Concussion Management Protocol Purpose: The purpose of this policy is to establish a protocol for defining concussions, recognizing symptoms of concussions, and determining the return to play of an athlete following a concussion at Jefferson City High School.

Definition of a concussion According to the International Conference on Concussion (2008) 1, a concussion is defined as: a complex pathophysiological process affecting the brain, induced by traumatic biomechanical force. It can be caused by numerous forces such as a direct blow to the head, face, neck, or elsewhere on the body causing an impulsive force transmitted to the head. Concussions usually result in impairment of neurological function in a rapid onset and resolve spontaneously.

Signs and Symptoms of Concussions (can include but not limited to the following): Headaches Light headedness Emotional symptoms Amnesia Loss of consciousness Behavioral changes Slowed reaction times Drowsiness

Concussion If an athlete is suspected to have sustained a concussion: Athlete should be evaluated by the onsite medical personnel. If no medical personnel are available the athlete should safely be removed from the playing field (only if no spinal injury suspected) and referred to a physician. Following any first aid management, that medical team should assess the athlete using SCAT2 concussion assessment tool. Once diagnosed with a concussion that athlete should not be allowed to return to play that day.

Second-Impact Syndrome “ Second impact syndrome occurs when a second, often minor, injury occurs subsequent to a previous closed head injury that has not completely cleared. The athlete develops rapid brain swelling associated with collapse, rapidly dilating pupils, loss of eye movement, and respiratory failure within seconds to minutes of the second injury. The outcome is uniformly severe brain injury or death. The only treatment is prevention.” – Taken from the MSHSAA Sport Medicine Handbook,

Management of a concussion The ImPACT program will be utilized to establish a baseline of the athletes’ neurocognitive responses prior to each athletic season. Upon sustaining a suspected concussion the athlete will be evaluated by the Athletic Trainer and the physician using the ImPACT program. Following the test and diagnosis of a concussion that athlete should have complete physical and cognitive rest until symptoms have resolved. A graduated return to play protocol has been outlined and recommended by the International Conference on Concussion (2008)

Return to Play Protocol StageFunctional Activities Allowed Objective No ActivityComplete RestRecovery Light aerobic exerciseWalking, swimming, stationary bike, HR below 70% Increase HR Sport specific exerciseRunning drills in soccer, basketball, football softball, volleyball, etc. No head impact Adding movement Non-Contact drills Progress to more complex drills, passing drills, progressive resistance Exercise coordination, and cognitive load Full Contact PracticeFollowing medical clearance, participate in normal training Restore confidence of athlete and allow for assessment Return to playNormal game play

Return to Play Protocol Each athlete is different. The athlete will be evaluated 24 and 48 hours after the concussion has occurred. After the athlete is symptom free, they will go through the above return to play protocol. The key to the return to play is progressing in the protocol symptom free.

Return to Play Protocol If any post concussion symptoms occur during a stage, the athlete will be dropped back to the previous asymptomatic stage, and progressed again after a further 24 hours period of rest. There is no set return to play time. The athlete may return to play in a minimal of one week or longer depending on their progression of symptoms and activities.

Referral and Home Care The athlete should be referred for further medical examination if he/she experiences any LOC, amnesia that lasts for more than 15 minutes, deterioration of symptoms, neurological symptoms, increase in blood pressure, unequal or dilated pupils, or if athlete is not stabilizing or conditions get worse.

Referral and Home Care Instructions, written and oral, should be given to the concussed athlete and to a care giver if the athlete is allowed to return home. The National Athletic Trainer’s Association 3 recommends that should an athlete experience loss of consciousness (LOC) or prolonged periods of amnesia, that athlete be woken up in the night to check for deterioration of symptoms.

Multiple Concussions The MSHSAA Sports Medicine committee recommends that if an athlete sustains 3 concussions during one season of play, that athlete should be disqualified for that season and a thorough examination should be performed before participating in an another season.

Prevention of Concussions It should be noted that there is no evidence available that states protective equipment will completely protect against a concussion. However, protective equipment can be used to help prevent and reduce impact forces to the brai n.

Prevention of Concussions In athletics there is always going to be athletes that try to hide their symptoms out of fear of losing playing time. Coaches, staff, and parents should be educated on the dangers of disguising head injuries and that all head injuries are serious.

Return to Play Dr. Michael Steenbergen is the recognized team physician at Jefferson City High School in concussion management. All Jefferson City High School athletes need to be cleared by Dr. Steenbergen prior to their return to sports. There is a progression of return to play performed by Dr. Steenbergen and the schools recognized athletic trainer from St. Mary’s Sports Medicine Center.

1. McCrory P., Meeuwisse, W., & Johnston, K., et al. Consensus State on Concussion in Sport: The 3 rd International Conference on Concussion in Sport Held in Zurich, November Journal of Athletic Training. (2009). 44(4); MSHSAA Sports Medicine Manual