Barnstable Public Schools Concussion Protocol

This protocol is designed to provide standardized procedures for persons involved in the prevention, training, management, and return to activity decisions regarding students who incur head injuries while involved in extracurricular athletic activities, including, but not limited to, interscholastic sports and Marching Band. It is effective upon date of approval by the Barnstable School Physician as indicated on page 3.

This protocol is established pursuant to Code of Massachusetts Regulations 105 CMR 201.000. All definitions used herein are as found in those regulations. The latest version of the regulations on effective date of this protocol is as of August 1, 2014; should the regulations be amended by the Massachusetts Department of Health after that date, any such amendments are incorporated automatically into this protocol. If any portion of this Protocol conflict with the regulations, now or hereafter, the regulations shall govern.     

Section 1.    What is a Concussion?

A concussion is a brain injury, and all brain injuries are serious. They may be caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works.

Symptoms may include one or more of the following:

1. Headache.
2. Nausea/vomiting.
3. Balance problems or dizziness.
4. Double vision or changes in vision.
5. Sensitivity to light or sound/noise.
6. Feeling of sluggishness or fogginess.
7. Difficulty with concentration, short-term memory, and/or confusion.
8. Irritability or agitation.
9. Depression or anxiety.
10. Sleep disturbance. 

1. Appears dazed, stunned, or disoriented.
2. Forgets plays or demonstrates short-term memory difficulties (e.g. is unsure of the game, score, or activity)
3. Exhibits difficulties with balance or coordination.
4. Answers questions slowly or inaccurately.
5. Loses consciousness.
6. Demonstrates behavior or personality changes.
7. Is unable to recall events prior to or after the hit.

Section 2.    Education and Information for Parents/ Guardians/Students

Before the start of each sports or marching band season, a student/family will receive the following documents from the Athletic Director or Marching Band Director:  

• A Fact Sheet for Athletes (Available from the CDC or equivalent)
• A Fact Sheet for Parents (Available from the CDC or equivalent)
• Massachusetts DPH Form Pre-Participation Head Injury/Concussion Report
• Massachusetts DPH Report Form Report of a Head Injury During Sports 

Each student and family will complete a current Massachusetts DPH Form Pre-Participation Head Injury/Concussion Report each season, and submit it to the Athletic Office or Marching Band Director as appropriate. This form, signed by parent and student, will contain up to date medical history information of any past concussions or any head and neck injuries the student has received in the past. Should any forms indicate past injury, copies will go to the School Nurse(s), Licensed Athletic Trainer, and as appropriate School or Team Physician for review.

Section 3.    Education and Information for Staff, Students, and Families:

The following personnel must yearly take and successfully complete a Massachusetts Department of Public Health approved Sports Head Injury and Concussion Awareness course. Certificates of completion requirements will be the responsibility of Athletic Office for sports, the Marching Band Director for marching band, and the District Nurse Leader for the School nurses.

• Coaches
• Licensed Athletic trainers
• Parent volunteers for any extracurricular athletic activity and marching band
• Physicians employed by the school or who volunteer for any extracurricular athletic activity
• School nurses
• Athletic Directors
• School marching band directors

Parents or legal guardians of students who participate in any extracurricular athletic activity including marching band, and the students themselves,  are required by 105 CMR 201.007 to acknowledge in writing that they have read and understood DPH approved training materials on Sports Head Injury and Concussion Awareness.

The Athletic office or Marching Band Director will provide to Parents or legal guardians of children who participate in any extracurricular athletic activity or marching band activity the Massachusetts Department of Public Health approved Sports Head Injury and Concussion Awareness course information, in handout form.

Section 4.    Reporting a Head Injury

During a school based athletic or marching band activity, any student athlete that has sustained or may have sustained a head injury must not return to any game that day and must not resume practice that day. The coach or licensed athletic trainer will complete the Massachusetts DPH Report Form Report of a Head Injury During Sports. The Athletic Trainer, Coach, or Marching Band Director will contact the parents of the student to verbally report the event and provide a copy to school nurses, school counselor and band director (if applicable) within the next school day. Should this injury occur outside of school hours during an athletic event and not at a Barnstable school, facility or field, the Parent or Guardian is responsible for completing the Massachusetts DPH Report Form Report of a Head Injury During Sports. This blank form will be provided to the student’s family at the start of each sports or marching band season. A copy of the completed form will go to the athletic trainer, school nurse, counseling, and marching band director (if applicable).   All athletes or marching band members will be evaluated by an appropriate heath care provider as provided in the Regulations and this protocol, and be performing at their pre-injury academic level before their full return to any form of physical education, sport, or band activity.

Section 5.    School Accommodation

A closed head injury may have profound effects on school performance and there will be students that will require accommodations in returning to their school schedules. The student’s school counselor will be notified by the school nurse and/or athletic trainer of any closed head injury as noted by parent, health care provider, or coach. The school nurse will contact the student’s physician to secure medication documentation recommending accommodations if that information was not already provided.  For all students, should medical documentation suggest school accommodations and/or modifications to be considered, the school nurse will notify the student’s School Concussion Management Team, (counselor, teachers, licensed athletic trainer, and band leader), with a copy of the recommendations. 

A Post Concussion Graduated Re-entry Plan for Return to Academics form (or its equivalent), will be requested by the school nurse for the health care provider to complete if it is not sent in. The school nurse will then share with school counselor, athletic trainer, band leader, parents, and teachers, as appropriate.

Section 6.    Guidelines for Returning to an Activity after a Concussion   

The medical provider giving medical clearance for returning to play must use the MDPH Medical Clearance Form, “Post Sports-Related Head Injury Medical Clearance and Authorization Form”, available on the MDPH website (www.mass.gov/dph/sportsconcussion), or a school based equivalent that includes the same information. The completed forms should be kept in the student’s medical record in the school health office as well as the athletic department office.

All students at BHS must be cleared to return to play/practice by a licensed medical professional (physician, NP in consultation with a physician, licensed athletic trainer in consultation with a physician, neuropsychologist in coordination with a physician managing the student’s recovery or physician assistant under the supervision of a licensed physician) after the graduated return to play has been completed. Sports activities include physical education class as well as sports practices and games:        

• The student should be completely symptom free at rest and with physical (sprints, non-contact aerobic activity) and cognitive exertion (school work).
• Return to play should occur gradually
• Students should be monitored for symptoms and cognitive function during each stage of exertion, and should progress to the next level of exertion only if they are asymptomatic at the current level.

In a situation in which a student has been medically cleared but school staff has observed continuing symptoms, the school’s medical personnel will make the final decision regarding a student’s return to play. School staff should communicate to the physician or health care provider to allow for re-evaluation by the health care provider.

A health care provider as specified by the Regulations and this protocol will evaluate any student that has sustained or may have sustained a head injury. In cases of diagnosed concussion and when an approved Massachusetts DPH Post-Sports Related Medical Clearance and Authorization form is completed by an authorized provider, and the student is performing at their pre-injury academic level, a written, stepped, return to play plan will be created, outlining the progression for return to full athletic participation. The Post-Concussion Graduated Re-entry Plan for Return to Play will be used by athletics.

Approved by Kathryn Rudman, M.D., Barnstable School Physician