Administrative Procedure 319: Concussion Protocol

Legal References

PPM 158 School Board Policies on Concussion

Related References

OPHEA / Parachute Canada

1. Purpose

The Avon Maitland District School Board (AMDSB) recognizes concussions as a serious injury which requires appropriate follow-up measures to reduce risk of potential additional injury.

Concussion awareness, prevention, identification and management are a priority for the Avon Maitland District School Board.

2. Responsibilities

AMDSB will:
2.1 Perform ongoing annual review of the Administrative Procedure to ensure guidelines align with current best practice recommendations and, at a minimum, Ontario Physical and Health Education Association (OPHEA) Concussion guidelines.

2.2 Create a concussion Board report (Ontario School Boards’ Insurance Exchange [OSBIE]/Appendix G, Student Concussion Diagnosis Report), to be completed by school principals, to track student concussions and record staff concussion education.

2.3 Review concussion Board reports annually to ensure compliance with and effectiveness of Administrative Procedure.

2.4 Ensure concussion education is made available to school personnel and volunteers.

2.5 Ensure concussion information and protocol is shared with organizations that use school facilities.

2.6 Implement concussion awareness and education strategies for students and their parents/guardians.

2.7 Ensure that all board staff involved in physical activity education and supervision (includes, but not limited to: recess supervision, curricular, interschool, and intramural physical activity, before and after school care), are trained on a yearly basis to recognize signs and symptoms of a suspected concussion and what immediate action to take.

2.8 Ensure that information on the Concussion Administrative Procedure is shared with the school community (such as agendas/handbooks and the AMDSB website).

2.9 Ensure each elementary and secondary school implements the Return to Learn and Return to Physical Activity plan (Appendix E).

Principal will:
2.10 Abide by the Concussion Administrative Procedure.

2.11 Ensure staff, volunteers, parents/guardians, and students are aware of the Concussion Administrative Procedure and understand their roles and responsibilities.

2.12 Ensure the Administrative Procedure is followed by all school staff (including occasional staff/support staff, parents/guardians, students, and volunteers).

2.13 Arrange for concussion in-servicing for staff and coaching volunteers.

2.14 Ensure the Concussion Recognition Tool (Appendix C) is included in occasional teacher lesson plans and field trip folders.

2.15 Share concussion information with students and their parents/guardians.

2.16 Ensure OPHEA safety guidelines are being followed.

2.17 Work as closely as possible with students, parents/guardians, staff, volunteers, and health professionals to support the recovery and academic success of concussed students.

2.18 Maintain up-to-date emergency contact and telephone numbers.

2.19 Complete concussion board report (OSBIE/Appendix G, Student Concussion Diagnosis Report) as each injury occurs or each term/semester.

2.20 Attempt to obtain parental/guardian cooperation in reporting all non-school related concussions.

2.21 Ensure concussion information is readily available to all school staff and volunteers.

2.22 Ensure that all incidents are recorded, reported and filed as required by the Administrative Procedure, and as appropriate with an OSBIE incident report.

2.23 For students who are experiencing difficulty in their learning environment as a result of a concussion, coordinate the development plan to return to learn. See Appendix B for Return to Learn Strategies/Approaches.

2.24 Approve any adjustments to the student’s schedule as required.

2.25 Alert appropriate staff about students with a suspected or diagnosed concussion.

2.26 Prior to student returning to school, ensure completion and collection of the following documentation:

2.26.1 Documentation of Medical Examination Form (Appendix D2)
2.26.2 Documentation for a Diagnosed Concussion – Return to Learn/Return to Physical Activity Plan (Appendix E)

2.27 Use discretion to cover costs associated with completing required documentation (e.g. Appendix D2 and E).
2.28 File above documents (Appendix D2 and E) and provide a copy to the appropriate school staff.
2.29 Once concussion is diagnosed, appoint a primary staff member to act as the student’s liaison to ensure adequate communication and coordination of their needs. School Staff (Includes administrative staff, teaching staff, support staff, coaches, volunteers, etc.) will:
2.30 Understand and follow the Concussion Policy and Administrative Procedure.
2.31 Attend and complete concussion training.
2.32 Be able to recognize signs, symptoms and respond appropriately in the event of a concussion. See Appendix A3: Concussion Guidelines – The Teachers/Coaches and Appendix C: Tools to Identify a Suspected Concussion.
2.33 Follow current OPHEA safety guidelines and implement risk management and injury prevention strategies.
2.34 Make sure that occasional teaching staff are updated on the concussed student’s condition.

