The Board of Education of the Lake George Central School District recognizes that concussions and head injuries are commonly reported injuries in children and adolescents who participate in sports and recreational activity and can have serious consequences if not managed carefully. Therefore, the District adopts the following policy to support the proper evaluation and management of head injuries.
A concussion is an injury to the brain. A concussion occurs when normal brain functioning is disrupted by a blow or jolt to the head. Recovery from a concussion will vary. Avoiding re-injury and overexertion until fully recovered are the cornerstones of proper concussion management.
While District staff will exercise reasonable care to protect students, head injuries may still occur. Physical education teachers, coaches, nurses and other appropriate staff receive training to recognize the signs, symptoms and behaviors consistent with a concussion. Any student exhibiting those signs, symptoms or behaviors while participating in a school sponsored class, extracurricular activity, or interscholastic athletic activity, shall be removed from the game, activity, or class and be evaluated as soon as possible by an appropriate health care professional. The coach/physical education teacher or staff members in charge will notify the student’s parents or guardians and recommend he or she sees a physician.
If a student sustains a concussion at a time other than when engaged in a school-sponsored activity, the district expects the parent/legal guardian to report the condition to the school nurse so that the district can support the appropriate management of the condition.
If a student is suspected of having a concussion, the student shall not participate in physical activities until authorized to do so by an appropriate health care professional. Any student who continues to have signs or symptoms upon return to activity must be removed from play and be reevaluated by their general physician. The district appointed medical director will make the final decision on return to activity in all unresolved or inconclusive matters that are not resolved by the student’s general physician. (Adopted: May 8, 2012. Amended: August 9, 2016)
AFTER SCHOOL CONCUSSION MANAGEMENT: SPORTS/ACTIVITIES SEASON PROTOCOLS
Parents and Students
All parents and students will have access to the Lake George Education Based Athletic Handbook which includes an explanation of the district’s Concussion Management Policy and Return to Play (RTP)/Return to School Protocols (RTS). A parent/guardian must sign a permission slip prior to participation in athletics acknowledging receipt and understanding of the document. The Lake George Education Based Athletic Handbook can be found at www.lkgeorge.org (athletics tab) or the athletic director can be contacted in order to obtain a hardcopy.
Coaches, Physical Education Teachers, School Nurses
All coaches/physical education teachers, school nurses, and appropriate staff members receive appropriate training per New York State guidelines. All suspected concussions will be reported by the coach/physical education teacher or staff member to the nurse, so he/she may follow up with the family and private health care providers as indicated. If a student with a known head injury in the season prior resulted in the student missing the remainder of that season he or she should have medical clearance to participate in the current season and it may be determined that he or she follow the RTP protocol.
Athletic Director
The athletic director will ensure that all coaches/physical education teachers are trained, understand concussions, and familiar with the RTP protocol. The athletic director will make certain all coaches are using the concussion checklist.
Staff Roles
Coach/Physical Education Teacher or Appropriate Staff Member:
If a trained medical person is not available, the coach/physical education teacher or appropriate staff member will evaluate whether the student has sustained a head injury, by observation, concussion checklist, and collaborative eyewitness accounts from teammates. If the student describes ANY symptoms or demonstrates any signs of a concussion per the concussion checklist:
- The student will be immediately removed from play and will not be allowed to return to play in the current game or practice.
- The student will not be left alone; the coach/physical education teacher or staff member will do his or her best to contact a parent. Close monitoring should be 24 done following injury by the coach or the parent. At any sign of deterioration, medical help must be immediately sought by calling 911 and parents must be notified.
- A player must be medically evaluated by a private physician following a suspected concussion, even if symptoms have resolved or are fleeting.
- ● A student who receives an injury that results in the appearance of any concussive symptoms may not return to play. The coach will not be making a medical determination for RTP.
- 911 must be called if a student loses consciousness.
- The school nurse will follow-up with the student medically throughout the five-day RTP protocol. If the student exhibits any symptoms of a concussion, the student will not be able to resume the return to play protocol and the nurse will notify the parent and request the student return to his or her physician.
School Nurse
The school nurse will contact the student and parents following a head injury to discuss the severity of the injury. The school nurse will also document whether the parent sought medical care and/or notified a private physician of the injury. If the parent did not seek proper care, the nurse will advise the parent to have the student evaluated as soon as possible. * The nurse shall receive copies of all physician notes. The school nurse will consult with the coach/physical education teacher or appropriate staff member and fill out an accident report. The school nurse will notify all appropriate staff/faculty about the student’s injury to ensure proper management of the injury. The school nurse will notify guidance counselors when a note from a physician states accommodations for learning is recommended. The school nurse will advise the parent to contact the student’s counselor if learning problems appear to develop during the healing phase.
When the private physician releases the student for RTP, the school staff shall interpret that as the child’s having had 24 hours free from all symptoms and, therefore, has been cleared to begin the five-day graduated stepwise program. The private physician’s clearance “without restriction” is not a determination for the student to return to regular play. It is only a clearance for the student to begin the RTP procedures. In order for the student to return to normal activity or competition immediately, a note from the physician must specify the student never suffered from a concussion. The nurse will work in conjunction with Athletic Director to inform his or her coach/physical education teacher of the injury. The nurse will follow-up with the student throughout the five -day RTP protocol. If any symptoms re-occur, the student will not be able to continue the RTP protocol and the nurse will contact the parent and advise further follow-up with their physician. The district physician will ultimately be responsible for permitting a student to return to play.
