Wilmington Public Schools (WPS), in order to protect the health and safety of students and to comply with 105 CMR 201.000 enacted in June 2011, has developed the following policy 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.
Head Injury, Concussion / TBI (traumatic brain injury) is defined as: A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. TBI may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head. TBI includes, but is not limited to, a concussion.
The Athletic Director will be responsible for the implementation of these policies and procedures.
Annual training is required for those specified below in the prevention and recognition of a sportsrelated-head injury, and associated health risks including second impact syndrome. WPS will maintain records of completion of annual training for all athletic staff. The Massachusetts
Department of Public Health (DPH) approved training materials will also be available to all athletes and their parents.
(1) Coaches
(2) Certified athletic trainers
(3) Volunteers
(4) School and team physician
(5) School nurses
(6) Athletic Directors
(7) Directors responsible for a school marching band, whether employed by a school or school district or serving in such capacity as a volunteer
(8) Parents of a student who participates in an extracurricular athletic activity
(9) Students who participate in an extracurricular athletic activity
Head injuries or suspected concussions sustained during extracurricular athletic activities must be reported to the school nurse and/or certified athletic trainer. If a Head Injury is suspected, the athlete must be removed from the activity, evaluated from a Certified Athletic Trainer and/ or
School nurse, and referred to a Physician that same day or the following day. A Physician will determine the accommodations needed and when to begin Return To Play steps. Return to play guidelines and reentry plans to school / academic activities are in accordance with 105 CMR
201.011.
Parents and students are responsible for completion of the Pre-participation forms including the
Medical History Form. No student athlete will be allowed to participate in athletic activities until all forms, including physical examinations, are signed, submitted and reviewed by WHS athletic staff.
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Information concerning an athlete's history of head injury and concussion, recuperation, reentry plan, and authorization to return to play and academic activities will be shared on a need to know basis consistent with requirements of 105 CMR 201.000 and applicable federal and state law including, but not limited to, the Massachusetts Student Records Regulations, 603 CMR 23.00, and the Federal Family Educational Rights and Privacy Act Regulations, 34 CFR Part 99.
Review and revision of such policies and procedures shall occur as needed but at least every two years.
Participation in all sport activities carries an inherent risk of injury and while many preventative actions can be taken to reduce the risk of injury such as proper fitting equipment, conditioning programs and good nutrition practices, this will not prevent injury occurring in all instances.
Compliance
As of November 2010, all coaches at Wilmington High School must complete the necessary training given by the National Federation of State High School Association (NFHS) and the MIAA to recognize signs and symptoms of a concussion. All athletic staff at Wilmington High School will be expected to renew the concussion training on an annual basis.
All student athletes are expected to properly fill out the medical history form, pre-participation form and submit a current physical examination prior to the beginning of the sports season. These forms include the necessary questions and information as stated in 105 CMR 201.006. Any athlete who does not submit these forms will not be allowed to participate.
Each student athlete and parent is asked to sign the pre-participation form agreeing to the statement below:
In conjunction with the State of Massachusetts and the MIAA, “any athlete who exhibits signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the practice or competition and must not return to practice or competition until they are cleared (in writing to the
Athletic Director) by an appropriated health care professional (as determined by the department of public health). Whenever is it decided to disqualify a student athlete from a further participation for a suspected concussion or other injury, the person making that decision must communicate about this matter with the injured athletes coach and athletic director in a timely fashion.”
Also in accordance with this law, Wilmington High School is asking all parents and athletes to take the online concussion course provided by the National Federation of High School Associations at http://www.nfhslearn.com/electiveDetail.aspx?courseID=15000
Exclusion from Play
- Any student athlete, who during a practice or competition, sustains a head injury or suspected concussion, or exhibits signs and symptoms of a concussion shall be removed from the practice or competition immediately and must be evaluated by a Health Care Professional, such as a Certified
Athletic Trainer.
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-The student athlete shall not return to practice or competition unless and until the student provides medical clearance and authorization as specified in 105 CMR 201.011
- The Athletic Training Staff or Coach shall communicate the nature of the injury directly to the parent in person or by phone immediately after the practice or competition in which a student has been removed from play for a head injury, suspected concussion or signs and symptoms of a concussion. The Athletic Training staff (if present) also must provide this information to the parent in writing, whether paper or electronic format, by the end of the next business day.
-The Athletic Training Staff or coach will communicate, by the end of the next business day, with the Athletic Director and school nurse that a student has been removed from practice or competition for a head injury, suspected concussion or signs and symptoms of a concussion.
- Each student athlete who is removed from practice or competition and subsequently diagnosed with a concussion shall have a written graduated reentry plan for return to full academic and extracurricular athletic activities.
Concussion Management and Practices
1.
All student athletes who participate in extracurricular athletic activities at Wilmington High School will be required to complete a baseline neuropsychological test (ImPACT) every two years in order to participate in WHS athletic sports. Testing will be available for all freshman and junior student athletes in August prior to the beginning of the fall season as well as prior to winter and spring seasons. ImPACT is used as another tool when diagnosing and managing concussions.