Parents/Guardians will:
2.35 Review with your child the concussion information that is distributed through the school (e.g. learn signs and symptoms of concussion Appendix A2).
2.36 Reinforce concussion prevention strategies (e.g., player code of conduct) with your child.
2.37 Understand and follow roles and responsibilities in the Administrative Procedure.
2.38 In the event of a suspected concussion, ensure the child is assessed as soon as possible by a physician/nurse practitioner, on the same day.
2.39 Cooperate with school to facilitate Return to Learn and Return to Physical Activity.
2.40 Follow physician/nurse practitioner recommendations to promote recovery.
2.41 Be responsible for the completion of all required documentation.
2.42 Support your child’s progress through the recommended Return to Learn and Return to Physical Activity guidelines.
2.43 Collaborate with the school to manage suspected or diagnosed concussions appropriately.
2.44 Report non-school related concussions to principal (Return to Learn/Return to Physical Activity guidelines will still apply).

Students will:
2.45 Learn about concussions, including prevention strategies, signs and symptoms, concussion management and student roles and responsibilities.
2.46 Immediately inform school staff of suspected or diagnosed concussions occurring during or outside of school.
2.47 Inform school staff if you experience any concussion related symptoms (immediate, delayed or reoccurring).
2.48 Remain on school premises until a parent/guardian arrives if a concussion is suspected.
2.49 Communicate concerns and challenges during the recovery process with staff concussion liaison, school staff, parents/guardians, and health care providers.
2.50 Follow concussion management strategies as per medical doctor/nurse practitioner direction and Return to Learn/Return to Physical Activity guidelines.

Physician and/or other health care professionals:
2.51 Assist in the development of an individualized academic and physical concussion management plan.
2.52 Monitor recovery process and modify concussion management plan as required.
2.53 Complete required documentation (Appendices D2 and E).
2.54 If symptoms persist beyond 10 days, referral may be made to a brain injury specialist.

3. Concussion Awareness

3.1 Seriousness

After the death of high school student Rowan Stringer as a result of head injuries she sustained while playing rugby in May of 2013, the government passed a law known as Rowan’s Law (Concussion Safety). This new legislation, which received all-party support, is intended to protect amateur athletes by improving concussion safety on the field and at school.

3.2 A Concussion:

      • 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.g., 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);
      • cannot be seen on X-rays, standard CT scans or MRIs;
is a clinical diagnosis made by a medical doctor or nurse practitioner*
*It is critical that a student with a suspected concussion be examined by a medical doctor or nurse practitioner as soon as possible on the same day.


3.3 Additionally:

3.3.1 children and adolescents are more susceptible to concussions and take longest to recover;
3.3.2 a concussion has a significant impact on a student’s cognitive and physical abilities;
3.3.3 tasks involving concentration can cause symptoms to reappear or worsen;
3.3.4 proper management and identification are crucial so as not to cause permanent brain damage;
3.3.5 should a secondary concussion occur before a student is symptom free from the first concussion, Second Impact Syndrome is possible, resulting in a prolonged recovery and potentially catastrophic results;
3.3.6 Return to Learn Strategies AND Return to Physical Activity Plans need to be implemented and regularly monitored by a team (the concussed student, his/her parents/guardians, school staff, any volunteers who work with the student, the medical doctor/nurse practitioner and the principal) led by the school principal.

3.4 Signs and Symptoms of a Concussion:

The first step to managing a concussion is being able to recognize common signs and symptoms. A concussion should be suspected following a blow to the head, face or neck, or a blow to the body that transmits a force to the head, if one or more of the signs or symptoms of a concussion is present. Review Appendix C for a list of common signs and symptoms and complete this form. The Concussion Recognition Tool is a pocket-sized tool that can also be used to identify a suspected concussion when access to Appendix C is not convenient (e.g. on the field). Note: Appendix C will still need to be completed.
 
