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Management of Sports-Related Concussions

Model Local Education Agency Concussion and Head Injury Policy 

Medical management of sports-related concussion continues to evolve. Recently, there has been a significant amount of new research regarding sports-related concussions in high school athletes. Model Local Education Agency (hereafter “LEA”) has established this protocol to provide education about concussion for coaches, school personnel, parents, and students. LEAs include local boards of education, local charter boards, as well as miscellaneous special programs. This protocol outlines procedures for staff to follow in managing concussions, and outlines school policy as it pertains to return to play issues following a concussion.

LEA seeks to provide a safe return to activity for all students following any injury, but particularly after a concussion. In order to effectively and consistently manage these injuries, procedures have been developed to aid in insuring that concussed students are identified, treated and referred appropriately, receive appropriate follow-up medical care during the school day and are fully recovered prior to returning to activity.

County or State Health Department employees and Physical Education specialists shall review this protocol annually. Any changes or modifications will be reviewed and given to athletic department staff, including coaches and other appropriate school personnel in writing.

All appropriate staff shall attend a yearly in-service meeting in which procedures for managing sporting event-related concussions are discussed.

Local education agencies should note that the Utah State Board of Education passed R277-614 on August 6, 2011.  The Rule directs LEAs to develop a policy using this, the USOE/Risk Management’s model policy, to provide training to appropriate personnel, to provide notice to parents of the LEA’s policy, to post a copy of the LEA’s policy,  and to use model parent  acknowledgement and permission forms.

Recognition of Concussion 

What is a concussion?  A concussion is type of traumatic brain injury that interferes with normal function of the brain. It occurs when the brain is rocked back and forth or twisted inside the skull as a result of a blow to the head or body. What may appear to be only a mild jolt or blow to the head or body can result in a concussion.  A concussion can occur even if a player or student in an activity is not knocked out or loses consciousness.  (NFHS “Suggested Guidelines for Management of Concussion in Sports.”)

Common signs and symptoms of sports-related concussion 

Signs (observed by others):

  • Student appears dazed or stunned
  • Confusion
  • Forgets plays
  • Unsure about game, score, opponent
  • Moves clumsily (altered coordination)
  • Balance problems
  • Personality change
  • Responds slowly to questions
  • Forgets events prior to hit
  • Forgets events after the hit
  • Loss of consciousness (any duration)

Symptoms (reported by student):

  • Headache
  • Fatigue
  • Nausea or vomiting
  • Double vision, blurry vision
  • Sensitive to light or noise
  • Feels sluggish
  • Feels “foggy”
  • Problems concentrating
  • Problems remembering

These signs and symptoms following a witnessed or suspected blow to the head or body are indicative of probable concussion. Any student 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 contest, game, or practice and shall not return to play until cleared by an appropriate health care professional.

Management and Referral Guidelines for All Staff

  1. The following situations indicate a medical emergency and require activation of the Emergency Medical System:

v  Any student with a witnessed loss of consciousness (LOC) of any duration should be spine boarded and transported immediately to nearest emergency department via emergency vehicle.

v  Any student who has symptoms of a concussion, and who is not stable (i.e., condition is worsening), is to be transported immediately to the nearest emergency department via emergency vehicle.

v  A student who exhibits any of the following symptoms should be transported immediately to the nearest emergency department, via emergency vehicle.

  • Deterioration of neurological function
  • Decreasing level of consciousness
  • Decrease or irregularity in respirations
  • Any signs or symptoms of associated injuries, spine or skull fracture, or bleeding
  • Mental status changes: lethargy, difficulty maintaining arousal, confusion or agitation
  • Seizure activity
  1. A student who is symptomatic but stable, may be transported by his or her parents. The parents should be advised to contact the student’s primary care provider, or seek care at the nearest emergency department, on the day of the injury.


Guidelines and Procedures for Coaches and Teachers Supervising Contests and Games:




Recognize concussion


  1. All educators and agents of the LEA should become familiar with the signs and symptoms of concussion that are described above.
  2. Educators and agents of  LEAs shall have appropriate training about recognizing and responding to traumatic head injuries, consistent with the employees’ responsibilities for supervising students and athletes.