2.
In the event that a student athlete suffers a concussion during the season, but not while participating in an extracurricular athletic activity, the parent should notify the school nurse and provide all necessary medical documentation from the treating physician. The Athletic Training staff will re-evaluate the athlete and begin the Return to Play protocol under the treating physician’s recommendations.
3.
A student athlete may not begin the Return to Play program until that student is back into a full academic schedule and work load.
4.
Any student athlete that is suspected of having a concussion at an athletic event will be removed from play by the coach or the Certified Athletic Trainer. If there is a Health Care Professional on site they will immediately evaluate the athlete. If that athlete is suspected to have suffered a concussion, that athlete must be referred to either their Primary Care Physician or another
Physician. If there is no HCP on site, the coach will refer the athlete to their Primary Care
Physician or if necessary the Emergency Room.
5.
Any student athlete referred to a physician for treatment, must return to school with the proper forms filled out by the treating physician and any academic considerations needed. Academic considerations to the School Nurse and athletic recommendations to the Certified Athletic
Trainer. Upon receiving the proper forms, the school nurse, certified athletic trainer, athletic director, and administrative staff will ensure follow-up on all recommendations and accommodations for the student. It is recommended that a point person be designated to coordinate said recommendations and accommodations and so the student has one point of contact to address any related concerns or challenges.
6.
The following sideline procedures will be used to evaluate the concussion.
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I NTRODUCTION :
I am going to ask you some questions.
Please listen carefully and give your best effort.
O RIENTATION
What Month is it?
What’s the Date today?
What’s the Day of the Week?
What Year is it?
What Time is it right now? (Within 1 hr.)
What team are we playing?
What is the score of the game?
I MMEDIATE M EMORY
I am going to test your memory. I will read you a list of words and when I am done, repeat back as many words as you can remember, in any order.
E LBOW CARPET B ABY S ADDLE B UBBLE
What do you remember just prior to the hit?
What was the score of the game prior to the hit?
Do you remember the hit?
C ONCENTRATION
Digits Backward: I am going to read you a string of numbers and when I am done, you repeat them to me backwards, in reverse order of how I read them to you. For example, if I say 7-1-9, you would say 9-1-7.
4-9-3 6-2-9
3-8-1-4 3-2-7-9
6-2-9-7-1
7-1-8-4-6-2
1-5-2-8-6
5-3-9-1-4-8
Months in Reverse Order: Now tell me the months of the year in reverse order. Start with the last month and go backward. So you’ll say December, November….go ahead.
Dec-Nov-Oct-Sept-Aug-Jul-Jun-May-Apr-Mar-Feb-Jan 0
Delayed Recall
Do you remember the list of words I read a few minutes ago? Tell me as many words from the list as you can remember in any order. .
E LBOW C ARPET B ABY S ADDLE B UBBLE
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Medical Clearance and Authorization to Return to Play
As authorized in 105CMR 201.011, the following steps must be taken for an athlete to be considered as Return to Play. The athlete will:
1.
Present the Athletic Training Staff with a Wilmington High School Head Injury form, that is properly filled out by a Qualified Health Care Professional as stated in
201.011(A)
2.
Be asymptomatic
3.
Pass a Post-Injury ImPACT test
4.
Return to a full academic schedule and work load.
5.
Have and complete a graduated Return to Play protocol administered by a Health
Care Professional if the Certified Athletic Trainer is not present.
The following guidelines will be used by the Wilmington High School Athletic Training staff on return to play decisions:
HR = heart rate, MPHR = maximum predicted heart rate.
Rehabilitation stage Functional exercise at each stage of rehabilitation Objective of each stage
1. No activity
2. Light aerobic exercise
Complete physical and cognitive rest
ImPACT Test
Walking, swimming or stationary cycling keeping intensity
<70% MPHR. No resistance training.
Recovery/Asymptomatic
Increase Heart Rate
3. Sport-specific exercise
4. Non-contact training drills
5. Full contact practice
Skating drills in ice hockey, running drills in soccer. No head impact activities
Progression to more complex training drills (e.g. passing drills in football and ice hockey). May start progressive resistance training).
ImPACT Test
Following medical clearance, participate in normal training activities
ImPACT Test
Normal game play
Add movement
Exercise, coordination, cognitive load
Restore confidence, assessment of functional skills by coaching staff
6. Return to play
*Each one of these “Return to play” steps must be completed without symptoms for the athlete to progress to the next step.
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Record Maintenance
All medical records associated with students athletes are kept in a locked cabinet in the
Athletic Training Office. Only the Athletic Trainer has access to this cabinet. These records include:
Medical History Form
Physician Notes pertaining to a particular athletic injury
Injury Report (filled out by Athletic Trainer)
Head Injury Report (when necessary0
ImPACT Baseline Test Conformation
Progress Notes associated with athletic injury
Upon graduation, the files are moved to an archived cabinet outside the athletic training office. These records are kept in Archive for 7 years. The Athletic Trainer and the Athletic
Director has access to this cabinet.
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