Note:
      • Signs and symptoms may be different for everyone
      • Signs and symptoms can appear immediately after the injury or may take hours or days to emerge
      • Concussion symptoms for younger students may not be as obvious compared to older students
      • A student may be reluctant to report symptoms because of a fear that he/she will be removed from the activity, his/her status on a team or in a game could be jeopardized or academics could be impacted
      • It may be difficult for students under (10), with special needs, or students for whom English/French is not their first language, to communicate how they are feeling
      • If student loses consciousness or signs or symptoms worsen, call 911


3.5 Curriculum Connections

Specific curriculum connections include:
Kindergarten:
Expectation 24.1: identify practices that maximize safety and lessen the risk of injury, including the risk of concussion, for themselves and others, and demonstrate an understanding of the importance of these practices.

HPE 1-8:
Strand B: Active Living
B3. Safety
Personal safety and safety of others during physical activity.

Grade 4
B3.2 describe common precautions for preventing accidents and injuries, including concussions, while participating in different types of physical activity (e.g., wearing goggles o protect the eyes when playing badminton, wearing a properly fitting helmet to protect the head, tucking in drawstrings to avoid catching them on equipment or other players, fastening all straps on a hockey sledge, staying clear of mud puddles on fields to avoid slipping) [A1.6 Thinking].

Grades 5-8
B3.1 demonstrate behaviours and apply procedures that maximize safety and lessen the risk of injury, including the risk of concussion, for themselves and others during physical activity (e.g., demonstrating personal responsibility for safety, using proper stretching techniques during cool-down activities, ensuring that their actions promote 190 HEALTH AND PHYSICAL EDUCATION, 2019 | The Ontario Curriculum, Grades 1–8 a positive emotional experience for themselves and others, reporting any equipment that is not in good working condition) [A1.4 Relationships, 1.5 Self].

HPE 9-12
Strand A: Active Living
A3. Safety
Personal safety and safety of others during physical activity.

4. Prevention

Regardless of the steps taken to prevent injury, some students will continue to be injured. The severity of the injury can be mitigated by the following:
 
    1. Education for coaches, staff, parents and students to:
      1. Recognize the symptoms of concussion;
      2. Remove the athlete from play;
      3. Refer the athlete to a medical doctor/nurse practitioner.
    2. Wearing the sport specific protective equipment:
      1. Equipment should fit properly;
      2. Equipment should be well maintained;
      3. Equipment should be worn consistently and correctly;
      4. Equipment should meet current safety standards;
      5. Damaged or expired equipment should be replaced.
    3. Follow OPHEA sport specific safety guidelines and enforce the fair play code of conduct.
    4. Ensure all students receive instruction, understand and follow the sport/activity specific safety rules and skills prior to participation (e.g. eliminate all checks to the head and eliminate all hits from behind).
    5. Teach skills in proper progression (e.g. emphasize the principles of head injury prevention keeping the head up and avoiding collision).
    6. Outline the concussion risks associated with the activity/sport and demonstrate how they can be minimized e.g. teach proper sport techniques: correct tackling in football, effective positioning in soccer, how to avoid overcrowding when using the creative playground.
    7. Students must follow their supervising staff/coach’s/volunteer’s safety instructions at all times.
    8. It is not a badge of honour to return to learn or physical activity while still recovering from a concussion.
    9. Discourage parents/guardians/teachers/coaches, school staff from pressuring recovering concussed students to play or learn before they are ready.
    10. Parents need to reinforce with their child the importance of following the school’s safety procedures.
    11. Parents need to report concussion history on the school medical form.
    12. Provide reassurance, support and request/offer academic accommodations as needed.

5. Management Procedures

Immediate action must be taken by the individual (e.g. principal, teacher, coach) responsible for the student if the student receives a blow to the head, face or neck, or a blow to the body that transmits a force to the head.

Steps and Responsibilities in Suspected and Diagnosed Concussions

NOTE: For a simplified version of roles and responsibilities in suspected and diagnosed concussion see Appendix F: Concussion Management Flow Chart: Roles and Responsibilities in Suspected and Diagnosed Concussions.

