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New Policy: 10-5-11

Philosophy

Medical management of sports‐related head injuries and concussions continues to evolve. In addressing this latest research, the South Sanpete Board of Education, in conjunction with Risk Management, has established this Policy to provide education and training about head injuries and concussions for coaches, administrators, school agents, parents, and students. This Policy outlines procedures for school agents to follow in managing concussions and also lists the protocol necessary for a student to return to play following a head injury or concussion.

Definitions

1. Agent

An agent may be a teacher, coach, representative, employee, volunteer, or an administrator or designee.

2. Concussion

A concussion is a type of "Traumatic Brain Injury" (TBI) 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.

Common Signs/Symptoms of Sports-Related Concussions Observed by Others:

• Student appears dazed, stunned, or disoriented

• 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

• Visual difficulties: Double vision, blurry vision, etc.

• Sensitive to light or noise

• Feels sluggish

• Feels "foggy"

• Problems concentrating

• Problems remembering

These signs and symptoms following a witnessed or suspected blow to the head or body are indicative of a probable concussion. Any student who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest, game, or practice and shall not return to play until cleared by an appropriate health care professional.

3. Health-Care Provider

For the purposes of this Policy, a qualified Health-Care Provider is one who is trained in the management of concussions and who:

• Is licensed under Utah Code, Title 58, Division of Occupational and Professional Licensing Act; and

• May evaluate and manage a concussion within the Health-Care Provider's scope of practice; and

• Has within three years, successfully completed a continuing education course in the evaluation and management of concussions.

4. Sporting Event

A sporting event means a game, practice, sports camp, physical education class, competition or tryout. It does not include a lift ticket or a pass issued by a ski resort unless the specific activity is organized, managed, or sponsored by the ski resort.

Policy

The purpose of this Policy is to establish protocol and guidelines for concussions and head injuries through the following: provide education and training; inform students, parents or legal guardians of this Policy and obtain the students' and parents' signature on the Parent/Student Consent Form before permitting a child to participate in a sporting event; require removal from a sporting event when the child is suspected of sustaining a concussion or traumatic head injury; and prohibit a child who has sustained a concussion or head injury from participating in a sporting event or returning to play until medical clearance from a qualified health care provider has been given.

The guidelines of this Policy are outlined in accordance with HB 204, "Protection of Athletes with Head Injuries"; State Board Rule R277-614, "Athletes and Students with Head Injuries"; and Utah Code 26-53-101, "Protection of Athletes with Head Injuries Act." In addition to this Policy, high schools may also utilize the "UHSAA Sports Concussion Management Policy" in the prevention, education, and treatment of concussions and head injuries.

1. Management and Referral Guidelines for All Staff

The following situations indicate a medical emergency and require medical attention from EMT's or a health-care provider.

A. Any student with a witnessed loss of consciousness of any duration should be spine boarded and transported immediately to nearest emergency department via emergency vehicle.

B. Any student who has symptoms of a concussion, and who is not stable (i.e., condition is worsening), is to be transported immediately to the nearest emergency department via emergency vehicle.

C. A student who exhibits any of the following symptoms should be transported immediately to the nearest emergency department, via emergency vehicle.

(1) Deterioration of neurological function

(2) Decreasing level of consciousness

(3) Decrease or irregularity in respirations

(4) Any signs or symptoms of associated injuries, spine or skull fracture, or bleeding

(5) Mental status changes: lethargy, difficulty maintaining arousal, confusion or agitation

(6) Seizure activity

D. Parents may transport a student who is symptomatic but stable. If this occurs, the parents should be advised to contact the student's health-care provider, or seek care at the nearest emergency department, on the day of the injury.

2. Guidelines and Procedures for Coaches and Teachers Supervising Contests and Games: RECOGNIZE ▪ REMOVE ▪ REFERGNIZE

RECOGNIZE Concussion

A. All educators and agents of the District should become familiar with the signs and symptoms of a concussion that are described in the definition of this Policy.

B. Agents of the District shall have appropriate training about recognizing and responding to traumatic head injuries, consistent with the employees' responsibilities for supervising students and athletes.

REMOVE from Activity

Any student who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the sporting event and shall not return to play until an appropriate health-care provider has evaluated the student and has provided a written statement clearing the student to resume participation. Always error on the side of safety and "When in doubt, sit them out." (Utah Code 26-53-301)

REFER the Athlete/Student for Medical Evaluation

A. The agent of the District is responsible for notifying the student's parent(s) or guardian(s) of the injury.

(1) Contact the parent(s) to inform a parent of the injury. Depending on the injury, either an emergency vehicle will transport or parent(s) will pick the student up at the event for transport.

