GREENBURGH-NORTH CASTLE UNION FREE SCHOOL DISTRICT

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1 POLICY Date Adopted: 6/19/13 Date Reviewed/Modified: 8/13/13 Policy #: 3172 Category: Pages: 1 of 6 GREENBURGH-NORTH CASTLE UNION FREE SCHOOL DISTRICT SUBJECT: CONCUSSION MANAGEMENT The following concussion management policy shall be followed for all students in the Greenburgh North Castle Union Free School District (GNC UFSD) that display signs and symptoms of a concussion. This includes interscholastic athletes as well as students in physical education classes. The items listed below are required for school districts to be in compliance with the law. The Concussion Management Team: The Concussion Management Team shall guide, implement and periodically review the program. The team will include the following individuals: - Assistant Superintendent of Schools - School Nurse - School Chief Medical Officer - Coach - Athletic Director Parent and Student Awareness of Concussion Management: The GNC UFSD will provide Concussion Management and Awareness information to parents and students. Information will be made available in written documents and sign off on GNC UFSD Permission to Participate Form. The Concussion Management policy will be made available on the GNC UFSD website ( Concussion Training Coaches, physical education teachers, nurses and the athletic director will have to complete an approved course on concussion management on a biennial basis. Coaches and physical education teachers must complete the Center for Disease Control Online Concussion Training for Coaches course: School nurses must complete the Preventing Concussion course: At the completion of the course, participants will receive a certificate to verify they have completed the course.

2 Removal from Athletics: Require the immediate removal from athletic activities of any pupil that has or is believed to have sustained a mild traumatic brain injury. - No pupils will be allowed to resume athletic activity until they have been symptom free for 24 hours and have been evaluated by and received written and signed authorization from a licensed physician. For interscholastic athletics, clearance must come from the School Physician or the pupil training physician. - Such authorization must be kept in the pupil s permanent health record. - Schools shall follow directives issued by the pupil s treating physician, unless otherwise directed by the School Physician. On Field Evaluation: During practices and contest, athletes demonstrating signs and symptoms of a concussion should be evaluated by the coach and then if determined to have a possible concussion, athlete should not be permitted to continue any activity at which the athlete must follow all protocols and procedures as outlined in this policy. Physical Education: Physical Education must report to the nurse any student exhibiting the signs and symptoms of a head injury. Any student, including athletes, who were reported to the nurse as exhibiting signs and symptoms of a head injury must be out of physical education class for a minimum of seven days and must have physician s note to return to class. If the student is on an athletic team, they must follow the return to play protocol. Definition of Concussion: A concussion is a reaction by the brain to a jolt or force that can be transmitted to the head by an impact or blow occurring anywhere on the body. Essentially, a concussion results from the brain moving back and forth or twisting rapidly inside the skull. Pediatric Concussive Injury: Concussions in the pediatric and adult athlete differ. Children are not little adults. They are actively developing organisms that respond differently, have different needs and face different expectations after injury. An appreciation of these differences and their implications is crucial for providing optimal care to the young athlete after concussion. Children ages (5-18) years old should not be returned to playing or training until clinically completely symptom free. Because of the physiological response during childhood to head trauma, a conservative return to play approach is recommended.

3 Defining the nature of a concussive head injury 1. Concussions may be caused either by a direct blow to the head, face or neck or elsewhere on the body with an impulse like force transmitted to the head. 2. Concussions typically result in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously. 3. Concussions may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than the structural changes. : 4. Concussions result in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. 5. Concussion is typically associated with grossly normal structural neuroimaging studies. Grading Concussions: Simple concussions refer to an athlete that suffers an injury that progressively resolves without complications over 7-10 days. Simple concussions represent the most common form of this injury. Simple concussions can be managed appropriately by primary care physicians or by certified athletic trainers working under medical supervision. Management of a simple concussion includes rest until all symptoms resolve followed by a step-by-step program of exertion before returning to sports. All concussions mandate evaluation by a medical doctor. Complex concussions encompass cases where the athlete suffers persistent symptoms, including persistent symptom recurrence with exertion. A complex concussion will typically have characteristics such as cognitive impairment. These athletes should be referred to and managed by physicians with specific expertise in the management of concussive injury. Such experts may include sports physicians, sports neurologists or neurosurgeons. Neurocognitive Testing The use of neurocognitive testing is one criterion in assessing recovery from concussions and determining the timing of return to play. It should only be used as a tool and should not be the only deciding factor in returning a concussed athlete to play. It provides objective data and prevents athletes who hide their symptoms from returning to play before they are fully recovered. GNC UFSD will use the Impact Testing Program and will baseline test, at a minimum, its athletes in contact or collision sports. Over the first few years of the program, athletes in grades 9-12 will be tested with eventually only testing athletes entering the night grade and then two years later in the eleventh grade. There are two parts of the test; Symptom Score Component and the six part Neurocognitive Test Component. Both component scores should return to baseline or normal before an athlete is permitted to resume playing a sport.

