Administrative Procedure 366
AP 366 - Concussions
Palliser Regional Schools recognizes the importance of the health, safety and overall well-being of its students and is committed to taking steps to reduce the risk of injury. Research demonstrates that a concussion can have a significant impact on a student - cognitively, physically, emotionally, and socially. In fact, research shows that activities that require concentration can actually cause a student's concussion symptoms to reappear or worsen. Without identification and proper management, a concussion can result in permanent brain damage and in rare occasions, even death. Research also suggests that a child or youth who suffers a second concussion before he or she is symptom-free from the first concussion is susceptible to a prolonged period of recovery, and possibly Second Impact Syndrome - a rare condition that causes rapid and severe brain swelling and often catastrophic results. It is equally important to help students as they "Return to Learn" in the classroom as it is to help them "Return to Physical Activity."
Palliser Regional Schools recognizes children and adolescents are among those at greatest risk for concussions and that while there is potential for a concussion any time there is body trauma, the risk is greatest during activities where collisions can occur, such as during physical education classes, playground time, school-based sports activities or field trips. Educators and school staff play a crucial role in the identification of a suspected concussion as well as the ongoing monitoring and management of a student with a concussion. Awareness of the signs and symptoms of concussion and knowledge of how to properly manage a diagnosed concussion is critical in a student's recovery and is essential in helping to prevent the student from returning to learning or physical activities too soon and risking further complications. Ultimately, the awareness and knowledge could help contribute to the student's long-term health and academic success.
Palliser Regional Schools has produced these concussion procedures as part of its operating guidelines. These procedures which are based on current research evidence and knowledge contain information on concussion prevention, symptoms and signs of a concussion, response procedures for a suspected concussion, and management procedures for a diagnosed concussion, including a plan to help a student return to learning and to physical activity.
The contents of this Palliser Regional Schools concussion procedure are the minimum standard that must be implemented and followed by administrators, educators, school staff, students, parents and school volunteers to assist them in:
- Understanding their respective role and responsibilities described in these concussion procedures
- Understanding the seriousness of concussions, its causes, the signs and symptoms;
- Minimizing the occurrence of a concussion through implementation of strategies for preventing and minimizing the risk of sustaining concussions;
- Following the steps for safe removal of an injured student from activity, responding appropriately to a suspected concussion, for identification of a suspected concussion, and steps to take following an initial diagnosis
- Following management procedures for a diagnosed concussion, including the Return to Learn/ Return to Physical Activity Plan;
- Attending/ completing appropriate training to remain informed of the concussion procedures.
A concussion is:
- is a brain injury that causes changes in how the brain functions, leading to symptoms that can be physical (e.g., headache, dizziness), cognitive (e., difficulty concentrating or remembering), emotional/behavioural (e.g., depression, irritability) and/or related to sleep (e.g., drowsiness, difficulty falling asleep);
- may be caused either by a direct blow to the head, face or neck, or a blow to the body that transmits a force to the head that causes the brain to move rapidly within the skull;
- can occur even if there has been no loss of consciousness (in fact most concussions occur without a loss of consciousness); and,
- cannot normally be seen on X-rays, standard CT scans or MRIs.
Concussion is the term for a clinical diagnosis that is made by a medical doctor or a nurse practitioner. Since a medical doctor or nurse practitioners are the only health professionals able to diagnose concussions, educators, school staff, or volunteers cannot make the diagnosis of concussion. In the best interest of the child it is critical that a medical doctor or nurse practitioner examine a student with a suspected concussion. Without medical documentation the student's participation in learning or physical activities will be restricted. This decision resides with the school Principal.
Note: It should also be noted that injuries that result from a second concussion may lead to "Second Impact Syndrome", which is a rare condition that causes rapid and severe brain swelling and often catastrophic results, if an individual suffers a second concussion before he or she is free from symptoms sustained from the first concussion.
