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Sports Medicine
ILLINOIS HIGH SCHOOL ASSOCIATION
2715 McGraw Drive Bloomington, IL 61704
www.ihsa.org Phone: 309-663-6377 Fax: 309-663-7479
IHSA Protocol for Implementation of NFHS Sports Playing Rule for Concussions
Any athlete 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 and shall not return to play until cleared by anappropriate health care professional.
The above language, which first appeared in all National Federation sports rule books for the 2010-11 school term, reflects a strengthening ofrules regarding the safety of athletes suspected of having a concussion, but not a revision in primary responsibilities in these areas. Previousrules required officials to remove any athlete from play who was unconscious or apparently unconscious. This revised language reflects anincreasing focus on safety, given that the vast majority of concussions do not involve a loss of consciousness. However, the revised languagedoes not create a duty that officials are expected to perform a medical diagnosis. The change in rule simply calls for officials to be cognizantof athletes who display signs, symptoms, or behaviors of a concussion from the lists below and remove them from play.
NOTE: The persons who should be alert for such signs, symptoms, or behaviors consistent with a concussion in an athlete includeappropriate health-care professionals, coaches, officials, parents, teammates, and, if conscious, the athlete him/herself.
Definition of a ConcussionA concussion is a traumatic brain injury that interferes with normal brain function. An athlete does not have to lose consciousness (be knockedout) to have suffered a concussion.
Behavior or signs observed indicative of apossible concussion Loss of consciousness Appears dazed or stunned Appears confused Forgets plays Unsure of game, score, or opponent
Moves clumsily Answers questions slowly Shows behavior or personality changes Cant recall events prior to or after the injury
Symptoms reported by a player indicative of apossible concussion Headache Nausea Balance problems or dizziness Double or fuzzy vision Sensitivity to light or noise
Feeling sluggish Feeling foggy or groggy Concentration or memory problems Confusion
This protocol is intended to provide the mechanics to follow during the course of contests/matches/events when an athlete sustains an apparentconcussion. For the purposes of this policy, appropriate health care professionals are defined as: physicians licensed to practice medicine inall its branches in Illinois and certified athletic trainers.
1. During the pre-game conference of coaches and officials, the official shall remind the head coaches that a school-approved appropriatehealth care professional will need to clear for return to play any athlete removed from a contest for an apparent head injury.
2. The officials will have no role in determining concussion other than the obvious situation where a player is unconscious or apparentlyunconscious as is provided for under the previous rule. Officials will merely point out to a coach that a player is apparently injured and
advise the coach that the player should be examined by the school-approved health care provider.3. If it is confirmed by the schools approved health care professional that the student did not sustain a concussion, the head coach may so
advise the officials during an appropriate stoppage of play and the athlete may re-enter competition pursuant to the contest rules.4. Otherwise, if an athlete can not be cleared to return to play by a school-approved health care professional as defined in this protocol, that
athlete may not be returned to competition that day and is then subject to the IHSA's Return to Play (RTP) Policy before the student-athletecan return to practice or competition.
5. Following the contest, a Special Report shall be filed by the contest official(s) with the IHSA Office through the Officials Center.6. In cases where an assigned IHSA state finals event medical professional is present, his/her decision to not allow an athlete to return to
competition may not be over-ruled.
Additional information regarding concussion has been made available to IHSA member schools and licensed officials and can be accessed onthe IHSA Sports Medicine website athttp://www.ihsa.org/initiatives/sportsMedicine/index.htm .
http://www.ihsa.org/initiatives/sportsMedicine/index.htmhttp://www.ihsa.org/initiatives/sportsMedicine/index.htmhttp://www.ihsa.org/initiatives/sportsMedicine/index.htmhttp://www.ihsa.org/initiatives/sportsMedicine/index.htm8/10/2019 Concussion Management Plans
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Return to Play (RTP) Policy
Background: With the start of the 2010-11 school term, the National Federation ofState High School Associations (NFHS) implemented a new national playing ruleregarding potential head injuries. The rule requires any player who exhibits signs,symptoms, or behaviors consistent with a concussion (such as loss of consciousness,headache, dizziness, confusion, or balance problems) shall be immediately removedfrom the game and shall not return to play until cleared by an appropriate health careprofessional. In applying that rule in Illinois, it has been determined that only certifiedathletic trainers and physicians licensed to practice medicine in all its branches in Illinois
can clear an athlete to return to play the day of a contest in which the athlete has beenremoved from the contest for a possible head injury.
Policy: In cases when an athlete is not cleared to return to play the same day as he/sheis removed from a contest following a possible head injury (i.e., concussion), the athleteshall not return to play or practice until the athlete is evaluated by and receives writtenclearance from a licensed health care provider to return to play.
For the purposes of this policy, licensed health care providers consist of physicianslicensed to practice medicine in all its branches in Illinois and certified athletic trainersworking in conjunction with physicians licensed to practice medicine in all its branches
in Illinois.
S orts Medicine
www.ihsa.org [email protected] Phone: 309-663-6377 Fax: 309-663-7479
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CommunityHighSchoolDistrict155
Head
Injury
Care
and
Return
to
Play
Guidelines
Injuriestotheheadareverydifferentthaninjuriestootherpartsofthebody.Itisknownthatan
adolescentssusceptibilitytoaheadinjury,specificallyaconcussion,isgreaterthanthatofan
adult.Additionally,thehealingtimeofanadolescentsconcussioncantakelonger.
District155understandsthesafetyandwelfareofourstudentathletesisaprimaryconcern.As
such,allDistrict155athleticcoaches,volunteerandpaid,willcompletetheNationalFederation
ofHighSchoolsConcussioninSportsWhatyouNeedtoKnowvideouponemployment.
Completionwillbemonitoredbytheschoolsathleticdirector.
Thereis
currently
no
concussion
proof
equipment
made
for
any
sport.
As
such,
the
following
guidelinesaretobefollowedbyDistrictpersonnelwhenastudentathleteincursaheadinjury.
SIGNS/SYMPTOMSCONSISTENTWITHACONCUSSION(INCLUDEBUTARENOT
LIMITEDTO):
SIGNSOBSERVEDBYSTAFF SYMPTOMSREPORTEDBYATHLETE
Appearsdazedorstunned
Isconfusedaboutassignmentor
position
Forgets
an
instruction
Isunsureofgame,score,oropponent
Movesclumsily
Answersquestionsslowly
Losesconsciousness(evenbriefly)
Showsmood,behaviororpersonality
changes
Cantrecalleventspriortohitorfall
Cantrecalleventsafterhitorfall
Headacheorpressureinhead
Nauseaorvomiting
Balanceproblemsordizziness
Double
or
blurry
vision
Sensitivitytolight
Sensitivitytonoise
Feelingsluggish,hazy,foggy,or
groggy
Concentrationormemoryproblems
Confusion
Justnotfeelingrightorisfeeling
down
ACTION
PLAN:
Ifyoususpectthatanathletehasaconcussion,youshouldtakethefollowingfoursteps:
1. Removetheathletefromplay.
2. Ensurethattheathleteisevaluatedbytheathletictrainer.
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3. Ifnoathletictrainerisavailable,theathletewillnotreturntopracticeorplay.Thecoach
willdecideif911shouldbecalled.Theparent(s)shouldbecalledandinformedoftheir
childscondition.If911iscalled,theathleticdirectororassistantathleticdirectorshould
becontactedimmediately.
