Policy #5.11.3.2-Head Injury / Concussion Policy

MILLIS PUBLIC SCHOOLS

POLICY #5.11.3.2 (REVISED) (3-22-17)

 HEAD INJURY/CONCUSSION POLICY

For Extracurricular Athletic Activities
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Millis Public Schools have developed this policy to address the prevention and management of head injuries and concussions in students participating in extracurricular athletic activities.  It is in compliance with Massachusetts General Law Chapter 111, section 222, and accompanying regulations 105 CMR 201.000: Head Injuries and Concussions in Extracurricular Athletic Activities.

Definitions​

For the purposes of this policy, consistent with the 105 CMR 201.005, the following words shall have the following meanings:

Licensed Athletic Trainer (AT) means any person who is licensed by the Board of Registration in Allied Health Professions in accordance with M.G.L. c. 112, § 23A and 259 CMR 4.00 as a professional athletic trainer and whose practice includes schools and extracurricular athletic activities.

Extracurricular athletic activity means an organized school sponsored athletic activity generally occurring outside of school instructional hours under the direction of a coach, athletic director or band leader including but not limited to Alpine and Nordic skiing and snowboarding, baseball, basketball, cheerleading, cross country track, fencing, field hockey, football, golf, gymnastics, horseback riding, ice hockey, lacrosse, marching band, rifle, rugby, soccer, skating, softball, squash, swimming and diving, tennis, track (indoor and outdoor), ultimate frisbee, volleyball, water polo, and wrestling. All interscholastic athletics are deemed to be extracurricular athletic activities.

Concussion means a complex disturbance in the brain function due to direct or indirect trauma to the head, related to neurometabolic dysfunction, rather than structural injury.

Head Injury means a direct blow to the head or indirect trauma to the head including a concussion or traumatic brain injury.  Scalp or facial laceration alone is not a head injury for purposes of 105 CMR 201.000.

Parent means the parent or guardian or foster parent of a student.

School-based Equivalent means a form or format that a school district or school develops in lieu of Department of Public Health forms, which at minimum include all of the information required by the most current Department form posted on the Department's website.

Second impact syndrome means a potentially lethal condition that can occur when a person sustains a head injury prior to the complete healing of a previous brain injury causing dysregulation of cerebral blood flow with subsequent vascular engorgement.

Trainer means a person who provides students who participate in an extracurricular athletic activity with health and fitness instruction, including but not limited to the fundamental skills of performance, strength, or conditioning, but who is not a licensed athletic trainer.

Traumatic Brain Injury (TBI) means 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.

Volunteer means an adult who volunteers as a game official, coach, assistant coach, team parent, physician, nurse, or in an authoritative role to assist students who are engaged in an extracurricular athletic activity.

In addition, in this document and any related documents, Qualified Medical Provider refers to a duly licensed physician; a licensed athletic trainer (AT) or nurse practitioner in consultation with a licensed physician; a physician assistant under the supervision of a licensed physician; or a licensed neuropsychologist in coordination with the physician managing the student’s recovery, pursuant to 105 CMR 201.011 (A).   Qualified Medical Providers providing medical clearance for return to play shall verify that they have received Department-approved training in post-traumatic head injury assessment and management or have received equivalent training as part of their licensure or continuing education. 

For further definitions please refer to 105 CMR 201.005.

Training

As specified in 105 CMR 201.007, the Millis Public Schools Athletic Department shall require annual training in the prevention and recognition of a sports-related head injury and associated health risks including second impact syndrome, and will keep documentation of the training on file for the following people: Coaches, Licensed Athletic Trainers, Trainers, Volunteers, School and Team Physicians (if applicable), School Nurses, Athletic Directors, Marching Band Directors, parents of students who participate in an extracurricular athletic activity, and students who participate in an extracurricular athletic activity.  This training will be completed utilizing Department of Public Health (DPH)-approved training materials or programs.

Prerequisites to Participation in Extracurricular Athletic Activities

Prior to a student’s participation in extracurricular athletic activities, students/parents must provide the following documentation to the Athletic Department: 

1.  Annual documentation of the student's physical examination, which is considered valid, per MIAA [1] rule, if performed within 13 months of the start of the sports season.  This documentation will be confirmed by the Athletic Department and kept in the student’s health record in the School Nurse’s office. 