Prevention and Minimizing the Risk of Concussions:
Education is the prime factor in supporting the prevention of a concussion. Any time a student/athlete is involved in physical activity there is a chance of sustaining a concussion. Therefore, it is important to take a preventative approach when dealing with concussions.
Prior to the activity school staff (includes administration staff, teaching staff, support staff, coaches, volunteers, etc.) must meet with participants to provide instruction on strategies for preventing and minimizing the risk of sustaining a concussion and other head injuries.
Summary of Return to Learn/Return to Physical Activity Plan:
The Return to Learn/Return to Physical Activity Plan is a collaborative effort between home and school to support the student's progress through the plan following a diagnosed concussion. Table 1 shows a summary of this plan. Refer to the form Documentation for a Diagnosed Concussion - Return to Learn & Return to Physical Activity Plan for detailed directions.
The 6 Step Plan is necessary and identifies the sequence of supporting a Return to Learn priority prior to a Return to Physical Activity focus. A minimum of 24 hours is necessary for EACH step. There is no set timeline for a student's progression through each of the steps.
Table 1: Summary of Steps for Return to Learn/Return to Physical Activity
Return to Learn/Return to Physical Activity - Step 1
· Completed at home; student requires cognitive and physical rest
· If symptom free, student may go directly to Return to Learn Step 2b and Return to Physical Activity Step 2
Return to Learn - Step 2a
· Symptoms improving
· Return to school with monitored re-integration to classroom and cognitive effort; and Physical Rest
Return to Learn - Step 2b
Note: Return to Learn Step 2b and Return to Physical Activity Step 2 occur concurrently
· Symptom free
· Return to regular school routine and learning activities
Return to Physical Activity - Step 2
· Light aerobic physical activity and regular learning activities
Return to Physical Activity - Step 3
· Begin sport specific type of physical activities
Return to Physical Activity - Step 4
· Greater range of physical activity options permitted, but no body contact
Return to Physical Activity - Step 5
· Full participation in all non-contact type physical activities, and return to training in contact sports
Return to Physical Activity - Step 6
· Full participation, no restrictions
If after Return to Learn Step 2a, concussion symptoms return, the student will return to the designated step as directed by the physician - this may include return to step 1.
- Perform a regular review of the Administrative Procedure for Concussion to ensure guidelines align with current best practice recommendations;
- Ensure that information on the Administrative Procedure for Concussion is shared with the greater school community, including organizations that use the school facilities, such as community sports organizations and licensed child-care providers operating in schools of the Board;
- Share concussion prevention, identification and management information with students and their parents/guardians;
- Abide by the Administrative Procedure for Concussion;
- Ensure staff, volunteers, parents/guardians, and students are aware of the Administrative Procedure for Concussion and understand their roles and responsibilities;
- Ensure the Administrative Procedure for Concussion is followed by all school staff (including occasional staff/support staff, recess supervisors), parents/guardians, students, and volunteers;
- Facilitate attendance and/or completion of concussion in-servicing/training for staff and coaching volunteers, and repeat as necessary;
- Ensure Administrative Procedure for Concussion documentation is readily available to all school staff and volunteers;
- Oversee that the "Physical Activity Letter to Parents/Guardians," the "Medical Information Form", and the appropriate "Permission and Acknowledgement of Risk Form" is distributed to all parents/guardians, collected by the school and remind all staff the form must be completed prior to student participation in any physical activity, physical education class, off-site activity, school intramural program, or interschool program;
- Ensure that all incidents are recorded, reported and filed as required by this Administrative Procedure, as appropriate, and with Palliser online incident report forms;
- Prior to student return to school, ensure completion and collection of the following documentation (forms can be found on the Palliser website):
- Documentation of Monitoring/Medical Examination Form
- Documentation for a Diagnosed Concussion - Return to Learn / Return to Physical Activity Plan Form is completed and signed by Parents/Medical Doctor/Nurse Practitioner as needed, as student progresses through each step
- File the above documents in the student's file and provide copy to appropriate school staff;