4. Theathleteisnottobeleftalonefollowingtheinjury.Monitoringoftheathletefor
deteriorationis
essential
over
the
initial
few
hours
following
the
injury.
5. Givetheathletesparentsorguardiansafactsheetonconcussion.
6. Keeptheathleteoutofplaythedayoftheinjuryanduntilahealthcareprofessional,
trainedintheevaluationandmanagementofconcussionsstatestheathleteissymptom
freeanditsOKtoreturntoplay.
7. Notifytheschoolnurseoftheathletesconcussion.
8. Whenindoubt,sitthemout.
GRADUATEDRETURNTOPLAYPROTOCOL
Step
1:
Lightaerobic
exercise
to
increase
heart
rate
and
blood
pressure
in
the
brain.
Step2: Performmoderatetoheavycardioand/orsportspecificdrills.
Step3: Lightcontactwithnoheadimpactactivities.
Step4: Fullparticipationinpracticewithfullcontact.
Step5: Ifnosymptomsreturninstep4,ANDneurocognitivescoreshave
returnedtonormal(ifused),thentheathletewillbeclearedtoresume
playwithnorestrictions.
RETURNINGTOPLAY:
PriortoreturningtoANYphysicalactivity(includingphysicaleducationclass)the
athletemustreporttotheAthleticTrainerforfurtherevaluation.Theathleteshould
notparticipateinanyphysicalactivityuntilclearedbytheAthleticTrainingStaff.
Theathleteshouldreceivecognitiverestwhilesymptomatic.Exposuretoloud
noises,brightlights,computers,videogames,televisionandphones(includingtext
messaging)mayworsenthesymptomsofaconcussion.
Neurocognitivetestingmaybeusedasatoolprovidedthestudentathletehas
completedapretest.
Intheeventtheathletehassymptomsduringanyoftheabovesteps,thentheprocess
returnstothepreviousstepwithaminimumof48hoursofrestbeforeresumingthe
sequence.
Foralistofphysiciansfamiliarwithconcussionmanagementprogramsandneurocognitive
testing,pleasecontactyourCertifiedAthleticTrainer.December2010
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undee Crown High School
Concussion Management Protocol
Rosemarie Patrick, ATC
Dundee Crown High School
Compiled by
Brian Kosan, ATC, !"MT#P
Head Athletic Trainer, $MSA
Accelerated !ehabilitation Centers
!osemarie Patric%, ATC
Head Athletic Trainer, DCHS
Accelerated !ehabilitation Centers
$n Consultation with
Dr& "li'abeth M& Pieroth, Psy& D, ABPP#C
europsychologist
Midwest Center (or Concussion Care
Created )*+-
Revised 8/2014
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Table o( Contents
Signs and Symptoms of Concussion.............................................................................................
Concussion Se!erity Classification................................................................................................ "
#mmediate $ield %anagement....................................................................................................... "
Concussion Treatment................................................................................................................... "
#mmediate Referral #ndications...................................................................................................... &
Delayed Referral #ndications..........................................................................................................&
Dis'ualification Timeta(le.............................................................................................................. )
Return to Play Algorithm............................................................................................................... *
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P a g e +
$ntroduction
The purpose of this protocol is to clearly address the issue of concussion recognition and managementhere at Dundee Crown High School. #t shall discuss the definition of a concussion, the signs andsymptoms of a concussion, how the Dundee Crown Sports %edicine staff will e!aluate and classifyconcussions, concussion treatment, indications for physician referral, and return to play procedures.This protocol is deri!ed from the most recent e!idence(ased medical practice as well as from theconsensus and position statements from !arious professional medical associations. $urthermore, thisprotocol was produced in consultation (y a concussion specialist as a standing medical order.
e(inition o( a Concussion
A concussion is a comple- inury process affecting the (rain which is caused (y a direct or indirecttraumatic force on the head and/or neck. This inury process typically results in the rapid onset of shortli!ed impairment of neurological function. Howe!er, these impairments are generally functionaldistur(ances and not a structural inury as the impairments are caused (y meta(olic changes in the(rain. These impairments result in a gradually impro!ing set of clinical symptoms which are reported(y the patient and o(ser!ed (y others.0
Signs and Symptoms o( Concussion
Recognition of the signs and symptoms of concussion is the cru- of its diagnosis and management. Asymptom is something that is reported (y the patient1 whereas a sign is something o(ser!ed (ycoaches, parents, or medical staff. The signs and symptoms of concussion !ary from person to personas well as from incident to incident. A concussion should (e suspected if anyone or moreof thefollowing occur in conunction with some sort of traumatic force to the head or neck 0,2,3
Symptoms Reported (y Athlete Signs 4(ser!ed (y 4thers
Headache
5ausea or !omiting
Di66iness
7lurred, dou(le, or a(normal !ision
Sensiti!ity to light and/or noise
$atigue
$eeling 8foggy9 or 8out of it9
Change in sleeping pattern
Concentration or memory issues
Confusion
Person appears da6ed or stunned
Disorientation to place and/or time
Can:t recall e!ents (efore inury
Can:t recall e!ents after inury
;oss of consciousness
Sei6ure acti!ity
#t should (e stressed that one need not lose consciousness in order to incur a concussion1 rather, lossof consciousness occurs in only a(out 0?@ of cases.2 A direct (low to the head is also not necessaryin order to get a concussion. The (rain only needs to mo!e within the cranium and collide with thewalls of the skull. Therefore, an indirect force to the head like coming to a sudden stop (y colliding withanother person or o(ect can cause the (rain to mo!e and create a concussion. Concussion symptomscan (e immediate or delayed up to 2" hours.
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Concussion ".aluation and Classi(ication Algorithm
".aluation o( Concussion
Any athlete who is suspected of sustaining a concussion should (e immediately remo!ed from play and
not allowed to return to play until e!aluated (y a health care professional trained in the e!aluation and
management of concussions. 5o athlete should e!er return to play the same day they ha!e sustained a
concussion. The e!aluation of a concussion shall (egin as soon as the medical staff makes contact
with the athlete, whether that is on the field or on the sideline. A detailed history shall first (e taken in
order to determine mechanism of inury, orientation, memory integrity, and a symptom in!entory. A
medical e-amination will also (e conducted so as to gather !ital sign and neurological (aselines. 4nce
immediate life threats are ruled out and a concussion is suspected (y !irtue of findings listed in the
8Signs and Symptoms of Concussion9 section of this protocol, the staff shall utili6e the SCAT
assessment tool =located in Appendi- C> to document findings.0
#f the medical staff is not a!aila(le to complete an e!aluation of the athlete, the coaching staff should
remo!e the athlete from competition. #f the inury occurs at another school, that school:s sportsmedicine staff will take the place of the Dundee Crown High School Sports %edicine Staff.
