Concussion Protocols

School administrators, coaches, trainers, nurses and parents must know the facts about concussions and appreciate the potential for permanent damage. While understanding concussions is an inexact science, these facts are indisputable:

• A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head.
• Concussions can also occur from a blow to the body that causes the head and brain to move quickly back and forth, allowing the brain to bounce around within the skull.
• All concussions are serious. The sudden movement of the brain can cause stretching, tearing and damage to brain cells and create chemical changes within the brain.
• Concussions can occur without loss of consciousness.
• They can occur in any sport.
• Recognition and proper management of concussions when they occur can help prevent further injury and, in extreme cases, death.

Adults and others at a sporting event should be alert to a forceful bump, blow or jolt to a player’s head or body that causes a rapid movement or whiplash of the head. In addition, they should look for concussion signs and symptoms, such as a change in the athlete’s behavior, thinking or physical functioning. If there is reason to suspect a concussion, the athlete should be removed from play.

Although signs and symptoms generally show up soon after the hit, the full effect of the injury may not be noticeable immediately. The athlete who appears a little dazed right after a fall, might not recall coming to the practice or game when asked about it an hour later. Coaches should check repeatedly for signs of concussion after a blow and tell parents to watch for any worsening of symptoms, which indicates a medical emergency. In all cases of suspected concussion, the coach or athletic director should ensure that the parents or guardians are fully informed, and the student should be evaluated by a health care professional.

Time and rest are required for healing. Most athletes with a concussion will recover quickly and fully, but sometimes the symptoms linger. A repeat concussion that occurs before the brain recovers from the first can slow the recovery or increase the chances for long-term problems. In rare cases, repeat concussions can result in brain swelling, permanent brain damage or death.

Despite an athlete’s eagerness to return to sports practices, he or she must do so only after clearance by a medical profession. The athlete must be monitored closely by a team trainer or coach.

The return to play should be gradual and take place not in one day, but over the course of days, weeks and, perhaps, months. Appropriate steps include light aerobic exercise, followed by moderate jogging and weightlifting, then heavy non-contact physical activity such as sprinting and high-intensity stationary biking. Later, full contact in a controlled practice setting is the last step before the athlete returns to competition. Of course, if the student’s symptoms come back during the process, the athlete must stop the activity, check with the health care provider and begin the re-entry at the previous step.

The Massachusetts Concussion Law, enacted in 2010 and formally known as Senate Bill 2496, requires schools, parents and athletes to be educated and have procedures in place regarding concussion reporting.

School administrators should develop a policy that outlines protocol for parents and athletes and ensures accurate, updated medical information is kept with the school nurse. St. John’s Prep in Danvers has a model program which might be replicated in other schools. You can access their protocol here.

It requires students and parents to take a free online course on concussions and sign the school’s concussion policy statement. Athletes must complete an initial baseline impact test and file a pre-participation concussion reporting form before every sport season. The school nurse keeps the records with the annual physical form.

In addition, the school requires a student with a suspected concussion to be examined by a medical professional on the day of the injury and forbids the student to return to practice or play the same day a concussion is diagnosed.

It is naïve to think that concussions can be eliminated. But schools and districts can insist on safety procedures that minimize the risks for concussions and other serious brain injuries. These include:

• Ensure that athletes follow safety rules and the rules of each sport.
• Encourage good sportsmanship on and off the field.
• Require athletes to wear a helmet. There is no “concussion-proof” helmet, but a sturdy, well-fitted helmet can reduce the risk of brain injury and skull fracture.
• Avoid hits to the head through education, practice and enforcement of rules.

Use the links to access more information about concussions and developing a school policy to prevent and treat them: