GRADES 7-12 

Purpose

This policy provides for the implementation of MA 105 CMR 201.000, Head Injuries and Concussions in Extracurricular Athletic Activities. The policy applies to all public middle and high school students who participate in any extracurricular athletic activity, including marching band. As designated by the Superintendent, the Athletic Director is responsible for implementing this policy in accordance with MA 105 CMR 201.000. This policy provides the procedures and protocols for the Falmouth Public Schools in the prevention and management of sports-related head injuries occurring in extracurricular athletic activities. Review and revision of this policy is required every two years, by the FPS administration, guidance, athletic director and medical staff. Any changes or modifications will be given to the school committee for approval.

The Falmouth Public Schools (FPS) seeks to provide a safe return to activity for all students after injury, particularly after a concussion. In order to effectively and consistently manage these injuries, procedures have been developed to aid in ensuring that concussed athletes are identi fied, treated and referred appropriately, receive appropriate follow-up medical care during the school day, including academic assistance, and are fully recovered prior to returning to activity.

Goals

• to make a commitment to the health and safety of our district students with prevention education and outreach that focuses on utilizing strategies that reinforce safe playing techniques and the importance of properly fitted/well maintained equipment for our student athletes
• to increase concussion awareness to all members of the school community, specifically how this head injury impacts the school aged child
• to prevent the potential cumulative and/or catastrophic consequences of a second concussion in the significantly vulnerable student who has not fully recovered from an initial concussion
• to identify appropriate school team members and essential communication strategies to support and advocate for the student recovering from a concussive injury

Concussion Overview

A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Concussions can also result from a fall or from players colliding with each other or obstacles on the playing field. Contrary to previously thought, an athlete does not have to be knocked unconscious in order to sustain a concussion.

A concussion - also known as a traumatic mild brain injury - changes how the cells in the brain normally work. The immediate effect of a concussion is a disruption of the sodium/potassium pump necessary for intracellular health. This leads to a release of glutamate (an excitatory amino acid 40 to 60 times greater in high school versus college athletes) which over the next 2 to 7 days leads to a marked (50%) decrease in cerebral blood flow.

Recognition of Concussion

Depending on the severity of the concussive blow, the area of the brain affected, and the neurological pathways involved, the symptoms will vary:

• Symptoms noted by the injured student: headache or "pressure" in head; nausea or vomiting; balance problems or dizziness; double or blurry vision; sensitivity to light; sensitivity to noise; sleep pattern disturbance, feeling sluggish, hazy, foggy or groggy; concentration or memory problems; confusion; and/or does not "feel right"
• Symptoms observed by the coaching staff: loss of consciousness (occurs in only 10% of concussive injuries); shows behavior or personality change(s); can't recall events prior to the hit, bump, or fall; can't recall events after the hit, bump, or fall; appears dazed or stunned; is confused about assignn1ent or position; moves clumsily; forgets sports plays; and/or is unsure of game score (or opponent)
• Symptoms observed by teaching staff: appears dazed or stunned; is confused about events; answers questions slowly; repeats questions; shows behavior or personality changes; forgets class schedule or assignn1ents; may have difficulty following directions; may be disorganized; may have dropping grades; may not have homework done (completely); may have difficulty remembering; and/or may have spotty attendance
• A concussed student may look: sleepy, exhausted; distracted, zoned out and/or inattentive; slow to respond; confused; overwhelmed; emotional/sad; irritable; defiant and/or inappropriate; moves clumsily; answers questions slowly; and/or shows behavior or personality 

Post-Concussion Syndrome

Although the majority of athletes who experience a  concussion  are  likely  to  recover,  an  unlmown number of these individuals may experience clU'onic cognitive and neurobehavioral difficulties related to recurrent injury. Symptoms may include: chronic headaches,  fatigue,  sleep  difficulties,  personality changes (e.g. increased irritability, emotionality), sensitivity to light or noise, dizziness when standing quickly, and/or deficits in short-term memory, problem solving and general academic functioning. This constellation of symptoms is referred to "Post-Concussion Syndrome" and can be quite disabling for a student. In some cases, such difficulties can be permanent and disabling.

In addition to Post-Concussion Syndrome, suffering a second blow to the head while recovering from an initial concussion can have catastrophic consequences as in the case of "Second Impact Syndrome," which has led to approximately 30-40 deaths over the past decade.

Concussion Management Guidelines

At the forefront of proper concussion management is the implementation of baseline and/or post-injury neurocognitive testing (ImPACT). ImPACT evaluates multiple aspects of neurocognitive function, including memory, attention, processing speed, reaction time, and concussion symptoms. Such evaluation can help to objectively evaluate the concussed student's post-injury condition and track recovery for the safe return to play - as well as the appropriate time to return to a full academic workload thus preventing the cumulative effects of concussion. In fact, neurocognitive testing has recently been called the "cornerstone" of proper concussion management by an international panel of sports medicine experts. All students participating in Falmouth High School Athletics are required to take a baseline ImPACT test prior to participation in sports.