4 Concussion Management: A player should never return to play while symptomatic. When an athlete shows ANY symptoms or signs of a concussion: 1. The player will not be allowed to return to play in the current game or practice. 2. The player will not be left alone; and regular monitoring for deterioration is essential over the initial few hours following injury. Once the athlete is released to the parent following a contest or practice, it becomes the responsibility of the parent/guardian to monitor the athlete. 3. The player should be medically evaluated following the injury using the Concussion checklist on the sideline or in the trainer s office. 4. Return to play must follow a medically supervised step-by-step plan currently recommended by NYSPHSAA. 5. The athlete must be picked up by parent/guardian. 6. A head injury warning sheet will be given to the athlete and parent/guardian that picks up the athlete. 7. A follow-up call will be made by the medical staff or person that cared for the athlete to check on the status of the athlete. 8. The incident must be reported to the nurse s office and an accident report must be filled out. Return to play Protocol: During the recovery period, in the first few days following the injury, it is important to emphasize to the athletes that physical and cognitive rest is recommended. Activities that require concentration and attention may exacerbate the symptoms and as a result, delay recovery. Return to play following a concussion follows the following six step process: (see attached checklist): This progression will be over 7-10 days for return to play with a minimum of 7 days. 1. No physical activity. Once asymptomatic, proceed to the next level. 2. Light aerobic exercise, such as walking or stationary biking (non-athletic activity). 3. Sport specific exercise (skating in hockey, running in soccer, etc.). 4. Non-contact drills. 5. Full contact training and/or exertion testing after medical clearance. 6. Game play. With this progression, the athlete should continue to the next level if asymptomatic at the current level. If any post-concussion symptoms occur, the athlete should drop back to previous asymptomatic level and try to progress again after 24 hours. Athletes should be symptom free without the use of any medications to mask the pain. The program and return to play will be monitored by the Athletic Director. The above policy will be followed by all Health care professionals (athletic directors, nurses, school physicians) coaches and teachers in the GNC UFSD are responsible for the supervision of student athletes. The concussion management/retrun to play protocol will be followed for returning an athlete to play after a concussion, despite the athlete presenting a prescription note to return to play sooner from their primary care

5 physician or emergency room physician. If an athlete presents a prescription form their primary care physician they will be started on the appropriate level of the return to play protocol. Prior to returning to play, the athlete is required to have the Return to Play Form signed by the following: Primary Physician, School Physician, School Nurse and Athletic Director.

6 GREENBURGH-NORTH CASTLE UNION FREE SCHOOL DISTRICT 71 S. Broadway (914) , Ext Dobbs Ferry, NY Fax (914) EDWARD W. PLACKE, Ed.D. Superintendent of Schools BOARD OF EDUCATION Anona Joseph, President Anne C. Crudge, Vice President Betsy Biddle Dr. William Pratella Dr. Robert Maher Abbey Connett Eric Granick Jennifer Herrera, Clerk Concussion Management Return to Play Checklist Today s Date: Athletes Name: Date of Concussion: Six Step Return Protocol: 1. No activity until asymptomatic 2. Light aerobic activity 3. Sport specific exercise 4. Non-contact drills 5. Full contact training/after medical clearance 6. Game play Date completed: Clearance note from Primary Physician received: Yes No Impact Test within normal limits: Yes No The above athlete has completed the return to play protocol and is currently symptom free. The athlete can return to full participation but will continue to be monitored for a return in symptoms. Primary Physician School Nurse School Physician Athletic Director

Director of Athletics

3341-8-1 Concussion Management Policy. Applicability Intercollegiate Athletics Responsible Unit Policy Administrator Intercollegiate Athletics/Director of Athletics Director of Athletics (A) Policy Purpose