2.  Prior to each sports season, a completed Pre-Participation Head Injury/Concussion Reporting Form or school based equivalent "Pre-Participation Form".  The Athletic Department will review this information upon receipt, and any information indicating a history of head injury will be further reviewed by the AT and/or School Nurse.  The Athletic Department will also provide a copy of any such information to the appropriate coaches.          

3.  A certificate of completion for any DPH approved online course or a signed acknowledgment that they have read and understand DPH approved written materials, or attended a school-sponsored training at which their attendance was recorded. The certificate and/or acknowledgement are valid for one year. 

4.  Educational materials on the dangers of opiate use and misuse from the bureau of substance abuse services and the educational materials from the bureau of substance abuse services will also be distributed in written form to all students prior to the commencement of athletic seasons.

If the student/parent fails to provide any of the above information, the student will not be permitted to participate in the activity, tryouts or practices until the above documents are submitted.  If necessary, the Athletic Director or designee, or the Coach, will contact the parent to attempt to obtain the required documents, even when the student has completed the training, but the parents have not.  If it is not possible to produce a certificate of completion from the online course, the Millis Public Schools will accept a written or electronic confirmation that the parents/students have read and understand DPH approved written materials.

Exclusion from Play and Reporting Requirements

Any student, who during participation in an extracurricular athletic activity, sustains a head injury or suspected concussion, exhibits signs and symptoms of a concussion, or loses consciousness, even briefly, shall be removed from participation immediately and may not return to participation that day.  Evaluation and clearance by a Qualified Medical Provider will be required in order for the student to return to participation.

Parents will be notified promptly of the nature of the injury, in person or by phone, by whomever the injury is reported to (coach, AT, School Nurse, etc.), so that the parent can ensure that the student receives medical evaluation and treatment.  This communication must occur no later than immediately following the activity in which a student has been removed from play for a head injury, suspected concussion, signs or symptoms of a concussion, or loss of consciousness.  The Parent must also be provided with this information in writing by the notifying party, whether paper or electronic format, by the end of the next business day.

Emergency Medical Services (EMS) will be contacted if the student experiences loss of consciousness, seizure, persistent vomiting, amnesia, significant alteration or deterioration in mental status, and/or significant worsening of signs or symptoms.

If the AT is on-site anywhere on the Millis Public Schools campus, the AT must be notified of the injury immediately, so that the AT can assess and monitor the student until the parent arrives, or, if necessary, other medical attention via EMS is provided. 

If the AT is not on-site, or the injury occurs at an away or off-site event, the Coach must ensure that the Parents are notified as above.  The Coach or their designee must supervise the student until the Parent arrives, or other medical attention is provided.  The Coach must also notify the AT about the injury as soon as possible and no later than 24 hours after the injury occurred.

The AT and/or Coach will communicate, by the end of the next business day, with the Athletic Director (AD) and School Nurse that the student has been removed from activity for a head injury, suspected concussion, signs or symptoms of a concussion, or loss of consciousness.  The Coach will also complete the Report of Head Injury During Sports Season Form, or school-based equivalent (“Report of Head Injury Form”), and provide a copy to the AT and School Nurse in a timely manner. This form may also be completed by the AT.

If a student sustains a head injury or concussion during the season, but not while participating in an extracurricular athletic activity, the parent shall notify the school as soon as possible, and complete the Report of Head Injury Form, or a school-based equivalent, and submit it to the AT, School Nurse, AD, and/or Coach.

Any Pre-Participation Forms which indicate a history of head injury, as well as all Report of Head Injury Forms, shall be reviewed in a timely manner by the AT, student’s coaches and School Nurse, so as to identify students who are at greater risk of repeated head injury, and to allow for provision of appropriate care and follow-up for new head injuries.  The Millis Public Schools may use a student’s history of head injury or concussion as a factor to determine whether to allow the student to participate in an extracurricular activity or whether to allow such participation under specific conditions or modifications.   

Communication and sharing of 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 conducted 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).

Graduated Reentry to Academics and Activity

Each student who is removed from participation and subsequently diagnosed with a concussion shall have a written graduated reentry plan for return to full academic and extracurricular athletic activities.  The plan will involve the School Nurse, AT, the student’s guidance counselor and teachers, the student’s parents, coaches, the student’s primary care physician or other qualified medical provider in consultation with any other appropriate individuals as needed on a case-by-case basis. The return to athletic activity plan will be overseen by the AT. 

