Here’s what we know about concussions
• An estimated 3.8 million sports and recreation-related concussions each year, according to the Center for Disease Control (CDC).
• Adolescents take longer to recover from a concussion than an adult.
• Our old protocols and policies for concussion management are not as effective as they need to be.
• Concussions not only occur in athletics, they also occur in recreation activities, physical education classes, skateboarding, automobile accidents, and everyday life.
• Since the brain controls the body’s functions and its cognitive abilities, it is extremely important for us to do the very best we can to provide proper care for students who suffer concussions.
What a concussion is
• A concussion is defined as a brain injury that results in a temporary disruption of normal brain function. (McCrory, 2008)
• 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. (McCrory, 2008)
• A concussion can occur from contact with another player, hitting a hard surface such as the ground or court or getting hit by a piece of equipment such as a bat, stick or ball.
Why we’re implementing this policy
After studying the new concussion research and information, we at Indian Land High School have decided to be proactive in making a comprehensive concussion policy to better protect our students.
• This concussion policy is not just for our athletes, but for every student at Indian Land High School.
• After researching concussions, state concussion laws, policies of other programs; and communicating with experts in the field of concussion management, we have decided the Team Approach to concussion management is the best option for our students.
• We have looked in depth at the Jake Snakenburg Act of Colorado (SB 11-040) and Max’s Law of Oregon (OAR 581-022-0421) to pull information to fit our needs.
• We have been in verbal contact with Karen McAvoy, PsyD of the Rocky Mountain Youth Sports Medicine Institute Center for Concussion, The Colorado State Department of Education, and the author of the REAP Project for Concussion Management to glean information and advice from her as we create our policies.
• We have decided to closely mimic the REAP Project and use it as our template for our Concussion Assistance Policy.
We would like to thank Karen McAvoy for her assistance and guidance on our concussion management project. We would like to see a state law written in South Carolina before we have to name a law after a student who is no longer with us. As we’ve stated, our effort is to be proactive instead of reactive. We want to do what is best for our students at Indian Land High School and Lancaster County. As our school district’s motto states, “Putting our Children First” is our first priority.
David J. Sweem
Assistant Principal/Concussion Team Coordinator
How a concussion affects us
• Signs and Symptoms of a concussion are broken into four areas: Physical, Cognitive, Emotional, and Maintenance (McAvoy, 2011).
• It’s important to remember – not all signs or symptoms will be displayed.
Procedures
1. If at any time a student shows the signs and symptoms of a concussion, the student will be removed from play until evaluated by a proper health care provider.
a. Proper health care providers who can assess and clear a student for same day return to play are:
i. Medical Doctor (M.D.). or Doctor of Osteopathy (D.O.)
ii. Athletic Trainer who is Nationally and/or State Certified in SC.
b. Proper health care providers who can assess and medically clear a diagnosed concussion for gradual return to play are:
i. M.D. or D.O.
ii. Licensed Physician Assistant
iii. Licensed Nurse Practitioner
2. If a proper health care provider is not available at the practice or contest, then the student must see a physician (M.D. or D.O.) for treatment of the condition and will not be allowed to return to play until the student is cleared by a physician.
a. The physician must be familiar with concussions and head trauma.
b. Once cleared by a physician, the student will begin the gradual return-to-play process.
c. Once diagnosed with a concussion, the student will begin the gradual return-to-academics process through the Concussion Assistance Team (CAT).
3. The clearance of a student to return to play/academics must include the Concussion Assistance Team.
a. The team includes The Family Team, School Physical Team, School Academic Team, and the Medical Team.
b. The school holds the right to hold any student out of practice and competition if a Concussion assistance Team member observes any signs of a concussion even after medical clearance.
4. An athlete recovering from a concussion must be cleared academically (including PE and JROTC) before they can be cleared to return to practice.
5. All coaches must
a. undergo concussion training each year before their respective teams begin practicing
b. be familiar with gradual return-to-play procedures.
6. All student athletes and their parents/guardian must
a. undergo a concussion information session before they are allowed to participate in sports at Indian Land High School
b. sign the student/parent agreement form for concussion education and return it to the school designated official.
7. All teachers will go through training that includes
a. concussion recognition of signs and symptoms
b. gradual return to academics procedures for students with concussion.
Best Practices
Concussion Assistance Team
As stated earlier, we believe a multi-disciplinary team approach is the best method for concussion assistance and is the most effective method for putting the best interests of the student first.
• We believe we should have four teams involved with the students care after a concussion, an approach modeled after the REAP approach.
• These teams are the Family Team, School Physical Team, School Academic Team, and the Medical Team. Below we will explain each team and how the process will work.
*The list of team members is not all inclusive. Every school is unique in the resources they have and we want to leave room for growth in our school. It is also very possible that all members listed may not be available to be a part of the Concussion Assistance Team. Each case is different and could be unique in its team members, but there will be representation from each team as part of the CAT.
Concussion Assistance Team (CAT) Responsibilities
Administration
• Promote change in culture of concussion management by putting in place concussion management policies
• Provide the necessary programs and training for everyone involved with concussion management so that students return fully to athletics and academics safely
Athletic Director
• Support all parties involved in concussion management
• Promote concussion awareness to students/athletes/coaches
• Help with facilitation of training for all parties involved
• Ensure proper and well maintained equipment
• Monitor the appropriate incident protocols
• Encourage the proper tracking of all injuries
Certified Athletic Trainer (ATC) {If employed at the school}
• Help with the treatment and gradual return to play of the student athlete per physician’s orders
• Notify the school nurse and the CAT Coordinator of athlete who has sustained a concussion
• Work as a vital part of the school physical team
• Help provide education to staff and coaches on concussion signs, symptoms, and treatment protocols for head injuries and concussion.
