Procedure 2.1.36 CONCUSSION MANAGEMENT
Approved: June 3, 2014
Revised: November 3, 2020
1.0 Roles and Responsibilities
1.1 Role of Senior Administration:
Senior Administration will:
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- 1.1.1 Conduct an annual review of the Concussion Management Protocol and Board supporting documents to ensure that they align with the current best practices, and at minimum, the Ophea Concussion guidelines and Ontario School Boards’ Insurance Exchange (OSBIE) requirements.
- 1.1.2 Ensure that concussion awareness training is made available to all relevant school staff and volunteers, including the signs and symptoms of concussion, immediate action to take if a concussion is suspected, prevention strategies and other information as appropriate to their roles.
- 1.1.3 Ensure that concussion awareness and education strategies are made available to students and parents/guardians (websites, hand-outs, newsletters, team meetings, curriculum, etc.).
- 1.1.4 Provide support to school administrators and staff to ensure implementation of the concussion procedures and Return to School Plan.
- 1.1.5 Ensure that information on the concussion procedures is provided to community users of school facilities and licensed third-party care providers not operating Extended Day Programs.
1.2 Role of Principals/Vice-Principals:
Principals and Vice-Principals will:
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- 1.2.1 Provide annual awareness training to all relevant staff and volunteers outlined in this policy informing them of the:
- Signs and symptoms of concussions (Appendix A);
- Return to school process (Section 5.0);
- Their roles and responsibilities (Section 1.3).
- 1.2.1 Provide annual awareness training to all relevant staff and volunteers outlined in this policy informing them of the:
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- 1.2.2 Receive confirmation from each of the following individuals, that an approved Concussion Awareness Resource was reviewed every school year prior to participation in board-sponsored interschool sports:
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- Students participating
- Parents of students under 18 years of age who are participating;
- Coaches participating;
- Team trainers participating;
- Officials participating.
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- 1.2.3 Ensure that the relevant Concussion Code of Conduct is reviewed every year prior to participation in board sponsored interschool sports for each of the following groups:
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- School staff, support staff, coaches and volunteers participating (Appendix B);
- Students participating (Appendix C);
- Parents/Guardians of students under 18 years of age who are participating (Appendix D).
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- 1.2.4 Ensure all staff and coaches are qualified for the classes/sports they are involved in.
- 1.2.5 Ensure all staff and coaches follow the applicable Ophea Safety Guidelines.
- 1.2.6 In the event of a student sustaining or being suspected of sustaining a concussion, ensure that all relevant staff are kept apprised of the student’s status.
- 1.2.7 Maintain an inventory of all personal protective equipment (PPE), including but not limited to, the date of purchase, inspection dates and date to be replaced.
- 1.2.8 Ensure all equipment is certified (if applicable), in good condition, is worn properly and is appropriate for the activity.
- 1.2.9 Encourage applicable staff coaches to participate in Standard First Aid training.
- 1.2.10 Ensure that that students and parents/guardians are aware of the concussion protocol and what their roles and responsibilities are.
- 1.2.11 Ensure OSBIE Incident Reports are completed online by the appropriate staff member as required.
- 1.2.12 Ensure incident is documented in Student Information System, under the Student Top Tab, Details side-tab. Add a Medical Alert record with the medical condition = Concussion, and a start date = date concussion occurred.
1.3 Role of school staff, support staff, coaches, volunteers:
School staff, support staff, coaches and volunteers will:
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- 1.3.1 Participate in required awareness training and understand and follow Concussion Procedures as outlined in the DSB1 Concussion Management Policy and the content of the approved Concussion Awareness Resources available from the Government of Ontario.
- 1.3.2 Commit to the Concussion Code of Conduct (Coach/Team Trainer) (Appendix B) for coaches and team trainers who are participating in board-sponsored interschool sports. A signed copy of Appendix B must be submitted annually to the school Principal.
- 1.3.3 Be aware of the signs and symptoms of concussions, methods of prevention and the management protocol in the event of a concussion including Return to Learn and Return to Physical Activity Plans.
- 1.3.4 Ensure that the Medical History & Informed Consent/Permission Form for School Teams (Appendix E) are completed and on file prior to the student participating in any physical activity.
- 1.3.5 Follow all applicable Ophea Safety Guidelines.
- 1.3.6 Ensure that all equipment used is certified (if applicable), in good condition, worn properly and is appropriate for the activity.
- 1.3.7 Ensure that all activities are age appropriate.
- 1.3.8 Ensure that all skills are taught in order of progression.
- 1.3.9 Ensure that all participants participate in the appropriate safety training prior to performing the task/activity.
- 1.3.10 In the event of an injury, complete the Student/Athlete Concussion Assessment Tool (Appendix F).
- 1.3.11 Supervise students at all times.
- 1.3.12 Ensure each team has an emergency action plan.
1.4 Role of Students:
Students will:
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- 1.4.1 Complete (students 18 years of age or older and parents/guardians) and return the Medical History & Informed Consent/Permission Form (Appendix E) before participating in a school team activity.