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P a g e + &
a!aila(le is to get plenty of sleep, keep hydrated, and to maintain a healthy, (alanced diet. The use ofadditional e!aluati!e tools =SCAT, #mPACT> will (e implemented on a case (y case (asis.
#f a studentathlete is suspected of ha!ing a concussion, their parents will (e contacted and they shall(e sent home for o(ser!ation. The Dundee Crown Sports %edicine staff encourages families toconsider keeping their child home for at least 0 school day in order to promote mental rest. hile this
time out of school may put them (ehind in the shortterm, returning to the academic en!ironment toosoon can (e detrimental in the longterm. The student:s (rain may not (e a(le to operate at its highestcapacity in terms of processing speed, memory formation, and memory recall. Additionally, thecogniti!e load can potentially slow reco!ery. A simple analogy to consider is that thinking on aconcussion is like trying to run on freshly sprained ankle.
#n the past, people were told to awaken someone with a concussion e!ery 2 hours through the night.This practice has gone (y the wayside as it has (een determined to (e generally unnecessary anddisrupts the sleep that is so important to reco!ery. The patient should (e awakened at certain inter!alsduring the night onlyif it is specifically ordered (y a physician.2
All patients shall (e sent home with a head inury home care instructions sheet. The sheet summari6es
this section to the parents and also pro!ides information for monitoring the patient. The sheet isincluded in this protocol, and it can (e located in Appendi- 7.
$ndications (or Physician !e(erral
The decision for referral to a physician will (e (ased on se!erity of symptoms. The Dundee Crown
Sports %edicine staff will work with the parents to guide them on immediate referral to the emergency
room !ersus delayed referral to a physician trained in concussion management. Recommendations will
(e (ased on reported symptoms, physical findings and patient history.
$mmediate !e(erral $ndications
The following are e!aluation findings that, when present, the Dundee Crown Sports %edicine staff willstrongly ad!ise that the athlete (e seen that day (y a physician or in an emergency department 23
;oss of consciousness on the field
Amnesia lasting longer than 0&
minutes Deterioration of neurological function
Decreasing le!el of consciousness
Decrease or irregularity in respirations
Decrease or irregularity in pulse
#ncrease in (lood pressure
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This is the type of physician referral that is most likely to (e recommended. Delayed referral meansthat the family can wait and o(ser!e the athlete to see if any of the following indicators arise in the daysfollowing the inury (efore seeking a physician:s care23
Appearance of any of the indicators listed in the immediate referral section
Postconcussion symptoms worsen or do not impro!e o!er time
#ncrease in the num(er of postconcussion symptoms reported Postconcussion symptoms (egin to interfere with the athlete:s daily acti!ities =i.e. sleep
distur(ances, trou(le in school>
Any appearance of immediate referral indicators in the days after the incident means that the athleteshould (e taken to the nearest emergency department. Howe!er, the other delayed referral indicatorsdo not necessarily re'uire emergent e!aluation. $amily physicians are certainly an option for referral,(ut they may or may not (e !ery e-perienced in the management of concussions. The Dundee CrownSports %edicine staff can help arrange e!aluation with a concussion management specialist so as topro!ide access to local and high 'uality physicians trained in the most uptodate concussion treatmentstandards.
hile many of us may (e part of families with physicians and other highly 'ualified medicalprofessionals as parents or relati!es, the Dundee Crown Sports %edicine staff strenuously insists thatany indi!idual referred to a physician for a concussion e!aluation should (e seen (y an independentphysician. This position is intended to help protect all parties from ethical conflicts of interest.
!eturn to Play Criteria
Concussions take time to heal, and returning to play too soon can either seriously hamper reco!ery ore!en pro!e dangerous for the athlete. Two concussions too close together, especially in youngathletes, can result in the conditions known as PostConcussion Syndrome and Second #mpactSyndrome. PostConcussion Syndrome is when symptoms of a concussion continue to linger outside
of the normal reco!ery window, usually in the presence of e-ertion, and may impact daily li!ing.Although it is a rare complication, Second #mpact Syndrome causes rapid swelling of the (rain that ismost often fatal0,2.
is0uali(ication Timetable
#t is with these considerations in mind that the athlete can only return to play once certain milestonesand indicators are met. As mentioned in the 8#mmediate $ield %anagement9 section, a Dundee Crownathlete will never(e returned to practice or competition that day if a concussion is suspected. Theathlete will remain dis'ualified from competition until he/she has (een cleared to (egin the return toplay protocol (y all mem(ers of the sports medicine team.
!eturn to Play Algorithm
At this time, District ?? will (e implementing the use of #mPACT and Dundee Crown High School will(e (aseline #mPACT testing all student athletes. As stated pre!iously in the EConcussion TreatmentSection: of this document, #mPACT, SCAT and other assessment tools may (e utili6ed following asuspected head inury as an additional e!aluati!e tool. 4nce the athlete is asymptomatic at rest, theyshall (e allowed to progressi!ely work (ack to competition. There is a stepwise manner in which theymust progress, and at least a 2" hour period must elapse (efore mo!ing to the ne-t stage. The athletemay not mo!e on to the ne-t stage unless they demonstrate accepta(le a(ility at the current stage.Any recurrence of symptoms means that the stage must (e repeated after asymptomatic for 2" hours.The stages of progression are as follows03
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P a g e + *
Stage Functional Exercise Stage Objective
0. 5o Acti!ity Complete physical F mentalrest
Reco!ery
2. ;ight Aero(ic e-ercise alking, swimming, stationary
(ike G *?@ of ma- heartrate1
5o resistance training
#ncrease heart rate and test
e-ertion in a controlleden!ironment
. SportSpecific e-ercise Running, shooting, or skatingdrills
Add mo!ement with e-ertion
". 5oncontact trainingdrills
Progression to more comple-training drills1 may startprogressi!e resistance
training
-ercise, coordination, andcogniti!e load
&. $ullcontact practice $ollowing medical clearance,return to normal training
acti!ities
Restore athlete:s confidence1coaching staff assesses
functional skills
). Return to play 5ormal game play
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P a g e + O
3. Cantu RC. 8Posttraumatic Retrograde and Anterograde Amnesia3 Pathophysiology and#mplications in rading and Safe Return to Play.9 Journal of Athletic Training. 2??01)=>32""2"N.
