Head Injury Policy
The following policy applies to all students at PVCICS in accordance with Massachusetts State Law 105 CMR 201.00 and as specified by PVCICS.
The Executive Director shall be responsible for the implementation and enforcement of this policy.
The information regarding how to access this policy will be included in the student and faculty handbooks.
I. Definitions: The words below as used in this policy shall be defined as follows unless otherwise stated per Department of Public Heath in Massachusetts law 105 CMR 201.00: Head Injuries and Concussions in Extracurricular Athletic Activities.
Athlete: A student who prepares for or participates in an extracurricular athletic activity.
Athletic Director: An individual employed by a school district or school and responsible for administering the athletic program or programs of a school. The term Athletic Director refers to the Director and Assistant Directors.
Certificate of completion as defined by PVCICS: Written proof that the National Federation of State High School Associations (NFHS) concussion course was completed.
Coach: An employee or volunteer responsible for organizing and supervising student athletes to teach them the fundamental skills of extracurricular athletic activities, referring to both head and assistant coaches.
Concussion: A complex disturbance in brain function, due to direct or indirect trauma to the head, resulting in neurometabolic dysfunction rather than structural.
Diagnosed: A physician’s or nurse practitioner’s opinion, derived from observation, examination, and evaluation of procedures or tests, that a patient has or has had a concussion.
Extra-curricular Athletic Activity: An organized school sponsored athletic activity generally occurring outside of school instructional hours under the direction of a coach, athletic director, or teacher; including but not limited to Alpine and Nordic skiing/snowboarding, baseball, basketball, cheerleading, cross country and track and field, fencing, field hockey, football, golf, gymnastics, horseback riding, ice hockey, lacrosse, marching band, rifle, rugby, soccer, skating, softball, squash, swimming and diving, tennis, ultimate Frisbee, volleyball, water polo, wrestling, and outing clubs. All interscholastic athletics are deemed to be extracurricular athletic activities.
Head Injury: A direct blow to the head or indirect trauma to the head including a concussion or traumatic brain injury. A scalp or facial laceration alone is not a head injury.
Neuropsychologist: A professional who is licensed as a psychologist and certified as a health service provider by the Board of Registration of Psychologists pursuant to M.G.L. c. 112, §§ 118 through 129A with additional specialized training and expertise in the applied science of brain-behavior relationships and who has specific experience in evaluating neurocognitive, behavioral and psychological conditions and their relationship to central nervous system functioning. The neuropsychologist has specialized experience in administering and interpreting neuropsychological tests and has duties which may include, but are not limited to pre-injury measurement of the cognitive abilities that may be disturbed by a concussion, testing within the first few days post-head injury, and periodic retesting to track resolution of the student's symptoms and improvement in cognitive functioning. The neuropsychologist may also advise school staff regarding the student's need for post injury academic accommodations.
Nurse Practitioner: A duly licensed and registered nurse authorized to practice in an expanded role as a nurse practitioner whose professional activities include performing physical examinations, diagnosing health and developmental problems, managing therapeutic regimens, and ordering therapies and tests.
Physician: A duly licensed doctor of medicine or osteopathy. Physician designee as defined by PVCICS: A qualified health care professional licensed by the State of Massachusetts, working in the same professional capacity and physical space as a particular physician. This shall include fellow physicians, nurse practitioners, and neuropsychologists.
Game play as defined by PVCICS: Participation in an extracurricular activity for the purpose of competition including scrimmages.
Pre-injury academic level as defined by PVCICS: The level of academic performance achievable by the student prior to sustaining a head injury as assessed by school staff and baseline ImPACT neurocognitive testing if completed.
School Nurse: A nurse practicing in a school setting who is licensed to practice as a Registered Nurse by the Board of Registration in Nursing pursuant to M.G.L. c. 112, who is licensed to work as an educator in a school by the Department of Elementary and Secondary Education pursuant to 603 CMR 7.00: Educator Licensure and Preparation Program Approval, and who is appointed or assigned to a public school by a school committee or a board of health in accordance with M.G.L. c. 71, § 53 or employed by a superintendency district comprised of several towns in accordance with M.G.L. c. 71,§ 53A and 53B or, who is employed, in the case of a charter or private school, by a board of trustees.
Student: A person enrolled for part-time or full-time attendance in an educational program operated by a school or school district, including home schoolers.
Teacher: Any person employed in a school or school district under a license listed in 603 CMR 7.00: Educator Licensure and Preparation Program Approval or person employed to teach students in a non-public school.
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.