5.1 Initial Response
 
i) Unconscious Student (or in the event there was any loss of consciousness)
 
Action Responsibility
Stop the activity immediately – assume concussion Supervising School Staff/Volunteers
Initiate school Emergency Action Plan and call 911. Assume neck injury. Only if trained, immobilize student. DO NOT move student or remove athletic equipment unless breathing difficulty Supervising School Staff/Volunteers
Remain with student until emergency medical services arrive Supervising School Staff/Volunteers
Monitor student and document any changes (physical, cognitive, emotional/behavioural) Supervising School Staff/Volunteers
If student regains consciousness, encourage student to remain calm and still. Do not administer medication (unless the student requires medication for other conditions (e.g., insulin) Supervising School Staff/Volunteers
Complete and sign Appendix C: Tool to Identify a Suspected Concussion and, if present, provide duplicate copy to parent/guardian retaining a copy Supervising School Staff/Volunteers
If present, provide the parent/guardian a copy of Appendix D2 Documentation of Medical Examination and inform parent/guardian that form needs to be completed and submitted to principal prior to student’s return to school Supervising School Staff/Volunteers
Complete board injury report (Appendix 1 Student Concussion Diagnosis Report /OSBIE), inform principal of suspected concussion, and forward copy of the completed and signed Appendix C: Tool to Identify a Suspected Concussion Supervising School Staff/Volunteers
Ensure student is examined by a medical doctor or nurse practitioner as soon as possible that day Parent/Guardian/Emergency Contact
Once diagnosis is made, complete Documentation of Medical Examination Appendix D2 and return completed and signed document to school principal prior to student’s return to school Parent/Guardian
Inform all school staff (e.g., classroom teacher, SERTs, physical education)  Principal
Indicate that the student shall not participate in any learning or physical activities until parent/guardian communicates the results of the medical examination to the school principal Principal

ii) Conscious Student
 
Action Responsibility
Stop the activity immediately Supervising School Staff/Volunteers
Initiate school Emergency Action Plan Supervising School Staff/Volunteers
When safe to do so, remove student from activity/game Supervising School Staff/Volunteers
Conduct an initial concussion assessment of the student using Appendix C: Tool to Identify a Suspected Concussion Supervising School Staff/Volunteers

iii) If Concussion is Suspected; If in Doubt, Sit Them Out
 
Action Responsibility
Do not allow student to return to play in the activity, game or practice that day even if the student states s/he is feeling better Supervising School Staff/Volunteers
Contact the student’s parent/guardian (or emergency contact) to inform them:
  • Of the incident;
  • That they need to come and pick up the student;
  • That the student needs to be examined by a medical doctor or nurse practitioner as soon as possible that day
Supervising School Staff/Volunteers
Monitor and document any changes (e.g., physical, cognitive, emotional/behavioural) in the student. If signs or symptoms worsen, call 911 Supervising School Staff/Volunteers
Complete, sign, and photocopy Appendix C: Tool to Identify a Suspected Concussion Supervising School Staff/Volunteers
Do not administer medication (unless student requires medication for other conditions (e.g., insulin) Supervising School Staff/Volunteers
Stay with the student until his/her parent/guardian (or emergency contact) arrives Supervising School Staff/Volunteers
Student must not leave the premises without parent/guardian supervision Supervising School Staff/Volunteers
Provide parent/guardian (emergency contact) with signed copy of Appendix C: Tool to Identify a Suspected Concussion and retain a copy for your own Records Supervising School Staff/Volunteers
Provide parent/guardian (or emergency contact) with a copy of Appendix D2: Documentation of Medical Examination and inform parent/guardian that the form needs to be completed and submitted to principal prior to student’s return to school Supervising School Staff/Volunteers
Inform parent/guardian (or emergency contact) that the student should be Examined by a medical doctor or nurse practitioner as soon as possible that day  Supervising School Staff/Volunteers
Complete Board injury report (Appendix G: Student Concussion Diagnosis Report/OSBIE), inform principal of suspected concussion, and forward copy of the completed and signed Appendix C: Tool to Identify a Suspected Concussion Supervising School Staff/Volunteers
Ensure student is examined by a medical doctor or nurse practitioner as soon as possible that day Parent/Guardian/Emergency Contact
Complete Documentation of Medical Examination (Appendix D2) once diagnosis is made and return completed and signed document to school principal prior to student’s return to school Parent/Guardian
Inform all school staff (e.g., classroom teacher, SERTs, PE teachers, intramural supervisors, coaches) and volunteers who work with the student of the suspected concussion Principal
Indicate that the student shall not participate in any learning or physical activities until parent/guardian communicates the results of the medical examination to the school principal Principal