- 1.4.2 Commit to the Concussion Code of Conduct for Interschool Sports (Students) (Appendix C) for students participating in board-sponsored interschool sports. A signed copy of Appendix C must be submitted annually to the team coach.
- 1.4.3 Participate in all safety training and learn to recognize the signs/symptoms of a concussion.
- 1.4.4 Wear any required equipment in the correct manner.
- 1.4.5 Follow all rules and regulations of the activity.
- 1.4.6 Immediately report any concussion symptoms to staff/coaches.
- 1.4.7 Inform staff/coaches if they notice/observe concussion signs in any of their peers.
- 1.4.8 Follow concussion management strategies of their medical practitioner.
- 1.4.9 Understand and follow the Return to School Plan (Appendix G) as directed by school staff.
1.5 Role of Parents/Guardians:
Parents and Guardians will:
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- 1.5.1 Commit to the Concussion Code of Conduct for Interschool sports (Parent/Guardian) (Appendix D) for parents and guardians of students under 18 years of age who are participating in board-sponsored interschool sports. A signed copy of Appendix D must be submitted annually to the team coach.
- 1.5.2 Learn the signs and symptoms of concussion and review them with their child/ren (Appendix A).
- 1.5.3 Have their child assessed by a medical doctor or nurse practitioner as soon as possible in the event that a concussion is possible.
- 1.5.4 Collaborate with the school and medical doctor or nurse practitioner to manage possible or diagnosed concussions appropriately.
- 1.5.5 Support concussed students with their recovery.
- 1.5.6 Collaborate with school staff and support a student on the Return to School Plan (Appendix G) as per the established Board Policy and Operational Procedures on Concussions.
- 1.5.7 Report any non-school related concussion to the school principal so the Return to Learn and Return to Physical Activity Program can be followed.
1.6 Role and Responsibility of Medical Doctors or Nurse Practitioners
Medical Doctors and Nurse Practitioners may:
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- 1.6.1Review The Concussion Signs and Symptoms Form completed by the school.
- 1.6.2 Provide support and medical assistance to the student’s recovery process.
- 1.6.3 Participate with the school in the recovery process and in the development or review of a Return to Learn and Return to Physical Activity Plan (Appendix G) as applicable.
2.0 Training Requirements
Principals and Vice-Principals will:
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- 2.1 Develop and implement procedures to train school staff and volunteers on concussion, including signs and symptoms, prevention, identification and management as appropriate to their roles;
- 2.2 Develop strategies to raise awareness and inform students on concussion, their roles and responsibilities and create or use curriculum strands/resources as available;
- 2.3 Develop strategies to raise awareness of concussion in parent/guardians and inform them of their roles and responsibilities.
3.0 Concussion Prevention and Awareness
As part of the introduction to the class or team, the teacher/coach/supervisor must meet with students to discuss the following:
- The rules of the game and the importance of practicing fair play;
- The risks for concussion associated with the activity/sport and how to minimize those risks;
- The definition and causes of a concussion, signs and symptoms, and dangers of participating in an activity while experiencing the signs and symptoms of a concussion;
- The student’s responsibility to immediately inform the teacher/coach/supervisor and parent/guardian of any signs or symptoms of a concussion, and to remove themselves from the activity;
- The importance of ensuring a student with a suspected concussion is not left alone;
- The need for evaluation by a medical doctor where there is a suspected concussion; and
- The importance of wearing properly fitted protective equipment.
4.0 Concussion Incident Management
When a student is suspected of having suffered a concussion at school or during a school-organized activity, the teacher/coach/supervisor will manage the incident as outlined below:
4.1 If the student is conscious and a concussion is suspected:
- Stop the activity immediately and when safe to do so, remove the student from the activity or game;
- Assess the student for signs and symptoms of a concussion using Appendix F;
- If signs of concussion are not observed, no symptom(s) are reported and the student passes the Quick Memory Function Assessment (which is part of Appendix F):
- The student may return to physical activity at the discretion of the teacher/coach/supervisor.
- The parent/guardian (or emergency contact) must be informed of the incident by the teacher/coach/supervisor on the day of the incident.
- If sign(s) of concussion are observed and/or symptom(s) are reported and/or the student fails the Quick Memory Function Assessment (Appendix F), medical attention may be required. The teacher/coach/supervisor will:
- Determine whether medical attention is needed immediately.
- Contact the parent/guardian (or emergency contact) to inform them of the incident, request that the student be picked up immediately and encourage them to have the student examined by a medical doctor or nurse practitioner as soon as possible.
- Monitor and document any changes (i.e. physical, cognitive, emotional/behavioural) in the student;
- Not administer any medications to treat the suspected concussion, except where required for other known conditions.
- Stay with student until their parent/guardian (or emergency contact) arrives. The student must not leave the premises without parent/guardian (or emergency contact) supervision.
- Once the immediate medical needs of the student have been met, inform the School Principal, and complete and file Appendix F.