*Any outside physician visit is subject to parental expense unless district policy suggests differently.
BORDERLINE/UNRESOLVED CALLS
Staff is asked to adhere to the simple philosophy of, “WHEN IN DOUBT, SIT THEM OUT!” If there is any doubt whether a student has sustained a concussion, it will be treated as a concussion. The student will be referred to his or her physician and if the physician notes he or she never suffered a concussion, the student may return to regular play or competition. Unresolved cases where no outside physician was sought or if evidence of symptoms is still present (e.g. learning difficulties) will be referred to the district appointed medical director and he or she will make the final determination on whether RTP should be followed. The district appointed medical director may request an evaluation of the student and/or ask to evaluate the student to assist in making the final determination.
Concussion Management
Return to Play (RTP) Protocol
There are many risks to premature return to play including: a greater risk for a second concussion because of a lower concussion threshold, second impact syndrome (abnormal brain blood flow that can result in death), exacerbation of any current symptoms, and possibly increased risk for additional injury due to alteration in balance. If the student is having difficulty performing “normal” activities that may affect academics, parents should contact his or her child’s guidance counselor and/or teachers. Return to play following a concussion involves a day-by-day progression once the student is symptom free for a minimum of 24 hours. No student should return to play while symptomatic. Students are prohibited from returning to play the day the suspected concussion is sustained. If there is any doubt as to whether a student has sustained a concussion, it should be treated as a concussion. Once the student is symptom free for 24 hours and has a signed release by the treating physician, he/she may begin the return to play progression below (provided there are no other mitigating circumstances). The Lake George School District will follow guidelines based on the National Federation of State High School Associations NFHS model listed below:
Step 1: Light aerobic exercise- e.g. 5 to 10 minutes on an exercise bike or light jog; no weight lifting, resistance training, or any other exercises
Step 2: Moderate aerobic exercise- e.g. 15 to 20 minutes of running at moderate intensity in the gym or on the field without a helmet or other equipment
Step 3: Non-contact training drills in full uniform. May begin weight lifting, resistance training and other exercises
Step 4: Full contact practice or training
Step 5: Full game play
Once asymptomatic, each step will take place per 24-hour period. If any post-concussion symptoms occur while in the program, then the student must be reevaluated by the student’s physician and will return to day one of the program after the student has been medically cleared and asymptomatic for 24 hours.
Return to School
Following a concussion, a student may have difficulty in school. This may include but are not limited to the following symptoms: difficulty concentrating, sensitivity to bright lights, and difficulty with tasks that require sustained concentration. It is important that parents, students and the school to work together to develop accommodations to help with the healing process.
Return to School (RTS) Protocol
Responsibilities of the School Nurse after notification of student’s concussion:
1. The athlete will be instructed to report to the school nurse upon his or her return to school. At that point, the school nurse will:
a) Check-in with the student.
b) Provide individualized healthcare plan based on the athlete’s current condition, recommendations from the athlete’s physician and the athlete’s medical and educational needs as identified by his/her physician.
2. Notify the student’s guidance counselor of the educational needs as identified by his/her physician.
3. Notify the student’s PE teacher of any restrictions as identified by the physician or the parents.
4. Check in with the athlete at least once per school day during the RTP process. Ask student to check in during free periods or lunch or if they are experiencing any issues during the day.
Responsibilities of the student’s guidance counselor:
1. Once notified by the school nurse, monitor the student closely and recommend appropriate academic accommodations when he or she exhibits symptoms of post-concussion syndrome.
2. Communicate with the school health office on a regular basis, to provide the most effective care for the student.
3. Communicate with student, student’s parent(s), and teachers
Responsibilities of the student’s teachers:
1. When notified by guidance counselor, monitor the student closely and work with the guidance counselor to recommend appropriate academic accommodations when he or she exhibits symptoms of post-concussion syndrome.
2. Communicate with the school health office on a regular basis, to provide the most effective care for the student.
All teachers interacting with the student (including the physical education teacher): Teachers can often help observe changes in a student, including symptoms that may be worsening. Teachers are also in a position to interact regularly with the student’s parents, thereby providing a channel to obtain and share information with them about the student’s progress and challenges.
Responsibilities of the student’s parents:
1. Notify school nurse of concussion (if sustained other than when engaged in school activity) Understand what a concussion is and follow physician’s orders.
2. Limit their child’s activities that require concentration or mental stimulation, providing cognitive rest. Exposure to loud noises, bright lights, computers, video games, television and phones (including texting) all may worsen the symptoms of concussion. As the symptoms lessen, increased use of computers, phone, video games, etc., may be allowed, as well as a gradual progression back to full academic work.
3. Communicate with their child’s teachers, guidance counselor, and nurse if learning difficulties occur.
4. Encourage their child to get plenty of sleep and rest.
Responsibilities of the student:
The student: The affected student should be “in the loop,” and encouraged to share his/ her thoughts about how things are going, and symptoms he or she is experiencing. The student should receive feedback from the rest of the team that is appropriate to his/her age, level of understanding, and emotional status.
Resources:
U.S. Department of Health Center for Disease Control and Prevention
https://www.cdc.gov/headsup/index.html
New York State Public High School Athletic Association http://www.nysphsaa.org/
Dr. Martin Breen, MD, Glens Falls, NY, Pediatrics, Medical Director, Lake George Central School
Dr. Cynthia Devore, Medical Director, Monroe #1 BOCES