Exclusion from Play

• Any student, who during a practice or competition, sustains a head injury or suspected concussion, or exhibits signs and symptoms of a concussion, shall be removed from the practice or competition immediately and may not return to the practice or competition on that day. Coaches should reach out to the school's Certified Athletic Trainer, when available, to make an evaluation on the athlete.
• The student shall not return to practice or competition without full medical documentation/clearance. 

Concussion Treatment

The goal of concussion treatment is to allow the brain injury to heal. The treatment of concussions differs depending on the level of severity. Concussion treatment may include:

• Physical and Cognitive Rest - provide adequate time for recovery from a Do not rush back into daily activities for work or school
• Preventing re-injury - avoid activities that might jolt or jar your Never return to a sports activity until your doctor has given you clearance. Ask when it's safe to drive a car, ride a bike, work or play at heights, or use heavy equipment
• Ongoing medical assessment - to track/monitor the recovery process
• Follow-up Post-Concussion ImPACT Testing - as medically indicated, to track symptom resolution and neurocognitive recovery
• Periodic Concussion Assessment by the School Nurse as necessary and periodic evaluation as requested by the Certified Athletic Trainer

Concussion Recommendations for Return to Play

According to the 2017 Berlin Concussion in Sport Group Consensus Statement (https://bjsm.bmj.com /content/52/10/635) athletes who have been diagnosed with concussion, may only return to sport after:

• Concussion related symptoms, at rest and with match-intensity exercise, have returned to baseline levels;
• Neurological examination (including baseline testing) is normal; and
• Cognitive testing (computerized and/or pencil-and-paper) has returned to baseline or age­ appropriate

The Falmouth Public Schools' multidisciplinary team will develop an individualized plan for the student's return to play - this team may consist of the Certified Athletic Trainer, School Nurse, School Physician, and the student's Primary Care Physician. The student must be symptom free at rest and medically cleared in order to return to practice/play. A medical clearance authorizing a return to play may be obtained from: a duly licensed physician; a duly licensed nurse practitioner in consultation with a licensed physician; or a duly licensed neuropsychologist in coordination with the duly licensed physician managing the student's recovery.

Note: the final return/clearance to play at the high school level requires the approval of the Certified Athletic Trainer; and the final return/clearance to play at the intramural level requires the approval of the building School Nurse

Falmouth return to play procedure includes:

• Impact Test back to baseline
• Day 1: 20 minutes of cardiovascular exercise under supervision of ATC
• Day 2: 20 minutes and sp01is specific drills under supervision of ATC
• Day 3: Return to team without contact
• Day 4: Full return

Responsibilities of School Staff

The following persons shall complete the annual training as required by 105 CMR 201.007:

• Coaches;
• Licensed Athletic Trainers;
• Volunteers;
• School and team physicians;
• School nurses;
• Athletic Directors;
• Directors responsible for a school marching band, whether employed by a school or school district or serving in such capacity as a volunteer;
• Parents/Guardians of a student who participates in an extracurricular athletic activity; and
• Students who participate in an extracurricular athletic

Responsibilities of the Athletic Director

The Athletic Director shall participate in the development and biannual review of the policies and procedures required by 105 CMR 201.006 for the prevention and management of sports-related head injuries within the school district or school.

1. The Athletic Director shall complete the annual training as required by 105 CMR 007.
2. The Athletic Director shall be responsible for:
   1. Ensuring that approved training requirements for staff, parents, coaches, game officials, students, and volunteers are met, recorded, and records are maintained in accord with 105 CMR 201.016; documentation of such training/certificate of completion (by Athletic Department Staff) shall be provided to the Athletic Director annually.
   2. Documentation of physical examination prior to a student's participation in extracurricular athletic activities on an annual basis, consistent with 105 CMR 200.100(B)(3) and information for students participating in multiple sports seasons that documentation of one physical examination each year is sufficient;
   3. Ensuring that all students participating in extracurricular athletic activities have completed and submitted all *Mandatory Student Athlete Forms prior to participation each season;
   4. Ensuring that all *Mandatory Student Athlete Forms are reviewed according to 105 CMR 009(A);
   5. Ensuring that the Student Concussion History Forms are completed by the parent/guardian or coach and reviewed by the coach, school nurse, certified athletic trainer and school physician as specified in 105 CMR 20 l .009(A);
   6. Ensuring that athletes are prohibited from engaging in any unreasonably dangerous athletic technique that endangers the health or safety of an athlete, including using a helmet or any other sports equipment as a weapon;
   7. Scheduling - 3 times annually - a mandatory Parent/Guardian and Student Athlete Sports Night prior to the start of each extracurricular athletic season to review the Falmouth Public Schools Concussion Education/Management Program; and
   8. Reporting annual statistics to the Department in accordance with 105 CMR 017. (to be co-managed with the School Nurse Leader).

