The recognition and treatment of athletes who have suffered a concussion has become a national priority.  An increasing number of studies have revealed that concussions, not properly treated, can result in permanent physical and cognitive deficits.

Recovery from a concussion requires limitation of physical activity, especially sports activity, and physical education activities.  In significantly symptomatic students, mental activity should also be limited to allow the brain time to heal.  In light of this information,

Georgetown Public Schools seeks to provide a safe return to activity for all students after a concussion and has developed the following policy.

Training Program

1. The following persons annually shall complete one of the head injury safety training programs approved by the Department as found on the Department’s website:

1.      Coaches;

2.      Certified athletic trainers;

3.      Trainers;

4.      Volunteers;

5.      School and team physicians;

6.      School Nurses;

7.      Athletic Directors;

8.      Directors responsible for a school marching band, whether employed by a school or school district or serving in such capacity as a volunteer;

9.      Parents of a student who participates in an extracurricular athletic activity; and

10.  Students who participate in an extracurricular athletic activity.

2. The required training applies to one school year and must be repeated for every subsequent year.
 
3. Georgetown Public Schools will maintain a record of completion of annual training for all persons specified by 105 CMR 201.007(A) through:

1.      a certification of completion for any Department-approved on-line course; or

2.      a signed acknowledgement that the individual has read and understands Department-approved written material required by 105 CMR 201.008 (A)(1).

4. Game officials shall complete one of the training programs approved by the Department as specified on the Department’s website annually and shall provide independent verification of completion of the training requirement to schools or school districts upon request.

Participation Requirements for Students and Parents

1.  Pre-participation Requirements.

1.      Each year, Georgetown Public Schools shall provide current Department-approved training, written materials or a list and internet links for Department-approved on-line courses to all student who plan to participate in extracurricular activities and their parents in advance of the student’s participation.

2.      All students who plan to participate in extracurricular athletic activities and their parents shall satisfy the following pre-participation requirements:

a)      Each year, before the student begins practice or competition, the student and the parents shall:  complete current Department-approved training regarding head injuries and concussions in extracurricular athletic activities and provide the school with a signed acknowledgement that they have read and understand Department –approved written materials.

b)      Before the start of every sport season, the student and the parent shall complete and submit a Pre-participation form (included as part of the registration), signed by both, which provides a comprehensive history with up-to-date information relative to concussion history; any head, face or cervical spine injury history, and any history of co-existent concussive injuries.

2.  Ongoing Requirements 

If a student sustains a head injury or concussion during the season, but not while participating in an extracurricular athletic activity, the parent shall complete the Report of Head Injury Form, and submit it to the coach, athletic trainer or school nurse.

      Documentation and Review of Head Injury and Concussion History and Forms

A.    The school shall ensure that all forms or information from all forms that are required by 105 CMR 201.000 are completed and reviewed in a timely manner:

1.                  All pre-participation and Report of Head Injury Forms so as to identify students who are at greater risk of repeated head injuries by:

a.       athletic trainer, and

b.      coaches. 

2.                  All Pre-participation Forms which indicate a history of head injury and Report of Head Injury Forms, by:

a.       the school nurse, and

b.      the school physician if appropriate.  

3.      Accurate, updated information regarding each athlete who has reported a history of head injury or a head injury during the sports season by:

a.       athletic trainer, and

b.      school nurse

B.      The school may use a student’s history of head injury or concussion as a factor to determine whether to allow the student to participate in an extracurricular athletic activity or whether to allow such participation under specific conditions or modifications.

Exclusion from Play/Re-entry Process to School

1.  Any student, who during a practice or competition, sustains a head injury or suspected concussion, or exhibits signs and symptoms of a concussion, or loses consciousness, even briefly, shall be removed from the practice or competition immediately and may not return to the practice or competition that day.
 
2. The student shall not return to practice or competition unless and until the student provides medical clearance and authorization as specified in 105 CMR 201.011.
 
3. The coach/athletic trainer shall communicate the nature of the injury directly to the parent in person or by phone immediately after the practice or competition in which a student has been removed from pay for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness.  The coach/athletic trainer also must provide this information to the parent in writing, whether paper or electronic format, by the end of the next business day.
 
4. The coach/athletic trainer 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 consciousness.
 
5. Each student who is removed from practice or competition and subsequently diagnosed with a concussion shall have a written graduated reentry plan for return to full academic and extracurricular athletic activities.

1.      The plan shall be developed with input from the following, as appropriate:

a.       the student’s teachers,

b.      the student’s guidance counselor,

c.       school nurse

d.      athletic trainer

e.       parent

f.       IEP team,

g.      in consultation with the student’s primary care provider or the physician who made the diagnosis or who is managing the student’s recovery. 

2.       The written plan shall include instructions for students, parents and school personnel, addressing but not be limited to:

a.       Physical and cognitive rest as appropriate;

b.      Graduated return to extracurricular athletic activities and classroom studies as appropriate, including accommodations or modifications as needed;

c.       Estimated time intervals for resumption of activities;

d.      Frequency of assessments, as appropriate, by the school nurse, primary car physician, certified athletic trainer, and school physician until full return to classroom activities and extracurricular athletic activities are authorized; and

e.       A plan for communication and coordination between and among school personnel and between the school, the parent, and the student’s primary care provider or the physician who made the diagnosis or who is managing the student’s recovery.