Remove from activity

Any student 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 sporting event and shall not return to play until cleared by an appropriate health care professional.

When in doubt, sit ‘em out


Refer the athlete/student for medical evaluation

  1. The agent of the LEA is responsible for notifying the student’s parent(s) of the injury.
    1. Contact the parent(s) to inform a parent of the injury. Depending on the injury, either an emergency vehicle will transport or parent(s) will pick the student up at the event for transport. (see Section II).
    2. A medical evaluation is required before returning to play.
  2. In the event that a student’s parent(s) cannot be reached, and the student is able to be sent home (rather than directly to MD):
  • The LEA’s agent should insure that the student will be with a responsible individual, who is capable of monitoring the student and understanding the home care instructions, before allowing the student to go home.
  • The LEA agent should continue efforts to reach a parent.
  • If there is any question about the status of the student, or if the student cannot be monitored appropriately, the student should be referred to an Emergency Department for evaluation. An LEA’s agent should accompany the student and remain with the student until a parent arrives.
  • The LEA’s agent shall provide for supervision of other students for whom he or she is responsible when accompanying the injured student.

Students with suspected head injuries should not be permitted to drive home.

  1. LEA agents should seek assistance from the host site certified athletic trainer (ATC) or team physician, if available, at an away contest if the injury occurs at a formal athletic contest.


Return to Play (RTP) Procedures After Concussion

  1. Return to activity and play is a medical decision. The student must meet all of the following criteria in order to progress to activity:
    1. Asymptomatic at rest and with exertion (including mental exertion in school) AND
    2. have written clearance from the student’s primary care provider or concussion specialist (student must be cleared for progression to activity by a physician other than an Emergency Room physician, if diagnosed with a concussion).
  2. Once the above criteria are met, the student will be progressed back to full activity following the step-wise process detailed below. (This progression must be closely supervised by an LEA agent. If your school does not have an athletic trainer, then the coach must have a very specific plan to follow as directed by the athlete’s physician).
  3. Progression is individualized, and will be determined on a case-by-case basis. Factors that may affect the rate of progression include: previous history of concussion, duration and type of symptoms, age of the student, and sport/activity in which the student participates. An athlete/student with a prior history of concussion, one who has had an extended duration of symptoms, or one who is participating in a collision or contact sport may be progressed more slowly.
  4. Stepwise progression as described below:

Step 1. Complete cognitive rest. This may include staying home from school or limiting school hours (and studying) for several days. Activities requiring concentration and attention may worsen symptoms and delay recovery.

Step 2. Return to school full-time.

Step 3. Light exercise. This step cannot begin until the student is no longer having concussion symptoms and is cleared by a physician for further activity. At this point the athlete may begin walking or riding an exercise bike. No weight lifting.

Step 4. Running in the gym or on the field. No helmet or other equipment.

Step 5. Non-contact training drills in full equipment. Weight training can begin.

Step 6. Full contact practice or training.

Step 7. Play in game. Must be cleared by physician before returning to play.

  • The student should spend 1 to 2 days at each step before advancing to the next. If post concussion symptoms occur at any step, student must stop the activity and the treating physician must be contacted. Depending upon the specific type and severity of the symptoms, the student may be told to rest for 24 hours and then resume activity at a level one step below where he or she was at when the symptoms occurred. This resumption of activity could be considerably simplified for a student injured during recess compared to a student injured at a game or formal practice.


Potential Problem Areas

While current Utah law designates that a student may be returned to play by “an appropriate health care provider” it is the prerogative of each LEA to designate the credentials of the providers from whom they will accept clearance. This is a very important decision and should be made after careful consideration by the athletic director, principal, superintendent, teacher (elementary), and parent(s). The school district’s liability carrier may also be consulted.

For students injured during formal competitions, serious consideration must also be given as to what the school will do in the case where an athlete is clearly still having concussion symptoms, yet given return to play clearance by a health care provider. A formal policy should be developed which designates a specific individual (preferably an expert in the field of concussion management- typically a physician or neuropsychologist) who shall evaluate the athlete and make the final decision regarding return to play.

