Chapter I - Health and Safety

Part 2.0 Illness or Accident

Section 2.2 Concussion and Head Injury

Policy Statement:

Concussion and Head Injury

American Preparatory Academy has established this protocol to provide education about concussion for coaches, school personnel, parents, and students.  This protocol outlines procedures for staff to follow in identifying, treating, and appropriately referring concussed students.  School policy is specified as to return-to-activity issues following a concussion.

The school's Administrative Director shall appoint a School Concussion Specialist.  In coordination with Physical Education Instructors, School Secretaries, and the Administrative Director, the School Nurse shall review this protocol annually.  Any changes or modifications will be provided in writing by July 1st to the school's Administrative Director.  The Administrative Director will annually ensure that (1) the updates are included in staff policy books, written parent notification, and the school website; (2) all staff and coaches are trained in concussion identification, response procedures and return-to-activity policies; and (3) parents receive, sign and return the "Acknowledgement of Head Injury Policy" form.

Recognition of a Concussion

What is a concussion?  A concussion is a type of traumatic brain injury that interferes with normal function of the brain.  It occurs when the brain is rocked back and forth or twisted inside the skull as a result of a blow to the head or body.  What may appear to be only a mild jolt or blow to the head or body can result in a concussion.  A concussion can occur even if a player or student in an activity is not knocked out or loses consciousness.  (NFHS "Suggested Guidelines for Management of Concussion in Sports.")

Common signs (observed by others):

  • Student appears dazed or stunned
  • Confusion
  • Forgets plays
  • Unsure about game, score, opponent
  • Moves clumsily (altered coordination)
  • Balance problems
  • Personality change
  • Responds slowly to questions
  • Forgets events prior to hit
  • Forgets events after the hit
  • Loss of consciousness (any duration)

 

Common Symptoms (reported by student):

  • Headache
  • Fatigue
  • Nausea or vomiting
  • Double vision, blurry vision
  • Sensitive to light or noise
  • Feels sluggish
  • Feels "foggy"
  • Problems concentrating
  • Problems remembering

RED ALERT: Any student with a witnessed trauma to the head, back or neck that causes loss of consciousness (LOC), numbness in extremities, or seizure activity.

  • Do not move the student.  Call 9-1-1 or send a student in to the main office to call 9-1-1.  Stay with the student until the School Concussion Specialist arrives.  Designated school personnel must accompany the child until relieved of custodial responsibilities by a parent.

ORANGE ALERT:  Any student who has symptoms of a concussion, and who is not stable (i.e., condition is worsening).  These may include:

  • Deterioration of neurological function
  • Decreasing level of consciousness
  • Decrease or irregularity in respirations
  • Any signs or symptoms of associated injuries, spine or skull fracture, or bleeding
  • Mental status changes: lethargy, difficulty maintaining arousal, confusion or agitation
  • Place the student in a rolling chair and carefully wheel the student to the main office.  Contact parents for immediate transportation to an emergency medical facility.  Alert the School Concussion Specialist.

YELLOW ALERT:  Any student who has symptoms of a concussion, and who is stable.

  • Accompany the student to the main office.  Alert the School Concussion Specialist.  Notify the parents of the injury and advise them to contact the student's primary care provider or seek care at an emergency medical facility as soon as possible and before the day's end.

BLUE ALERT: Any student with a witnessed trauma to the head but without  concussion symptoms.

  • When in doubt, sit 'em out.  Do not allow the student to participate in physical activities.  Alert the School Concussion Specialist.  Inform parents of the nature and time of the event.  Students with suspected head injuries should not be permitted to drive home.

Concussion Events That Occur Off School Property (Such as Sporting Events or Field Trips)

Respond appropriately based on the above guidelines.  Seek assistance from the host site.  Ensure that other students are supervised for whom you are responsible while you attend to or accompany the injured student.  Promptly notify the school administration.

Return to Play (RTP) Procedures After a Diagnosed Concussion

  1. Return to activity and play is a medical decision.
  2. Once expert medical clearance has been documented, school personnel will require re-evaluation if concussion symptoms are still evident and will make the final decision regarding resumption of activity.
  3. Once the above criteria are met, the School Concussion Specialist will supervise student progression back to full activity following the step-wise process detailed below.
  4. Progression is individualized, and will be determined on a case-by-case basis. Factors that may affect the rate of progression include: previous history of concussion, duration and type of symptoms, age of the student, and sport/activity in which the student participates. An athlete/student with a prior history of concussion, one who has had an extended duration of symptoms, or one who is participating in a collision or contact sport may be progressed more slowly.
  5. The student should spend 1 to 2 days at each step before advancing to the next. If post concussion symptoms occur at any step, student must stop the activity and the treating physician must be contacted. Depending upon the specific type and severity of the symptoms, the student may be told to rest for 24 hours and then resume activity at a level one step below where he or she was at when the symptoms occurred. This resumption of activity could be considerably simplified for a student injured during recess compared to a student injured at a game or formal practice.

Step-wise Process for RTP

  1. Complete cognitive rest.  This may include staying home from school or limiting school hours (and studying) for several days.  Activities requiring concentration and attention may worsen symptoms and delay recovery.
  2. Return to school full-time.
  3. Light exercise.  This step cannot begin until the student is no longer having concussion symptoms and is cleared by a physician for further activity.  At this point the athlete may begin walking or riding an exercise bike. No weight lifting.
  4. Running in the gym or on the field.  No helmet or other equipment.
  5. Non-contact training drills in full equipment.  Weight training can begin.
  6. Full contact practice or training.
  7. Play in game.  Must be cleared by physician before returning to play.

Supplemental Materials:

Handouts:                   HO I 2.2 APA Head Injury Policy

Office Forms:             OF I-2.2 Acknowledgement of Head Injury Policy

Legal References:     Utah Code Title 26 Chapter 53 Protection of Athletes with Head Injuries Act

                                    Utah Administrative Code R277-614, Athletes and Students with Head Injuries                            

Supportive Research: SR I-2.2 Head Injury Training PowerPoint