4. Holtsford S. 8Head Trauma.9 2009-2010 Southern Fo !alle" #$S S"ste% Standard &'erating(rocedures. Kuly 2??O3"0.
Appendi1 B 2 Home Care $nstruction Sheet
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Appendi1 C 2 Sports Concussion Assessment Tool 3 4SCAT35 /orm
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ampshire igh School
Concussion Management Protocol
Jessica Forystek MS, ATC
Hampshire High School
Compiled by
Brian Kosan, ATC, NRMT!P
Head Athletic Trainer, "MSA
Accelerated Rehabilitation Centers
#essica $oryste% MS, ATC
Head Athletic Trainer, HHS
Accelerated Rehabilitation Centers
"n Consultation &ith
'r( li)abeth M( Pieroth, Psy( ', ABPP!CN
Neuropsychologist
Mid&est Center *or Concussion Care
Medically appro+ed by
Created -./0/
Revised 8/2014
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Table o* Contents
Signs and Symptoms of Concussion............................................................................................. 3
Concussion Seerity Classification................................................................................................ !
"mmediate Field Management....................................................................................................... !
Concussion Treatment................................................................................................................... !
"mmediate #eferral "ndications...................................................................................................... $
%elayed #eferral "ndications..........................................................................................................$
%is&ualification Timeta'le.............................................................................................................. (
#eturn to )lay Algorithm............................................................................................................... *
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) a g e + 3
"ntroduction
The purpose of this protocol is to clearly address the issue of concussion recognition and managementhere at Hampshire High School. "t shall discuss the definition of a concussion, the signs and symptomsof a concussion, ho the Hampshire Sports Medicine staff ill ealuate and classify concussions,concussion treatment, indications for physician referral, and return to play procedures. This protocol isderied from the most recent eidence-'ased medical practice as ell as from the consensus andposition statements from arious professional medical associations. Furthermore, this protocol asproduced in consultation and approed 'y a concussion specialist as a standing medical order.
'e*inition o* a Concussion
A concussion is a comple in/ury process affecting the 'rain hich is caused 'y a direct or indirecttraumatic force on the head and0or neck. This in/ury process typically results in the rapid onset of short-lied impairment of neurological function. Hoeer, these impairments are generally functionaldistur'ances and not a structural in/ury as the impairments are caused 'y meta'olic changes in the'rain. These impairments result in a gradually improing set of clinical symptoms hich are reported'y the patient and o'sered 'y others.1
Signs and Symptoms o* Concussion
#ecognition of the signs and symptoms of concussion is the cru of its diagnosis and management. Asymptom is something that is reported 'y the patient2 hereas a sign is something o'sered 'ycoaches, parents, or medical staff. The signs and symptoms of concussion ary from person to personas ell as from incident to incident. A concussion should 'e suspected if anyone or moreof thefolloing occur in con/unction ith some sort of traumatic force to the head or neck 1,,34
Symptoms #eported 'y Athlete Signs 5'sered 'y 5thers
Headache
6ausea or omiting
%i77iness
8lurred, dou'le, or a'normal ision
Sensitiity to light and0or noise
Fatigue
Feeling 9foggy: or 9out of it:
Change in sleeping pattern
Concentration or memory issues
Confusion
)erson appears da7ed or stunned
%isorientation to place and0or time
Can;t recall eents 'efore in/ury
Can;t recall eents after in/ury
a'normal eye tracking?
"t should 'e stressed that one need not lose consciousness in order to incur a concussion2 rather, lossof consciousness occurs in only a'out 1@ of cases. A direct 'lo to the head is also not necessaryin order to get a concussion. The 'rain only needs to moe ithin the cranium and collide ith thealls of the skull. Therefore, an indirect force to the head like coming to a sudden stop 'y colliding ithanother person or o'/ect can cause the 'rain to moe and create a concussion. Concussion symptomscan 'e immediate or delayed up to ! hours.
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) a g e + $
aaila'le is to get plenty of sleep, keep hydrated, and to maintain a healthy, 'alanced diet. The use ofadditional ealuatie tools >SCAT3, "m)ACT? ill 'e implemented on a case 'y case 'asis.
"f a student-athlete is suspected of haing a concussion, their parents ill 'e contacted and they shall'e sent home for o'seration. The Hampshire Sports Medicine staff encourages families to considerkeeping their child home for at least 1 school day in order to promote mental rest. Dhile this time out of
school may put them 'ehind in the short-term, returning to the academic enironment too soon can 'edetrimental in the long-term. The student;s 'rain may not 'e a'le to operate at its highest capacity interms of processing speed, memory formation, and memory recall. Additionally, the cognitie load canpotentially slo recoery. A simple analogy to consider is that thinking on a concussion is like trying torun on freshly sprained ankle.
"n the past, people ere told to aaken someone ith a concussion eery hours through the night.This practice has gone 'y the ayside as it has 'een determined to 'e generally unnecessary anddisrupts the sleep that is so important to recoery. The patient should 'e aakened at certain interalsduring the night onlyif it is specifically ordered 'y a physician.
All patients shall 'e sent home ith a head in/ury home care instructions sheet. The sheet summari7es
this section to the parents and also proides information for monitoring the patient. The sheet isincluded in this protocol, and it can 'e located in Appendi 8.
"ndications *or Physician Re*erral
The decision for referral to a physician ill 'e 'ased on seerity of symptoms. The Hampshire Sports
Medicine staff ill ork ith the parents to guide them on immediate referral to the emergency room
ersus delayed referral to a physician trained in concussion management. #ecommendations ill 'e
'ased on reported symptoms, physical findings and patient history.
"mmediate Re*erral "ndications
The folloing are ealuation findings that, hen present, the Hampshire Sports Medicine staff illstrongly adise that the athlete 'e seen that day 'y a physician or in an emergency department 4
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This is the type of physician referral that is most likely to 'e recommended. %elayed referral meansthat the family can ait and o'sere the athlete to see if any of the folloing indicators arise in the daysfolloing the in/ury 'efore seeking a physician;s care4
Appearance of any of the indicators listed in the immediate referral section
)ost-concussion symptoms orsen or do not improe oer time
"ncrease in the num'er of post-concussion symptoms reported )ost-concussion symptoms 'egin to interfere ith the athlete;s daily actiities >i.e. sleep
distur'ances, trou'le in school?
Any appearance of immediate referral indicators in the days after the incident means that the athleteshould 'e taken to the nearest emergency department. Hoeer, the other delayed referral indicatorsdo not necessarily re&uire emergent ealuation. Family physicians are certainly an option for referral,'ut they may or may not 'e ery eperienced in the management of concussions. The HampshireSports Medicine staff can help arrange ealuation ith a concussion management specialist so as toproide access to local and high &uality physicians trained in the most up-to-date concussion treatmentstandards.
Dhile many of us may 'e part of families ith physicians and other highly &ualified medicalprofessionals as parents or relaties, the Hampshire Sports Medicine staff strenuously insists that anyindiidual referred to a physician for a concussion ealuation should 'e seen 'y an independentphysician. This position is intended to help protect all parties from ethical conflicts of interest.
