Concussion Care Protocol

A concussion is a brain injury, and all brain injuries are serious. Concussions are caused by a bump, blow, or jolt to the head or another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are potentially serious and may result in complications, including prolonged brain damage and death if not recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious. You can’t see a concussion, and most sports concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away. See the concussion information sheet for symptoms.

A child's best chance of full recovery from a concussion involves two critical components: Cognitive and physical rest or "brain and body" rest. Continued research has shown cognitive rest is essential for the quick resolution of concussion symptoms. Cognitive stimulation includes things like driving, playing video games, computer/chromebook use, text messaging, cell phone use, loud and/or bright environments, watching television, reading, and studying. These activities must be limited, and in some cases, completely avoided, for a period of time during recovery. Physical activity such as physical education, athletics, and strength or cardiovascular conditioning must be completely avoided or regulated while recovering from a concussion. It is recommended that this protocol is shared with the child’s primary care physician (licensed to practice medicine in all its branches, i.e. pediatrician) during the initial visit.

Points of Emphasis:

It is important to note that the recovery from a concussion is a very individualized process. Caution must be taken not to compare your child's experience with another's as he/she progress through the recovery process.
The child must be initially evaluated by a primary care physician in order to initiate the concussion care protocol (licensed to practice medicine in all of its branches), and documentation must be provided to the school nurse. An emergency room/acute care note is only temporary until seen by the child’s primary care physician within one week.
The child’s missed academic work will be reviewed and granted extra time to complete, in conjunction with the physician's recommendations and guidance from the counselor/social worker and school nurse.
As the child’s recovery progresses through Stages 1-3, teachers should identify essential academic work in each subject and collaborate, as needed, to determine potential reduction in course workload. This will promote healing and help reduce the student’s anxiety level related to the perceived volume of work that may be required once the student is medically cleared to resume a full academic load.
The teacher has the option of assigning the student a grade of incomplete for the progress mark, final exam, and/or semester grade.
For the student: Upon returning to school, it is important for the student report to the school nurse daily to monitor symptoms and determine progression to the next stage within the concussion care protocol.

Steps of Concussion Protocol Recovery and Academic/Athletic Participation:

Complete Brain and Body Rest at Home.
Return to School.
Full Academic and Athletic Participation.

Step One - Complete Brain and Body Rest at Home

Symptoms of a Concussion

Symptoms may include but are not limited to:
- Headache or pressure in head, dizziness, nausea, photosensitivity, auditory sensitivity, inability to focus/concentrate, memory/lack of recall, feeling mentally foggy, unusual changes in mood, fatigue.
- Students may complain of intense and continuous/frequent headaches.
- Students may not be able to read for more than 10 minutes without an increase in symptoms.

Concussion Protocols and Actions

With a certified doctor's note - Excused attendance from school, practices or contests.
Certified doctor informs CSMS nurse or doctor's note delivered to CSMS nurse.
Nurse - sends note to all teachers.
Based on doctor's note and discussion with nurse, as appropriate, no homework, reading, texting, watching TV, playing video games, watching movies, computer or cell phone use. Need complete brain and body rest.
Monitor eating. Make sure student is eating small amounts of healthy foods and progressing to a normal healthy diet. Lack of food can also cause headaches, dizziness, and make the concussion symptoms last longer.
As directed by a certified doctor as symptoms decrease - progress to step two.

Progress to Step 2 when:

Student has decreased sensitivity to light or noise.
Student has decreased intensity and frequency of headaches and dizziness.
Student has ability to do light reading for 10 minutes without increased symptoms.
Student has decreased feeling of fogginess or confusion.

Step Two - Return to School

Characteristics of concussion symptoms

Mild symptoms at rest, but increasing with physical and mental activity.

Concussion Protocols and Actions

Plan (as appropriate) to go to school for a full day. A student recovering from a concussion reports daily to the school nurse before school starts. School starts at 7:45am.
- Engage in class discussions, complete homework, use Chromebook, study for and take quizzes & tests as tolerated.

All student-athletes report to the school nurse before and after school.
Nurse - sends note to all teachers regarding returning student and possible accommodation

If no significant increase in symptoms, progress to step three.
If concussion symptoms increase at school, consider modifications as guided by the doctor and nurse
Use interventions - as suggested by the school nurse or your doctor.
When class period attendance does not increase concussion symptoms - progress to step three.

Progress to Step 3 when:

School activity does not increase symptoms.
Overall symptoms continue to decrease.

Step Three - Full Academic and Athletic Participation.

Characteristics of concussion symptoms

Asymptomatic with academic/cognitive and physical activities.

Concussion Protocols and Actions

A student recovering from a concussion reports daily to the school nurse before school starts. School starts at 7:45am.
The student must receive clearance from his/her doctor to return to physical education. A written note is required from the doctor. Student will progress back into the physical education curriculum using the 5 Phase system outlined below.
Counselor/social worker - sends note to all teachers.
Student athletes may begin athletic participation Return to Play protocol. There are 5 phases to Return to Play. Student athlete will be monitored by his/her coach and the CSMS nurse. No student will be allowed to begin the Return to Play without a release from his/her doctor. When the doctor's release is received by the school nurse, the student may begin and move through the phases below to return to play. The student will be monitored by his/her coach and the CSMS nurse.
- Phase One - Light aerobic activity - One day minimum - if no significant increase in symptoms, progress to phase two.
- Phase Two - Increased aerobic activity - One day minimum - if no significant increase in symptoms, progress to phase three.
- Phase Three - Non-contact activity related to specific sport/skills - One day minimum - if no significant increase in symptoms, progress to phase four.
- Phase Four - Full contact activity - One day minimum - if no significant increase in symptoms, progress to phase five.
- Phase Five - Return to competition.

Follow Up:

The student is encouraged to meet with school counselor/social worker regularly to discuss progress, grades, and status of make-up work.

The student is encouraged to meet with the school nurse to assess any recurring symptoms.