*Mandatory Student Athlete Forms consist of the following: Pre-participation Form, Student Concussion History Form, Student Athlete Emergency Card, and for Grades 7 and 8 only, the Interval Health History Form. These forms can be found attached to this policy, as well as on Family ID (in digital format) when the student is signing up to participate in the athletic program.

Responsibilities of Coaches

Coaches shall be responsible for:

1. Completing the annual training as required by 105 CMR 007;
2. Reviewing Mandatory Student Athlete Forms so as to identify those athletes who are at greater risk for repeated head injuries;
3. Completing an Accident/Illness Report upon identification of a student with a head injury or suspected concussion that occurs during practice or competition; please refer to the district's Injury Reporting Procedure
4. Receiving and reviewing the Student Concussion History Forms - completed by a parent/guardian - which report a head injury during the sports season, but outside of an extracurricular athletic activity, so as to identify those athletes who are at greater risk for repeated head injuries;
5. Promptly transmitting the Student Concussion History Forms (to be maintained in the student's health record), and/or the Accident/Illness Reports (to be maintained in a secure location in the school health office) to the School Nurse for review per 105CMR 201.013(A)(2) and (3); and
6. Discouraging and prohibiting athletes from engaging in any unreasonably dangerous athletic technique that endangers the health or safety of an athlete, including using a helmet or any other sports equipment as a weapon; assure that players wear approved and properly fitted/well maintained protective equipment; discussion with students about the dangers of concussion as well as potential consequences of concussive injuries; and
7. Identifying athletes with head injuries or suspected concussions that occur in practice or competition and removing them from play.

C. The coach shall communicate the nature of the injury directly to the parent/guardian in person or by phone immediately after the practice or competition in which a student has been removed from play for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness. The coach also must provide this information to the parent/guardian in writing, whether paper or electronic format, by the end of the next business

D. The coach shall communicate, by the end of the next business day, with the Athletic Director and school nurse that the student has been removed from practice or competition for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of

E. All Mandatory Student Athlete Forms must be reviewed each season by the coaching staff before a student athlete is allowed to participate in any extracurricular athletic activity.

Responsibilities of the Certified Athletic Trainers

Certified athletic trainers shall be responsible for:

1. Participating in the development and biannual review of the policies and procedures required by 105 CMR 201.006 for the prevention and management of sports-related head injuries within the school district or school;
2. Completing the annual training as required by 105 CMR 007;
3. Reviewing information from Mandatory Student Athlete Forms, including the Pre­ Participation Form, which indicate a history of head injury (Student Concussion History) and from Accident/Illness Forms, to identify students who are at greater risk for repeated head injuries;
4. Identifying athletes with head injuries or suspected concussions that occur in practice or competition and removing them from play;
5. Participating - in collaboration with the School Nurse, student's Primary Care Physician, parent(s)/guardian(s) and teachers (when appropriate) - with the graduated reentry planning and implementation for students who have been diagnosed with a concussion - refer also to sections below on Exclusion from Play and Return to Play;
6. The Certified Athletic Trainer is responsible for following up with the Athletic Director and School Nurse regarding any student removed from practice or competition as directed in 105 CMR 201.010(D) - this would also include the prompt submission of a completed Accident/Illness

Responsibilities of the School Nurse

The School Nurse shall be responsible for:

1. Participating in the development and bimmual review of the policies and procedures required by 105 CMR 201.006 for the prevention and management of sports-related head injuries within the school district or school;
2. Completing the annual training as required by 105 CMR 007; the documentation of such training/certificate of completion shall be provided to the School Nurse Leader annually;
3. Reviewing - or arranging for the school physician to review - completed Mandatory Student Athlete Forms, including the Pre-Participation Form, that indicate a history of head injury and following up with parents/guardians as needed prior to the student's participation in extracurricular athletic activities;
4. Reviewing - or arranging for the school physician to review - Accident/Illness Forms - and following up with the coaching staff and the parent(s)/guardian(s) as needed;
5. Maintaining (1) Student Concussion History Forms in the student's health record; and (2) Accident/Illness Forms in a secure location within the school health office;
6. Initiating and maintaining an Individualized Health Care Plan (IHCP) for any student diagnosed with a concussive injury;
7. Initiating Post-Concussion ImPACT Testing when indicated/requested by the physician managing the student's recovery;
8. Participating in the graduated reentry planning for students who have been diagnosed with a concussion to discuss any necessary accommodations or modifications with respect to academics, course requirements, homework, testing , scheduling and other aspects of school activities consistent with a graduated reentry plan for return to full academic and extracurricular athletic activities after a head injury and revising the IHP as needed;
9. Monitoring recuperating students with head injuries during the school day as necessary , while providing ongoing feedback to the student's parent(s)/guardian(s) - keeping the lines of communication open during the recovery process;
10. Collaborating with student's parent(s)/guardian(s), Primary Care Physician, teachers, and Certified Athletic Trainer to ensure that the graduated reentry plan for return to full academic and extracurricular athletic activities required by 105 CMR 010(E) is being followed; and
11. Providing ongoing educational materials on head injury and concussion to teachers, staff and students; staff trainings will be presented annually by district Health Services' personnel