II. Pre-Participation Requirements For Students Participating in Extracurricular Athletic Activities:
1. Prior to participation in extracurricular athletic activities, students and their parent(s)/guardian(s) will be required to view the Head’s Up Concussion video presented by the Center for Disease Control or complete the free on-line concussion training provided by the National Federation of State High School Associations (NFHS). The link to both resources can be found on the extracurricular athletic activity permission slip form and on the athletics page of the school website. There is a section of the permission slip form where the student and at least one parent/guardian must indicate that they have viewed the video or completed the NFSH training at least once within the past twelve months. Parents with limited English proficiency will be given translated written materials containing the same information as in the on-line resources.
2. The extracurricular athletic activity permission slip form & Pre-Participation form must be completed by a parent/guardian and submitted to the athletic director before the start of every athletic activity the student participates in. Students will not be allowed to participate in any extracurricular athletic activity without the completion of the form in its entirety, including the required signatures, regardless of the circumstances. When the activity has ended the form will be given to the school nurse and become part of the student’s medical file.
3. All permission slip forms and Pre Participation forms will be screened by the athletic director and/or school nurse to identify students that have had a prior head injury. In the event that a student has had a head injury in the past, it will be reported to the school nurse and/or school physician for appropriate follow up.
4. Verification of documentation of physical examination shall be performed by the athletic director and/or school nurse prior to student’s participation in extracurricular athletic activities, consistent with 105 CMR 200.100 (B) (3).
III. Education for Coaches/Staff:
1. All school staff including, but not limited to, athletic directors, coaches, teacher and parent volunteers for extracurricular athletic activities, school physician(s), and school nurses will be required to complete the National Federation of State High School Associations (NFHS) concussion course on a yearly basis and submit the certificate of completion to the athletic director.
2. It is the responsibility of those listed above, and other staff deemed appropriate by the administration and/or athletic director and school nurse, to complete the concussion training and submit the certificate of completion before participating in any capacity in extracurricular activities requiring physical exertion.
3. In the event that a coach or faculty advisor fails to complete step one before the start of an extracurricular athletic activity, the administration, athletic director, and/or school nurse reserve the right to exclude said person from the activity until the certificate of completion has been submitted. The activity may continue in the interim as long as there is another individual deemed qualified by the administration and/or athletic director to participate in that activity.
All coaches/advisors of extracurricular athletic activities will be given hard copies of the head injury reporting form, the medical clearance form, and the graduated re-entry plan with associated materials before the start of the activity. Additional copies will be kept by the school nurse and the athletic director and are available on the athletics page of the school website.
IV. Reporting a Head Injury:
1. If a suspected head injury, based on subjective and objective demonstration of signs and symptoms, is sustained during any extracurricular activity:
a. It is the responsibility of the coach/faculty advisor to call 911 immediately if (a) the student loses consciousness at any time, (b) there is a progressive decrease in mental status or neurological function, (c) the student demonstrates irregular breathing patterns, or (d) seizure activity is observed. The student’s parent(s)/guardian(s) must then be notified as quickly as possible.
b. The student must be removed from the activity, including practice and game play, for the remainder of that day if the student is symptomatic but stable.
c. The coach or school staff member that was witness to the event must contact the parent(s)/guardian(s) of said student to provide a verbal report of the event as quickly as possible.
d. The head injury reporting form needs to be completed by the coach/faculty advisor as soon as possible after the event and submitted to the athletic director or school nurse the next business day. It is the responsibility of the athletic director and/or school nurse to notify each other when a head injury is reported. Within twenty-four hours of receiving the head injury reporting form, the athletic director will provide a copy of the report, as well as the medical evaluation form and the graduated re-entry plan, to the parent(s)/guardian(s). After doing so, the athletic director or school nurse will document it on the bottom of the head injury reporting form. The head injury report will then be given to the school nurse and become part of the student’s confidential health file.
e. The student must be evaluated by their primary care provider or another equally qualified health care professional (physician, nurse practitioner, or neuropsychologists). Parent(s)/guardian(s) may choose to take the athlete of their primary care physician, health clinic, or to the emergency room. Regardless of the method for evaluation, medical authorization is required for the student to return to extracurricular athletic activity. If a concussion is diagnosed medical authorization is required before returning to school (see the Medical Evaluation section below).
2. If a suspected head injury occurs during school hours or at school sponsored event, the same protocol as listed above shall be followed.
3. If a suspected head injury occurs outside of school hours and not at a school related event or extracurricular activity, the parent(s)/guardian(s) will be responsible for completing the report of a head injury, which can be found on the athletics page of the school website. Once completed, the report should be given to the school nurse no more than one business day after the incident to ensure appropriate follow up. Medical evaluation is still required (see the Medical Evaluation section below). V. Medical Evaluation:
1. All students are required to submit part one of the medical clearance form, completed and signed by a physician or designee before returning to extracurricular athletic activity. If a concussion is diagnosed, part one of the medical clearance form needs to be completed before returning to school. Parent(s)/guardian(s) should bring the medical clearance form to the physician, nurse practitioner, or neuropsychologist evaluating the student following the injury.
