Introduction
The Berne‐Knox‐Westerlo Central School District recognizes that concussions and head injuries are commonly reported injuries in children and adolescents who participate in sports and recreational activity and can have serious consequences if not managed carefully. Therefore, the district adopts the following policy to support the proper evaluation and management of head injuries.
Concussion is a mild traumatic brain injury. Concussion occurs when normal brain functioning is disrupted by a blow or jolt to the head. Recovery from concussion will vary. Avoiding re‐injury and over‐exertion until fully recovered are the cornerstones of proper concussion management.
Education
Concussion education training will be provided for all physical education teachers, coaches, school nurses and athletic trainers. Education of parents should be accomplished through preseason meetings for sports and/ or information sheets provided to parents. Education should include, but not be limited to the definition of concussion, signs and symptoms of concussion, 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 and return to activity or interscholastic athletics. The protocols will cover all students returning to school after suffering a concussion regardless if the accident occurred outside of school or while participating in a school activity.
Concussion Management Team
The district’s Concussion Management Team will coordinate training for all administrators, teachers, coaches and parents. Training will be mandatory for all coaches, assistant coaches and volunteer coaches that work with these student‐athletes regularly. In addition, information related to concussions will be included at parent meetings or in information provided to parents at the beginning of sports seasons.
Parents need to be aware of the school district’s policy and how these injuries will ultimately be managed by school officials.
Training should include: 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 should obtain appropriate medical clearance prior to returning to 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.
Concussion Management Protocol
Injury
While district staff will exercise reasonable care to protect students, head injuries may still occur. Physical education teachers, coaches, nurses and other appropriate staff will receive training to recognize the signs, symptoms and behaviors consistent with a concussion. Any student exhibiting those signs, symptoms or behaviors 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 school nurse, coach or extracurricular advisor will notify the student’s parents or guardians and recommend appropriate monitoring for the student.
If a student sustains a concussion at a time other then when engaged in a school‐sponsored activity, the parent/guardian are obligated to report the condition to the school nurse. This allows the district to support the appropriate management of the condition.
The student shall not return to school or school related activities until authorized to do so by an appropriate health care professional. The school’s chief medical officer will make the final decision on any return to activity. Any student who continues to have signs or symptoms upon return to activity must be removed from play and reevaluated by their health care provider. Once the student‐athlete is symptom free, a return to play protocol will be initiated and must be completed before the student athlete is allowed to return to play.
Return to play
Return to play following a concussion involves a stepwise progression once the individual is symptom free. 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. These NYSPHAA current returns to play recommendations are based on the most recent international expert opinion. 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 and has a signed release by the treating clinician, she/he may begin the return to play progression below (provided there are no other mitigating circumstances).
- Day 1: Light aerobic activity
- Day 2: Sport‐specific activity
- Day 3: Non‐contact training drills
- Day 4: Full-contact practice
- Day 5: Return to play
Each step should take 24 hours so that an athlete would take approximately one week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise. If any post-concussion symptoms occur while in the stepwise program, then the student should drop back to the previous asymptomatic level and try to progress again after a further 24‐hour period of rest has passed.
Resources & Guidance
NYS Fact Sheet for Parents and Caregivers “When in doubt, take them Out”
(links to https://health.ny.gov/publications/3278.pdf )
The New York State Education Department has developed guidelines for concussion management in the school setting. View the guidelines at the New York State Education Department website at http://www.p12.nysed.gov/sss/schoolhealth/ConcussionManageGuidelines.pdf.
In New York State, school nurses, certified athletic trainers, coaches, and physical education teachers are mandated to complete sports concussion management training every two years. The approved courses are listed on the New York State Education Department website at: http://www.p12.nysed.gov/sss/schoolhealth/schoolhealthservices/MandatoryTraining.html.
LEARNet, a resource developed by the Brain Injury Association of New York State, includes a problem solving system designed to help identify useful procedures for helping students with brain injury in school and at home. Access the system via the LEARNet website at http://www.projectlearnet.org/.