The LCSD Athletic Program recognizes that concussions and head injuries are commonly reported in children and adolescents who participate in sports and recreational activity. Therefore, the district adopts the following guidelines to assist in the proper evaluation and management of head injuries.

A concussion is a mild traumatic brain injury. Concussions occur when normal brain functioning is disrupted by a blow or jolt to the body or head. Recovery from a concussion will vary. Avoiding reinjury and over-exertion until fully recovered are the cornerstones of proper concussion management.

Any student demonstrating signs, symptoms or behaviors consistent with a concussion while participating in interscholastic athletic activity will be removed from the game or activity, be evaluated immediately and will not return to play that day. The LCSD will notify the student’s parents or guardians and recommend appropriate monitoring.

Concussion Management Team

The LCSD will assemble a concussion management team (CMT). The CMT will consist of representation from the following groups: the athletic director, school nurse, administration, coaches, teachers, parents, and student-athletes. The athletic director will set the time and agenda for each meeting, at least one time per year.

The district’s CMT should coordinate training for all administrators, teachers, coaches and parents. Training should be mandatory for all coaches, assistant coaches and volunteer coaches that work with these student-athletes regularly. In addition, information related to concussions should also be included at parent meetings or in the information provided to parents at the beginning of sports seasons. Parents need to be aware of the school district’s policy and how these injuries will ultimately be managed by school officials.

Training should include: signs and symptoms of concussions, post-concussion, and second impact syndromes, return to play and school protocols, and available area resources for concussion management and treatment. Particular emphasis should be placed on the fact that no athlete will be allowed to return to play the day of injury and also that all athletes should obtain appropriate medical clearance prior to returning to play or school.

The CMT will act as a liaison for any student returning to school and/or play following a concussion. The CMT will review and/or design an appropriate plan for the student while the student is recovering.

*The LCSD CMT can utilize the NYSPHSAA’s concussion information page as well as for information related to the signs and symptoms of concussions and the appropriate return to play protocols. A handout describing the Concussion Management teams is also available on the NYSPHSAA website. A Concussion Management Check List that has been approved and recommended by NYSPHSAA is available on this site.

LCSD Concussion Management Plan

The concussion program consists of four components:

• Education
• Proper sideline management/guidelines
• Proper Emergency Room follow-up
• Proper Return to Play Protocol/Clearance back to athletics

Education

Concussion education will be provided for all coaches, school nurses and school-appointed physicians. Education of parents would be accomplished through pre-season meetings for sports and/or information sheets provided to parents. This education program covers the definition of concussion, signs/symptoms, guidelines for removal from play, guidelines for return to play, possible consequences of mistreatment of concussions.

This education program will be provided annually and will be overseen by the Bon Secours Charity Medical System; consisting of 3 hospitals: Bon Secours Community in Port Jervis, St. Anthony’s in Warwick, and Good Samaritan in Suffern.

All CMT members, staff coaches, physical education teachers and nurses of the LCSD will be required to complete an online concussion course presented by the National Federation of High Schools (NFHS) via www.nfhslearn.com.

Proper Sideline Management

Coaches, nurses and school physicians will be trained on the proper guidelines for removing a student-athlete from play. As per the NYSPHSAA regulation, any student removed from play
because of suspected head injury cannot return to play on that day unless cleared by the school medical officer(s) approved by the LCSD.

Proper Emergency Room Evaluation

It is imperative that an athlete who sustains a head injury be seen by a trained medical officer familiar with concussion signs and symptoms. Bon Secours Medical System is trained in the diagnoses and treatment of concussions in Orange County. If an on-site evaluation is not available then student-athletes will be directed to the hospital for emergency room care.

Proper Return to Play Protocol and Clearance

Once a student-athlete is diagnosed with a concussion, they should only be cleared back to athletics by the LCSD chief medical officer or a concussion-certified physician.

No student should return to full athletics before going through a thorough return-to-play protocol. This is usually a 5-step supervised program. Return to play following a concussion requires a stepwise progression once the individual is symptom-free. There are many risks to premature return-to-play including a greater risk of a second concussion because of a lower concussion threshold, second impact syndrome (abnormal brain blood flow that can result in death), exacerbation of any current symptoms, and possibly increased risk for additional injury due to alteration in balance. No student-athlete should return–to–play if symptomatic. Students are prohibited from returning to play the day the concussion is suspected. If there is any doubt as to whether a student has sustained a concussion, it should be treated as a concussion. When in doubt, sit them out.

The following criteria will be utilized before any athlete is cleared to return to play:

• Asymptomatic during return–to–play protocol

The concussion management team will oversee the return to play protocol. Final return-to-play decisions are made by the LCSD chief medical officer or its designee; or a district-approved
concussion-certified physician. It is suggested the student-athlete receive clearance from a concussion-certified physician. All documentation will be kept with the school nurse; including but not limited to activities, signs/symptoms and response. A protocol will be documented and kept on record.

At least one member of the school’s concussion team should be present at any 504 meetings or other academic strategy/accommodation planning meetings for kids that have a concussion so that there is continuity.

See the list below of current concussion-certified hospitals approved by the LCSD. This list is subject to change. Other concussion-certified physicians may be added over time.

LCSD Approved Concussion-Certified Physicians

Dr. Nicholas Belasco, D.O. Bon Secours Concussion Management Program; Scranton, Albany, Westchester, Englewood NJ

5 Step Supervised Return-to-Play Program

Once the student-athlete is symptom-free at rest for 24 hours and has a signed release by the treating clinician, she/he may begin the return to play progression below (provided there are no other mitigating circumstances). A note from a physician indicating “return-to-play/return-to-sports” following a head injury diagnoses will initiate the 5 step Return-to-play Program.

Step 1: Light aerobic activity
Step 2: Sport-specific activity
Step 3: Non-contact training drills
Step 4: Full-contact practice
Step 5: Return-to-play

Each step should take 24 hours so that an athlete would take approximately one week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise. If any post-concussion symptoms occur while in the stepwise program, then the student should drop back to the previous asymptomatic level and try to progress again after a further 24- hour period of rest has passed.

[These NYSPHAA current return-to-play recommendations are based on the most recent international expert opinion.]

S3953B-2011: Directs commissioners of education and health to adopt rules and regulations for the treatment and monitoring of students with mild traumatic brain injuries

Enacts the “concussion management and awareness act”; directs the commissioners of education and health to adopt and implement rules and regulations for the treatment and monitoring of students with mild traumatic brain injuries; requires school personnel to receive training in mild traumatic brain injuries; such rules and regulations shall apply to school districts and boards of cooperative educational services; requires provisions of information pamphlet on mild traumatic brain injuries to parents of pupils participating in interscholastic sports or who have suffered a mild traumatic brain injury; requires written consent of and acknowledgment of receipt of such pamphlet by parents prior to participation in interscholastic sports; provides for the establishment of concussion management teams to implement such provisions.

The bill:

• Prohibits students from returning to sports until he or she has been symptom-free for no less than 24 hours and received written permission from a physician to play sports.
• Directs the state health commissioner, in conjunction with the education commissioner, to develop rules and regulations for allowing students to return to school and athletic activity.
• Requires coaches, physical education teachers, school nurses and athletic trainers to receive instruction on the signs and symptoms of concussions and “return to play” protocol.
• Requires school districts to create a concussion management team, which may include athletic directors, school nurses, school doctors, coaches and athletic trainers, to oversee implementation of the state regulations.