What Every Concussion Management Plan Needs

While it’s impossible to completely avoid head injuries, there are a number of things you can do to limit further injury and accelerate the healing process for student athletes. Make sure your organization’s concussion management plan includes the following components:

Training

Educate all coaches, athletic trainers, sideline staff, athletes and parents of athletes who are minors on concussions. Document this training, and address the following topics:

Signs and symptoms of injury, so they can clearly identify when a head injury occurs
The importance of reporting signs and symptoms to medical staff
Long-term effects of head injuries
Treatment protocol

Head’s up: On an annual basis, require athletes and/or their parents or guardians to review and sign a concussion and head injury information sheet before the student athletes begin practice or competition.

Baseline Testing

Require athletes to undergo baseline testing to determine their neurological state prior to participation — the results will help first responders effectively determine impairment when injuries occur. The test, which can typically be taken online in a school computer lab, involves the athlete responding to a series of questions and instructions to determine his or her current cognitive skills. These results are compared with responses to similar questions and instructions on the sideline after a possible head injury to determine the level of impairment.

Head’s up: Among the more popular companies offering this service are ImPACT and XLNT Brain Sport.

Identification

Athletes who receive direct head contact and/or exhibits behaviors consistent with a concussion should be promptly evaluated by a medical staff member with experience in the evaluation and management of concussions.

Head’s up: Some of the companies that offer baseline testing also have a mobile app that can be used to quickly compare an athlete’s cognitive function with baseline measurements to assess possible head injury. This is a good resource to have on hand.

Removal from Participation

If a sideline evaluation confirms that an athlete displays symptoms of a head injury, immediately remove the athlete from participation. Do not allow the athlete to return until cleared by a qualified medical professional. Notify parents or guardians of minor athletes, and remind them of the treatment protocol and the Return to Play process.

Head’s up: Under no circumstances should the coach or other non-medical staff make a determination of an athlete’s ability to return to participation.

Treatment

Following sideline evaluation, potentially concussed athletes should receive treatment from a medical professional experienced in traumatic brain injury. Treatment should include follow-up cognitive testing 24-72 hours after the suspected injury. Treatment typically includes periods of significant rest. Some injuries may require vestibular and/or physical therapy. Athletes needing additional testing should be referred to a neuropsychologist. School medical staff should assist in coordination of treatment and communication between parents/athletes, teachers and coaches.

Return to Non-Contact Activity

An athlete may be able to return to non-contact activity after meeting certain criteria. These criteria should include the following:

The athlete must be symptom-free at rest and with cognitive exertion.
Post-injury testing should be within normal range of the baseline.
The athlete should have a normal vestibular evaluation.

If A, B and C are not met, the athlete should return to treatment. If A, B and C are met, the athlete should obtain written clearance for progression to activity from the supervising physician.

Head’s up: Ease the athlete back into participation gradually with light non-contact activity progressing to full non-contact exertion.

Return to Learn

Concussed athletes will need time away from class and academic activities as they recover. That’s where a Return to Learn protocol comes in handy — it allows your organization to effectively coordinate treatment and activities among parents, students, coaches and teachers. Your Return to Learn plan should be managed by school personnel and may include academic accommodations as well as a leave of absence.

Head’s up: Check out this fact sheet from the Centers for Disease Control and Prevention (CDC) for tips on helping students return to school following a concussion.

Return to Play

Most states have enacted legislation that requires clearance from a qualified medical professional prior to returning to competition, so research your state and local guidelines when developing your school’s policy. Athletes should not return to full activity until they exhibits no symptoms at rest and following physical or cognitive exertion. In addition, the athletes' cognitive test scores should have returned to their baselines.

Head’s up: Need help developing your school’s Return to Play policy? This CDC article outlines a gradual five-step progression.

Bonus: This scannable checklist summarizes the key points in this article and can help you quickly identify concussion management to-dos, ensuring you’re making the right progress.

Sources: Centers for Disease Control and Prevention | National Collegiate Athletic Association | Cincinnati Children’s Hospital