I. Definition

A concussion is a traumatic brain injury caused by a direct or indirect blow to the head or body.

II. Indicators of Concussions and Head Injuries

A. Possible Signs of Concussions (Could be observed by teachers, coaches, athletic trainer, school/team physician, or school nurse):

Appears dazed, stunned, or disoriented

Is forgetful, or demonstrates short term memory difficulty

Exhibits difficulties with balance or coordination

Answers questions slowly or inaccurately

Loses consciousness

B. Possible Symptoms of Concussions (Reported by the student)

Headache

Nausea/vomiting

Balance problems or dizziness

Double vision or changes in vision

Sensitivity to light or sound/noise

Feeling sluggish or foggy

Difficulty with concentration and short term memory

Sleep disturbance

Irritability

III. Staff Training

In accordance with N.J.S.A. 18A:40-41:3, the district shall adopt an interscholastic head injury training program to be completed by all coaches, school nurses, school/team physicians, certified athletic trainers and other district personnel, as determined by the Superintendent.

The interscholastic head injury training program must include:

The recognition of the symptoms of head and neck injuries, concussions, and injuries related to second impact syndrome; and
The protocol for a return to practice or competition, which may specify an appropriate amount of time to delay the return to sports competition or practice of a student-athlete who has sustained a concussion or other head injury

IV. Return to School

A student who has suffered a concussion or head injury is excused from school a minimum of the next two calendar days. A physician’s note is required for return to school. Members of the interscholastic head injury training program or the school nurse, as appropriate, will oversee the student’s return to school and extracurricular activity.

V. Temporary Accommodations for Students with Concussions or Head Injuries

(Requests for these accommodations shall be directed to the school nurse. In addition, student-athletes involved in the interscholastic sports program should consult with the interscholastic training team. See Section VI below.)

Mental exertion increases the symptoms from concussions and affects recovery. Therefore, for recovery, cognitive rest is just as important as physical rest. The student should be monitored for the reoccurrence of symptoms due to mental exertion, such as reading, working on a computer, or taking a test.

Students who return to school after a concussion may need to:

Take rest breaks as needed

Spend fewer hours at school

Be given more time to take tests or complete assignments

Receive help with school work

Reduce time spent on the computer, reading, and writing

Be granted early dismissal from classes to avoid crowded hallways

Be excused from physical education classes.

VI. Student-Athletes Involved in Interscholastic Sports

A. Background

Students who participate in an interscholastic sports program and are suspected of sustaining a concussion or other head injury in practice or competition shall be immediately removed from the sports practice or competition. A student-athlete who is removed from competition or practice shall not participate in further sports activity until he or she is evaluated by a physician or licensed healthcare provider trained in the evaluation and management of concussions, and receives written clearance.

Implementation of the policy is the shared responsibility of a team consisting of coaches, the Athletic Director, the Athletic Trainer, the school nurse, and the school administration, with the district Medical Officer leading the team.

B. Prevention

Pre-season baseline testing

Review of educational information for student-athletes on prevention of concussions

Reinforcement of the importance of early identification and treatment of concussions to improve recovery

Student-athletes who are exhibiting the signs or symptoms of a sports-related concussion or other head injuries during practice or competition shall be immediately removed from play and may not return to play that day.

C. Protocol When a Concussion is Suspected

When a concussion or head injury is suspected, the following protocol must be followed:

Immediate removal from competition or practice.
When available, the student-athlete should be evaluated by the school’s licensed healthcare provider to determine the presence or absence of a sports related concussion or head injury. 911 should be called if there is a deterioration of symptoms, loss of consciousness, or direct neck pain associated with the injury.
School personnel shall contact the student-athlete’s parent/guardian with information about the suspected sports related concussion or head injury.
Student-athletes must be evaluated by a physician or licensed health care provider trained in the evaluation and management of concussions.
School personnel shall provide the parent/guardian with the approved information/medical checklist to provide to the physician or other licensed healthcare professional.
The student-athlete must receive written clearance from his or her physician or licensed healthcare provider that he or she is asymptomatic at rest and may begin the graduated return-to-play protocol. School personnel may consult with the school/team physician after medical clearance is given by the student-athlete’s physician, especially in cases where the medical clearance is inconsistent with district policy.

D. Graduated Return to Practice and Competition Protocol

After the student-athlete submits written medical clearance stating that he or she is asymptomatic, he or she may begin a graduated individualized return-to-play protocol, such as the following.

Complete physical, cognitive, emotional and social rest is advised while the student-athlete is experiencing symptoms and signs of a sports-related concussion or other head injury.
Following medical clearance stating that the student-athlete is asymptomatic, completion of a full day of normal physical and cognitive activities (school day, studying for tests, watching practice, interacting with peers) without re-emergence of any signs or symptoms. If there is no return of symptoms, next day advance to:
Light aerobic exercise, which includes walking, swimming, or stationary cycling, keeping the intensity to less than 70% maximum percentage heart rate (no resistance training.) The objective of this step is increased heart rate. If there is no return of symptoms, next day advance to:
Sport-specific exercise including skating, and/or running; no head impact activities. The objective of this step is to add movement and continue to increase heart rate. If there is no return of symptoms, next day advance to:
Non-contact training drills (e.g. passing drills.) The student athlete may initiate progressive resistance training. If there is no return of symptoms, next day advance to:
Following medical clearance (consultation between school health care personnel, i.e., licensed athletic trainer, school/team physician, school nurse and student-athlete’s physician) participation in normal training activities. The objective of this step is to restore confidence and to assess functional skills by the coaching staff. If there is no return of symptoms, next day advance to:
Return to play involving normal exertion or game activity.

Utilization of available tools such as symptom checklists, baseline, and balance testing is suggested.

If the student-athlete exhibits a re-emergence of any post concussion signs or symptoms once he or she returns to play, he or she will be removed from exertional activities and returned to the school/team physician or primary care physician for evaluation.

If concussion symptoms reoccur during the graduated return-to-play protocol, the student-athlete will return to the previous level of activity that caused no symptoms.

E. Documentation

The DOE Concussion and Head Injury Fact Sheet shall be distributed annually to the parents or guardians of student-athletes. A signed acknowledgement of the receipt of the fact sheet shall be obtained from the parent or guardian of the student-athlete and retained by the school for future reference.

Bridgewater-Raritan Middle School

Athletic Training

Concussions

ImPACT Testing

Concussion Information

Parent / Athlete Resources

Forms and Registration