Concussion Management Protocol - League Athletics
Definition
Concussion Management Protocol
Concussion: (1) A concussion or mild traumatic brain injury (mTBI) is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include: 1. Concussion may be caused either by a direct blow to the head, face or neck or a blow elsewhere on the body with an “impulsive” force transmitted to the head. 2. Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously. 3. Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. 4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. In a small percentage of cases, however, post-concussive symptoms may be prolonged. 5. No abnormality on standard structural neuroimaging studies is seen in concussion. 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. 6. Second Impact Syndrome: results from acute, usually fatal, brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion that causes vascular congestion and increased intracranial pressure, which may be difficult or impossible to control. 7. Common signs of a concussion include but are not limited to headache, nausea, dizziness, blurred vision, double vision, confusion.
On-Site Staff Athletic Trainer Evaluation Process The on-site Staff Athletic Trainer will be responsible for evaluating and administering the proper treatment plan for athletes that sustain a concussion. If the Staff Athletic Trainer from the visiting team’s school is present, he/she may choose to administer the treatment plan as they deem appropriate (e.g., varsity soccer game).
Documentation Process Each suspected concussion should be documented by the Staff Athletic Trainer that performs the initial evaluation. 1) High School (Home Games) – Staff Athletic Trainer should notify head coach and parents. 2) High School (Away Games) – Host site Staff Athletic Trainer should notify visiting team Head Coach, visiting team Staff Athletic Trainer, and parents if possible. 3) Middle School – Should be documented by head coach and referred to home school Staff Athletic Trainer as soon as possible. The head coach is responsible for notifying the parents and high school athletic trainers. 4) Athletes must have a UIL Return to Play (RTP) and RRISD release form on file before returning to participation. Parent, athlete and athletic trainer must sign RTP form The following people should be kept in the communication circle for any athlete that sustains a concussion: Coaches, Parents, School Nurse, Teachers, School Counselors, School Administrators (as deemed appropriate by Staff Athletic Trainer)
Page 1 of 4
Updated 12/2011
Concussion Management Protocol Return to Play Protocol (Criteria) (1) The return to play protocol follows a stepwise progression of activity until full return. Athlete will fill out a Graded Symptom Checklist daily (preferably around the same time each day) following a concussion. Once all symptoms are graded to be a zero then a return to play protocol will be initiated. Athlete will continue to fill out Graded Symptom Checklist until return to full practice. Generally, each step takes 24 hours to complete. If any concussion symptoms return at any point during the progression, you must return to the beginning of the protocol. 1) Concussion a. Day one -Asymptomatic for 24 continuous hours Must obtain medical clearance from physician before Day 2 b. Day two -Light aerobic exercise (e.g., stationary bike for 10-15 minutes). c. Day three- Training drills and weights. Goal is to have athlete sweat and increase heart rate. d. Day four- Sport specific conditioning e. Day five - Practice with no contact (e.g., no pads in football). f. Day Six-Full contact athletic practice. g. Day Seven-Return to full play 2) Multiple Concussions a. Second concussion within a 6 month period: physician clearance, double RTP b. Third Concussion (calendar year from occurrence of first concussion): Parent/Guardian, student athlete and COT, including physician, must convene. COT decision is final.
Concussion Oversight Team Physician: Richard T. Strawser, M.D. Athletic Trainers: Greg Bauer (WWHS), Linda Bowman (SPHS), Ashley Brown (WWHS), Jose Carrillo (RRHS), Melissa Harrington (CRHS), John Horsley (CRHS), Brooke Kneuper (SPHS), Kirk Mollenkopf (MHS), Melissa Ochs (MHS), Nikki Vincent (RRHS)
REFERENCES 1) McCrory, P., et al. Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008. Journal of Clinical Neuroscience, pg. 755763. Feb. 2009. 2) Summary Statement by the Quality Standards Subcommittee of the American Academy of Neurology. Practice Parameter: The Management of Concussion in Sports. Neurology, pg. 581585. 1997. 3) National Federation of High School Associations, Suggested Guidelines for the management of Concussions in Sport; January 2011. 4) University Interscholastic League, Implementation Guide for NFHS Suggested Guidelines for Concussions and Chapter 38, Sub Chapter D of the Texas Education Code. 5) UIL Medical Advisory Committee
Page 2 of 4
Updated 12/2011
Concussion Management Protocol Graded Symptom Checklist
Name: Sport: Grade/ Team:
Date of Injury: Date: Time: __________________
How do you feel? You should score yourself on the following symptoms, based on how you feel now. None: 0 Mild: 1-2 Moderate: 3-4 Severe: 5-6 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
Headache “Pressure in head” Neck Pain Nausea or vomiting Dizziness Blurred vision Balance problems Sensitivity to light Sensitivity to noise Feeling slowed down Feeling like “in a fog” “Don’t feel right” Difficulty concentrating Difficulty remembering Fatigue or low energy Confusion Drowsiness Trouble falling asleep More emotional Irritable Sadness Nervous or Anxious Ringing in the ears
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Do symptoms get worse with physical activity? Do symptoms get worse with mental activity?