The School Nurse will be responsible for:

1. Observing students for signs and symptoms of a concussion; completing a Concussion Signs and Symptoms Checklist during this time/throughout the recovery period; initiating an IHCP for any student diagnosed with a concussive injury;
2. Notifying the student's parent(s)/guardian(s) that their child has had an injury to the head; instructing parent(s)/guardian(s) re the signs and symptoms of a concussion;
3. Completing/filing the Accident/Illness Report;
4. Referring the student immediately to their primary care physician; activating EMS immediately if any deterioration in condition is noted during the assessment; the student should not retum to sports or recreational activities on the day of the injury. Note: Students must provide written documentation/medical orders from their primary care physician regarding a graduated return to school and physical activity (physical activity includes Physical Education class, recess, sports practices and/or competitive play)
5. Informing the student's guidance/teaching staff of the injury; instructing the teaching staff to return the student for follow-up evaluation if/when a child complains of any symptoms - physical, emotional and/or

Parent/Guardian Responsibilities:

1. Complete and return Mandatory Student Athlete Forms, including the Pre-Participation Form.
2. Inform school if student sustains a concussion outside of school Complete new concussion history form following new injury.
3. If student suffers a concussion outside of school, complete head injury fonn and return it to the school nurse.
4. Complete a training provided by the school on concussions and return certificate of completion to the athletic department.
5. Watch for changes in your child that may indicate that your child does have a concussion or that your child's concussion may be worsening. Report to a physician:
   1. Loss of consciousness
   2. Headache
   3. Dizziness
   4. Lethargy
   5. Difficulty concentrating
   6. Balance problems
   7. Answering questions slowly
   8. Difficulty recalling events
   9. Repeating questions
   10. Irritability
   11. Sadness
   12. Emotionality
   13. Nervousness
   14. Difficulty with sleeping
6. Encourage your child to follow concussion protocol.
7. Enforce restrictions on rest, electronics and screen time.
8. Reinforce recovery plan.
9. Request a contact person from the school with whom you may communicate about your child's progress and academic needs.
10. Observe and monitor your child for any physical or emotional changes.
11. Request to extend make up time for work if necessary.
12. Recognize that your child will be excluded from participation in any extracurricular athletic event if all forms are not completed and on file with the athletic department.

Responsibilities/Expectations of the High School Guidance Counselor

The High School Guidance Counselor shall be responsible for:

1. Making (and adjusting) appropriate academic accommodations as necessary for any student who has been medically diagnosed with a concussive injury;
2. Collaborating with the School Nurse, the student's teaching staff and the parent(s)/guardian(s) to assure optimal cognitive rest for the injured student athlete; the student's teaching staff will modify "work" (assignments, testing, etc.) per the medical recommendations provided; and
3. Communicating/following up with the student's parent(s)/guardian(s) re academic progress during the recovery period.

Record Maintenance

The school, consistent with any applicable state and federal law, shall maintain the following records for three years or at a minimum until the student graduates:

1. Verifications of completion of annual trainings and receipt of materials
2. All Mandatory Student Athlete Forms
3. Accident/Illness Report Forms
4. Medical Clearance and Authorization Forms
5. Graduated reentry plans for return to full academic and extracurricular athletic activities

The school shall make these records available to the Massachusetts Department of Public Health  by August 31st of each year and the Department of Elementary  and Secondary  Education,  upon request  or in connection with any inspection or program review.

The District will share an athlete's history of head injury and concussion, recuperation, reentry plan, and authorization to return to play and academic activities on a need to know basis consistent with requirements of 105 CMR 201.000 and applicable federal and state law including but not limited to the Massachusetts Student Records Regulations, 603 CMR 23.00, and the Federal Family Educational Rights and Privacy Act Regulations, 34 CFR Part 99.

To the extent practicable, the District will translate a summary of the Policy, as well as any of the required forms, into other languages spoken at home if needed.

Penalties, including but not limited to personnel sanctions and forfeiture of games, will occur for failure to comply with provisions of the district's policy.