Connecticut State Department of Education (CSDE) and the Connecticut Interscholastic Athletic Conference (CIAC)
Concussion and Head Injury Annual Review 2017-18 Required for ALL School Coaches in Connecticut
NOTE: This document was developed to provide coaches with an annual review of current and relevant information regarding concussions and head injuries. In addition to reviewing this form, the annual review must include one of the following prescribed resources: Connecticut Concussion Task Force video, Centers for Disease Control and Prevention (CDC) Heads Up: Concussion in Youth Sports training course, or the National Federation of State High School Associations (NFHS) concussion training course. Links to these resources can be found at: http://concussioncentral.ciacsports.com/. A new form is required to be read, signed, dated and kept on file by coaches’ associated school districts annually to comply with Connecticut General Statutes (C.G.S.) Chapter 163, Section 149b: Concussions: Training courses for coaches. Education plan. Informed consent form. Development or approval by the State Board of Education.
What is a Concussion?
Centers for Disease Control and Prevention (CDC) - “A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head 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.” -CDC, Heads Up: Concussion http://www.cdc.gov/headsup/basics/concussion_whatis.html
Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious.” -CDC, Heads Up: Concussion Fact Sheet for Coaches http://www.cdc.gov/headsup/pdfs/custom/headsupconcussion_fact_sheet_coaches.pdf
Section 1. Concussion Education Plan Summary
The Concussion Education Plan and Guidelines for Connecticut Schools was approved by the Connecticut State Board of Education in January 2015. Below is an outline of the requirements of the Plan. The complete document is accessible on the CSDE Web site: http://www.sde.ct.gov/sde/cwp/view.asp?a=2663&q=335572
State law requires that each local and regional board of education must approve and then implement a concussion education plan by using written materials, online training or videos, or in-person training that addresses, at a minimum, the following:
- The recognition of signs or symptoms of concussion.
- The means of obtaining proper medical treatment for a person suspected of sustaining a concussion.
- The nature and risks of concussions, including the danger of continuing to engage in athletic activity after sustaining a concussion.
- The proper procedures for allowing a student-athlete who has sustained a concussion to return to athletic activity.
- Current best practices in the prevention and treatment of a concussion.
Section 2. Signs and Symptoms of a Concussion: Overview
A concussion should be suspected if any one or more of the following signs or symptoms are present, or if the coach/evaluator is unsure, following an impact or suspected impact as described in the CDC definition above.
Signs of a concussion may include (i.e. what the athlete displays/looks like to an observer):
- Trouble resting/getting comfortable
- Lack of concentration
- Slow response/drowsiness
- Incoherent/slurred speech
- Slow/clumsy movements
- Loses consciousness
- Amnesia/memory problems
- Acts silly, combative or aggressive
- Repeatedly ask same questions
- Dazed appearance
- Constant attempts to return to play
- Constant motion
- Disproportionate/inappropriate reactions
- Balance problems
Symptoms of a concussion may include (i.e. what the athlete reports):
- Headache or dizziness
- Nausea or vomiting
- Blurred or double vision
- Oversensitivity to sound/light/touch
- Ringing in ears
- Feeling foggy or groggy
State law requires that a coach MUST immediately remove a student-athlete from participating in any intramural or interscholastic athletic activity who: a) is observed to exhibit signs, symptoms or behaviors consistent with a concussion following a suspected blow to the head or body, or b) is diagnosed with a concussion, regardless of when such concussion or head injury may have occurred. Upon removal of the athlete, a qualified school employee must notify the parent or legal guardian within 24 hours that the student-athlete has exhibited signs and symptoms of a concussion.
Section 3. Return to Play (RTP) Protocol Overview
Currently, it is impossible to accurately predict how long an individual’s concussion will last. There must be full recovery before a student-athlete is allowed to resume participating in athletic activity. Connecticut law now requires that no athlete may resume participation until she/he has received written medical clearance from a licensed health care professional (physician, physician assistant, advanced practice registered nurse (APRN), athletic trainer) trained in the evaluation and management of concussions.
Concussion Management Requirements:
- No athlete shall return to participation in the athletic activity on the same day of concussion.
- If there is any loss of consciousness, vomiting or seizures, the athlete MUST be transported immediately to the hospital.
- Close observation of an athlete MUST continue following a concussion. The athlete should be monitored for an appropriate amount of time following the injury to ensure that there is no worsening/escalation of symptoms.
- Any athlete with signs or symptoms related to a concussion MUST be evaluated by a licensed health care professional (physician, physician assistant, advanced practice registered nurse (APRN), athletic trainer) trained in the evaluation and management of concussions.
- The athlete MUST obtain an initial written clearance from one of the licensed health care professionals identified above directing her/him into a well-defined RTP stepped protocol similar to the one outlined below. If at any time signs or symptoms return during the RTP progression, the athlete should cease activity.
- After the RTP protocol has been successfully administered (no longer exhibits any signs or symptoms or behaviors consistent with concussions), final written medical clearance is required by one of the licensed health care professionals identified above for the athlete to fully return to unrestricted participation in practices and competitions.
