Newfane Central School District

Concussion Management Plan

In July of 2011 the Concussion Management and Awareness Act became law.  The law took effect on July 1, 2012 and is now included in the Commissioner’s Regulations section 135.6.  The details of the law are included in this document, the Concussion Management Plan.   Additional information that will help educate and inform both students and parents on concussion management can be found district web site under the Health Office and Athletic homepages.  The law requires that a parent must sign off acknowledging that they have received information on concussion management.  The athletic handbook signature page or the athletic handbook outline page will serve as the consent form that must be signed and handed in to your child’s coach.  You will receive this form from your child’s coach during the pre-season.  NCS has received a one year grant to be able to purchase neurocognitive testing software and have our nurses trained to administer test, this neurocognitive test is called ImPACT. This neurocognitive test will be administered to all incoming fall student athletes before the start of their season to establish a baseline.

This document is a summary of NYSED’s “Guidelines for Concussion Management in a School Setting” and it will serve as the Newfane Central School Concussion Management Plan.  The plan will be kept on file in the Health Office and Athletic Office.  It will also be disseminated to students and parents via the coach at the beginning of each sports season and again if a student is suspected of a head injury.  Furthermore, each student will also receive concussion information as part of the PE curriculum at the beginning of each year as well as additional information that can be found on the NCS website.  If you have any questions about the Newfane Central School Concussion Management Plan, please direct them to the Director of Health / Physical Education and Athletics, Mr. Douglas Ames.  Mr. Ames can be contacted at (716)-778-6560. 

Information and Prevention

• Preventing a concussion:

o  Although the risk of a concussion may always be present with certain types of activities, in order to minimize the risk, the following actions will be taken:

• Educate students, staff, and parents on all of the information in the Concussion Management Plan
• Teach proper skills
• Issue proper equipment
• Ensure that facilities are safe and regularly inspected
• Provide appropriate supervision
• Design lesson plans with student safety being a top priority
• Review and enforce rules of play
• Enforce rules of sportsmanship  
• Prevent students from initiating contact to another player with their head or to the head of another player
• Instruct players on sport-specific safe body alignment and encourage them to be aware of what is going on around them
• Proper strength and conditioning will help reduce head injuries
  
  Information available on the school website:

o  The Newfane Central School Concussion Management Plan

o  The Newfane Central School Student-Athlete Handbook

o  The Newfane Central School Board of Education Policy on Concussion Management

o  An informational pamphlet provided by the NYSPHSAA on concussions that is designed for parents and students

o  A link to http://www.health.ny.gov/prevention/injury_prevention/concussion.htm

o  A link to http://www.nysphsaa.org/safety/, this will lead to more concussion information that can be found on the NYSPHSAA website or via other links, such as the New York State Education Department and the Centers for Disease Control and Prevention.

• Pre-season required information:

o  By law, parent consent is required to compete in interscholastic athletics.  The Student-Athlete Handbook signature page or the Student-Athlete Handbook Outline page will serve as the consent form. The coach must review the Concussion Management Plan with the players prior to the start of the season.  NYSED’s “Guidelines for Concussion Management in the School Setting”, can be found by visiting the NCS district web site for details, this document includes detailed information on guidelines that should be shared with the students (page 14).  Note – PE teachers need to review these same guidelines with all of their students as part of the “opening day agenda”.

Steps following a head injury:

• The following steps are required in the event a student may have sustained a concussion:

o  The COACH/PE TEACHER must remove any student who has taken a significant blow to head or body, or presents with signs and symptoms of a head injury immediately from play because the Concussion Awareness Management Act requires immediate removal of any student believed to have sustained a concussion.

Symptoms of a concussion include, but are not necessarily limited to:

• Amnesia (e.g. decreased or absent memory of events prior to or immediately after the injury, or difficulty retaining new information)
• Confusion or appearing dazed
• Headache or head pressure
• Loss of consciousness
• Balance difficulty or dizziness, or clumsy movements
• Double or blurry vision
• Sensitivity to light and/or sound
• Nausea, vomiting, and/or loss of appetite
• Irritability, sadness  or other changes in personality
• Feeling sluggish, foggy, groggy, or lightheaded
• Concentration or focusing problems
• Slowed reaction times, drowsiness
• Fatigue and/or sleep issues (e.g. sleeping more or less than usual)

o  Contact the school nurse or certified athletic trainer (if available) for assistance with any student injury.

o  Send any student exhibiting signs and symptoms of a more significant concussion (see below) to the nearest hospital emergency room via emergency medical services.

