BREWSTER HIGH SCHOOL

CONCUSSION GUIDELINES AND PROCEDURES

Education

Concussion education should be provided for all administrators, teachers, coaches, school nurses, certified athletic trainers and guidance counselors. Education of parents should be accomplished through preseason meetings for sports and/or information sheets provided to parents. Education should include, but not be limited to the definition of concussion, signs and symptoms of concussion, how concussions may occur, why concussions are not detected with CT Scans or MRI’s, management of the injury and the protocol for returning to school and returning to activity or interscholastic athletics. The protocols will cover all students returning to school after suffering a concussion, regardless if the accident occurred outside of school or while participating in a school activity.

Concussion Management Team

The District will assemble a concussion management team (CMT). The team will consist of: Brewster Central School’s Physician, Athletic Trainer, Director of Physical Education, Health and Athletics, Brewster High School nursing staff, Wells Middle School nursing staff, and one Physical Education Teacher from the District. The District’s CMT should coordinate training for all administrators, teachers, coaches and parents. Training should be mandatory for all coaches, assistant coaches and volunteer coaches that work with these students regularly. In addition, information related to concussions should also be included at parent meetings or in information provided to parents at the beginning of sports seasons. Parents need to be aware of the school district’s policy and how these injuries will ultimately be managed by school officials.

Training should include: signs and symptoms of concussions, post-concussion and second impact syndromes, return to play and school protocols, and available area resources for concussion management and treatment. Particular emphasis should be placed on the fact that no student will be allowed to return to play the day of injury and also that all students should obtain appropriate medical clearance prior to returning to play or school.

The CMT will act as a liaison for any student returning to school and/or playing following a concussion. The CMT will review and/or design an appropriate plan for the student while the student is recovering.

Definition of Concussion

A concussion is an injury to the brain that results in temporary alteration of normal brain function. It is usually caused by a blow to the head or other body part. Many times there are no signs of trauma. A concussion doesn’t require a loss of consciousness and many times, it won’t.

Grading Concussions

Grading systems for concussions have been deemed obsolete in favor of a more conservative approach. The severity of a concussion cannot be fully determined until all symptoms have resolved and the student returns to practice/competition.

Complications of Concussion

1. Second impact syndrome:
   • Inability to predict occurrences
   • Can occur within minutes of suffering a 2nd concussion while still suffering from the initial injury.
   • Both injuries can occur in the same sporting event
   • Vascular engorgement leads to massive intracranial pressure and herniation of the brain stem.
   • May occur from a subdural hematoma
   • Can result in brain damage or death
   • Most cases in literature, students were under 20 years old.
   • These cases should be treated as medical emergencies.
2. Post-Concussion Syndrome:
   • Persistent post-concussion symptoms lasting months,
   • Indicator of severity: no return to play while symptoms persist.
   • Students with post-concussive symptoms should be evaluated by a neurologist before returning to activity.
3. Convulsions:
   • Convulsive movement within seconds of concussion
   • Usually benign
   • Students should be referred to an Emergency Room (ER).
4. Seizures Disorder:
   • Can occur days or months after a concussion
   • Students should be referred to a physician/ neurologist for treatment before being allowed to return to activity.

Post-Concussion Treatment

Physical and mental rest is the most important treatment after suffering a concussion. Student/athletes should remain in a relatively quiet, stimulant free environment during this rest period in the first 24-48 hours following injury. Electronic screens such as cell phones, computers, video games, TV, should be minimized, perhaps to one such screen at a time to limit brain fatigue.  As with any injury, please follow the directions of your treating physician.  Here are some suggestions from our Brewster Central School District Physician about things student athletes should avoid during this period:

• alcohol consumption
• medications such as Aspirin or Motrin/Advil (Tylenol permitted)
• overeating

These items stress brain function, worsen symptoms, and may prolong the recovery process.  Once symptoms have begun to improve, total rest becomes unnecessary, and light physical activity such as walking and the use of a treadmill has recently been shown to shorten the full recovery time following a concussion and minimize deconditioning as well as improve emotional well-being.

