Concussion Protocol

Prescott High School

Protocols and Procedures: Concussions

 

Introduction:  Catastrophic Head injuries or Concussions are potentially life threatening or altering injuries.  The outcome of serious head injuries is dependent on the efficiency of the management process and the timeliness of the transfer to a controlled environment for diagnosis and treatment.  At Prescott High School all necessary precautions, protocols and procedures will be followed as outlined in this document by the Athletic Trainer, Team Physician, Coaches, and Administrative personnel (the following individuals will be referred to as the “Sports Medicine Team” for the duration of this document).

 

Summary: The level of consciousness and airway will be assessed and maintained.

When the victim is unconscious brain and spine injuries will be assumed, therefore neutral alignment in the cervical spine will be created and maintained.

Unconscious victims with a suspected head and cervical spine injury will be stabilized and transferred properly to the appropriate emergency care facility.

Suspected head injury victims will be assessed and monitored thoroughly.

Concussed athletes will be referred to Physicians when necessary.

Concussed athletes will not be allowed to return-to-play until cleared by the Certified Athletic Trainer or a Physician.

 

Protocols and Procedures:

 

Defining and Recognizing Concussions

  1. The Sports Medicine Team, especially the Certified Athletic Trainer will have a high sensitivity for the various mechanisms and presentations of traumatic brain injuries (TBI), including mild, moderate, and severe cerebral concussion.
  2. Signs and Symptoms of concussions may or may not be obvious such as:  altered levels of consciousness, balance problems, and memory and concentration problems as well as not so obvious concussion signs and symptoms such as:  headache, ringing in the ears, and nausea.
  3. The term “ding” will not be used by the sports medicine team and all head injury symptoms will be taken seriously and reported symptoms may not be rescinded.  If an athlete shows concussion-like signs and reports symptoms, such as a sustained headache, after contact to the head, the athlete has, at the very least, sustained a (mild TBI) or mild concussion and will be treated as such.
  4. The Athletic Trainer will be very active in communicating and educating coaches, athletes, and parents about concussions and the serious risks of playing with signs or symptoms of a concussion.  The result of which can be death or permanent brain damage.
  5. The PHS Athletic Trainer will document all the pertinent necessary information to the concussed athlete, including:  the mechanism of injury (if possible), initial signs and symptoms, level of consciousness, findings of neuropsychological function and postural-stability tests, instructions given to the athlete, parents, and coaches, any recommendations provided by the athletes physician, the athletes progression over time, the date and time of the athlete’s return to play, and any prior history the athlete may have with head injuries and their recovery.

 

Evaluating and Making Return-to-Play Decisions

  1. The Athletic Trainer and or Physician will evaluate all suspected concussed athletes and determine whether there may be a concussion.  Careful attention will be placed on the athlete’s recovery via signs and symptoms, neurocognitive testing, presence of amnesia (retrograde or anterograde), level of consciousness (LOC), headache, concentration problems, dizziness, blurred vision, etc.
  2. This assessment will be consistent regardless of the athlete, sport, or circumstances surrounding the athlete or the injury.
  3. The suspected concussed athlete will also be evaluated for any cervical spine and cranial nerve damage if necessary.
  4. The Athletic Trainer will document all pertinent information on the initial injury and all consequent assessment information noting the absence or presence of signs and symptoms.  Parents will also be provided with the Physician Concussion Home Instructions forms which may be provided via email.
  5. Initially the Athletic trainer will monitor signs and symptoms and assess the athlete at least every 5 minutes after the concussion until the athlete is with a parent.
  6. A member of the Sports Medicine Team will remain with the athlete until the athlete is with their parents or guardians, other healthcare professionals, or in no risk of further injury or danger.
  7. In addition to the formal clinical evaluation when possible post cognitive and postural-stability testing will be use and base-line data will be examined to determine the seriousness of the injury and return-to-play decisions.
  8. The athlete may participate in cardiovascular training before signs and symptoms subside as long as such training is cleared by the Athletic Trainer and or Physician.  If signs or symptoms re-occur with this training, it will be discontinued.
  9. Once the concussed athlete is sign and symptom free for 24 hours return-to-play will be considered. An ImPACT test may be used in the determination of a return to play progression.
  10. The returning athlete will first participate in sports specific activities that have no risk of injury to the head.  If signs and symptoms do not come back then the athlete will be allowed to participate in activities that do have some risk, if signs and symptoms do not return the athlete can participate fully.  If signs and symptoms return at any time the Sports Medicine Team must be informed and proper precautions taken including the cessation of activity for that athlete.

Cervical Spine Considerations

  1. When an athlete is unconscious serious head and cervical spine injuries will be assumed and all necessary precautions will be taken including:  assessment of airway, cervical spine and skull, proper referral, transfer, and immobilization of athletes with and without sport specific equipment.

