Medical Related Information

MTBI/Concussion/Head Injury Management Policy

The Board of Education recognizes that concussions and head injuries are the most commonly reported injuries in children and adolescents who participate in sports and recreational activities. The physical and mental well-being of our students is a primary concern. Therefore the Clarence School District adopts the following policy to support the proper evaluation and management of concussion injuries.

 A concussion is a mild traumatic brain injury (MTBI). A concussion occurs when normal brain functioning is disrupted by a blow or jolt to the head or body that causes the head and brain to move rapidly back and forth. Recovery from a concussion and its symptoms will vary. Avoiding re-injury and over-exertion until fully recovered are the cornerstones of proper concussion management. Concussions can impact a student’s academics as well as his athletic pursuits.

MTBI/Concussion/Head Injury Management Team

 In accordance with the Concussion Management and Awareness Act, the Clarence School District has established a Concussion Management Team (CMT) which is composed of the certified athletic director, the high school nurse, the middle school nurse, the school physician, the certified athletic trainer, and such other appropriate personnel as may be necessary. This CMT shall oversee and implement the school district’s concussion policy and regulations.

 Components of the Policy 

• The Clarence School System recognizes the potential for head injuries in all school activities and will ensure that all reasonable precautions will be taken to minimize the likelihood of such injuries happening.

• Each Clarence coach, physical education teacher, school nurse, and certified athletic trainer who works with or provides instruction to students in school-sponsored athletic activities (including physical education class and recess) shall complete a course of instruction every two (2) years in the recognition of concussions and the proper monitoring and referral for appropriate medical care. The instruction can be completed by courses approved by the NYSED. 

Concussion management handouts will be reviewed with parents and students at the preseason meetings and will be sent home with the permission slip for parental review and approval.

 

The concussion management policy, handouts, and additional material will be on the Clarence Athletic Department website under Concussion Management.

• Any student exhibiting signs, symptoms, or behaviors suggestive of a concussion while participating in a school-sponsored class, extracurricular activity, or interscholastic athletic activity shall be removed from the game or activity and shall be evaluated as soon as possible by an appropriate health care professional. The coach, school nurse, or athletic trainer shall notify the student’s parents/guardians and recommend appropriate monitoring

If a student sustains a concussion at a time other than when engaged in a school-sponsored activity, the Clarence School District expects the parent/guardian to report the condition to the school nurse so that the school can support the appropriate management of the condition.

• Clarence recognizes the importance of the private physician’s care of the student and will do all it can to support any recommendations from the student’s doctor with regard to school activities. The school physician will make the final decision on return to school activities including physical education class and after-school sports.

• The Concussion Management Policy will be reviewed yearly by the Concussion Management Team.

MTBI/ CONCUSSION/HEAD INJURY MANAGEMENT PROCEDURE & TREATMENT PLAN

RECOGNITION OF CONCUSSION

A sports-related MTBI usually results from a blow to the head, though it can follow a body blow resulting in a shaking up of the brain.  The following signs and symptoms are commonly seen with concussions.

1.  An athlete with a witnessed loss of consciousness (LOC) of any duration should be spine boarded and transported immediately to the nearest emergency department via an emergency vehicle.
2. An athlete who has symptoms of a concussion and is not stable (condition is deteriorating) is to be transported to the nearest emergency department via an emergency vehicle.
3. An athlete who exhibits any of the following signs is unstable and should be transported to the nearest emergency room via emergency vehicle:
   • Deterioration of neurological function
   • Decreasing level of consciousness
     Decrease or irregularity of respiration or pulse
   • Unequal, dilated or nonreactive pupils
   • Any signs or symptoms of associated injuries, spine or skull fractures
     Fluid (clear or blood) from the eyes, ears, nose, and mouth
   • Seizure activity
   • Cranial nerve deficits
   • Mental status change:  lethargy, difficulty maintaining arousal, increasing confusion, 
     or agitation. 
4. An athlete who is symptomatic but stable (not exhibiting any signs of instability listed above), may be transported by his or her parents.  The parents should be advised to contact the athlete’s primary care physician within 24 hours.  If they feel the athlete’s condition is worsening, they should be advised to go to the emergency room.
5. If the parents are not available, a responsible individual may be allowed to transport the athlete home if the individual understands the home care instructions and is able to monitor the athlete.  Efforts should continue to be made to contact the parents.
6. Parents should always have the option of emergency transportation, even if it is not deemed necessary.