iv) If signs are NOT observed, symptoms are NOT reported AND student passes the Quick Memory Function Assessment (appendix C)
 
Action Responsibility
Recommended precautionary withdrawal of student from physical activity Supervising School Staff/Volunteers
Inform parent/guardian (or emergency contact) of the incident and provide signed copy of Appendix C: Tool to Identify a Suspected Concussion, retaining a copy. Explain to parent/guardian (or emergency contact) that student should be monitored for 24-48 hours after the incident as concussion symptoms may take hours or days to emerge. If any signs or symptoms appear, the student needs to be examined by a medical doctor or nurse practitioner as soon as possible on the same day and results shared with the principal before return to school. Supervising School Staff/Volunteers
Inform Supervising School Staff/Volunteers if symptoms appear during learning or any activity Student
If symptoms appear, proceed with Action Items under "If a Concussion is Suspected" Supervising School Staff/Volunteer and Parent/Guardian/Emergency Contact

5.2 Once Diagnosis Is Made

i) If NO CONCUSSION is diagnosed, student may resume regular learning and physical activity
 
Action Responsibility
Communicate diagnosis to school principal and return completed and signed Appendix D2: Documentation of Medical Examination Parent/Guardian
Inform all school staff (e.g., classroom teacher, SERTs, PE teacher, intramural supervisors, recess supervisors, coaches) and volunteers who work with the student of the diagnosis Principal
File any related written documentation of the incident and results of the medical examination Principal
Resume regular learning and physical activity Student

ii) If CONCUSSION IS DIAGNOSED: Return to Learn/Return to Physical Activity (Note: Student must successfully complete return to learn steps before initiating return to physical activity steps)
 
Communicate diagnosis to school principal and return completed and signed Appendix D2: Documentation for a Diagnosed Concussion. Also report non-school related concussions. Parent/Guardian
Provide parent/guardian Appendix E: Document for a Diagnosed Concussion Return to Learn/Return to Physical Activity Plan and indicate that student must be symptom free or improved and form needs to be completed and signed before student can return to school. Ensure parent/guardian understands the plan, addressing their questions, concerns, and working with parent/guardian to overcome any barriers. Principal
Complete Step 1 – Return to Learn/Return to Physical Activity: Keep student home for cognitive rest (no school, no homework, no texting, no screen time) and physical rest (restricting recreational/leisure time and competitive physical activities) until student is feeling better. Once symptoms start to improve, gradually increase mental activity (limit activities such as reading, texting, television, computer, and video games that require concentration and attention to 5-15 minutes). If moderate symptoms return, stop activity and allow student a 30-minute break to resolve symptoms. If symptoms don’t resolve, return to complete cognitive rest. Continue to gradually increase mental activity and monitor symptoms.  Parent/Guardian and Student
Continue cognitive and physical rest at home for at least 24-48 hours (or longer) until student’s symptoms are improving or s/he is symptom free. Student should be able to complete 1-2 hours of mental activity (e.g., reading, homework) at home for one to two days before attempting return to school. Parent/Guardian and Student
Inform all school staff (e.g., classroom teacher, SERTs, PE teachers, intramural supervisors, recess supervisors, coaches) and volunteers who work with the student of the diagnosis. Principal
Identify collaborative team (e.g., principal, concussed student, his/her parents/guardians, school staff and volunteers who work with the student, and the student’s medical doctor/nurse practitioner) and designate a school staff member of the team as the concussion liaison to serve as the main pint of contact for the student, the parent/guardians, or other school staff and volunteers who work with the student, and the medical professional. Principal
Meet with collaborative team to review potential cognitive and emotional/behavioural difficulties student may experience, explain how these symptoms can impact learning and identify strategies/approaches to manage these symptoms.
See Appendix B: Return to Learn Strategies/Approaches.
Principal
Ensure collaborative team understands the importance of not placing undue pressure on concussed student to rush through the return to learn/physical activity steps to avoid prolonged or increase symptoms. Return to learn should proceed slowly and gradually. Principal