Medical Clearance RTP protocol (Recommended one full day between steps)*
Functional exercise at each stage of rehabilitation
Objective of each stage
1. No activity
Complete physical and cognitive rest until asymptomatic. School may need to be modified.
2. Light aerobic exercise
Walking, swimming or stationary cycling maintaining
Intensity, less than 70% of maximal exertion; no resistance training
Increase Heart Rate
3. Sport specific exercise No contact
Skating drills in ice hockey, running drills in soccer; no head impact activities
4. Non-contact sport drills
Progression to more complex training drills, such as passing drills in football and ice hockey; may start progressive resistance training
Exercise, coordination and cognitive load
5. Full contact sport drills
Following final medical clearance, participate in normal training activities
Restore confidence and assess functional skills by coaching staff
- Full activity
Return to full athletic participation
* If at any time signs or symptoms should worsen during the RTP progression, the athlete should stop activity that day. If the athlete’s symptoms are gone the next day, she/he may resume the RTP progression at the last step completed in which no symptoms were present. If symptoms return and do not resolve, the athlete should be referred back to her/his medical provider.
ImPACT Concussion Program
The ImPACT test is a simple 20 minute-long web-based neurocognitive battery that measures memory recall and reaction times. Developed by the University of Pittsburgh, the program allows trained medical personnel to determine when an athlete should continue athletic participation after suffering a concussion or head injury. The intent of this program is to reduce the risk of further injury to your son or daughter after suffering a concussion. It provides objective data that can help quantify the extent of injury to the brain. This may reduce the likelihood of “Second Impact Syndrome,” which can lead to serious or permanent head injury, or even death. ImPACT is a program used by the National Football League, the National Hockey League, many minor league teams, and many college and high school programs across the nation.
Student-athletes who participate in interscholastic athletics are required to participate in ImPACT testing.
A link will be sent home with the student-athlete to provide you with the web address for beginning the ImPACT Test procedure. These athletes should test once in their freshman year and once again in the beginning of their junior year. If you have previously taken the ImPACT baseline test, please provide the athletic department with a doctor’s note confirming that a current test is on file.
If, in the future, your son or daughter suffers a concussion or head injury he/she will be assessed and monitored by a certified athletic trainer. Parents/Guardians will be notified and recommendations for care and referral will be made at this time. The school’s nursing staff will be made aware of the concussion so that any adjustments to the student-athlete’s academic workload can be made in conjunction with the guidance department. Within the first 48-72 hours a post-injury ImPACT test will be administered. Once the athlete is symptom free a second test will be done to see if the athlete has returned to pre-injury levels. Testing will continue until these levels are reached. Results will be made available ONLY to parents/guardians upon request so that ImPACT data may be used to aid the treating physician in determining when it is safe to return to activity.
- A video outlining the benefit of ImPACT can be viewed at www.impacttest.com/video/ONQMAG.mpg
- Further information on ImPACT can be found on the web at www.impacttest.com. If you have any questions, please contact the school’s athletic trainer through the athletic office.
Preparing for the Online ImPACT Concussion Baseline Assessment
- You will be able to run the online ImPACT concussion baseline assessment smoothly from your desktop or laptop computer with an internet connection BUT you must use an external mouse. Also, do not run the laptop from the battery, use the A/C connection.
- Close all other programs before starting the baseline assessment. If you have a pop-up blocker installed, you will need to turn it off or temporarily allow pop-ups from our site.
- Make sure you are using Internet Explorer 5.0 and above or Firefox. The baseline assessment is currently ONLY supported by these browsers.
- You must have the most current Macromedia Flash Player installed on your computer to take the baseline assessment. You can download Adobe Flash Player for free at www.adobe.com/products/flashplayer.
- To ensure that results are accurate, a parent/guardian must supervise the student-athlete during the baseline assessment procedure.
- The baseline assessment will take approximately 20 to 30 minutes. To ensure the most accurate result, turn off music, TV, or other background noises while taking the baseline assessment. These things can potentially interfere with your ability to answer clea
Accessing the Online ImPACT Concussion Baseline Assessment
- Once a student-athlete is selected to a team, a link will be sent home with the student-athlete to provide you with the web address for beginning the ImPACT Test procedure. This is for your immediate and personal use only and should not be shared with others.
- You will be linked directly to the assessment website. Select Connecticut then click on the Launch Baseline Test button. Please only take the test once. There are a limited amount of tests that can be done through this site and we cannot afford to waste tests. Only current student-athletes attending Greenwich High School should be testing through this site.
- Initially, you will be directed to a series of questions that you will need to answer before taking the baseline assessment. Please answer all questions as honestly as possible.
- Follow the instructions carefully. Missing key instructions or not giving the baseline assessment your full attention will affect your results.
- Put in your best effort. This is a difficult assessment. No one gets everything right, so don't get frustrated.
- If you become confused about the directions, keep trying to do your best