Concussion Protocol

HEAD TRAUMA & CONCUSSIONS 

DEFINITIONS 
  • A concussion is a type of traumatic brain injury (TBI), caused by a bump, blow, or jolt to the head or body that can change the way your brain normally works. 
  • Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth, without direct hit to the head. 
  • A concussion cannot be seen on a CT scan or on an MRI. 
  • Most athletes do not have loss of consciousness (knocked out) with a concussion. 
  • Signs and symptoms of concussion can be in four areas: Physical, Cognitive/Thinking, Emotions/Mood and Energy/Sleep. 
  • Rarely, athletes with head trauma may have a potentially life-threatening head injury such as bleeding, bruising or swelling of the brain or fracture of the skull. 

SIGNS AND SYMPTOMS OF CONCUSSION 
  • PHYSICAL 
    • Headache, Nausea/Vomiting, Blurred Vision, Numbness/Tingling, Dizziness, Sensitivity to light or noise, Poor balance, Seeing "stars", Ringing in ears, Neck pain, Vacant stare/Glassy eyed 
  • COGNITIVE 
    • Disorientation and/or confusion, Feeling mentally "foggy" or "slowed down", Memory loss or difficulty remembering, Difficulty concentrating, feeling easily distracted, Slowed and/or slurred speech 
  • EMOTIONAL 
    • Irritability, Feeling anxious/nervous, Personality change, Sadness, Feeling more emotional, Inappropriate emotions 
  • SLEEP/ENERGY
    • Drowsiness, Increased sleep, Fatigue, Trouble falling or staying asleep 

ASSESSMENT/PROCEDURE 
There may be a concussion if there is a jolt/hit to body or head and there is at least 1 sign or 1 symptom listed above. 
  • Call 911 to activate EMS if any one of the following occurs: These may indicate severe injury. 
    • Loss of consciousness 
    • Persistent vomiting (more than one episode of vomiting) 
    • Deteriorating mental alertness 
    • Amnesia or confusion that lasts for more than 10 minutes 
    • Any seizure activity 
    • Bruising under the eyes or behind the ears 
    • Concerns for cervical spine injury (see neck injury protocol). 
  • Athlete will be removed from participation if there are any signs and/or symptoms of a concussion 
  • The Valor Athletic Training staff will evaluate the athlete for a concussion using any of the follow tests:
    • VOMS
    • BESS
    • SAC
    • Graded Symptom Checklist
  • Evaluate the injured athlete and monitor until turned over to the parent/guardian. 
  • Don't allow the athlete to sit alone (i.e. sideline, bus or in the locker room) until symptoms improve or parent/guardian picks him/her up. 
  • The Valor Athletic Training staff will contact with the parent or guardian to explain the suspected injury. 
    • Educate them on what to look for if symptoms begin worsening
    • Instruct parent/guardian to seek medical help if the severe symptoms listed above occur at any time. 
    • Explain the necessity for an appointment with a physician, as well as the clearance and RTP process. 
MANAGEMENT 
  • Students may need to stay home from school for a few days, returning within 2-3 days when symptoms calm down. 
  • The Valor Athletic Training staff will notify Sheila Beckie to help modify the athlete's academic requirements over the course of the concussion.
  • Academic modifications can remain in place until the athlete is ready to begin the return-to-play protocol. Once protocol has begun, the athlete should be taken off of all academic modifications. 

The Role of the Licensed Athletic Trainer 
  • Assist in removing the athlete from athletic participation and coordinating further evaluation, and follow up if a concussion is suspected 
  • Once cleared from a concussion by a licensed medical professional, the athletic trainer may help the athlete complete a graduated return-to-play process 
RETURN TO SPORT 
  • Once a student has received clearance from a qualified medical provider they should be progressed through the return-to-play protocol
  • Returning a student to sports participation who is still symptomatic increases the risk of reinjury at a time when the brain is still vulnerable. 
  • Reinjury before concussion is fully resolved may increase the risk of longer recovery, long-term or permanent symptoms and very rarely "Second Impact Syndrome" (SIS). SIS is the rare phenomenon in which an athlete still suffering from a concussion has severe brain swelling from a second injury, typically resulting in severe disability or death. 
  • Return-to-Play protocol
    • When the athlete's physician clears him/her from the concussion, the athlete will begin the return-to-play protocol at the Athletic Trainer's discretion. 
      • A doctor's clearance by itself DOES NOT clear the athlete for full participation
      • The Valor Athletic Training staff has complete control over the final clearance of an athlete's return to play
    • The athlete will complete the return-to-play protocol before returning to full activity
    • There will be 24 hours between steps 
    • If the athlete experiences return of symptoms at any point during the protocol, we will wait 24 hours and repeat the step
      • Step 1- Athlete is symptom free with normal daily activity
      • Step 2- Light aerobic activity
      • Step 3- Moderate aerobic activity
      • Step 4- Non-contact practice
      • Step 5- Full practice