2. In the event that a student is evaluated in the emergency room, part one of the medical clearance should be completed by the student’s primary care physician at a subsequent visit or the provider to whom the student was referred by the emergency room for follow up care; this individual must be the provider that will be monitoring the student through his/her recovery. In the event that the appointment with said provider is scheduled more than one school day after the emergency room visit and a concussion was diagnosed, the student should not come to school until after that appointment. If the emergency room physician deems it appropriate for the student to return to school, supporting documentation needs to be provided, including the need for academic accommodations if appropriate, to the school nurse on the day of return. Part one of the medical clearance form still needs to be completed as instructed above.
3. Student athletes will be required to submit part one of medical clearance form in order to begin the process of returning to extracurricular athletic activity. See the section below titled Returning to Activity After Diagnosis for further information.
Upon completion, part one of the medical clearance form should be given to the athletic director or school nurse and will become part of the student’s confidential health file.
VI. Returning to Activity After Diagnosis:
1. Academic Modifications and Performance:
a. After a head injury a student may require academic modifications until the recovery process is complete. If the medical clearance form indicates that academic modifications are necessary, the school nurse and/or athletic director will coordinate with the guidance department to ensure the student’s needs are being met. All students, regardless of the extent or nature of the head injury, will be provided academic modifications if appropriate.
b. All students recovering from a head injury will be allowed to access the school nurse as needed for rest periods and symptom management as deemed appropriate by the school nurse.
c. All students must be performing at their pre-injury academic level before participating in school related athletic activities of any kind, including but not limited to extracurricular athletic activities. Athletes will not be allowed to begin the re-entry to activity process until they are performing at their pre-injury academic level. Academic modifications will be provided as necessary until that time.
d. All students in the process of rehabilitation after a head injury should check in with the school nurse and/or guidance department daily to ensure the rehabilitation process is successful and effective for the student.
2. Graduated Re-entry:
a. After it has been determined that the student is performing at their pre-injury academic level, and part one of the medical clearance form has been completed, a written graduated re-entry plan will be initiated to return the student to full participation in extracurricular athletic activities. The written graduated re-entry plan is mandatory for student athletes. The purpose of the graduated re-entry plan is to prevent further complications after a head injury by appropriately returning to play and to provide essential documentation of that process (see the graduated re-entry plan form).
b. Each step of the plan will last a minimum of one full day. Each step must be dated and initialed by the coach/faculty advisor or athletic director on the day of completion. The plan will be dated and initialed by the parent/guardian, or by school staff when appropriate, for students who do not participate in athletic activities.
c. The student must remain symptom free for the entire period of activity at each step to move onto the next step. If symptoms return at any point during the re-entry process, whether it be with activity or not, the athlete will return to rest for at least one full day. When it is appropriate the athlete will resume the graduated re-entry plan one step prior to the step at which symptoms occurred. The athlete is not permitted to participate in game play until step five of the graduated re-entry plan is complete and part two of the medical clearance form has been obtained. See the Medical Clearance section.
d. The six steps of the graduated re-entry plan are as follows:
Step One: Rest. Student may be present at extracurricular activities, whether it be practice or game play, but for viewing purposes only. Student must remain benched at all times.
Step Two: Light exercise. Student may complete light non-contact exercises such as walking or riding a stationary bike. Student may NOT participate in weight lifting or other strenuous activity.
Step Three: Activity specific play involving light exercise without body contact such as running. Student may participate in all activities of practice that involve light exercise with NO body contact.
Step Four: Full practice without body contact and resume resistance training. Student may fully participate in any aspect of practice that DOES NOT involve body contact.
Step Five: Full practice with body contact. Student may fully participate in all practice play.
Medical clearance: Part two of the medical clearance form must be completed before the student proceeds to step six. See the Medical Clearance section below.
Step Six: Return to full play. Student may fully participate in all aspects of the activity, including game play.
e. The administration, athletic director and school nurse reserve the right to keep a student at any step for longer than one full day, even if the athlete is symptom free, if deemed in the best interest of the student.
Once the graduation re-entry plan has been completed it will be given to the school nurse and become part of the student’s confidential health file.
VII. Medical Clearance:
Each student who is removed from practice or competition for a head injury or suspected concussion, or loses consciousness, even briefly, or exhibits signs and symptoms of a concussion, shall obtain and present to the Athletic Director or School Nurse a Department Post Sports-Related Head Injury Medical Clearance and Authorization Form (Medical Clearance and Authorization Form) prior to resuming the extracurricular athletic activity. This form must be completed by a physician or one of the individuals as authorized by 105 CMR 201.011(A). 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 administration, athletic directors, and school nurses of PVCICS reserve the right to keep a student out of play or to only allow partial play, even if the student has medical clearance, if it is deemed in the best interest of the student.
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