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Concussion Protocol

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Concussion Protocol

The goal of this concussion policy is to ensure that any student/athlete who sustains a concussion at school or non-school-sponsored event, is properly diagnosed, given adequate time to heal, and is fully supported until he/she is symptom free and eligible to return to the playground, the athletic field and the classroom.

As cited in the Athletic Concussion Protection Act of 2011 a concussion is defined as “a traumatic injury to the brain causing a change in mental status at the time of the injury, such as feeling dazed, disoriented or confused, which may or may not involve in a loss of consciousness resulting from:

  • A fall
  • A blow or jolt to the head or body
  • The shaking or spinning of the head or body
  • The acceleration and deceleration of the head”

It is well known that adolescents and teenagers will often underreport symptoms of injuries, and concussions are no different.  Student/athlete with the signs and symptoms of a concussion will be removed from play immediately.

Concussions can occur in any sport or recreation activity. Most concussions occur without loss of consciousness, however all are serious.  All coaches, parents, and athletes need to learn concussion signs and symptoms and what to do if a concussion occurs. Concussion symptoms can last anywhere from a week to a year.  Recognition and proper response to concussions when they first occur can help prevent further injury or even death.

Signs:                                                                       Symptoms:

–          Appears dazed or stunned                                    – headache

–          Is confused about assignment                              – Nausea or vomiting

–          Forgets plays                                                        – Dizziness or Balance Problems

–          Is unsure of game, score, or opponent                 – Blurred or Double Vision

–          Moves clumsily                                                      – Sensitivity to light or noise

–          Loses consciousness (even temporarily)              – Feeling sluggish

–          Any change in typical behavior/personality           – Feeling “foggy”

–          Forgets events prior to hit                                      – Change in sleep pattern

–          Forgets events after hit                                     – Concentration or memory problems

–          Changes in emotion (anger, sadness, etc.)

Required Training

Education is the key to identifying and treating student-athletes that show signs of a concussion during athletic participation.  It is very important that every administrator, coach, parent, official, athlete, and health-care provider know the symptoms and steps to take when dealing with student-athletes that display signs of a possible concussion.  Concussion can be a serious health issue and should be treated as such.

TSSAA is enforcing the administration of every TSSAA/TMSAA member school to meet with their coaching staff and review this policy prior to the beginning of every sports season.  The state office will distribute this information to as many officials, athletic trainers, and health-care providers as possible.  We ask that school personnel do the same in their area.  This information should also be given to all parents and student-athletes.

The NFHS has also developed a free 20-minute course online entitled “Concussion in Sport – What you Need to Know”.  The TSSAA is requiring every coach (head, assistant and volunteer) at Bradley Central to complete this course.  You can access the course at NFHS/Learn.org click on concussions and the course will appear.  You will have to create an account to access the video this is simple and free.  The video is also available to parents and athletes.

ImPACT  and Baseline Testing

ImPACT is a 20-minute computerized neurocognitive battery of tests that has been scientifically validated to measure the effects of concussions.  ImPACT is not just a software program; ImPACT provides a comprehensive and medically validated model for concussion management based on currently accepted international guidelines and practices.  ImPACT has undergone rigorous and independent scientific validations over a 15 year period (no other neurocognitive test has undergone this process).

While traditional neurological and radiological procedures such as computed tomography (CT) and magnetic resonance imaging (MRI) are helpful in identifying serious brain injuries (like skull fractures and hematomas), they are not effective at identifying the functional effects of concussions.  Accordingly, clinicians must often rely on subjective observations or patient self-reports to diagnose and track a concussion.  Alleviating this problem is the area where ImPACT can help the most.  ImPACT measures subtle changes in cognitive functioning that cannot be accurately measured by relying on an athlete to report symptoms.  It can be difficult to communicate symptoms of concussions and athletes are notorious for hiding or obscuring various concussive symptoms so they can return to play which is very dangerous and can lead to death.

Before the start of each high risk, contact sport season (football, soccer, etc.), each athlete will be given a baseline test.  If a concussion is suspected, a follow-up test (post-injury) is administered to see if or how the results have changed from the baseline.  This comparison helps to identify and manage the concussion. 

Initial Evaluation and Diagnosis

A student who is suspected by his/her teacher, coach, athletic trainer, school nurse, or team physician of sustaining a concussion during a School-sponsored practice or game shall be removed from the activity at that time. A student, who has been removed from play, must be immediately evaluated by the Athletic Trainer using the Concussion Signs and Symptoms Checklist and/or the Sport Concussion Assessment Tool (SCAT 3) tool.   This sideline assessment tool tests short and long term memory, balance, and concentration.  Objective/subjective signs and symptoms are also assessed along with exertion maneuvers (when appropriate).