iii) Student’s Symptoms are Improving: Principal, Concussion Liaison, SERT, Parent/Guardian, Medical Professional
 
Action Responsibility
Complete, sign and forward Appendix E: Documentation for a Diagnosed Concussion Return to Learn/Return to Physical Activity Plan Parent/Guardian
Proceed to Step 2a – Return to Learn: Student returns to school. Develop a plan (See Appendix B for Return to Learn Strategies/Approaches) with slow and gradual increase in cognitive activity (both at home and school). Absolutely no recreational/leisure and competitive physical activity. Doctor/Nurse Practitioner, Student, Parent/Guardian
Monitor the student’s progress through the Return to Learn/Return to Physical Activity Plan. This may include identification of the student’s symptoms and how s/he responds to various activities. Strategies may need to be developed or modified to meet the changing needs of the student. Concussion Liaison (in consultation
with other members of the collaborative
team)
Follow individualized classroom strategies/approaches for return to learn plan until student is symptom free School staff, Volunteers, Student

iv) Student is Symptom Free
 
Action Responsibility
Complete, sign and forward Appendix E: Documentation for a Diagnosed Concussion Return to Learn/Return to Physical Activity Plan (Step 2a). Parent/Guardian
Inform all school staff (e.g., classroom teacher, SERT, PE teacher, intramural supervisors, coaches, Concussion Liaison, and volunteers) who work with the student that student is symptom free and can return to regular learning activities without individualized classroom strategies and/or approaches. Student can proceed to Step 2b/c Return to Physical Activity (see Appendix E). Principal
Closely monitor student for the return of any concussion symptoms and/or deterioration of work habits and performance. Concussion Liaison (in consultation with other collaborative team members)
Report any return of symptoms to supervising staff/volunteer. Student
If symptoms return, stop activity and see Table below titled: Return of Symptoms. For more information, see the last sections of Appendix E: Documentation for a Diagnosed Concussion Return to Learn/Return to Physical Activity Plan. Supervising Staff/Volunteer
Begin regular learning activities without individualized classroom strategies and/or approaches and initiate Step 2b/c – Return to Physical Activity: individual light aerobic physical activity (e.g., walking, swimming, or stationary cycling) only. Objective is to increase heart rate. Absolutely NO participation in resistance/weight training, competition (including practices), participation with equipment or other students, drills, or body contact. Student and Supervising Staff/Coaches/Volunteers
Complete and sign Appendix E: Documentation for a Diagnosed Concussion Return to Learn/Return to Physical Activity Plan Step 2b/c –Physical Activity if your child/ward is symptom free after participating in light aerobic physical activity and return to principal. Parent/Guardian
Inform all school staff (e.g., classroom teacher, SERTs, PE teachers, staff supervisors, recess supervisors, coaches, Concussion Liaison, and volunteers) who work with the student that s/he may proceed to Step 3Return to Physical Activity. Provide supervising staff/coaches/volunteers Appendix E: Documentation for a Diagnosed Concussion Return to Learn/Return to Physical Activity Plan to record student progress through Steps 3 and 4. Principal
Continue with regular learning activities at school and begin Step 3: individual sport specific physical activity one (e.g., running drills in soccer, skating skills in hockey, shooting drills in basketball) to add movement. Absolutely NO resistance/weight training, competition (including practices), body contact, head impact activities (e.g., heading a soccer ball) or other jarring motions (e.g., high speed stops, hitting a baseball with a bat). Student and Supervising
If symptom free, proceed to Step 4 Return to Physical Activity. Student may begin activities where there is no body contact (e.g., dance, badminton); light resistance/weight training; non-contact practice; and non-contact sport specific drills (e.g., passing drills in football and hockey) to increase exercise, coordination and cognitive load. Absolutely NO activities that involve body contact, head impact or jarring motions. Student and Supervising Staff/Coaches/Volunteers
Record student progress through Steps 3 and 4. Once student has completed Steps 3 and 4 and is symptom free, complete and sign Appendix E: Documentation for a diagnosed Concussion-Return to Learn/Return to Physical Activity Plan form section titled “Step 4-Return to Physical Activity. Communicate with parent/guardian that the student has successfully completed Steps 3 and 4 and return completed and signed form Appendix E to parent/guardian to obtain medical doctor/nurse practitioner diagnosis and signature. Student and Supervising Staff/Coaches/Volunteers
Provide school principal with written documentation from a medical doctor or nurse practitioner (e.g., completed and signed Appendix E: Return to Learn/Return to Physical Activity Plan section titled "Medical Examination") that indicates the student is symptom free and able to return to full participation in physical activity. Parent/Guardian
Inform all school staff (e.g., classroom teacher, SERTs, PE teachers, intramural supervisors, recess supervisors, coaches, Concussion Liaison, and volunteers)who work with the student that the student may proceed to Step 5Return to Physical Activity. File written documentation (e.g., completed and signed Appendix E). Student and Supervising Staff/Coaches/Volunteers
Continue with regular learning activities and begin Step 5 by resuming full participation in regular physical education/intramurals/ interschool activities in non-contact sports and full training practices for contact sports. The objective is to restore confidence and assess functional skills by teacher/coach. Absolutely NO competitions (e.g., games, meets, events) that involve body contact.
Student and Supervising Staff/Coach/Volunteers
If student remains symptom free, proceed to Step 6: Return to full participation in contact sports with no restrictions.
Student and Supervising Staff/Coach/Volunteer
 
