Hamilton-Wentworth District School Board Athletics Concussion Protocol Part I Introduction Concussions are brain injuries caused by excessive, rapid movement of the brain inside the skull. This movement causes damage that changes how brain cells function, leading to symptoms that can be physical (headaches, dizziness), cognitive (problems with memory or concentration), or emotional (feeling depressed, irritable). A concussion can result from a blow to the head or body in any number of activities including receiving a check in hockey, being in a motor vehicle collision, or slipping on an icy sidewalk. 1 An athlete affected by concussion can experience any or all of nearly 50 identified symptoms that can occur in phases over hours, days or weeks. No two athletes will experience concussion in the same way and may not have the same symptoms or have similar symptoms last the same length of time. But for all, the effect is not unlike a snow globe that has been shaken: the athlete needs to stop, rest, let the brain settle down and heal. A critical aspect of concussion management is understanding the potential for second impact syndrome. This is a condition where the brain swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided. This deadly second blow may occur days, weeks or minutes after an initial concussion. 2 Early recognition of the signs or symptoms of concussion, combined with the immediate removal from the game or activity and following return to play guidelines will greatly reduce the chance of second impact syndrome. One of the objectives of this concussion protocol is to raise awareness of second impact syndrome and establish measures that will avoid the possibility of having it happen. This protocol is intended to work in conjunction with the Ontario Physical and Health Education Association (OPHEA) Safety Guidelines, which provides additional information on concussion management and return to play guidelines. The Role of Hamilton-Wentworth District School Board The Hamilton-Wentworth District School Board will take a pro-active role with coaches, students and parents on concussion awareness while placing an emphasis on managing risk associated with concussions and provide a clear process for students to follow as they prepare to return to play from concussion. This will be done by ensuring the following: 1. provide information to students and parents/guardians to help them understand what a concussion is, what symptoms might typically be expected and how to react to such a situation should it occur; 2. educate the team coach on the symptoms of concussion, the circumstances under which concussions often occur and provide direction on how to manage situations where a student athlete is displaying concussion related symptoms; 1 ThinkFirst Canada: Concussion Resources 2 Cifu D and Drake D (August 17, 2006). "Repetitive head injury syndrome". emedicine.com
3. establish an in-game procedure whereby players, coaches and referees can collaboratively identify and manage situations where an athlete may have suffered a concussion so as to allow for the immediate removal of that athlete from play to facilitate medical evaluation; 4. provide a clear, written process for the student athlete and parents to follow, overseen by a physician, that will facilitate a safe return to play. The Role of the Coach The role of the coach includes the following: 1. to have an awareness of practice or game situations where athletes may have been at above normal risk of a blow to the head or body; 2. to immediately remove an athlete from a practice or game when there appears to have been a blow to the head or body that is affecting normal function; 3. to be aware of and to recognize the symptoms of a concussion; 4. to observe the athlete and react to the onset of any symptoms related to concussion by referring the student to medical attention as soon as possible; 5. to be aware of the importance of not leaving an athlete alone who shows any signs or symptoms of concussion. The Role of the Student Athlete As the individual at the centre of activity, and therefore the risk of injury, the role of the student athlete during a practice or athletic competition includes the following: 1. be aware of circumstances that present an above normal risk of a blow to the head or body; 2. perform a functional self-check after taking a blow to the head or body; 3. be aware of and recognize the symptoms of a concussion; 4. to inform the coach of any recent history of concussion; 5. inform the coach, a teammate, or first aid attendant (if present) if symptoms of concussion appear; 6. seek medical attention as soon as possible if any symptoms of concussion appear; The role of the Parents/Guardians It is important that parents/guardians understand the following: 1. what a concussion is and what symptoms accompany a concussion; 2. to inform the coach of any recent history of concussion; 3. that medical attention is required; 4. that most students will get better; 5. the potential effects on school learning and performance; 6. the importance of following guidance from a health care provider in order to ensure the most rapid and complete recovery possible