Coach
• Responsible for knowing and implementing the rules of his/her sport and to insure safe conditions for practice and play.
• Must remove an athlete with possible head injury from play until cleared by a physician familiar with head and brain injuries
• In the absence of an ATC must help with the implementation of gradual return to play as specified in the procedures.
School Counselor
• Help to oversee student’s return to academic activities
• May provide counseling to the student when needed
• Help keep teachers informed of the student’s progress.
School Psychologist
• Provide advice on modifications needed in the classroom
• Help in the facilitation and development of the CAT
School Nurse
• Help with daily treatment of the student athlete
• Involved with the school physical team for implementation of the Concussion Assistance Team (CAT).
• All physician notes should go through the school nurse and ATC (if present) for the physical and academic school teams of the CAT
Teachers
• Work as part of the CAT/Academic Team
• Help provide accommodations needed for the student
• Help in daily assessment for the CAT with signs and symptoms observed
• Submits Teacher’s CAT form in to the CAT Facilitator.
Parents
• Take student athlete to proper medical professional as soon as possible
• Sign the release to notify the school of the student’s condition so the rest of the management team can be prepared for when the student returns to school
• Monitor signs and symptoms at home (Physical & Cognitive Signs & Symptoms)
• Communicate with the school and medical teams about progress and any regressions
• Make the student athlete rest physically and cognitively.
– No video games
– No computers,
– No TV
– No texting
– No driving
– No prolonged reading until cleared to do so by a medical professional and signs and symptoms are totally absent
Student/Athlete
• REST, REST, REST, until asymptomatic
• Listen and do what is recommended to you. No video games, texting, prolonged TV, exercise, or anything that causes your symptoms to get worse.
• Work with the Management Team truthfully – report any and all signs and symptoms.
• If your teammate is the concussed athlete, report anything you see to your coach, trainer, teacher, school nurse, and/or guidance counselor.
Team Medical Provider (Physician)
• Provide care for the student athlete
• Works with the Concussion Assistance Team to provide the proper care for the student athlete’s recovery
• Serves as a vital part of the CAT but must be willing to work with all parties involved.
Hospital Medical Provider (Emergency Department)
• When treating a student athlete from Indian Land with a possible concussion, have the parents sign the release of information form
• Fax the concussion notification form to the Concussion Assistance Team Coordinator so the coordinator can provide the necessary information to all parties involved and begin the process for accommodations when the student is able to return to school.
Implementation of REAP at Indian Land High School
The REAP program written by Karen McAvoy, PsyD. of the Rocky Mountain Youth Sports Medicine Institute of Centennial, Colorado is a multidisciplinary approach to concussion management of students by the teams mentioned above.
• The members of the teams and their responsibilities will vary at each school using the program based on personnel at the schools.
• Below is how we at Indian Land High School plan to implement the REAP program into a living plan to fit our students needs while living up to our capabilities as a school.
REAP stands for Reduce, Educate, Accommodate, and Pace
Reduce
• Reduce the chance for further injury to the brain by taking the student athlete out of play or practice as soon as you observe or have reported to you the signs and symptoms of a student athlete having a possible concussion.
• Remember that only a medical professional such as a Physician or Physicians Assistant can make a medical diagnosis of a concussion, but if you as a coach, trainer, players, parents, etc suspect the possibility of a concussion or observe the signs and symptoms of a concussion, you have the responsibility to
– pull the player out and
– make the recommendation to the parent/guardian that the student athlete needs to be seen by an appropriate medical provider for a possible concussion.
• If a student is suspected of having a possible concussion, the school holds the right to, and will hold the student out of play, until cleared by an appropriate medical provider (M.D. D.O., Physicians Assistant, Licensed Nurse Practitioner; with training in concussion management), regardless of parents consent to put them back into play!
Educate
To Educate has two segments in the REAP program – Education and Collaboration.
• Education
– Education can be as simple as knowing the signs and symptoms of a concussion.
– It is important that all parties involved in the recovery and management of the student’s concussion know the four categories for signs and symptoms mentioned above.
• Collaboration
– As stated before, concussion management is a team approach with many stakeholders. The Concussion Assistance Team (CAT) are those stakeholders.
– Collaboration means all these stakeholders are on the same page and can communicate effectively with each other.
– The REAP program is a “Multi-Disciplinary Team” approach in which team members provide multiple perspectives of the student/athlete and they share multiple sources of data to assist in the student/athletes recovery (McAvoy, 2011).
– It is recommended in REAP that each case is unique and may have different people on the management team (CAT).
– Below is an outline describing how we envision – in an ideal setting – our management of concussions to flow. Please note each case is unique and the people who make up theses teams will change depending on the CAT and what is available to them.
1. Suspected head injury occurs
a. If injury is reported to coach
i. Coach will sit the student athlete out.
ii. The coach will contact the parent/guardian and fill out the Coach Notification Form and give the appropriate copy to the parent/guardian.
b. If injury is reported later to Athletic Trainer or School Nurse
i. Trainer/Nurse will contact the parent/guardian and the coach of the sport.
ii. The Trainer/Nurse will have the parent fill out the Trainer-Nurse Incident form and give the appropriate copy to the parent/guardian.