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Y Y
4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
N N
Total Number of Symptoms: Symptom Severity Score:
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Updated 12/2011
Concussion Management Protocol
Athlete Name: __________________________ Date of Injury: ____________________ Sport /Team: __________________________
Time of Injury:____________________
Concussion History:________________________________________________________ Description of how the injury occurred:_________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Symptoms at the time of injury: (Circle all that apply) Headache Blurred vision Nausea Amnesia Repetitive questioning Slurred Speech
Dizziness Double vision Vomiting Sleepiness Confusion Slow responses
Ringing in ears Irritability Sensitivity to Light Aggression/Anger Dazed Coordination Issues
Evaluating Athletic Trainer: ____________________________ Date: _____________ Name/Number of Parent Called:_______________________________________________ Last date w/symptoms: _____________ Name of Physician: _____________________________ Date of Visit:______________ Signature of Physician: __________________________________ Cleared to return to activities: Yes No Reasons: ______________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Restrictions: ______________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Day 1 – Asymptomatic for 24 continuous hours Day 2 – Stationary Bike
Parent Signature:______________________
Day 3 – Training Drills Day 4 – Sport Specific Conditioning & Weights Day 5 – Practice with No Contact FB – Helmet, Shoulder Pads, Shorts, Girdle Day 6 – Full Athletic Practice Day 7 – Return To Play In order for us to give the best possible care to our athletes, we want to follow the treatment plan you have designed for the above athlete. The Sports Medicine Department requires a hard copy release before an athlete can return to activity from the treating healthcare professional. An athlete may not be able to participate without THIS form complete and on file with the school Athletic Trainer. This Form also gives permission to release medical information for above athlete related to his/her injury to become a confidential permanent record of the Sports Medicine Department.
Page 4 of 4
Updated 12/2011
Concussion Management Protocol
Concussion: (1) A concussion or mild traumatic brain injury (mTBI) is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include: 1. Concussion may be caused either by a direct blow to the head, face or neck or a blow elsewhere on the body with an “impulsive” force transmitted to the head. 2. Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously. 3. Concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. 4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. In a small percentage of cases, however, post-concussive symptoms may be prolonged. 5. No abnormality on standard structural neuroimaging studies is seen in concussion. 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. 6. Second Impact Syndrome: results from acute, usually fatal, brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion that causes vascular congestion and increased intracranial pressure, which may be difficult or impossible to control. 7. Common signs of a concussion include but are not limited to headache, nausea, dizziness, blurred vision, double vision, confusion.
On-Site Staff Athletic Trainer Evaluation Process The on-site Staff Athletic Trainer will be responsible for evaluating and administering the proper treatment plan for athletes that sustain a concussion. If the Staff Athletic Trainer from the visiting team’s school is present, he/she may choose to administer the treatment plan as they deem appropriate (e.g., varsity soccer game).
Documentation Process Each suspected concussion should be documented by the Staff Athletic Trainer that performs the initial evaluation. 1) High School (Home Games) – Staff Athletic Trainer should notify head coach and parents. 2) High School (Away Games) – Host site Staff Athletic Trainer should notify visiting team Head Coach, visiting team Staff Athletic Trainer, and parents if possible. 3) Middle School – Should be documented by head coach and referred to home school Staff Athletic Trainer as soon as possible. The head coach is responsible for notifying the parents and high school athletic trainers. 4) Athletes must have a UIL Return to Play (RTP) and RRISD release form on file before returning to participation. Parent, athlete and athletic trainer must sign RTP form The following people should be kept in the communication circle for any athlete that sustains a concussion: Coaches, Parents, School Nurse, Teachers, School Counselors, School Administrators (as deemed appropriate by Staff Athletic Trainer)
Page 1 of 4
Updated 12/2011
Concussion Management Protocol Return to Play Protocol (Criteria) (1) The return to play protocol follows a stepwise progression of activity until full return. Athlete will fill out a Graded Symptom Checklist daily (preferably around the same time each day) following a concussion. Once all symptoms are graded to be a zero then a return to play protocol will be initiated. Athlete will continue to fill out Graded Symptom Checklist until return to full practice. Generally, each step takes 24 hours to complete. If any concussion symptoms return at any point during the progression, you must return to the beginning of the protocol. 1) Concussion a. Day one -Asymptomatic for 24 continuous hours Must obtain medical clearance from physician before Day 2 b. Day two -Light aerobic exercise (e.g., stationary bike for 10-15 minutes). c. Day three- Training drills and weights. Goal is to have athlete sweat and increase heart rate. d. Day four- Sport specific conditioning e. Day five - Practice with no contact (e.g., no pads in football). f. Day Six-Full contact athletic practice. g. Day Seven-Return to full play 2) Multiple Concussions a. Second concussion within a 6 month period: physician clearance, double RTP b. Third Concussion (calendar year from occurrence of first concussion): Parent/Guardian, student athlete and COT, including physician, must convene. COT decision is final.