v) Return of Symptoms
 
  • Action Responsibility
    Report any return of symptoms to supervising staff/volunteers. Student If signs of returned concussion symptoms and/or deterioration of work habits and performance occur, stop activity and contact student’s parent/guardian (or emergency contact) and report to principal. Complete Board (Appendix G: Student Concussion Diagnosis Report/OSBIE) report and forward to principal who will file. Supervising Staff/Volunteer/Concussion Liaison
    Contact parent/guardian (or emergency contact) to inform of returned symptoms and need for medical examination on the same day. Provide Appendix E: Documentation for a Diagnosed Concussion-Return to Learn/Return to Physical Activity Plan form and indicate that the last section titled "Return of Symptoms" must be completed, signed and returned before student can return to school. Principal or Concussion Liaison/School Designate (if Principal not available)
    Have student examined by a medical doctor/nurse practitioner as soon as possible on the same day. Parent/Guardian
    Complete, sign, and forward Appendix E: Documentation for a Diagnosed Concussion-Return to Learn/Return to Physical Activity Plan section titled “Return of Symptoms” to principal. Parent/Guardian
    Follow medical doctor/nurse practitioner’s treatment. Student and Parent/Guardian
    Inform all school staff (e.g., classroom teacher, SERTs, PE teachers, intramural Supervisors, recess supervisors, coaches), Concussion Liaison, and volunteers who work with the student that the student has experienced a return of symptoms and which step of the Return to Learn/Return to Physical activity to proceed from. Principal

    Note:
    • Cognitive or physical activities can cause student’s symptoms to reappear.
    • Steps are not days – each step must take a minimum of 24 hours and the length of time needed to complete each step will vary based on the severity of the concussion and the student.
    • The signs and symptoms of a concussion often last for 7-10 days but may last longer in children and adolescents.
    • Compared to older students, elementary school children are more likely to complain of physical problems or misbehave in response to cognitive overload, fatigue, and other concussion symptoms.
    • If a student returns to activity while symptomatic they are at an increased risk of sustaining another concussion with symptoms that can be prolonged and increased.
    • Principals, supervising staff, coaches and volunteers must not place pressure on injured students to “Return to Learn” or “Return to Physical Activity” prematurely.
    • Parents/guardians must report non-school related concussions.
    • Return to Learn/Return to Physical Activity steps must be followed regardless of where diagnosed concussion occurred.