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  • Students have 5 calendar days from the date quarter grades are electronically posted to remedy eligibility problems. Probation or dismissal from a team or office will occur if the student is still ineligible after 5 calendar days.
  • All eligibility appeals must be made in writing to the Standards Committee and must detail any extenuating circumstances. A student may only make one appeal to the Standards Committee during junior high.
  • Probation guidelines are explained in the “Constitution” for student officers and cheerleaders.




Academic Standards:Attain and maintain a 2.0 G.P.A. or better for the previous quarter or a cumulative 2.0 G.P.A. computed from the four previous successive quarters (not semester) and receiving not more than one F for previous and current quarter. The printed report card will be the basis for determining eligibility. The determination of eligibility under this rule shall be made no later than five calendar days following the last day of the grading period. Grade changes after that time cannot restore lost eligibility. Reading/Advisory class grade may or may not count towards eligibility. Eligibility is the responsibility of each individual school and will be governed by the school.


Citizenship Standards: A student participating in junior high sports would be eligible with one U, or one N and one U, or two N’s for the previous quarter and current quarter. Any other combination beyond this a student would no longer be eligible for athletics. Printed report card will be the basis for determining eligibility. The determination of eligibility under this rule shall be made no later than five calendar days following the last day of the grading period. Grade changes after that time cannot restore lost eligibility. Reading/Advisory class citizenship may or may not count towards eligibility. Eligibility is the responsibility of each individual school and will be governed by the school.


Behavior Standards: Students must maintain acceptable behavior standards while on an athletic team. Coaches and administration will determine if violations to school policy are serious enough to warrant removal from the team. Truancy, fighting, safe school violations, drug and alcohol violations, suspensions, etc. may be grounds for removal from a team.



Homework Haven

Appropriate dress is important to the educational performance and attitude of the students. Students are expected to maintain dress and appearance that is modest and not distracting to students or teachers, and is not distracting to the educational process of the school. When a student’s appearance is distracting, disruptive, immodest, or is felt to be detrimental to the educational process, reasonable and appropriate action will be taken. The following expectations/standards will be followed:

  • School clothing must be modest.
  • Shirts, tops, and dresses must have a minimum of a cap sleeve, even if covered by sheer or see-through clothing.
  • No low-cut fronts, bare backs, or bare midriffs (when elbows are raised to shoulder height) even if covered by sheer, knitted or see-through clothing.
  • Shorts or skirts must be at least mid-thigh length from the knee. (Discretion of the school officials)
  • Underwear must not be visible or exposed at anytime.
  • Pants, etc. must be worn at the natural hip/waistline. No sagging pants. No pajama pants or sleepwear, including slippers.
  • Holes in pants above the fingertip line or in excess (at the discretion of the principal) will not be permitted.
  • Headwear will not be permitted – including but not limited to hats, caps, scarves, bandanas, etc.
  • Clothing will not be permitted that is sexually provocative, mutilated, displays offensive language or slogans advertising or displaying any substances a student cannot legally possess, or is gang-related.
  • No potentially dangerous apparel items, such as chains, spiked clothing or spiked accessories, etc.
  • Hair should be well groomed and not distract from the educational process. Style and/or color should not be a distraction to others and disruptive to the learning environment. We suggest natural styles and tones (color) be used as a guideline for the student’s hair.
  • State Health Law requires that shoes be worn in the school at all times. (No slippers)

Areas of Strength/Focus

  • ·The students learn practical applications for numeracy and literacy.  We prepare students for the pursuit of higher education and/or careers in Applied Technology occupations.  We integrate current technology theory and practice into the students learning activities through student-centered learning and problem solving activities.
  • ·Using the information we have learned at conferences, professional development, and continued education, we have implemented a variety of teaching methods to maximize student achievement.
  • ·Each teacher is highly qualified to teach in his/her content area.
  • ·Teacher lesson plans include a variety of learning activities and techniques to ensure that the needs of different learning styles are addressed.  We attend IEP and 504 meetings and make accommodations accordingly.  We meet the needs of our deaf students, ESL and low level readers.
  • ·We follow the state standards and course objectives.  In the classes where state competency tests are given, the majority of our students score higher than the state average. 
  • ·We insure that every student has equitable access to technology. Teachers utilize every resource available and are trained to effectively integrate technology into the curriculum. 

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