The following protocol has been implemented by Bellarmine College Preparatory to identify, diagnosis, manage, and return students-athletes safely to the classroom and sport following a concussion.
CONTENTS:
- Understanding a Concussion
- Concussion Education
- California Concussion Laws; Ed Code 49475, AB 2127, CIF Bylaw 503H
- Sideline assessment tool (SCAT6)
- Diagnosis
- Management and Treatment
- Return to Learn (RTL) Guidelines
- Return to Play (RTP) Guidelines
- Bellarmine Concussion Packet
Understanding a Concussion
- Definitions may include, but are not limited to:
- Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces
- An injury to the brain may not necessarily cause a structural change but a change in the functional mechanics of the cerebral tissue
- Any trauma induced alteration in mental status that may or may not include a loss of consciousness
- Resulting in neuropathological changes undetectable on standard structural neuroimaging studies.
- The follow characteristics will be used to understand a concussion:
- a change in brain function
- follows a force to the head
- may be accompanied by temporary loss of consciousness
- is identified in awake individuals
- includes measures of neurologic and cognitive dysfunction
- Symptoms may include:
- Physical – headache, nausea, vomiting, balance problems, dizziness, visual problems, fatigue, photophobia, phonophobia
- Cognitive – feeling mentally foggy, feeling slowed down, difficulty concentrating and remembering, confusion
- Emotional – irritability, sadness, more emotional, nervousness
- Sleep – drowsiness, sleep more or less than usual, trouble falling asleep
Concussion Education
- All student-athletes must undergo a pre-participation exam (PPE) prior to participating in their respective sports. The PPE includes questions relating to past concussions and their severity.
- All parents and students-athletes must sign a concussion awareness form before participating in Bellarmine Athletics.
- Student-athletes will be educated on the signs and symptoms of a concussion and the importance of reporting all symptoms of a concussion to the athletic trainers.
- The Director of Sports Medicine will speak to the parents at the beginning of every season during the parents meeting for each sport and review the signs and symptoms of a concussion and explain the Bellarmine concussion protocol.
- Coaches are required to have training in concussions by the NFHS.
California Concussion Laws
Education Code 49475 (Jan 1. 2012)
As it stands, Ed Code 49475 requires a private high school that elects to offer athletic programs to immediately remove from a school-sponsored athletic activity for the remainder of the day an athlete who is suspected of sustaining a concussion or head injury during that activity. The bill prohibits the return of the athlete to that activity until he or she is evaluated by, and receives written clearance from, a licensed health care provider, as specified*. The bill also requires, annually, a concussion and head injury information sheet to be signed and return to school site, by the athlete and the athlete’s parent or guardian before the athlete may begin practice or competition. In addition to the above statute, the new law enacts a mandatory graduated return to play (RTP) protocol of no less than 7 days (from date of diagnosis), in cases where it is determined by the licensed health care professional that the athlete sustained a concussion. This bill also directs that the RTP shall be carried out under the supervision of a licensed health care professional.
Assembly Bill No. 2127 (Jan 1, 2015)
This bill, an act to amend Ed Code 49475, would provide that an athlete suspected of sustaining a concussion or head injury is prohibited from returning to athletic activity until the athlete is evaluated by a licensed health care provider, as defined to mean a licensed health care provider trained in the management of concussion and acting with the scope of his or her practice, and the athlete receives written clearance from a licensed health care provider.
CIF Bylaw 503H - Concussion Protocol
A student-athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time for the remainder of the day. A student-athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed health care provider trained in education and management of concussion and receives written clearance to return to play from that health care provider. A concussion and head injury information sheet shall be signed and returned by all athletes and the athlete’s parent or guardian before the athlete’s begins practice or competition.
* California state statutes define the “scope of practice” for licensed health care providers and medical professionals. This scope of practice will limit the evaluation to a medical doctor (MD) or doctor of osteopathy (DO).
Sideline Assessment Tool
- The athletic trainer will provide an initial assessment of the student athlete.
- The student athlete will be REMOVED from the game if there is a suspicion of a concussion.
- The lead athletic trainer will utilize the SCAT6 for further evaluation.
- The athlete trainer will activate the EAP if the student athlete shows signs of a life-threatening injury, such as a c-spine injury or TBI.
Diagnosis
Once the sideline assessment has been completed, the athletic trainer and team physician (if available) will review the athletes SCAT6.
The Vestibular Ocular Motor Screening (VOMS) will be performed.
The combination of these objective tools and the athlete’s subjective intake will determine the diagnosis.
Management and Treament
If the athletic trainer and/or team physician have a suspicion the athlete has a concussion, the student-athlete will be removed from practice or competition for the remainder of the day. A concussion packet will be handed out to the student athlete and/or legal guardian. The parents will be asked to review the Bellarmine Concussion Packet and to share it with the treating physician.
At the earliest convenience, the concussed athlete will be encouraged to see a licensed health care provider trained in the management of concussion (AB 2127). A written diagnosis must be turned in to the sports medicine department.
The VOMS will be performed by the athletic trainer when appropriate. The VOMS tool will be used to determine potential rehabilitation strategies.
The athlete will report to the athletic training room daily for the post-concussion syndrome score (PCSS).
Academic accommodations will be given to the student-athlete per doctor’s recommendations and/or academic adjustments will be implemented by the athletic trainer according to the return to learn protocol established by Bellarmine.
The athlete will begin light aerobic activity when the treating physician and athletic trainer deem appropriate.
Return to Learn (RTL)
Within 24 hours of suspicion of a concussion for any student-athlete, Bellarmine will send an email to the teachers/counselors regarding generic academic adjustments needed in the classroom. Once the student-athlete has been seen a doctor for formal diagnosis, Bellarmine's academic adjustment form will be sent to the teachers/counselors.
Ongoing care for student-athlete in the classroom will be handled by the sports medicine staff.
The student-athlete MUST complete the return to learn protocol before they can be cleared to return to competition.
Return to Play (RTP)
According to the CA state law, the student-athlete will go through the mandatory return to play (RTP) protocol in no LESS than 7 days from the day of diagnosis of the student-athletes concussion.
The RTP will be carried out under the supervision of the sports medicine staff.
Bellarmine Sports Medicine Concussion Packet
This packet will be given to any student-athlete that sustains a concussion during a practice or competition while participating in Bellarmine Athletics.
This packet is to be taken to the student-athletes doctor to be filled out and return to the sports medicine staff.