Return to Play Criteria
Concussions take time to heal, and returning to play too soon can either seriously hamper recoery oreen proe dangerous for the athlete. To concussions too close together, especially in youngathletes, can result in the conditions knon as )ost-Concussion Syndrome and Second "mpactSyndrome. )ost-Concussion Syndrome is hen symptoms of a concussion continue to linger outside
of the normal recoery indo, usually in the presence of eertion, and may impact daily liing.Although it is a rare complication, Second "mpact Syndrome causes rapid selling of the 'rain that ismost often fatal1,.
'is1uali*ication Timetable
"t is ith these considerations in mind that the athlete can only return to play once certain milestonesand indicators are met. As mentioned in the 9"mmediate Field Management: section, a Hampshireathlete will never'e returned to practice or competition that day if a concussion is suspected. Theathlete ill remain dis&ualified from competition until he0she has 'een cleared to 'egin the return toplay protocol 'y all mem'ers of the sports medicine team.
Return to Play Algorithm
At this time, %istrict 3@@ ill 'e implementing the use of "m)ACT and Hampshire High School ill 'e'aseline "m)ACT testing all student athletes. As stated preiously in the Concussion TreatmentSection; of this document, "m)ACT, SCAT3 and other assessment tools may 'e utili7ed folloing asuspected head in/ury as an additional ealuatie tool. 5nce the athlete is asymptomatic at rest, theyshall 'e alloed to progressiely ork 'ack to competition. There is a step-ise manner in hich theymust progress, and at least a ! hour period must elapse 'efore moing to the net stage. The athletemay not moe on to the net stage unless they demonstrate accepta'le a'ility at the current stage.Any recurrence of symptoms means that the stage must 'e repeated after asymptomatic for ! hours.The stages of progression are as follos14
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) a g e + *
Stage Functional Exercise Stage Objective
1. 6o Actiity Complete physical G mentalrest
#ecoery
.
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Certi*ication and ndorsement
This protocol has 'een complied to conform to the most recent eidence-'ased medical practice andthe standards as set forth 'y my profession. The directies contained therein ill 'e adhered to 'y
myself or any other athletic trainer acting on my 'ehalf. Any deiation for this protocol shall occur onlyupon ritten orders 'y a physician. This protocol ill undergo an annual reie, and it shall 'e reisedas needed.
KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKJessica Forystek MS, ATCHead Athletic Trainer, Hampshire High School
Appendi2 A! Re*erences
1. McCrory ), Meeuisse D, Johnston L, et al. 9Consensus Statement on Concussion in Sport4The 3rd"nternational Conference on Concussion in Sport Held in urich, 6oem'er @@N.:
Journal of Athletic Training. @@O2!!>!?4!3!-!!N.2. Puskieic7 LM, 8ruce S3?4N@-O*.
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) a g e + O
3. Cantu #C. 9)osttraumatic #etrograde and Anterograde Amnesia4 )athophysiology and"mplications in Prading and Safe #eturn to )lay.: Journal of Athletic Training. @@123(>3?4!!-!N.
4. Holtsford S. 9Head Trauma.: 2009-2010 Southern Fo !alle" #$S S"ste% Standard &'erating(rocedures. July @@O4!1.
Appendi2 B 3 ome Care "nstruction Sheet
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Appendi2 C 3 Sports Concussion Assessment Tool 4 5SCAT46 $orm
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Huntley High School Concussion Policy Information and Sign-off
A concussion is a brain injury. It is caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force
transmitted to the head. A concussion can range from mild to severe and disrupt the way the brain normally works. Even though most
concussions are mild, allconcussions are potentially serious and may result in complications including prolonged brain damage
and death if not recognized and managed properly. Even a ding or a bump on the head can be serious. You cant see a
concussion and most concussions occur without loss of consciousness. Signs and symptoms of a concussion may appear right after the
injury or take hours or days to fully appear. If your child reports any symptoms of a concussion, or if you notice the symptoms or
signs of a concussion, seek medical attention right away.
Symptoms Reported by Student-Athlete Signs observed by others:
Headache
Nausea
Balance problems or dizziness
Blurred, double, or fuzzy vision
Sensitivity to light or noise
Fogginess or grogginess
Drowsiness or sluggishness
Concentration or memory problems
Confusion
Loss of consciousness
Appears dazed
Confused about play/assignment or forgets play/assignment
Unsure of game, score, or opponent
Clumsiness
Slowly responds to questions
Slurred speech
Behavior or personality changes
Cant recall events prior to or after injury
Seizures or convulsions
Vacant facial expression
What can happen if my child keeps on playing with a concussion or returns too soon?A student-athlete with the signs/symptoms of a concussion should be removed from play immediately. Continuing to play with the
signs/symptoms of a concussion leaves the student-athlete vulnerable to greater injury. There is an increased risk of significant
damage from a concussion for a period of time after a concussion occurs, particularly if the student-athlete suffers another concussion
before completely recovering from the first one. This can lead to prolonged recovery, or to severe brain swelling (second impact
syndrome) with devastating and even fatal consequences. Student-athletes sometimes fail to report injury symptoms. Concussions are
no different. Education of administrators, coaches, parents and students is the key to the safety of student-athletes.
Return to Play (RTP) PolicyAny student-athlete suspected of suffering a concussion should immediately be removed from play. No student-athlete may return to
play after a concussion without medical clearance, regardless of how mild it seems or how quickly symptoms clear. Close observationof the student-athlete should continue for several hours. IHSA Policy states that a student-athlete removed from an interscholastic
contest or practice due to a possible concussion, and not cleared to return to that same contest or practice, is required to provide the
school with written clearance from either of the medical professionals listed below.
1. Physician licensed to practice medicine in all its branches
2. Certified athletic trainer working in conjunction with a physician licensed to practice medicine in all its branches
In accordance with Public Act 097-0204, all IHSA member schools are required to follow this policy.
Inform the coach if you think your child may have a concussion. It is better to miss one game than to miss the whole season.
When in doubt, the student-athlete sits out.
For current and up-to-date information on concussions you can go to:
http://www.cdc.gov/ConcussionInYouthSports/.
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.D. Jacobs igh School
Concussion Management Protocol
Christopher Thorson, ATC
Jacobs High School
Compiled by
Brian Kosan, AC, !"#M$P
Head Athletic rainer, %MSA
Accelerated "ehabilitation Centers
Christopher horson, AC
Head Athletic rainer, JHS
Accelerated "ehabilitation Centers
%n Consultation &ith
Dr. #li'abeth M. Pieroth, Psy. D, ABPP$C!