Concussion Management Protocol

Any significant blow to the head witnessed or brought to the attention of the CMT will be treated as a concussive event. Concussion symptoms, if present, must be cleared before the RTP procedure can commence.

If the student exhibits any signs or symptoms located on the concussion checklist, it should be treated as a concussion. No student should return to play while symptomatic. Students are prohibited from returning to play the day the concussion is sustained. If there is any doubt as to whether a student has sustained a concussion, it should be treated as a concussion. Returning to play following a concussion involves a stepwise progression once the individual is symptom free.

The student should be re-evaluated by the Certified Athletic Trainer within 24-72 hours post injury. Once she/he is asymptomatic, they will take the post-concussion ImPACT test and the results will be sent to the school physician for interpretation to determine if they are ready to start the RTP protocol below.

1st concussion: Once the student is symptom free at rest for 24 hours and has a signed release/clearance by the treating clinician*, she/he will take the ImPact post injury test and have this verified by the school physician.  Once approved by the school physician, the athlete may begin the return to play progression below (provided there are no other mitigating circumstances).

2nd concussion in 1 calendar year from first/symptoms lasting for 7 days or more/LOC: Once the student is symptom free and has a signed release by the treating clinician*, she/he will be required to rest an additional 7 days before beginning the return to play progression below. (provided there are no other mitigating circumstances).

3rd concussion in 1 calendar year from first: Once the student is symptom free and has a signed release by a treating clinician*, she/he will be required to rest an additional 30 days before beginning the return to play progression below. For the safety of the student, she/he may also be permanently disqualified from any and all contact sports at Brewster Central Schools.

*Treating physician for Brewster Central Schools students must be trained in the evaluation and management of concussions. All other physician notes will not be accepted and will be referred to our school’s physician.

The Return to Play Protocols must be supervised by the Brewster High School Athletic Trainer and ultimately approved by the Brewster Central School District Physician.

Step 1:  Take the Post-Concussion ImPact Test

Step 2: Light aerobic activity

1. Stationary bike/walking 15 minutes. (When possible the nursing and/or physical education staff can assist with the completion of this step.)

2. If there are any signs and symptoms during the activity, the student will be stopped and will retry once symptoms are gone for 24 hours.

3. If asymptomatic for 24 hours, proceed to step 3.

Step 3: Moderate aerobic activity

1. Jog/run/bike/sport specific exercises for 30 min.

2. If there are any signs and symptoms during the activity, the student will be stopped and will retry once symptoms are gone for 24 hours.

3. If asymptomatic for 24 hours, proceed to step 4.

Step 4: Non-contact sport specific drills at full speed.

1. Full speed sport specific drills for 45 minutes.

2. If symptoms return, remove from practice and restart step 3 after 24 hours with no symptoms.

3. If asymptomatic for 24 hours, proceed to step 5.

Step 5: Full contact practice

1. Return to normal practice.

2. Any return of symptoms, stop activity.

3. After 24 hours of no symptoms, proceed to Step 6.

Step 6: Return to normal play, no restrictions

Once the Athletic Trainer determines that the Return to Play Protocols is complete, final clearance from the Brewster Central School District Physician is required.

Each step should take 24 hours so that a student would take approximately one week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise. If any post-concussion symptoms occur while in the stepwise program, then the student should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed.

Brewster Central School District Philosophy on ImPact Testing

The Brewster Central School District strongly recommends baseline ImPact testing, repeated every two years, in sports deemed at higher risk for a concussive event. In the event that pre-testing is not performed, and the student suffers a concussion during the sport season, it may affect the medical director’s ability to clear the student for post-injury participation.

Concussion Checklist and Physician Evaluation Form

Revised: 3/21/2017
Revised: 4/10/2018