(2) A medical evaluation from a health-care provider is required before returning to play.

B. In the event that a student's parent(s) cannot be reached, and the student is able to be sent home (rather than directly to MD):

(1) The District's agent should insure that the student will be with a responsible individual, who is capable of monitoring the student and understanding the home-care instructions, before allowing the student to go home.

(2) The District agent should continue efforts to reach a parent.

(3) If there is any question about the status of the student, or if the student cannot be monitored appropriately, the student should be referred to an emergency department for evaluation. A District's agent should accompany the student and remain with the student until a parent arrives.

(4) The District's agent shall provide for supervision of other students for whom he or she is responsible when accompanying the injured student. Students with suspected head injuries should not be permitted to drive home.

C. For away contests and games, the agent should seek assistance from the host site school administrator, certified athletic trainer, emergency personnel, or team physician in assisting with head injuries.

3. Return to Play (RTP) Procedures After a Concussion

A. Return to activity and play is a medical decision. The student must meet all of the following criteria in order to progress to activity:

(1) Asymptomatic at rest and with exertion (including mental exertion in school) and

(2) Have a written clearance from the student's primary health-care provider or concussion specialist (student must be cleared for progression to activity by a physician other than an Emergency Room physician, if diagnosed with a concussion).

B. Once the above criteria are met, the student will be progressed back to full activity following the Step-Wise Progression detailed in item D. This Progression must be closely supervised by a District agent and must have a very specific plan to follow as directed by the athlete's health care provider.

C. 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 a concussion, one who has had an extended duration of symptoms, or one who is participating in a contact sport may be progressed more slowly.

D. Step-Wise Progression:

Step 1- Complete cognitive rest as required by a health-care provider. This may include staying home from school or limiting school hours for several days. Activities requiring concentration and attention may worsen symptoms and delay recovery.

Step 2- Return to school full-time.

Step 3- Begin with light exercise. This step cannot begin until the student is no longer having concussion symptoms and is cleared by a health-care provider for further activity. At this point, the athlete may begin walking or riding an exercise bike. No weight lifting.

Step 4- Run in the gym or on the field with no helmet or other equipment.

Step 5- Proceed to non-contact training drills. Weight training may also begin.

Step 6- Participate in full-contact practice or training.

Step 7- Cleared by health-care provider (in writing) before returning to competitive play.

The student may spend one to two days at each step before advancing to the next. If post-concussion symptoms occur at any step, the student must stop the activity and the health-care provider 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.

4. Reoccurrence of Symptoms

If a student returns to play and is clearly still having concussion symptoms even after receiving clearance from a health-care provider, the school administrator or supervising agent may discontinue the student's competitive play and practice until the student is re-evaluated and cleared by a health-care provider trained in the evaluation and management of a concussion.

While current Utah law designates that a student may return to play by "an appropriate health-care provider," the school administration has the prerogative to designate the credentials of the providers from whom they will accept clearance. This is a very important decision and should be made after careful consideration by the school administrator or supervising agent. They may choose to contact Risk Management for advice and direction as needed.

5. Annual Dissemination and Training

A. The school administrator or designated supervising agent shall review and discuss this Policy with all appropriate personnel/agents and provide yearly training in the procedures and protocol for managing concussions and head injuries outlined in this Policy or in the UHSAA "Sports Concussion Management Policy."

B. The District shall post this Policy on the District's Website.

C. High schools shall include a copy of this Policy and the Parent/Student Consent Form in the school's "Extra-Curricular Guide." In addition, student athletes shall be educated on the signs, symptoms, and risks of sport-related concussions and their obligation to notify appropriate school agents when experiencing such symptoms or signs.

D. Before permitting a student to participate in a sporting event, the agent shall provide a written copy of this Policy to a parent or legal guardian of the student. In addition, students and parents/guardians must sign the Parent/Student Consent Form (Policy JL-1) acknowledging they have read, understand, and agree to abide by the Policy.

E. County or State Health Department employees and physical education specialists shall review this concussion protocol annually. Any changes or modifications will be reviewed by the Board and then given to school administrators, athletic department staffs, and other appropriate school agents.

6. References

A. State Board Rule R277-614 "Athletes and Students with Head Injuries" (8-6-11)

B. Utah Code 26-53-101, 102, 201, 301 "Protection of Athletes with Head Injuries Act" (8-3-11)

C. HB 204 "Protection of Athletes with Head Injuries" (Gen. Session 2011)

D. "UHSAA Sports Concussion Management Policy" (8-17-11)

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