!europsychologist
Mid&est Center (or Concussion Care
Created )*+-
Revised 8/2014
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able o( Contents
Signs and Symptoms of Concussion............................................................................................. 3
Concussion Severity Classification................................................................................................ 4
mmediate !ield "anagement....................................................................................................... 4
Concussion Treatment................................................................................................................... 4
mmediate #eferral ndications...................................................................................................... $
%elayed #eferral ndications..........................................................................................................$
%is&ualification Timetable.............................................................................................................. '
#eturn to (lay Algorithm............................................................................................................... )
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Concussion #aluation and Classi(ication Algorithm
#aluation o( Concussion
Any athlete +ho is suspected of sustaining a concussion should be immediately removed from play and
not allo+ed to return to play until evaluated by a health care professional trained in the evaluation andmanagement of concussions. 6o athlete should ever return to play the same day they have sustained a
concussion. The evaluation of a concussion shall begin as soon as the medical staff ma0es contact
+ith the athlete, +hether that is on the field or on the sideline. A detailed history shall first be ta0en in
order to determine mechanism of inury, orientation, memory integrity, and a symptom inventory. A
medical e-amination +ill also be conducted so as to gather vital sign and neurological baselines. 5nce
immediate life threats are ruled out and a concussion is suspected by virtue of findings listed in the
9Signs and Symptoms of Concussion: section of this protocol, the staff shall utili7e the SCAT3
assessment tool >located in Appendi- C? to document findings.1
f the medical staff is not available to complete an evaluation of the athlete, the coaching staff should
remove the athlete from competition. f the inury occurs at another school, that school;s sportsmedicine staff +ill ta0e the place of the Jacobs High School Sports "edicine Staff. =nless the medicalstaff on site directs that the athlete be ta0en to the hospital, the athlete shall report to the AthleticTraining 5ffice upon their return to school for a more thorough medical evaluation.
Concussion Seerity Classi(ication
There is considerable debate in the sports medicine community as to +hich, if any, classificationsystem to use. =nfortunately, there is no consensus on system utili7ation as no single system isempirically proven nor fits every individual every time. t also needs to be stressed that theseclassifications historically +ere primarily used for initial management and they have not been positivelycorrelated +ith recovery time.
Concussion Management and reatment
%mmediate /ield Management
Any suspicion of concussion +ill dis&ualify that athlete from return to play that day. They shall continueto be monitored by the medical staff through the rest of the event. The athlete;s family +ill be notified ofthe situation. The indications for referral to a physician or emergency department +ill be discussed +ithfamily at this time. #efer to the 9ndications for (hysician #eferral: section of this protocol for ane-planation of these indicators.
Concussions +ith loss of consciousness shall be treated as a medical emergency. A high inde- ofsuspicion shall be upheld in these athletes. =pon arrival at the athlete;s side and initial evaluation
sho+ing loss of consciousness, the cervical spine should be immobili7ed, assure air+ay patency,address any immediate life threats, and B"S should be activated per the Jacobs High SchoolBmergency Action (lan. These patients shall be transported to the hospital via ambulance in order toreceive further medical care and evaluation4.
Concussion reatment
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( a g e * $
available is to get plenty of sleep, 0eep hydrated, and to maintain a healthy, balanced diet. The use ofadditional evaluative tools >SCAT3, m(ACT? +ill be implemented on a case by case basis.
f a studentathlete is suspected of having a concussion, their parents +ill be contacted and they shallbe sent home for observation. The Jacobs Sports "edicine staff encourages families to consider0eeping their child home for at least 1 school day in order to promote mental rest. Dhile this time out of
school may put them behind in the shortterm, returning to the academic environment too soon can bedetrimental in the longterm. The student;s brain may not be able to operate at its highest capacity interms of processing speed, memory formation, and memory recall. Additionally, the cognitive load canpotentially slo+ recovery. A simple analogy to consider is that thin0ing on a concussion is li0e trying torun on freshly sprained an0le.
n the past, people +ere told to a+a0en someone +ith a concussion every hours through the night.This practice has gone by the +ayside as it has been determined to be generally unnecessary anddisrupts the sleep that is so important to recovery. The patient should be a+a0ened at certain intervalsduring the night onlyif it is specifically ordered by a physician.
All patients shall be sent home +ith a head inury home care instructions sheet. The sheet summari7es
this section to the parents and also provides information for monitoring the patient. The sheet isincluded in this protocol, and it can be located in Appendi- 8.
%ndications (or Physician "e(erral
The decision for referral to a physician +ill be based on severity of symptoms. The Jacobs Sports
"edicine staff +ill +or0 +ith the parents to guide them on immediate referral to the emergency room
versus delayed referral to a physician trained in concussion management. #ecommendations +ill be
based on reported symptoms, physical findings and patient history.
%mmediate "e(erral %ndications
The follo+ing are evaluation findings that, +hen present, the Jacobs Sports "edicine staff +ill stronglyadvise that the athlete be seen that day by a physician or in an emergency department
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This is the type of physician referral that is most li0ely to be recommended. %elayed referral meansthat the family can +ait and observe the athlete to see if any of the follo+ing indicators arise in the daysfollo+ing the inury before see0ing a physician;s care
Appearance of any of the indicators listed in the immediate referral section
(ostconcussion symptoms +orsen or do not improve over time
ncrease in the number of postconcussion symptoms reported (ostconcussion symptoms begin to interfere +ith the athlete;s daily activities >i.e. sleep
disturbances, trouble in school?
Any appearance of immediate referral indicators in the days after the incident means that the athleteshould be ta0en to the nearest emergency department. Ho+ever, the other delayed referral indicatorsdo not necessarily re&uire emergent evaluation. !amily physicians are certainly an option for referral,but they may or may not be very e-perienced in the management of concussions. The Jacobs Sports"edicine staff can help arrange evaluation +ith a concussion management specialist so as to provideaccess to local and high &uality physicians trained in the most uptodate concussion treatmentstandards.
Dhile many of us may be part of families +ith physicians and other highly &ualified medicalprofessionals as parents or relatives, the Jacobs Sports "edicine staff strenuously insists that anyindividual referred to a physician for a concussion evaluation should be seen by an independentphysician. This position is intended to help protect all parties from ethical conflicts of interest.
"eturn to Play Criteria
Concussions ta0e time to heal, and returning to play too soon can either seriously hamper recovery oreven prove dangerous for the athlete. T+o concussions too close together, especially in youngathletes, can result in the conditions 0no+n as (ostConcussion Syndrome and Second mpactSyndrome. (ostConcussion Syndrome is +hen symptoms of a concussion continue to linger outside
of the normal recovery +indo+, usually in the presence of e-ertion, and may impact daily living.Although it is a rare complication, Second mpact Syndrome causes rapid s+elling of the brain that ismost often fatal1,.
Dis0uali(ication imetable
t is +ith these considerations in mind that the athlete can only return to play once certain milestonesand indicators are met. As mentioned in the 9mmediate !ield "anagement: section, at Jacobs athletewill neverbe returned to practice or competition that day if a concussion is suspected. The athlete +illremain dis&ualified from competition until he/she has been cleared to begin the return to play protocolby all members of the sports medicine team.