 

 

 

When to Refer and Athlete to a Physician After a Concussion

  1. An athlete will be referred to a physician the day of a concussion if there is loss of consciousness, amnesia lasting longer than 15 minutes, deterioration of neurologic function, decreased level of conscious, deteriorating vital signs, unequal, dilated, or un-reactive pupils, Cranial nerve deficits, any signs or symptoms of spine injuries, mental status changes, seizures, vomiting, changes from the initial on-field evaluation in motor, sensory, or balance testing, post-concussion symptoms that worsen, additional post-concussion symptoms that occur after initial assessment, and if the athlete is still symptomatic at the end of the game or practice.
  2. Once the athlete is referred to a Physician the PHS Sports Medicine Team will refer to that Physician for all assessment, treatment, and return-to-play decisions.

 

When to Disqualify and Athlete

  1. If the athlete is symptom free after 20 minutes they will be exertionally tested with sideline jogging, sprinting, sit-ups, push-ups, and sports specific non-contact activities, if symptoms do not return they can return-to-play, however they will be closely monitored for the rest of the activity as well as 24 to 48 hours later, if symptoms do return they will be disqualified until further evaluation.
  2. If symptoms last longer than 30 minutes the athlete will be disqualified from participation.
  3. Athletes who have loss of consciousness and or amnesia will be disqualified until further evaluation.
  4. The Sports Medicine Team will be more conservative with athletes who have a history of brain injuries.  Athletes with 3 or more concussions will be recommended for temporary or permanent disqualification from contact sports.
  5. The sports medicine team will have a minimum of 10 minutes of undivided attention from an athlete to determine whether an athlete may return to play.
  6. An Athlete can be disqualified at the PHS Athletic Trainers discretion, even if the athlete is cleared by a physician.
  7. Athletes who are suspected of concussion will likely be disqualified to travel with the team for away events in order to encourage that proper rest and other precautionary measures are followed.

 

Special Considerations for Young Athletes

  1. The Sports Medicine Team will be aware that younger athletes may take longer to recover.
  2. Athletes will be managed conservatively.
  3. Athletes with suspected concussions will not travel with the team to participate in away events regardless of severity.
  1. Athletes will follow limitations on concussions as follows:
  • First Concussion results in a return to play and potentially clearance from a physician.
  • Second Concussion in the same season: the athlete may be removed from their current sport for the remainder of the season.
  • Third Concussion in the athletes 4 years of high school: The athlete’s parents will have a conversation with the athletic trainer/administration, in which the athlete will be recommended to not participate in contact sports.
  • On the fourth concussion, the athlete will need clearance from a physician that acknowledges that the athlete has had multiple concussions in the past to return to sports.

 

Home Care

  1. Concussed athletes will be instructed to avoid taking medications.
  2. Concussed athletes will be instructed to rest.
  3. A concussed athlete should be awakened at night ONLY if there was loss of consciousness, amnesia, or they are experiencing significant symptoms at bedtime.
  4. The parents or guardians will be given oral and/or written instructions for home care.

 

Return to play

 

If any concussion symptoms are noted more than 30 minutes after the head makes contact with any object, they will be assumed to have a possible concussion. They will be removed from participation and are then tested on ImPACT post-concussion testing (which may take place the following day). If their scores are lower than their baseline tests, they will go through concussion protocol. Concussion protocol is as follows:

 

  • The athlete will remain out of all activity that is not specifically prescribed by the athletic trainer.

 

  • On the first day the athlete is free of symptoms they will be tested again on ImPACT. If the athlete is back up to baseline levels, they will undergo a return to play.

 

  • A return to play will only take place on days that the athlete and the athletic trainer are both present, so weekends and holidays are often not included. If an athlete has symptoms, they must return to day 0. The return to play is as follows:

 

Day 0: rest until free of symptoms

Day 1: half a mile on the track

Day 2: full mile on the track

Day 3: 2 miles on the track

Day 4: non-contact practice

Day 5: full contact practice. (If day 5 is a game day, the athlete will not participate and return to practice the following day.)

 

The average return to play will take approximately three weeks and potentially longer. A physician’s clearance note may be required for return but it will not supersede a decision to remove an athlete from participation.

 

Day 0: rest until free of symptoms

Day 1: half a mile on the track

Day 2: full mile on the track

Day 3: 2 miles on the track

Day 4: non-contact practice

Day 5: full contact practice. (If day 5 is a game day, the athlete will not participate and return to practice the following day.)

 

Equipment Issues

  1. The Sports Medicine Team will ensure that all helmets meet the National Operating Committee on Standards for Athletic Equipment (NOCSAE) or American Society for Testing and Materials (ASTM) standards.
  2. Mouth guards are required for football and suggested for other contact sports.