equivalent training as part of their licensure or continuing education.

3. The ultimate return to play decision is a medical decision that may involve a multidisciplinary approach, including consultation with parents, the school nurse and teachers as appropriate.

4. The Leicester Public Schools shall have the final say on return to athletic play.

Gradual Return to Athletics and Academics

Each student who is removed from practice or competition for and subsequently diagnosed with a concussion shall have a written graduated reentry plans for return to full academic and extracurricular activities. Students must complete a graduated return to play program before returning to participation in extracurricular activities. Medical clearance for participation can only be provided after the student completes a graduated return to play and shows no recurrence of symptoms. The plan shall be developed by the student’s teachers, the student’s guidance counselor, the school nurse, a neuropsychologist if available or involved, a parent, members of the building based student support and assistance team or individualized education program team as appropriate, and in consultation with the student’s primary care provider or the physician who made the diagnosis or who is managing the student’s recovery.

The written plan shall include instructions for students, parents, school personnel, addressing but not limited to:
a. Physical and cognitive rest as appropriate;
b. Graduated return to extracurricular activities and classroom studies as appropriate, including accommodations and modifications as needed;
c. Estimated time intervals for resumption of activities;
d. Frequency of assessments, as appropriate, by the school nurse, school physician, or neuropsychologist, if available, until full return to classroom activities and extracurricular activities is authorized; and
e. A plan for communication and coordination between and among school personnel and between the school, the parents and the student’s primary care provider or the physician who made the diagnosis or who is managing the student’s recovery.

The student must be completely symptom free and medically cleared as defined above, in order to begin a graduated reentry plan to extracurricular activities. If the student-athlete experiences post-concussion symptoms during any stage, activity should cease and until symptoms have again resolved. The school staff should communicate to the physician or health care provider who provided medical clearance that the student is not symptom free. If the athlete is still having symptoms, he or she is not ready to begin or continue the graduated return to play program.

ADOPTED: January 9, 2011
REVISeD: June 8, 2015