Procedures for Head Injuries and Concussion in Extracurricular Athletics  

Development of Policy and-Procedures

 
The Concussion Policy and Procedures for Head Injuries and Concussion were developed according to 105 CMR 201.000 by a team of Shrewsbury Public School staff consisting of: Certified Athletic Trainer; Athletic Director; Director of Health, Nursing and Safety; High 
School Nurses; and Director of Guidance. The documents were reviewed by the HPS school physician, High School and Middle School Principals, Director of Pupil Services, teachers, and other members of the School Health & Safety Advisory Council. 

The person responsible for implementing policies and protocols related to return to athletics is the Athletic Director. A Concussion team, including athletic trainer, school nurse, and guidance counselor, will review student incidents of concussion and develop students' reentry plans, which include resumption of academics and athletics. These individuals will maintain regular communication of information regarding student status, limitations, and progression within reentry plan after concussion. The procedures will be reviewed and updated annually or as 
needed

Training of individuals in prevention and management of head injuries and concussion:

Each year, the Shrewsbury Public Schools (Athletic Department) will provide current training approved by the MDPH, written materials or a list and internet links for Department-approved on-line courses to all students who plan to participate in extracurricular athletic activities and their parents prior to the students' participation. Annual training in the prevention and recognition of sports-related head injury, and associated health risks including second impact syndrome will also be completed by SPS staff and associated individuals, including coaches, certified athletic trainers, trainers, volunteers, school and team physicians, school nurses, Athletic Directors, and Director of school marching band. Documentation of completion of this DPH-approved annual training will be maintained by the Athletic Director. 

Teacher training related to impact of concussion on learning and reentry plans for return to academics will be provided on a one-time basis and offered as needed when requested-and as laws, regulations or protocols change.

Requirements for students participating in extracurricular athletic activities:  

Documentation of a physical examination prior to a student's participation in extracurricular athletic activities (one PE/year sufficient for multiple sports seasons) will be reviewed by an HPS nurse or athletic trainer for eligibility (consistent with 105 CMR 200.100 (B)(3): Physical
Examination of School Children). Prior to student start of athletic activities, the Athletic Director will distribute to parents the Shrewsbury High School Athletic Participation Form and will maintain a record of completed forms. Students and their parents/guardians must sign this form prior to starting extracurricular athletic activities.

Reporting head injuries or suspected concussions:  

Athletic trainer arid/or coaches will report head injuries and/or suspected head injuries to the school nurse and counselor as soon as possible after injury. For head injuries and suspected concussions occurring during school day and non school-sponsored activities, school nurse, 
guidance counselor and other school staff will report to each other, athletic trainer. Teachers will be notified when medical diagnosis of concussion is confirmed.  

Steps when student suffers head injury and suspected concussion during practice or competition: 

The coach or athletic trainer removes student from play and performs assessment for signs and symptoms of concussion. Depending on the severity of symptoms, the coach or athletic trainer will activate EMS (for severe symptoms), keep the student out of play and notify parents/guardians (mild to moderate symptoms), or return to ph1y (no signs or symptoms present).  

The coach or athletic trainer will notify parents immediately in person or by phone if students has signs or symptoms of concussion; followed by information to parent in writing, paper or electronically, by the next business day. (201.010 C). Parent is provided two forms: 1) Report· of Head Injury During Sports Season Form to be completed and signed by the coach, marching band director, or parent/guardian; and 2) Post Sports-Related Head Injury Medical Clearance and Authorization Form to be completed and signed by a duly licensed physician; a certified athletic trainer in consultation with a licensed physician; a duly licensed nurse practitioner in consultation with a licensed physician; a duly licensed neuropsychologist in coordination with the physician managing the student's recovery (105 CMR.201.011).  

The coach or designee communicates by the end of the next business day with the Athletic Director and school nurse that student has been removed from practice or competition for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness. 
(201.010 D.)  

Steps for student returning to academics after concussion:  

The student will be returned to school and academics prior to resuming athletics.  

HPS nurse assesses student for post-concussion signs and symptoms and completes return to academics protocol checklist (see samples from Oregon - to be modified), including completion of plan with instructions for modifications needed. The nurse will provide the student with a 
copy of the checklist to give to teachers and will communicate this information to the counselor; athletic trainer and teaches. 

Steps for student returning to athletics after concussion: 

The student will provide two forms to the coach, athletic trainer, school nurse or counselor: 1) Report of Head Injury During Sports Season Form completed and signed by the coach, marching band director, or parent/guardian; and 2) Post Sports-Related Head Injury Medical Clearance and Authorization Form signed by a duly licensed physician; a certified athletic trainer in consultation with a licensed physician; a duly licensed nurse practitioner in consultation with a licensed physician; a duly licensed neuropsychologist in coordination with the physician managing the student's recovery (105 CMR 201.011). 

The return to play decision may also involve the parents, school nurse, counselors and teachers as appropriate. 

Upon return to academics in school, the athletic trainer provides the student (and parent) as needed written instructions, which outline progressive stepped approach for gradual return to activity and steps to take if symptoms recur (Concussion Protocol Return-To-Play Checklist).