4.2 If the student is unconscious or has experienced any loss of consciousness:
- Stop the activity immediately and call 911. Do not move the student and do not remove athletic equipment unless the student is having difficulty breathing.
- Stay with the student until emergency medical services arrive.
- Contact the student’s parent/guardian (or emergency contact) to inform them of the incident and that emergency medical services have been contacted.
- Monitor and document any changes in the student (i.e. physical, cognitive, emotional/behavioural).
- If the student regains consciousness, encourage them to remain calm and to lie still.
- Do not administer any medications related to the suspected concussion, unless required for another condition.
- Once the immediate medical needs of the student have been met, inform the School Principal, and complete and file Appendix F.
4.3 When a student has incurred a concussion or a suspected concussion, they must be seen by a doctor or nurse practitioner prior to returning to school. The parent/guardian must inform the school principal of the results of the medical examination and complete Medical Concussion Assessment Form (Appendix H).
5.0 Return to School Plan (Appendix G)
5.1 The steps for Return to Learn are as follows:
Step 1: Rest, with limited cognitive and physical activity. This means limited television, computer use, texting, video games, or reading. The student does not attend school during Step 1. Step 1 continues for a minimum of 24 hours and until the student’s symptoms/signs begin to improve or the student is symptom/sign-free. Step 1 for a student with a diagnosed concussion is the same for Return to Learn and Return to Physical Activity.
- The Return to Learn process is individualized and gradual to meet the particular needs of the student. There is no pre-set formula for developing strategies to assist a student with a concussion to return to their learning activities.
Step 2: Symptoms of Concussion are improving:
- During this step, the student requires individualized classroom strategies and/or approaches to return to full learning activities – these will need to be adjusted as recovery occurs.
- At this step, the student’s cognitive activity should be increased slowly (both at school and at home) because the concussion may affect their academic performance. Note: Cognitive activities can cause a student’s concussion symptoms to reappear or worsen.
Step 3: Student is symptom-free:
Student begins regular learning activities without any individualized classroom strategies and/or approaches. Even when students are symptom-free, they should continue to be closely monitored to see if symptoms/signs return and/or there is a deterioration of work habits or performance.
5.2 Return to Physical Activity (Appendix G)
The steps for return to Physical Activity are as follows:
Step 1: Rest, with limited cognitive and physical activity. This means limited television, computer use, texting, video games, or reading. The student does not attend school during Step 1. Step 1 continues for a minimum of 24 hours and until the student’s symptoms/signs begin to improve or the student is symptom/sign-free.
Note: Step 1 for a student with a diagnosed concussion is the same for Return to Learn and Return to Physical Activity.
Step 2: Individual, light aerobic physical activity only while at home such as walking or stationary cycling.
Step 3: Individual, light aerobic physical activity only, at home and at school, such as walking or stationary cycling.
Step 4: Individual activity related to specific sports, e.g. skating in hockey, running in soccer. No body contact.
Step 5: Activities where there is no body contact, such as progressive resistance training, non-contact practice and progression to more complex training drills, e.g. passing drills in football and ice hockey.
Note: Clearance by a medical doctor or nurse practitioner is required before Step 6 (Appendix I).
Step 6: Full participation in regular physical activity in non-contact sports following medical clearance. Full training/practice for contact sports.
Step 7: Full participation in contact sports.
5.3 When a student has suffered a concussion (whether at school or elsewhere), and is ready to return to school on a full or part-time basis:
- The school principal will obtain the appropriate medical documentation, including Appendix H. The principal shall work with the parents, staff and student to ensure that an appropriate Return to School strategy is in place.
- The Principal or designate shall ensure that the teaching staff involved with the student are informed of the Return to School Plan and the need for possible accommodations. Staff can also help by observing changes in a student, including symptoms that may be worsening.
- The classroom teacher(s) shall implement any educational accommodations (as deemed appropriate by the Principal or designate) as the student suffering from a concussion returns to school.
- In consultation with the in-school team or the multi-disciplinary team, when appropriate, the Principal may direct further supports for the student or that an Individual Education Plan be developed for a student who is suffering from a concussion.
- The Principal or designate shall liaise with the student, staff and parents to monitor the Return to School Plan and adjust accommodations as required until the student has successfully resumed normal activity.
- At any time during the Return to School Plan, the student and/or parent/guardian must advise the school if the student experiences a return of any concussion symptoms so that the plan may be modified accordingly and, where appropriate, a medical examination may be required.
Appendices
Appendix A: Common Signs and Symptoms of a Concussion
Appendix E: Medical History and Informed Consent
Appendix F: Tool to Identify a Suspected Concussion
Appendix G: Return to School Plan
Appendix H: Assessment Form
Appendix I: Clearance Form
References
Government of Ontario – Rowan’s Law: Concussion Awareness Resources:
Parachute.ca – Canada’s national charity dedicated to injury prevention:
Policy 2.1.36 – Concussion Management:
Policy/Program Memorandum No.158 – School Board Policies on Concussion: