Handbook & Guidelines

Guidelines for Concussion Management

Symptoms Requiring Immediate Emergency Attention

1. Seizure activity
2. Decreased level of consciousness
3. Decrease or irregularity in respiration
4. Unequal, dilated or unreactive pupils
5. Loss of consciousness on the field for more than 15 seconds
6. Any signs or symptoms of associated injuries, spine or skull fracture or bleeding
7. Mental status changes: lethargy, difficulty maintaining alertness, confusion, or agitation
8. Nystagmus (Dancing Eyes)

Day of Injury Referral (Not necessarily emergency transport)

1. Tinnitus
2. Amnesia
3. Cranial nerve deficits
4. Vomiting
5. Motor deficits subsequent to initial on-field exam
6. Sensory deficits subsequent to initial on-field exam
7. Balance deficits subsequent to initial on-field exam
8. Cranial nerve deficits subsequent to initial on-field exam

Delayed Referral (after the day of the injury)

1. Any of the findings in the day of injury referral category
2. Post-concussion symptoms worsen or do not improve over time
3. Increase in the number of post-concussion symptoms reported
4. Post-concussion symptoms begin to interfere with the athlete’s daily activities (i.e.sleep, cognition, depression, aggression, etc.)         

Return to Play Protocol for Students and Parents

EMS ISD has developed a protocol for managing concussions.  This policy includes a multidiscipline approach involving neuropsychological testing, athletic trainer clearance, physician referral and clearance, and successful completion of activity progressions related to their sport. The following is an outline of this procedure.  Your son/daughter must pass all of these tests in order to return to sport activity after having a concussion.

1. All athletes who sustain head injuries will be evaluated by the athletic trainer and a physician. They must have a normal physical and neurological exam prior to being permitted to progress to activity.  This includes athletes who were initially referred to an emergency department.
2. The student will be monitored daily at school by the athletic trainer. His/her teachers will be notified of their injury and what to expect.  Accommodations may need to be given according to physician recommendations and observations.  This may include physician-recommended absence from school or modified attendance.
3. The student will be given a neurocognitive test once they are symptom-free. All athletes in contact sports will have this assessment prior to their season to form a baseline.  EMS ISD utilizes the ImPact and Concussion Vital Signs software program for this.  The athlete’s post-injury testing data must be within normal limits before he/she is released to activity.
4. The student must be asymptomatic at rest and exertion.
5. Once cleared to begin activity, the student will start a progressive step-by-step procedure. The progressions will advance at the rate of one step per day.  The progressions are:
   1. No activity until the athlete is symptom-free
   2. Physician clearance to begin activity
   3. Light aerobic exercise
   4. Moderate aerobic exercise
   5. Heavy aerobic exercise
   6. Non-contact training drills with resistance training
   7. Full contact training drills
   8. Note – Athlete progression continues as long as the athlete is asymptomatic at the current activity level. If the athlete experiences any post-concussion symptoms, he/she will wait 24 hours and start the progressions again at the beginning.
6. Once the student has completed steps 1 through 5, he/she may return to their sport activity with no restrictions.

HOME HEAD INJURY CARE

Treatment:

• Rest
• Observation
• ABSOLUTELY NO aspirin, alcohol product, energy drinks, or any other type of blood thinner
• Ibuprofen (Advil or Motrin) or Acetaminophen (Tylenol) may be given in over the counter doses only
• No video game, TV, cell phone (only talking permitted, no texting or emails), iPod, computer use for the first 72 hours
• After 72 hours limit use of TV, cell phone, and iPod to 30-minute segments every 4 hours
• Limit physical activity of any kind

Report to the hospital immediately if any of the following symptoms occur:

• Persistent headaches, neck, or back pain
• Bleeding or clear fluid draining from the nose or ears
• Blurred or double vision
• Weakness in the arms and or legs
• Pupils that do not change size when exposed to light
• Persistent vomiting
• Confusion, irritability, unusual drowsiness, amnesia (inability to recall names and places)
• Repeatedly asks the same questions even though you answered them minutes earlier