FOLLOW-UP CARE DURING THE SCHOOL DAY

1. Responsibilities of the school nurse after notification of a student’s concussion.The athlete will be instructed to report to the school nurse upon his or her return to school.  The school nurse will:
   • Re-evaluate the athlete using a graded symptom checklist.
   • Notify the student’s guidance counselor and teachers immediately and include an individualized health care plan as needed.
   • Notify the student’s physical education teacher that the athlete is restricted from all physical activity until further notice.
   • If the school nurse receives notification from someone other than the ATC (parent, athlete, physician note) that the student has sustained a concussion, the ATC should be notified as soon as possible.
   • Monitor the athlete on a regular basis during the school day.
2. Responsibilities of the student’s guidance counselor:
   • Monitor the student-athlete closely and recommend appropriate academic accommodations to the student athlete’s teachers.
   • Communicate any changes made to the student athlete’s individual education plan to the school nurse.

RETURN TO PLAY GUIDELINES AFTER HEAD INJURY

1. Returning to play on the same day of injury:
   • An athlete who exhibits signs or symptoms of a concussion, or has abnormal cognitive testing shall not be permitted to return to play on the day of the injury.  Any athlete who denies symptoms but has abnormal sideline cognitive testing should also be held out of activity.
2. Return to play after Head Injury, MTBI, Concussion:
   • The athlete must meet all of the following criteria in order to return to activities:
     1. Must be cleared for the RTP protocol by a licensed physician trained in concussion management
        • For purposes of the head injury RTP protocol, an appropriate physician evaluation is completed by a practicing MD or DO within the following specialties: family medicine, pediatrics, sports medicine, neurology, or neurosurgery, with preference given to the individual’s primary care physician. Family members and friends of the family who are medical providers may not serve as an appropriate physician. The physician completing the physician’s evaluation form should document name, degree, specialty, practice name (if applicable), address, and phone number. 
     2. Asymptomatic for at least 24 hours.
     3. Cognitive testing (ImPACT) has returned to the athlete’s baseline testing.
     4. Graduated progression back to full activity, with no resumption of symptoms during the process.
3. The athlete’s primary care physician’s wishes with regard to returning to school and learning accommodations in school will be honored.  However, returning an athlete to athletic activity is the sole responsibility of the school physician.
4. Once the athlete is asymptomatic for 24 hours and his/her ImPACT test is back to baseline, the athlete may begin a graduated progression of activity leading to full activity.
   • This process will be supervised by the ATC.
   • The progression of activity will be individualized based on the athlete’s concussion history, the duration of symptoms, the age of the athlete, and the specific sport the athlete is returning to.
5. The graduated progression (following the guidelines of the Zurich Progressive Exertion Protocol):

Phase 1: low impact, non-strenuous, light aerobic activity such as walking or riding a stationary bike.  If tolerated without a return of symptoms over a 24 hour period, proceed to:
Phase 2: higher impact, higher exertion, and moderate aerobic activity such as running or jumping rope.  No resistance training.  If tolerated without return of symptoms over a 24 hour period proceed to:
Phase 3: sport specific non-contact activity.  Low resistance weight training with a spotter.  If tolerated without a return of symptoms over 24 hours proceed to:
Phase 4:  sport specific activity, non-contact drills.  Higher resistance weight training with a spotter.  If tolerated without a return of symptoms over a 24 hour period, proceed to:
Phase 5:  full contact training drills and intense aerobic activity.  If tolerated without return of symptoms over a 24 hour period proceed to:
Phase 6:  Return to full activities without restriction.

If the athlete experiences post-concussion symptoms during any phase, the athlete drops back to the previously tolerated phase and resumes activity after 24 hours.