Concussion Oversight Team Physician: Richard T. Strawser, M.D. Athletic Trainers: Greg Bauer (WWHS), Linda Bowman (SPHS), Ashley Brown (WWHS), Jose Carrillo (RRHS), Melissa Harrington (CRHS), John Horsley (CRHS), Brooke Kneuper (SPHS), Kirk Mollenkopf (MHS), Melissa Ochs (MHS), Nikki Vincent (RRHS)
REFERENCES 1) McCrory, P., et al. Consensus statement on concussion in sport – The 3rd International Conference on concussion in sport, held in Zurich, November 2008. Journal of Clinical Neuroscience, pg. 755763. Feb. 2009. 2) Summary Statement by the Quality Standards Subcommittee of the American Academy of Neurology. Practice Parameter: The Management of Concussion in Sports. Neurology, pg. 581585. 1997. 3) National Federation of High School Associations, Suggested Guidelines for the management of Concussions in Sport; January 2011. 4) University Interscholastic League, Implementation Guide for NFHS Suggested Guidelines for Concussions and Chapter 38, Sub Chapter D of the Texas Education Code. 5) UIL Medical Advisory Committee
Page 2 of 4
Updated 12/2011
Concussion Management Protocol Graded Symptom Checklist
Name: Sport: Grade/ Team:
Date of Injury: Date: Time: __________________
How do you feel? You should score yourself on the following symptoms, based on how you feel now. None: 0 Mild: 1-2 Moderate: 3-4 Severe: 5-6 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23.
Headache “Pressure in head” Neck Pain Nausea or vomiting Dizziness Blurred vision Balance problems Sensitivity to light Sensitivity to noise Feeling slowed down Feeling like “in a fog” “Don’t feel right” Difficulty concentrating Difficulty remembering Fatigue or low energy Confusion Drowsiness Trouble falling asleep More emotional Irritable Sadness Nervous or Anxious Ringing in the ears
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Do symptoms get worse with physical activity? Do symptoms get worse with mental activity?
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Y Y
4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
N N
Total Number of Symptoms: Symptom Severity Score:
Page 3 of 4
Updated 12/2011
Concussion Management Protocol
Athlete Name: __________________________ Date of Injury: ____________________ Sport /Team: __________________________
Time of Injury:____________________
Concussion History:________________________________________________________ Description of how the injury occurred:_________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Symptoms at the time of injury: (Circle all that apply) Headache Blurred vision Nausea Amnesia Repetitive questioning Slurred Speech
Dizziness Double vision Vomiting Sleepiness Confusion Slow responses
Ringing in ears Irritability Sensitivity to Light Aggression/Anger Dazed Coordination Issues
Evaluating Athletic Trainer: ____________________________ Date: _____________ Name/Number of Parent Called:_______________________________________________ Last date w/symptoms: _____________ Name of Physician: _____________________________ Date of Visit:______________ Signature of Physician: __________________________________ Cleared to return to activities: Yes No Reasons: ______________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Restrictions: ______________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Day 1 – Asymptomatic for 24 continuous hours Day 2 – Stationary Bike
Parent Signature:______________________
Day 3 – Training Drills Day 4 – Sport Specific Conditioning & Weights Day 5 – Practice with No Contact FB – Helmet, Shoulder Pads, Shorts, Girdle Day 6 – Full Athletic Practice Day 7 – Return To Play In order for us to give the best possible care to our athletes, we want to follow the treatment plan you have designed for the above athlete. The Sports Medicine Department requires a hard copy release before an athlete can return to activity from the treating healthcare professional. An athlete may not be able to participate without THIS form complete and on file with the school Athletic Trainer. This Form also gives permission to release medical information for above athlete related to his/her injury to become a confidential permanent record of the Sports Medicine Department.
Page 4 of 4
Updated 12/2011