• Headaches that worsen
• Seizures
• Looks drowsy and/or cannot be awakened
• Repeated vomiting
• Slurred speech
• Unable to recognize people or places
• Weakness or numbing  in arms or legs, facial drooping
• Unsteady gait
• Dilated or pinpoint pupils, or change in pupil size of one eye
• Significant irritability
• Any loss of consciousness
• Suspicion of skull fracture: blood draining from ear, or clear fluid from nose

o  The COACH will inform the PARENT/GUARDIAN of the need for evaluation by their primary private medical provider (physicians, nurse practitioners, and physician assistants). The COACH must provide the parent/guardian with the Newfane Central School District Concussion Management Plan which includes the Concussion Checklist that needs to be completed by the student’s private medical provider as well as written educational materials on concussions and the Newfane Central School Concussion Management Policy.  This will be the responsibility of the SCHOOL NURSE if the student was injured in PE class.  STUDENTS/PARENTS need to share all of the completed documents with the Health Office.

• The 1^st visit to the private medical provider should be immediately following the student’s injury.  The medical provider will determine if the student has a concussion.
• Depending on the timeline of the 1^st visit to the private medical provider, a 2^nd visit is most likely necessary.  No pupils will be allowed to resume athletic activity (graduated return to play phase process – listed below) until they have been symptom free for 24 hours and have been evaluated by and received written and signed authorization from a LICENSED PHYSICIAN.

o  The COACH/PE TEACHER will inform the Athletic/PE Director, certified athletic trainer, and the school nurse of the student’s potential concussion.  This is necessary to ensure that the student does not engage in activities at school that may complicate the student’s condition prior to having written clearance by a medical provider.

o  Students who have been diagnosed with a concussion require both physical and cognitive rest.  The SCHOOL NURSE/HEALTH OFFICE will inform the PE teachers, classroom teachers, coach, the building principal, and Athletic Director, regarding all restrictions, accommodations, and signs to look for when working with a student that suffered from a concussion.  NYSED’s “Guidelines for Concussion Management in the School Setting” includes detailed information on post-concussion management on pages 9-10.  Additional information on accommodations that can be used by the classroom teacher can be found on page 25 and 26 of NYSED’s “Guidelines for Concussion Management in the School Setting”.

o  The COACH/PE TEACHER will ensure that any student diagnosed with a concussion does not participate in any athletic activities until, in conjunction with the STUDENT’S LICENSED PHYSICIAN, the PE teacher/coach has received written authorization from the HEALTH OFFICE that the student has been cleared to participate by the SCHOOL DOCTOR. 

o  The COACH/PE TEACHER will ensure that students diagnosed with a concussion do not substitute mental activities for physical activities unless the medical provider clears the student to do so (e.g.  Due to the need for cognitive rest, a student should not be required to write a report if they are not permitted to participate in PE class by their medical provider).

ALL OF THE EVENTS LISTED ABOVE MUST TAKE PLACE PRIOR TO PHASE 1

GRADUATED PHASES TO RETURN TO FULL PLAY

o  Students must be monitored by DISTRICT STAFF daily following each progressive challenge, physical or cognitive, for any return of signs and symptoms of concussion.  STAFF MEMBERS need to report any observed return of signs and symptoms to the school nurse.  A student can only move to the next level of activity if they remain symptom free at the current level.  Return to activity occurs with the introduction of one new activity each 24 hours.  If any post concussion symptoms return, the student must drop back to the previous level of activity, then re-attempt the new activity after another 24 hours have passed  A more gradual progression should be considered based on individual circumstances and a private medical provider’s or other specialist’s orders and recommendations.

o  If a symptom does return, the person who discovered or received information about the symptom must report this to the Athletic Director, School Nurse, and Coach.  The SCHOOL NURSE will inform the parent regarding the return of a symptom.

o  A student cannot progress to the next step (Phases 2-5) without approval from the SCHOOL NURSE.  In the absence of the school nurse the SCHOOL ATHLETIC TRAINER can approve the progression of Phases 2-5.  If neither the school nurse nor athletic trainer is available then the student will remain on their current phase.

o  The SCHOOL NURSE will set up an appointment with the STUDENT each day.  After evaluating the student each day throughout the graduated phase process, the SCHOOL NURSE will inform (verbal, written, or email) the COACH/PE TEACHER if the student is allowed to progress to the next phase.  THE COACH/PE TEACHER is to assume that the student DID NOT progress to the next phase if he/she did not hear from the school nurse. 