6. Encouraging Parent/Guardian Engagement:

If the parent/guardian refuses a physician consultation and/or refuses to adhere to the concussion administrative procedure, the principal will:
      • Discuss parental concerns (e.g., documentation fees) surrounding the process and attempt to address these concerns;
      • Provide rationale for the required steps on the Concussion Administrative Procedure;
      • Include the parent/guardian and their child in every step of the recovery process;
      • Provide parents/guardians with concussion information to increase their awareness and knowledge;
      • Reiterate the importance of obtaining an official diagnosis from a trained physician;
      • Explain to the parent/guardian if staff feel immediate medical attention is required, that they are obligated to call 911 even on parent refusal;
      • Inform the parent/guardian that the school is obligated to follow the steps of the "Return to Learn" and "Return to Physical Activity" process;
      • If unsuccessful in acquiring full parental cooperation, seek support from Senior Administration.

7. Other Sources of Concussion Information

The following web links and organizations have information, videos and interactive games for parents, teachers and students on concussion recognition, prevention and management:

General Concussion Information
Centre for Disease Control: Traumatic Brain Injury
 
Guidelines
Canadian Guideline on Concussion in Sport
Concussion Guidelines for Coaches and Trainers

Online Videos
Dr. Mike Evans: Concussions 101

eLearning Modules
Making Head Way eLearning Series

Concussion Research
Consensus statement on concussion in sport: the 4th International Conference on Concussion

OPHEA Safety Guidelines
Ontario Physical Education Safety Guidelines

Concussion Tools
Coaches Association of Ontario Toolkit
Apps for Concussion Screening and Management
Concussion Recognition Tool

Student Education
Dr. Mike Evans: Concussions 101
Brain Day Hamilton Brain Injury Association: Bikes, Blades and Boards Education Program

Curriculum Documents
The 2019 Addendum to The Kindergarten Program
HPE Curriculum, Grades 1-8
HPE Curriculum, Grades 9-12

Huron County Health Unit
Perth County Health Unit

8. Conclusion

Despite prevention strategies listed above, head injuries will still occur. AMDSB staff and volunteers who are involved in intramural or interschool athletics or any part of the health and physical education curriculum will not be held personally liable in a civil proceeding for an act or omission if the person acts reasonably in the circumstances and in good faith.

9. Appendices (Please see AP 319 for Appendices)

Appendix A1 Roles and Responsibilities
Appendix A2 Concussion Guidelines: The Parents/Caregivers
Appendix A3 Concussion Guidelines: The Teachers/Coaches
Appendix B Return to Learn Strategies/Approaches
Appendix C Tool to Identify a Suspected Concussion
Appendix D1 Initial Response Identification
Appendix D2 Documentation of Medical Examination form
Appendix E Documentation for a Diagnosed Concussion – Return to Learn/Return to Physical Activity Plan
Appendix F Concussion Management Flow Chart: Roles and Responsibilities
Appendix G Student Concussion Diagnosis Report

10. References

Thanks in part to the District School Board of Niagara and the BHNCDSB in lending a draft of their concussion Policy and Procedure and protocols.
Parachute Canada (Formerly Think First)
http://www.youtube.com/parachutecanada
OPHEA Safety Guidelines, 2012 and 2013, Elementary and Secondary
Canchild Sponsored by McMaster University and McMaster Children’s Hospital
Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012
Sport Concussion Assessment Tool 3rd edition for use by medical professionals only
Sport Concussion Assessment Tool for children ages 5 to12 years for use by medical professionals only
Pocket Concussion Recognition Tool 2013
Children's Hospital of Philadelphia
Center for Disease Control and Prevention: Returning to School After a Concussion: A fact Sheet for School Professionals
Hockey Canada resources

Dan McIntosh CAT(c), ATC Owner/ Athletic Therapist www.Mspar.ca
MSPAR McIntosh Sports Performance and Rehabilitation
285 Lorne Ave E, Unit 4, Stratford, ON N5A 6S4 Phone: (226) 9211645 Fax: (519) 2721818

Revised March 2021