"eturn to Play Algorithm
At this time, %istrict 3@@ +ill be implementing the use of m(ACT and Jacobs High School +ill bebaseline m(ACT testing all student athletes. As stated previously in the FConcussion TreatmentSection; of this document, m(ACT, SCAT3 and other assessment tools may be utili7ed follo+ing asuspected head inury as an additional evaluative tool. 5nce the athlete is asymptomatic at rest, theyshall be allo+ed to progressively +or0 bac0 to competition. There is a step+ise manner in +hich theymust progress, and at least a 4 hour period must elapse before moving to the ne-t stage. The athletemay not move on to the ne-t stage unless they demonstrate acceptable ability at the current stage.Any recurrence of symptoms means that the stage must be repeated after asymptomatic for 4 hours.The stages of progression are as follo+s1
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( a g e * )
Stage Functional Exercise Stage Objective
1. 6o Activity Complete physical G mentalrest
#ecovery
.
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Certi(ication and #ndorsement
This protocol has been complied to conform to the most recent evidencebased medical practice andthe standards as set forth by my profession. The directives contained therein +ill be adhered to by
myself or any other Athletic Trainer acting on my behalf. Any deviation for this protocol shall occur onlyupon +ritten orders by a physician. This protocol +ill undergo an annual revie+, and it shall be revisedas needed.
KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKChristopher Thorson, ATCHead Athletic Trainer, Jacobs High School
have revie+ed this document, and find it to be reasonable and medically sound. This standingmedical order is to be used as the Jacobs High School concussion recognition and managementprotocol. This order is to be follo+ed by all licensed Athletic Trainers and Athletic Training students
serving at Jacobs High School. %eviation from this order can only be made +ith a +ritten physician;sorder.
KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK
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( a g e * L
Appendi1 A$ "e(erences
1. "cCrory (, "eeu+isse D, Johnston M, et al. 9Consensus Statement on Concussion in SportThe 3rdnternational Conference on Concussion in Sport Held in Nurich, 6ovember @@O.:
Journal of Athletic Training. @@L244>4?43444O.2. Pus0ie+ic7 M", 8ruce S
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Assess the athletes
symptoms to determine
if he/she should be
transported for
emergency management
Remove the
athlete from play
and closely
monitor symptoms
Next Steps Arrange an appointment to see the appropriate
health care Provider (Pediatrician, Family
Physician, or Concussion Specialist)
Post-Injury testing using ImPACT should be don
within the first 24-72 hours following the injury
Testing can be scheduled by calling:
The
Centegra Screening/Concussion Hotl
(815) 759-4342
Follow the Athletic Trainers as they manage the return to play process. The athletemay return to play when the follow criteria are met:
1) permission from a health care professional,
2) following completion of an incremental staged return to play process (see below),
3) the athletes ImPACT testing has returned to their baseline results
RETURN TO PLAY CRITERIA
Each step should be separated by at least 24 hrs without symptom reoccurrence.
If reoccurrence of any of the signs or symptoms of concussion happen at any step, the athlete
drops back to the previous step.
For persistent or concerning symptoms, consider further evaluation by a Neurologist
No physical
activity; rest
until athlete is
asymptomatic
Light aerobic
exercises
Sport specific
training
Non-contact
drills
Full Contact
drills (pending
assessment
and scores)
What to do in the Event of a ConcussionIf you have any
suspicion that your
athlete has sustained a
concussion, they may
not reenter
Return to pla
Rest the BrainLimit computer use, video
games, television
Stay Home
No academic/
mental activity
Stay Home
Light
academic/
mental activity
(30 minutes of
concentration)
Back to School
Part Time
2-3 classes
with
Modified
academics
School Part Time
4 classes plus
lunch or study
hall
Modified
academics
School Full-
Time
With modified
academics
School Full-
Time
No
modification
in academics
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Woodstock High School Sports MedicineConcussion Evaluation & Management Policy
3.
Evaluation
-t is the %TCs primary o!ective to rule out cervical spine involvement and determine the
severity of the head in!ury# -f at any time the student athlete losses consciousness" activate EMS#-f at any time the student athletes symptoms significantly increase" activate EMS# The %TC will
evaluate the integrity of the student athletes cranial nerve function & cervical myotomes#
Evaluate the athlete using Sports Concussion %ssessment Tool and 6raded Symptoms Checklist#
7nce the evaluation is complete and assessment is made the %TC will contact the parent or
guardian of the student athlete to inform them of the situation and medical treatment options" or
home care instructions# The student will e sent home with.parent will e provided with
Centegra Health System Sports Concussion Program folder
* Post!+n,ury/-ollow!up Care
% student who is deemed concussed y a Certified %thletic Trainer must receive physician
clearance prior to returning to activity# Students will e recommended to take the -mP%CT
Post/-n!ury Test in the Wellness Center at Centegra Health System M7) 3" Suite %" 8929 :oty
;oad" Woodstock" -llinois
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Woodstock High School Sports MedicineConcussion Evaluation & Management Policy
;epeating stages or completing additional workouts will not advance the student through the
protocol faster# 35 hours must lapse etween each stage# -f the onset of any post/concussion
symptoms occurs at any point during the return to play process" the parents will e notified? the
student must rest for 35 hours and restart the return to play protocol# -f symptoms arise again" theclearing physician will e notified and the student will need physician clearance again efore
eginning the return to play protocol#
)eturn to play protocol:
Stage -unctional E0ercise Stage 1",ect
@ight aeroic e,ercise Walking" swimming" stationary
ike A B92of ma, heart rate? $oresistance training
-ncrease heart rate and test e,ertion in
a controlled environment
Sport D specific e,ercise ;unning" shooting" or hitting drills %dd movement with e,ertion
$on/contact training drills Progression to more comple,
training drills? may start
progressive resistance training
E,ercise" coordination and cognitive
load
ull D contact practice ollowing medical clearance"
return to normal training activities
;estore athletes confidence? coaching
staff assesses functional skills
;eturn to play $ormal game play
+llinois High School 2ssociation )eturn to Play Policy
FHouse )ill 322" which recogni+es the dangers associated with head in!ury and concussion"ecame effective on Guly 1" 3211# The legislation also reuires -HS% memer schools to adopt a
policy regarding student/athlete concussions and head in!uries that is in compliance with the
protocols" policies" and y/laws of the -HS%# -nformation on the schools concussion and headin!ury policy must e a part of any agreement contract" code" or other written instrument that a
school reuires a student athlete and his or her parents or guardian to sign efore participating in
practice or interscholastic competition#
% student athlete who is suspected of sustaining a concussion or head in!ury in a practice or
game shall e removed from participation or competition at that time#
WHS Sports Medicine
0pdated 12.34.15
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Community Unit
School District 200High School
ConcussionProceduresContributors:
Accelerated Rehabilitation CentersCentegra Health Systems
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Community Unit School District 200 High School ConcussionManagement
Before injury occurs
Student athlete is Impact Baseline concussion tested (highly recommended, but subject to
parent/guardian consent!