The School Nurse or designee will notify the academic teachers of the affected student athlete and provide either written or emailed guidelines for concussion accommodation plans. The written plan shall include instructions for students, parents and school personnel, addressing but not limited to:

(a) Physical and cognitive rest as appropriate

(b) Graduated return to extracurricular athletic activities and classroom studies as appropriate including accommodations or modifications as needed

(c) Estimated time intervals for resumption of activities

(d) Frequency of assessments, as appropriate, by the school nurse, until full return to classroom activities and extracurricular activities are authorized

(e) A plan for communication and coordination between and among school personnel and between the school, parent, and the student’s primary care provider or the physician who made the diagnosis or who is managing the student’s recovery.

The student diagnosed with a concussion must be completely symptom free at rest in order to begin graduated reentry to extracurricular athletic activities.  The student must be symptom free at rest, with cognitive activity, and during exertion, in order to complete the graduated reentry plan and be medically cleared to play.

Medical Clearance and Authorization to Return to Play

Each student who is removed from participation for a head injury or suspected concussion, or loss of consciousness, even briefly, or exhibits signs or symptoms of a concussion shall not be permitted to return to play until they obtain a DPH Post Sports-Related Head Injury Medical Clearance and Authorization Form (“Head Injury Medical Clearance Form”), or school-based equivalent, prior to resuming the extracurricular athletic activity.  This form must be completed by a Qualified Medical Provider, and may only be completed after the student has been completely symptom free, and has completed their graduated return to academics and activity protocols.  It must be submitted to the AT or AD, and will be shared between the AT, AD, and School Nurse.  The ultimate return to play decision is a medical decision that may involve a multidisciplinary approach, including consultation with parents, the school nurse and teachers as appropriate.

The AT will provide final notification of clearance for each student to the coaches, the AD and the School Nurse.

These return to activity policies also apply to a student who is a current participant in an extracurricular athletic activity, but sustains a concussion or head injury outside of said activity.

Roles and Responsibilities

The Superintendent shall maintain or cause to be maintained complete and accurate records of the district’s compliance with the requirements of M.G. L. 111:222 and 105 CMR 201.000. 

The school, consistent with any applicable state and federal law, shall maintain the following records for three years or, at a minimum, until the student graduates:

         1.  Verifications of completion of annual training and receipt of materials

         2.  DPH Pre-participation Forms, or school-based equivalents

         3.  DPH Report of Head Injury Forms, or school-based equivalents

         4.  DPH Medical Clearance and Authorization Forms, or school-based equivalents

         5.  Graduated reentry plans for return to full academic and extracurricular athletic activities

The Athletic Director shall be responsible for the implementation of this policy and any accompanying procedures as it relates to students in grades 6 through 12 who participate in extracurricular athletic activities.

Coaches, ADs, ATs, trainers, and volunteers are required, as applicable, to teach form, techniques, and skills and promote protective equipment use to minimize sports-related head injury, and discourage and prohibit students from engaging in any unreasonably dangerous athletic technique that endangers the health and safety of a student, such as using a helmet or any other sports equipment as a weapon.

Students who engage in unreasonably dangerous behavior while participating in extracurricular athletic activities will be subject to the code of conduct, including forfeiture for games and personal sanctions, and possible disciplinary consequences.

Review and revision of this policy shall occur as needed and at minimum every two years.  Participants in this review shall include, but are not limited to, the AD, AT, and School Nurse. 

The Millis Public Schools Head Injury/Concussion Policy for Extracurricular Athletic Activities shall be made available on the Millis Public Schools website, and shall be published in the Millis High School Handbook (available at http://hs.millisps.org/information/school_handbook) and Millis Middle School Handbook available at http://ms.millisps.org/information/school_handbook).  Information, necessary forms, and materials relating to this policy will be made available to parents and students on the Millis Public Schools website, as well as through the Athletic Department.  These forms will be translated to parents with limited English proficiency and the Millis Public Schools will make special arrangements for parents with limited English proficiency for the trainings. 

All coaches, trainers, volunteers, ATs, and others involved with Millis Public School athletics are responsible to follow this policy and the procedures and protocols associated with this policy.  Failure to do so will result in penalties including, but not limited to personal sanctions.

These policies and procedures shall be made available to the Department of Public Health and Department of Elementary and Secondary Education upon request.  The Millis Public Schools will provide the Department of Public Health an affirmation biannually by September 30th of every odd numbered year that it is has developed policies in accordance with 105 CMR 201.00. 

 First Reading:               waived

Second Reading:           2/7/17

Third Reading:             3/20/17

Adopted:                     3/20/17



[1] Massachusetts Interscholastic Athletic Association

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