3.       The student must be completely symptom free and medically cleared as defined in 105 CMR 201.011 in order to begin graduated reentry to extracurricular athletic activities.

Medical Clearance and Authorization to Return to Play

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 Trainer, a Department Post Sports-Related Head Injury Medical Clearance and Authorization Form (Medical Clearance and Authorization Form), or appropriate doctor’s note, 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.

1. Only the following individuals may authorize a student to return to play:

1.      A duly licensed physician;

2.      A duly licensed certified athletic trainer in consultation with a licensed physician;

3.      A duly licensed nurse practitioner in consultation with a licensed physician or;

4.      A duly licensed neuropsychologist in coordination with the physician managing the student’s recovery.

Responsibilities of the Athletic Director

1.  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.
 
2. The Athletic Director shall complete the annual training as required by 105 CMR 201.007.
 
3. The Athletic Director shall be responsible for:

1.      Ensuring that the training requirements for staff, parents, volunteers, coaches and students are met, recorded, and records are maintained in accord with 105 CMR 201.016;

2.      Ensuring that all students meet the physical examination requirements consistent with 105 CMR 200.000:  Physical Examination of School Children prior to participation in any extracurricular athletic activity;

3.      Ensuring that all students participating in extracurricular athletic activities have completed and submitted Pre-participation Forms, prior to participation each season;

4.      Ensuring that student Pre-participation Forms are reviewed according to 105 CMR 201.009(A);

5.      Ensuring the Report of Head Injury Forms are completed by the parent or coach and reviewed by the coach, school nurse, certified athletic trainer and school physician as specified in 105 CMR 201.009(A); and

6.      Reporting annual statistics to the Department in accord with 105 CMR 201.017. 

Responsibility of Coaches

1.  Coaches shall be responsible for:

1.      Completing the annual training as required by 105 CMR 201.007;

2.      Reviewing Pre-participation Forms so as to identify athletes who are at a greater risk for repeated head injuries;

3.      Completing a Report of Head Injury Form upon identification of a student with a head injury or suspected concussion that occurs during practice or competition;

4.      Receiving and reviewing forms that are completed by a parent 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 forms in (3) and (4) above to the athletic trainer and school nurse for review;

6.      Teaching techniques aimed at minimizing sports-related head injury;

7.      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; and

8.      Identifying athletes with head injuries or suspected concussions that occur in practice or competition and removing them from play.  

2.  Coaches are responsible for communicating promptly with the parent of any student removed from practice or competition as directed in 105 CMR 201.010(C) and with the athletic trainer and school nurse as directed in 105 CMR 201.010(D).

Responsibilities of the Certified Athletic Trainer

The certified athletic trainer 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 201.007;
 
3. Reviewing information from Pre-participation Forms, which indicate a history of head injury, Report of Head Injury Forms and forms from parents that indicate a concussion outside of extracurricular activities, to identify students who are at greater risk of repeated head injuries;
 
4. Promptly transmitting forms in (C) above to the school nurse for review and maintenance in the student’s health record.
 
5. Identifying athletes with head injuries or suspected concussions that occur in practice or competition and removing them from play; and
 
6. Participating, as appropriate, in the graduated reentry planning and implementation for students who have been diagnosed with a concussion.

201.015:  Responsibilities of the School Nurse

The School Nurse 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 MCR 201.007;
 
3. Reviewing completed Pre-participation Forms that indicate a history of head injury and following up with parents as needed prior to the student’s participation in extracurricular athletic activities;
 
4. Reviewing Report of Head Injury Forms and following up with the coach, athletic trainer and parent as needed;
 
5. Maintaining:
1. Pre-participation Forms that indicate a history of head injury; and
2. Report of Head Injury Forms, in the student’s health record;
 
6. 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 health care plan as needed;
 
7. Monitoring recuperating students with head injuries and collaborating with the team to promote the effectiveness of the graduated reentry plan for return to full academic and extracurricular athletic activities required by 105 CMR 201.010(E); and

8. Providing ongoing educational materials on head injury and concussion to teachers, staff and students.

Record Maintenance

1. 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 training and receipt of materials;

2.      Department Pre-participation Forms with history of head injury;

3.      Department Report of Head Injury Forms;

4.      Department Medical Clearance and Authorization Forms or appropriate physician note; and

5.      Graduated reentry plans for return to full academic and extracurricular athletic activities.

2. The school shall make those records available to the Department and the Department of Elementary and Secondary Education, upon request or in connection with any inspection or program review.

Reporting

Starting school year 2011-2012, schools shall be responsible for maintaining and reporting annual statistics on a Department form or electronic format that at a minimum report:

1. The total number of Department Report of Head Injury Forms received by the schools; and

2. The total number of students who incur head injuries and suspected concussions when engaged in any extracurricular athletic activities.

SOURCE:  MASC  February 2011   

Adopted On:  February 9, 2012