Hamilton-Wentworth District School Board Athletics Concussion Protocol Part II Pre-season a student wishing to participate in school athletic activities will be required to review the Concussion Fact Sheet for Parents/Guardians and Student Athletes included in the Student Athlete Information Package and acknowledge that review by providing the signature of the student and the parent(s)/guardian(s) prior to participating in any game or practice. the Athletics Department will provide coaches with information on concussion signs and symptoms at a pre-season meeting and review the protocol coaches should follow should an athlete be suspected of sustaining a concussion during a game. Coaches will review with athletes the signs and symptoms of concussion and the dangers of participating in an activity while experiencing any of those signs and symptoms. The coach will also stress the importance of immediately informing the teacher/coach of any signs or symptoms of concussion, the importance of wearing properly fitted protective equipment and of playing within the rules of the game. officials for each sport will be informed of an in-game protocol for dealing with a player suspected of sustaining a head injury or possible concussion. In-Season coaches will monitor contact levels during practice in an effort to reduce the risk of high impact collisions; teams will be prepared to invoke the In-Game Action Plan should a student become injured during a game; a coach who is aware of a player that may have been injured during a school or community based activity and is experiencing any of the signs or symptoms of a concussion will require that player to submit a Return to Play Form prior to allowing the player to participate. Post-Season the Athletics Department will provide schools and coaches with an opportunity to provide feedback on all aspects of the concussion protocol; the Athletics Department will review the concussion protocol each off-season and update the protocol as new information becomes available or as circumstances warrant change.
Hamilton-Wentworth District School Board Athletics Concussion Protocol Part III In-Game Action Plan Any athlete who exhibits signs, symptoms, or behaviours consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional. 3 1. During the pre-game conference of coaches and officials, discussion shall include recognition on the part of either party of an athlete who may have incurred a head injury as a result of a collision; 2. the officials will have no role in determining a possible head injury other than the obvious situation where a player is unconscious or apparently unconscious as is provided for in #1 above. Officials will stop play and merely point out to a coach that a player is apparently injured and advise the coach that the player should be examined. 3. Should such an incident occur, coaches recognize the right of the game officials to immediately stop play. Similarly, should a coach recognize such an incident, the officials shall recognize the request of the coach to immediately stop play. The officials shall note on the game sheet the point in the game where the stoppage occurred. 4. in such circumstances, once play has been stopped, the game clock shall stop and the game will be temporarily suspended. If the player is unconscious or unable to leave the playing surface, teams are to return to their benches and the protocol for aiding an unconscious athlete detailed below in A. Unconscious Athlete followed. 5. a player who appears to be injured but is able to leave the playing surface must be observed by team personnel or designated first aid attendant (if on-site). If any of the signs, symptoms or behaviours consistent with a concussion are present, the player must be removed from the game, not permitted to return at any point or under any circumstances and the protocol for aiding an conscious but injured athlete detailed below in B. Conscious Athlete followed. 6. once the injured player has left the playing surface, the game officials shall determine, in conjunction with coaches, the amount of time (if any) teams will need to prepare to re-start the game. Once teams are ready, the game shall resume from the point of suspension. 3 National Federation of State High School Associations: Guidelines for Management of Concussions in Sport, 2011
Management Procedures for a Suspected Concussion During a Game A. Unconscious Athlete: For an athlete who is unconscious or there is/was a loss of consciousness, a concussion should be assumed and medical attention must be sought: where a designated first aid attendant is on-site, allow that individual to manage the situation initiate Emergency Action Plan and call 911 assume there is a possible neck injury and DO NOT move the student do not remove any athletic equipment unless there is difficulty breathing if the athlete regains consciousness, encourage him/her to remain calm and lie still. Do not administer any medication even if the athlete regains consciousness, he/she must be taken to the hospital for examination OR B. Conscious Athlete If there is no loss of consciousness, but a concussion is suspected due to a