"est is #alid $or t%o years!
Injury occurs
A coach, o$$icial, parent, or student athlete notices that a student demonstrates signs, symptoms
or beha#iors consistent %ith a concussion (such as loss o$ consciousness, headache, di&&iness,
con$usion, or balance problems!
"he o$$icial, parent, or student athlete immediately in$orms the coach o$ the suspected injury!
Student is immediately remo#ed $rom the game or practice!
Athletic "rainer responds on site!
I$ Athletic "rainer is not on site, coach %ill call Athletic "rainer or Athletic 'irector $or $urther
instruction!
Athletic Trainer intervention
'etermine se#erity o$ head injury
Contact parent/guardian and )S i$ necessary as determined by Athletic "rainer or on*site
super#isor!
In$orm the parent/guardian o$ situation and need $or student athlete to be e#aluated and cleared
$or return to play by student athlete+s physician!
Athletic trainer %ill gi#e parent/guardian a copy o$ the baseline concussion consent $orm $rom
Centegra! arent can submit this $orm to the treating physician so they are a%are that Impact
Baseline testing %as completed and %ho to contact $or results!
Athletic trainer %ill also in$orm parent that Impact ost*Injury Concussion "est can be scheduled
at Centegra Health Systems -.*- hours a$ter injury occurs, by calling (012 23*.4.-, selectprompt 1!
arent should in$orm Athletic "rainer i$ ost*Injury Impact "est is scheduled at Centegra!
Student Athlete %ill not start the return to play protocol or physical education class until cleared
by the athlete+s physician!
Follow-up treatment and return to play
IHSA Return to lay (R" olicy states, 5in cases %hen an athlete is not cleared to return to play
the same day as he/she is remo#ed $rom a contest $ollo%ing a possible head injury (i!e!, concussion,
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the athlete shall not return to play or practice until the athlete is e#aluated by and recei#es %ritten
clearance $rom a licensed health care pro#ider6 listed belo%:
hysician licensed to practice medicine in all its branches7 or
Certi$ied athletic trainer %or8ing in conjunction %ith a physician licensed to practice
medicine in all its branches!
"here is a step*%ise manner in %hich they must progress, and at least a -. hour period must
elapse be$ore mo#ing to the ne9t stage! "he athlete may not mo#e on to the ne9t stage unless
they demonstrate acceptable ability at the current stage! Any recurrence o$ symptoms means that
the seuence must be restarted!
Impact test can be repeated a$ter the injury occurs by calling Centegra Health Systems at (012*
23*.4.-, select prompt 1! Impact post*injury test results assist the treating hysician andAthletic "rainer in ma8ing decisions about the return to play process!
lease note: A student can be impact post*injury tested more than once and %on+t begin
return to play process until cleared by their treating hysician! In addition, i$ parent
chooses to schedule post*injury concussion test at Centegra Health Systems, results o$ the
post*injury test must also be re#ie%ed and ha#e returned to baseline be$ore beginning the
return to play process!
Return to play protocol:
Stage Functional !ercise Stage "#ject
;o Acti#ity Complete physical and mental rest Reco#ery
?@o$ ma9 heart rate7 ;oresistance training
Increase heart rate and test e9ertion in
a controlled en#ironment
Sport speci$ic e9ercise Running, shooting, or hitting drills Add mo#ement %ith e9ertion
;on*contact training drills rogression to more comple9
training drills7 may startprogressi#e resistance training
9ercise, coordination and cogniti#e
load
ull contact practice ollo%ing medical clearance,
return to normal training acti#ities
Restore athlete+s con$idence7 coaching
sta$$ assesses $unctional s8ills
Return to play ;ormal game play
$ome %are instructions for %oncussions
%ommon Signs and Symptoms
&hysical: headache, #isual problems, nausea/#omiting, $atigue, di&&iness, sensiti#ity to light or
noise, balance problems, numbness/tingling!
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%ognitive: $eeling mentally $oggy, $eeling slo%ed do%n, di$$iculty remembering, and di$$icultyconcentrating!
motional: irritability, sadness, more emotional, ner#ousness!
Sleep: dro%siness, sleeping less than usual, sleeping more than usual, trouble $alling asleep!
''See( Immediate %are if: ''
$eadaches worsen -- una#le to #e awo(en -- una#le to recogni)e people -- vomiting
*hat to do ne!t:
=atch your athlete closely! I$ any o$ his/her symptoms seem to be getting %orse or more
8eep sho%ing up, they should be ta8en to the mergency Room immediately!
Deep your athlete uiet and rela9ed! )inimi&e stimulation such as "E, computer, phone,
#ideo games, etc! =hen doing home%or8, ha#e him/her complete it in short time periods
%ith $reuent brea8s!
Four athlete needs sleepG Sleep is the best %ay $or the brain to reco#er! Fou can chec8 on
him/her throughout the night i$ you %ould li8e to, but i$ they appear to be sleeping
peace$ully, let them sleepG
+our athlete,s concussion care can #e managed through the Athletic irector at yourstudent,s school. /any times the needs of the athlete re0uire them to see a physician.
If this is the case1 #e sure to see a physician who has #ac(ground (nowledge in
concussion management. If you need a recommendation please call your child,s
Athletic irector
School:
In$orm the teachers, counselor, and administrators about your child+s injury and symptoms!
Sometimes a child may bene$it $rom ta8ing a $e% days o$$ to rest as it %ill help in reco#ery!
=hen appropriate, ha#e the student chec8 in %ith the Athletic "rainer on the $irst day
he/she returns!
"ell the !! teacher and coaches o$ the injury as they %ill be re$raining $rom acti#ity! Students %ho e9perience symptoms o$ concussion o$ten need e9tra help to per$orm school*
related acti#ities and may not per$orm at their best on classroom or standardi&ed tests!
Athletic "rainer can recommend that student be %ithheld $rom physical education class i$
concussion suspected and reco#ery not complete based on return to play protocol results!
"he injured person should not participate in A;F high ris8 acti#ities that might result in head
injury until e9amined and cleared by a uali$ied health pro$essional!
It is normal $or the child/teenager to $eel $rustrated, sad, and e#en angry because they cannot return
to sports or recreation right a%ay! ollo% the right steps and your athlete %ill reco#er and there
%ill be no lingering e$$ectsG lease call your Athletic 'irector i$ you ha#e any uestions orconcerns!
/edical Facilities
8/10/2019 Concussion Management Plans
51/51
Centegra ;euro*Rehabilitation and Concussion Clinic (012 42*-@@
Crystal
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