HOME OF THE CARDINALSDirector of Athletics: Gus Lindinegus_lindine@greenwich.k12.ct.usInterscholastic athletics are a vital part of school life and Greenwich High School offers a variety of opportunities.Our athletic program is one that reflects t

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Concussion Management Protocol

 
A concussion is a type of traumatic brain injury, or TBI, that is caused by a bump, blow or jolt to the head that can change the way a brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.  The following is the Greenwich High School Protocol for Concussion Management.

Step 1: Immediate Evaluation
  • Recognition of concussion signs and symptoms by the athlete, coach, parent, or athletic trainer.
  • Removal from athletic participation if a concussion is suspected.
  • Immediate evaluation of the athlete by a trained medical professional (physician or athletic trainer) should occur as soon as possible.
  • Following a concussion, the athlete should be referred to a physician for medical evaluation, on the same day as the injury if there was loss of consciousness, amnesia lasting longer than 15 minutes, vomiting, motor, sensory, balance deficits or symptoms that worsen.  Immediate transport to the hospital emergency room should occur in the case of pulse or respiration irregularity or decrease, unequal/dilated or un-reactive pupils, lethargy, confusion, seizures and other symptoms.
  • At the time of injury, parent(s)/guardian(s) will be given oral and written instructions regarding proper home care and management following a suspected concussion.
  • All concussions MUST be reported as soon as possible to the athletic trainer for proper follow-up care.
 Step 2: Removal from Participation
  • No adolescent who sustains a concussion should be allowed to play or return to a game/practice.
  • Athletes continuing to play (including exercise) or receiving multiple blows to the head, after sustaining a concussion, may take longer to recover and are at an increased risk for developing Post-Concussion Syndrome and Second Impact Syndrome.
  • If an individual has an increase in symptoms while doing a specific activity, that activity should be discontinued immediately.
 Step 3:  Neurocognitive Testing (ImPACT)
  • Post-concussion Neurocognitive testing with the ImPACT program should take place within 24-72 hours.
  • If the athlete is a participant in a contact sport, they will have a baseline ImPACT test performed during their freshman and junior years.
 Step 4: School/Activities Modified As Needed
  • School nurse and guidance counselors are to be notified of concussion injury.  This is especially important if academic/attendance considerations are to be made.
  • School attendance and other activities may need to be modified according to the individual’s symptoms.
  • Students who are unable to attend school for an entire day without symptoms may need special accommodations.
  • Workload and homework may also need to be reduced.
  • Extended periods of accommodations must be made by a physician or neuropsychologist.
 Step 5:   Monitor Symptoms and Repeat ImPACT Testing
  • The individual’s symptoms should be closely monitored until they feel symptom free.
  • ImPACT testing will be performed again once the symptoms have cleared, or 7-10 days after the first post-concussion test.
  • ImPACT testing will continue to be performed as recommended by the treating physician or athletic trainer that reviews the test data.
 Step 6: Clearance/Progressive Return to Athletic Participation
  • The athlete must be symptom free, and have written clearance to return to play by a physician.
  • Baseline ImPACT scores MUST be achieved prior to resuming activity.
  • A progressive return involves gradually increasing the level and intensity of the activity, while closely monitoring the athlete for any return of symptoms.
  • Example:?
Day 1: Walking or easy biking for 20-30 min.

Day 2: Jogging or moderate biking for 20-30 min.

Day 3: Running or heavy biking for 20-30 min.

Day 4: Sport specific drills/practice (non-contact)

Day 5: Return to contact sports
 
  • If symptoms return at any point during the progression the activity should be stopped. The athlete should return to rest and must be symptom free for at least 24 hrs before starting the progression again.
 Further Information:
  • Second Impact Syndrome: Occurs when an adolescent receives a second blow to the head after they have already sustained a concussion, which results in rapid swelling of the brain and is often fatal. Even a very minor blow can cause Second Impact Syndrome.
  • Post-Concussion Syndrome: Is characterized by prolonged concussion symptoms (headache, nausea, dizziness, difficulty concentrating, poor memory, etc.) that may continue for months or longer.
  • ImPACT Neurocognitive Testingwww.impacttest.com