Phase 1- low impact, non-strenuous, light aerobic activity such as walking or riding a stationary bike.  If tolerated without return of symptoms over a 24 hour period proceed to;

Phase 2- higher impact, higher exertion, and moderate aerobic activity such as running or jumping rope. No resistance training.  If tolerated without return of symptoms over a 24 hour period proceed to;

Phase 3- Sport specific non-contact activity. Low resistance weight training with a spotter. If tolerated without return of symptoms over a 24 hour period proceed to;

Phase 4- Sport specific activity, non-contact drills. Higher resistance weight training with a spotter. If tolerated without return of symptoms over a 24 hour period proceed to;

Phase 5- Full contact training drills and intense aerobic activity. If tolerated without return of symptoms over a 24 hour period proceed to;

PRIOR TO PHASE 6 – THE FOLLOWING MUST BE COMPLETED:

o  Once a student diagnosed with a concussion has successfully completed all 5 phases, a LICENSED PHYSICIAN must provide written, signed and completed clearance in order for the student to begin full activities without restrictions.  If the school doctor has concerns or questions about the physician’s orders, the SCHOOL DOCTOR should contact that provider to discuss and clarify.  Additionally, the SCHOOL DOCTOR has the final authority to clear students to participate in or return to extra-class physical activities in accordance with 8NYCRR 135.4(c)(7)(i). The SCHOOL NURSE will inform the parents if the school doctor does not approve a return to play.  The SCHOOL DOCTOR will consider all of the information (incident report, concussion checklist, physician’s orders, and school nurse or school doctor’s evaluations) prior to clearing an athlete return to play.

o  After the SCHOOL DOCTOR approves the student to return to full activities without restriction, the SCHOOL NURSE/HEALTH OFFICE will inform the PE teachers, classroom teachers, coach, and Athletic Director in writing that the student may fully participate in athletic activities.

Phase 6- Return to full activities without restrictions.

• Additional Information:

o  It cannot be emphasized enough that any student suspected of having a concussion – either based on the disclosure of a head injury, observed or reported symptoms, or by sustaining a significant blow to the head or body – must be removed from athletic activity and/or physical activities (e.g. PE class, recess), and observed until an evaluation can be completed by a medical provider.  For example, if a student comes to school with a symptom of a concussion as a result of a head injury that occurred at home, the student must be immediately removed from all athletic activities and the Concussion Management Plan must be enacted.

o  District staff members who observe a student displaying signs and/or symptoms of a concussion, or learn of a head injury from the student, should have the student accompanied to the school nurse.  Information on concussions will be shared with teachers at the first faculty meeting of the year. 

o   The Centers for Disease Control and Prevention (CDC) recommends that physicians, nurse practitioners, and physician assistants use the Acute Concussion Evaluation Form (ACE) to conduct an initial evaluation.  http://www.cdc.gov/concussion/headsup/pdf/ACE-a.pdf  

o  The Health Office must maintain any record of a head injury in the student’s folder.

o  Students, whose symptoms worsen or generally show no reduction after 7-14 days, or sooner depending on symptom severity, should be considered for referral to a neuropsychologist, neurologist, physiatrist, or other medical specialist in traumatic brain injury.

o  Coaches and PE teachers are required to complete a NYSED approved concussion course every two years.  NYSED has approved the course Heads Up, Concussion in Youth Sports for these professions, which is a free web-based course that has been developed by the CDC.  It is available at http://www.cdc.gov/concussion/HeadsUp/online_training.html. The Director of Physical Education and Athletics will keep this information on file in the Athletic Office as is done with all other coaching certification requirements.

o  School nurses and athletic trainers must complete a NYSED approved concussion course every two (2) years.  NYSED has approved the course Heads Up to Clinicians for these professions, which is a free web-based course developed by the CDC.  It is available at http://preventingconcussions.org/.  The Director of Physical Education and Athletics will keep this information on file in the Athletic Office.

o  The Concussion Management Team consists of the Director of Physical Education and Athletics, the School Nurse, the School Doctor, and a coach.  There will be an ongoing review of the Concussion Management Plan.  Revisions to the Concussion Management Plan will occur on an annual basis.