Granby Jr/Sr High School

Athletic Department

Concussion Information and Return to Play Protocol

Concussion Information

The Massachusetts Interscholastic Athletic Administration (MIAA) Board of Directors adopted a policy concerning concussions. This policy applies to all member schools including Granby Jr/Sr High School. The policy reads, “Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional.”

Any head injury can be a serious life threatening condition. It is important that the athlete and parent/guardian, pay careful attention to these symptoms:

Granby Jr/Sr High School

Athletic Department

Concussion Information and Return to Play Protocol

·  headache/ pressure in head

·  irritability

·  nausea or vomiting

·  balance problems or dizziness

Granby Jr/Sr High School

Athletic Department

Concussion Information and Return to Play Protocol

·  double or blurry vision

·  sensitivity to light or noise

·  feeling sluggish, hazy, foggy, or groggy

·  confusion, concentration or memory issues

Granby Jr/Sr High School

Athletic Department

Concussion Information and Return to Play Protocol

If any of these symptoms occur during any phase of the recovery process, whether in school, practice, or at home, the coach, trainer, school nurse, or health care provider need to be notified. Athletes who have not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences from a second concussion injury. Such difficulties are prevented if the athlete is allowed time to recover from the concussion and return to play decisions are carefully made. No athlete should return to sport or other high-risk activities when symptoms of concussion are present and recovery is ongoing. Don’t Hide It! It is better to miss a few games than a whole season

The following procedures will be followed in the event an athlete receives a head injury:

·  Athlete is removed from the contest or practice.

·  The athletic trainer will conduct a Standardized Assessment of Concussion.

·  If athletic trainer is not available, the coach will notify parents to recommend follow up with athlete’s health care provider.

Granby Jr/Sr High School

Athletic Department

Concussion Information and Return to Play Protocol

·  The athletic trainer/coach will notify parent/guardian and director of athletics.

·  Director of athletics will notify school nurse.

·  School nurse will contact athlete’s teachers and guidance counselor.

Any athlete showing signs or symptoms of a concussion must receive medical clearance from an appropriate health care professional to return to play. Any athlete diagnosed with a concussion must complete the Gradual Return to Play Protocol. It is not necessary to suffer loss of consciousness to have a concussion.

Gradual Return to Play Protocol:

Return to play will occur only after the following steps have been completed, in the order listed below:

  1. Parent/Guardian reads and signs the Concussion Information and Gradual Return to Play Protocol.
  2. Athlete reads and signs the Concussion Information and Gradual Return to Play Protocol.
  3. An appropriate health care professional: physician (MD, DO), physicians assistant (PA), or nurse practitioner (NP) grants clearance and signs Concussion Information and Gradual Return to Play Protocol.
  4. Student Athlete will take the POST CONCUSSION ONLINE TEST and must have a valid result before they start the four physical steps.
  5. Athletic director notifies coach and gives copies of completed form to school nurse.
  6. Coach and/or Athletic Trainer implement Physical Post Concussion Steps

Granby Jr/Sr High School

Athletic Department

Concussion Information and Return to Play Protocol

Granby Jr/Sr High School

Athletic Department

Concussion Information and Return to Play Protocol

Physical Post Concussion Steps

The athlete must complete the four physical post concussion steps, administered by an athletic trainer or coach. Only one test may be given per day. The next test will be administered only when previous test is passed. These steps will take a minimum of four days.

Step 1: (to increase heart rate): Low Levels of physical activity. This includes walking, light jogging, and light stationary biking.

Step 2: (to increase heart rate with movement): Moderate levels of physical activity with body/head movement. This includes moderate jogging, brief running, moderate intensity on the stationary cycle.

Step 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).

Step 4: Full contact in sports specific practice.

Athlete’s Name ______Age ______

Date of Injury ______Sport ______

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Parent/Guardian Signature:

I have read the Concussion Information, and I understand the seriousness of a concussion, its symptoms, and the Gradual Return to Play Protocol. Questions? Call high school nurse @ 413-467-7105 or athletic office @ 413-467-2705

______

Parent/Guardian Signature Date

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Athlete Signature

I have read and understand the Concussion Information and its symptoms.

______

Athlete Signature Date

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Health Care Professional Clearance

I have seen ______and I

Athlete’s Name

c Will allow him/her to return to full sports activity.

c Will allow him/her to return to full sports activity with the following restrictions:

c Will NOT allow him/her to return to full sports activity until.

______

Health Care Professional Signature Date

______

Print Name

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Test Completion Dates with Asymptomatic Results

______

Step 1 Step 2 Step 3 Step 4

I verify that ______has completed the four physical

Athlete’s Name

post-concussion steps and said athlete reported to be asymptomatic for all steps.

______

Coach’s Signature Date

Granby JR/SR High School

Athletic Department

Concussion Information and Return to Play Protocol