- Alert appropriate staff about students with a suspected or diagnosed concussion;
- Work as closely as possible with students, parents/guardians, staff, volunteers, and health professionals to support concussed students with their recovery and academic success;
- For students who are experiencing difficulty in their learning environment as a result of a concussion, coordinate the development of an Individual Learning Plan, using Table 1: Return to Learn Strategies/Return to Physical Activity and approve any adjustments to the student's schedule as required;
- Attempt to obtain parental/guardian cooperation in reporting all non-school related
School Staff (Includes administration staff, teaching staff, support staff, coaches, volunteers, etc.) will:
- Understand and follow the Administrative Procedure for Concussion;
- Attend and complete concussion training (e.g. staff meeting, online, workshop, read Administrative Procedure for Concussion package, )
- Prior to students participation in school, physical education, off-site activities, or intramural programs ensure the following documentation has been adequately administered and signed by parents where required:
- Physical Activity Letter to Parents/Guardians
- Medical Information Form and Acknowledgement of Risk for School/Physical Education/ Intramurals and Clubs
- Prior to students participating in Interschool Athletics ensure the following documentation has been adequately administered and signed by parents where required, once per year:
- Physical Activity Letter to Parents/Guardians
- Permission and Acknowledgement of Risk - Interschool Athletics
- Implement risk management and injury prevention strategies specific to each sport/activity;
- Provide concussion educational materials to students and athletes;
- Be able to recognize signs, symptoms and respond appropriately in the event of a suspected concussion;
- Be familiar with the resources:
- Concussion Guidelines for Teachers o Concussion Guidelines for Coaches
- Concussion Recognition Tool
- Be able to use the Concussion Recognition Tool;
- If a concussion is suspected, fill out and send the Documentation of Concussion Monitoring Medical Examination form home to parent/guardian. This form must be returned to the school signed by the parent/guardian prior to a student re-engaging in physical activity;
- When a student concussion has occurred, implement and track the Documentation for a Diagnosed Concussion - Return to Learn/Return to Physical Activity form. This should be done in conjunction with the school Principal;
- Provide the following resources to parents and students as educational and treatment information as required:
- Concussion Recognition Tool
- Concussion Guidelines for Athletes
- Concussion Guidelines for Parents
- Parent Guide to Dealing with Concussions;
- Ensure the appropriate content from this Administrative Procedure for Concussion is included in teacher lesson plans and that the appropriate forms are carried on field trips and athletic events;
- Make sure that occasional teaching staff is updated on concussed student's condition.
- Reinforce concussion prevention strategies with their child (e.g. following rules of fair play, playground safety rules, wearing properly fitted helmets, using equipment safely);
- Understand and follow parents/guardian roles and responsibilities in the Administrative Procedure for Concussion;
- In the event of a suspected concussion, ensure child is assessed as soon as possible by medical doctor/nurse practitioner;
- Be responsible for the completion of all required documentation;
- Collaborate with school to manage suspected or diagnosed concussions appropriately;
- Follow physician/nurse practitioner recommendations to promote recovery;
- Cooperate with school to facilitate concussion diagnosis and treatment and support their child's progress through the Documentation for Diagnosed Concussion - Return to Learn /Return to Physical Activity Form;
- Report non-school related concussion to principal (Documentation for Diagnosed Concussion Return to Learn/Return to Physical Activity plan forms will apply);
- Learn about concussions, including prevention strategies, signs and symptoms, concussion management and student roles and responsibilities, throughout applicable curriculum, coaches modules, and safety lessons connected to personal safety and injury prevention;
- Immediately inform school staff of suspected or diagnosed concussions occurring during or outside of school;
- Inform school staff if they experience any concussion related symptoms (immediate, delayed or reoccurring);
- Remain on school premises until parent/guardian arrives if concussion is suspected;
- Follow concussion management strategies as per medical doctor/nurse practitioner direction and Diagnosed Concussion Return to Learn / Return to Physical Activity plan;
- Communicate concerns and challenges during recovery process with school lead, school staff, parents/guardians, and health care providers.