If a concussion is suspected, the athletic trainer will determine when a post-injury ImPACT test needs to be taken by the athlete, this is usually done 24-72 hours after the concussion was sustained.  Once the post-injury test is taken the athlete will then be scheduled to be seen by Dr. Gary Voytik.  By taking the post-injury ImPACT prior to the physicians visit we are providing needed information to the physician ahead of time which can assist in the diagnoses and management of a concussion.

TENNESSEE STATE PROTOCOL FOR SCHOOLS WHEN PLAYERS EXHIBIT SIGNS, SYMPTOMS, OR BEHAVIORS CONSISTENT WITH A CONCUSSION DURING PRACTICE OR COMPETITION

1.  Continue to monitor players for possible signs of injury as usual.

2.  Remove any player that shows signs, symptoms, or behaviors consistent with a concussion from the activity or competition.

3.  The school shall have the player examined by the school’s designated health care provider. If the designated health care provider determines that the student has not sustained a concussion, the player may return to the activity or competition.

4.  The head coach shall be responsible for obtaining clearance from the school’s designated health care provider.

5.  If the school does not have access to a designated health care provider, or if the school’s designated health care provider suspects that the athlete may have sustained a concussion, the only means for an athlete to return to practice or play is for the student to be evaluated and cleared by a licensed medical doctor (M.D.), Osteopathic Physician (D.O.) or a Clinical Neuropsychologist with Concussion Training. The person clearing the student must complete and sign the “TSSAA Concussion Return to Play” form. Schools must keep this form on file.

Designated Health Care Providers – Certified Athletic Trainer, Certified Nurse   Practitioner, Physicians Assistant, Doctor of Medicine, Osteopathic Physician

Student and Parent Responsibility

If injury/incident occurred during a non-school sponsored event, parents are expected to immediately follow-up with a physician to diagnose a concussion.  Once diagnosed with a concussion by a physician, parents/student will need to communicate any instructions given by the physician to the Athletic Trainer.

Students are then expected to limit their use of a computer, cell phone, texting, video games, television, thus avoiding things that stimulate the brain.  For the first couple days avoid taking any medication (Tylenol) and adhere to all other restrictions set forth by the physician.  Students and/or parents also need to communicate with the school Athletic Trainer about their progress and challenges.  The student needs to be patient, concussion recovery may be slow.

Return to Play

Before a student may return to physical activity, PE, practice, games or other activities all aspects of the Bradley Central Concussion Management Requirements for Return to Play and the Bradley Central Friends Concussion Management Requirements for Return to Academia policies must be met.

Return to Play Concussion Management

     It is important to note that after a student receives a concussion, that he/she will not return to activity until cleared by Dr. Gary Voytik and the Certified Athletic Trainer.  The student  must have a completed “TSSAA Return to Play Concussion Form”.  Even with written clearance from a licensed health care provider, the Certified Athletic Trainer or Health Care Coordinator may withhold the student-athlete from returning to play if it is deemed a risk to their overall health.

RTP Requirements:

  1. 1. The student-athlete is symptom free for at least a full day; the student no longer exhibits concussion-related signs, symptoms or behaviors at rest or with physical exertion.2. The student-athlete has been cleared by a Physician and has a complete TSSAA Concussion Return to Play Form and the Athletic Trainer has a copy.3. After all the above have been accomplished, the student-athlete may gradually return to play following these specific Guidelines for Return to Play which is monitored by the Athletic Trainer.

These guidelines must be followed in order and under the observation of the Certified Athletic Trainer or the Physician.  If the student is able to clear a stage with no sign or symptoms returning, they progress to the next stage.   If at any time signs or symptoms that are consistent with a concussion return, the student returns to no activity (Stage 1) until they become symptom-free and return to the previous stage.

Day 1 – Low levels of physical activity (i.e. symptoms do not come back during or after the activity).  This includes walking, light jogging, light stationary biking, and light weightlifting (low weight – moderate reps, no bench, no squats).

Day 2 – Moderate levels of physical activity with body/head movement.  This includes moderate jogging, brief running, moderate intensity on the stationary cycle, moderate intensity weightlifting (reduce time and or reduce weight from typical routine).

Day 3 – Heavy non-contact physical activity.  This includes sprinting/running, high intensity stationary cycling, completing the regular lifting routine, non-contact sport specific drills (agility – with 3 planes of movement)

Day 4 – Sports Specific Practice

Day 5 – Full contact in controlled drill or practice

Day 6 – Return to competition

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