Category J: Students
Procedure J2: Head Injury
According to the U.S. Centers for Disease Control (CDC), “a concussion is a type of traumatic brain injury that changes the way the brain normally works. A concussion is caused by bump, blow, or jolt to the head or body that causes the head and brain to move
rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious.” The CDC states that:
- Most concussions occur without loss of consciousness.
- If [students] at any point in their lives had a concussion, they have an increased risk for another concussion.
- Young children and teens are more likely to get a concussion and take longer to recover than adults.
The District shall comply with Massachusetts state laws and regulations regarding head injury. For athletic related injury, the District shall be guided by CMR 201.005 as established by the Massachusetts Department of Public Health. As allowed by state law, these guidelines will also be extended to non-athletic head injury involving the Districts’ extracurricular activities. Given this, the following procedure applies to all students who participate in extracurricular school-sponsored events—both athletic and non-athletic.
The Superintendent or his/her designee shall be the person responsible for implementation of head injury protocols. For all athletic activities, the Athletic Director shall serve as the Superintendent’s designee. For non-athletic activities, the principals shall be responsible for compliance with head injury policy and procedures.
The District will ensure that people specified in 105 CMR 201.007 will receive annual training in the prevention and recognition of a sports-related-head injury and associated health risks, including second impact syndrome, utilizing the Department of Public Health-approved training materials or program. At the discretion of the Superintendent or principals, other non-athletic staff may be required to receive training. The District will document each person’s completion of such training. Those required by state law to receive annual training include:
- Athletic Director
- Athletic trainers/trainers
- School nurses
- Team health care staff
- Parents of a student who participates in an extracurricular athletic activity
- Students who participate in an extracurricular athletic activity
The District must have documentation of a physical examination prior to each student’s participation in extra-curricular athletic activities in the Districts, consistent with 105 CMR 200.100(B)(3). For students participating in multiple sports, documentation of one physical examination every 13 months is sufficient. Non-athletic extra-curricular activities may require such documentation at the approval of the principal.
The Districts’ will obtain and review, prior to enrollment in the extra-curricular activity, the current required information regarding a student’s history of head injuries and concussions. Participating students will be required to submit this pre-participation information using a District-designated process consistent with DPH requirements. In the event that a student has a history of a head injury or suspected concussion, the Districts’ will conduct a timely medical or nursing review. The review process will be determined by the Athletic Director, Principal or District Nurse Coordinator, with the cooperation of the participating student and his/her family.
In the occurrence of a head injury or concussion during an extracurricular activity, either athletic or non-athletic, the supervising on-site District staff shall follow established state and District protocols that are based upon recommendations from the Massachusetts Department of Public Health and the U.S. CDC. Any student who, during a practice, competition or other activity, sustains a head injury or suspected concussion, or exhibits signs and symptoms of a concussion, or loses consciousness, even briefly, shall be removed from the practice, competition or activity immediately and may not return to the practice, competition or activity that day. Per CDC recommendations, immediate medical attention should be sought by onsite staff. The coach, District staff, or other on-site, non-medical staff should not try to judge the severity of the injury.
The coach or District staff responsible for the activity shall communicate the nature of the injury directly to the parent in person or by phone immediately after the practice, competition or activity in which a student has been removed and shall communicate, by the end of the next business day, with the school nurse and the Athletic Director or Principal (depending on if it is an athletics related injury or not) that the student has been removed from practice, competition or activity for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness.
If a student suffers a head injury outside of school-sponsored extracurricular athletics or activities, parents/guardians are expected to inform the coach, school nurse, Principal or Athletic Director. District staff needs this information to ensure students’ safe participation in school athletics and other extracurricular activities.
Each student who is removed from practice, competition or activity and is subsequently diagnosed with a concussion shall have a written graduated reentry plan for return to full academic and extracurricular activities. The plan shall be developed by the student’s teachers, guidance counselor, school nurse, certified athletic trainer (if on staff), neuropsychologist (if involved), parent, members of the student support and assistance team, or individualized education program team as appropriate and in consultation with the student’s primary care provider or the physician who made the diagnosis or who is managing the student’s recovery. The written plan shall include instructions for students, parents and school personnel, addressing but not limited to:
- Physical and cognitive rest as appropriate;
- Graduated return to extracurricular activities and classroom studies as appropriate, including accommodations or modifications as needed;
- Estimated time intervals for resumption of activities;
- Frequency of assessments by the school nurse, school physician, team physician, certified athletic trainer if on staff, or neuropsychologist, if available, until full return to classroom activities and extracurricular activities are authorized; and
- A plan for communication and coordination between and among school personnel and between the school, the parent, and the student’s primary care provider or physician who made the diagnosis or who is managing the student’s recovery.
The student must be symptom-free in order to begin graduated re-entry to the extracurricular activities. The Districts’ protocol regarding medical clearance will comply with state law, including a completed authorization form. State law requires that the student must receive a medical clearance in order to return to athletic play after a diagnosed concussion; the District shall also require medical clearance for students to return to non-athletic activities. Only the following clinicians may authorize a student to return to play:
- A licensed physician;
- A licensed physician assistant working under the supervision of a licensed physician;
- A licensed certified athletic trainer in consultation with a licensed physician;
- A licensed nurse practitioner in consultation with a licensed physician; or
- A licensed neuropsychologist in coordination with the physician managing the student’s recovery
Information about the head injury procedure will be included in the school handbooks. Information for students and parents with limited English proficiency will be provided.
Sharing of information on a student’s history of head injury and concussion, recuperation, reentry plan, and authorization to return to play and academic activities will be on a need-to-know basis consistent with the requirements of 105 CMR 201 and federal and state laws regarding confidentiality of student records.
As required by state law, review and revision of these procedures shall occur as needed but at least every two years.