direct blow to the head or a major physical trauma to other parts of the body (causing whiplash effect on the head and neck): remove the athlete from the current activity or game immediately where a designated first aid attendant is on-site, allow that individual to manage the situation look for any signs or symptoms related to concussion do not leave the athlete alone and continue to monitor signs and symptoms do not administer any medication do not allow the athlete to return to play in the activity, game or practice that day even if the athlete states that he/she is feeling better the athlete must not leave the premises without parent/guardian (or emergency contact) supervision 4 If signs are NOT observed or symptoms NOT reported: where a designated first aid attendant is on-site, allow that individual to manage the situation after a period of observation, if signs and symptoms of a concussion are not obvious or reported by the athlete and a concussion is not suspected the athlete may return to physical activity however, the athlete s parent/guardian (or emergency contact) must contacted and informed of the incident. Sources: National Federation of State High School Associations: Suggested Guidelines for Management of Concussion in Sports ThinkFirst Canada: Concussion Resources Ontario Physical and Health Education Association: Ontario Safety Guidelines McMaster University CanChild Centre for Childhood Disability Research: Return to Activity Guidelines, 2012 Arkansas Activities Association: Concussion Fact Sheet for Athletes and Parents Centres for Disease Control and Prevention: Get a Heads Up on Concussion in Sports Policies 4 OPHEA Safety Guidelines: Appendix C-1 Concussion Management Procedures: Return to Learn and Return to Physical Activity - 2013
Part IV - Request to Resume Athletic Participation - Concussion Related Injuries Step 1: evaluation by a physician or nurse practitioner (visit #1); no activity and complete rest until symptoms resolve Step 2: light exercise no resistance training or weight lifting; 10-15 mins. light exercise max. twice a day. Discontinue activity if any symptoms return. Step 3: sport specific activity no body or head contact, sudden starts or stops; 20-30 mins. general conditioning twice a day Step 4: sport specific practice with team but no contact Step 5: evaluation by a physician or nurse practitioner (visit #2); sport specific practice with team with contact provided clearance is give after Visit #2 Step 6: return to play Detailed information on each step is available in the OPHEA Safety Guidelines Appendix C1-C4 Athlete s Name: The athlete must complete the following 2 visits with the physician and follow physician s instructions below: Physician/Nurse Practitioner Visit #1 Concussion no activity until symptoms and signs have gone No Concussion athlete may return to: regular physical education class activities intramural activities/clubs interschool sport activities. Physician signature: Date: Comments: Physician/Nurse Practitioner Visit #2 All concussion related symptoms and signs have gone. Athlete may return to: regular physical education class activities intramural activities/clubs interschool sport activities. Physician signature: Date: Comments:
Request to Resume Athletic Participation - Concussion Related Injuries This form must be returned to an administrator or designate, and a procedure must be established to inform all relevant personnel (teacher of Health and Physical Education, coach of interschool team, intramural supervisor, etc.) and to provide each with a copy of this form. If an athlete has been/is suspected of having a concussion, a physician must sign this form. Prior to beginning Step 3, the parent/guardian signature is required. Parent/Guardian Responsibility Step 1: No activity, complete rest. Once the athlete is asymptomatic (concussion symptoms and signs have stopped) proceed to Step 2. Step 2: Light aerobic exercise, such as walking or stationary cycling, for 10-15 minutes, no resistance training. In signing below, I give permission for my son/daughter to proceed to Step 3 and participate in interschool team activities as described. Parent/Guardian Signature: Date: School Role Step 3: Facilitation of sport-specific exercise (e.g., running in soccer, ball drills, shooting drills) for 20-30 minutes. No resistance/weight training. Step 4: Facilitation of on field/court/ice activity such as ball drills, shooting drills and other activities with NO CONTACT (e.g., no checking, no heading the ball.) May add light resistance training and progress to heavier weights. The teacher s initials indicate that the athlete has completed Steps 3 and 4. (initial here). Return form to student. Parent/Guardian Responsibility Note: After Step 4 and before Step 5 (return to full contact training practice), the athlete must return to the physician for final approval to engage in full contact activity. The time needed to progress from on field/court/ice activity to full contact training practice will vary with the severity of the concussion and the athlete. This form has been adapted from the Ophea Physical Education Safety Guidelines Secondary Interschool 2011