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Concussion Management

Skaneateles Central School District
Concussion Adminstrative Procedures & Guidelines
Concussion Education should be provided for all adminstrators, teachers, coaches, school nurses, athletic trainers and guidance counselors. Education of parents should be accomplished through preseason meetings for sports and/or information provided in student agenda books and on the school website. Education should include, but not be limited to the definition of concussion, signs and symptoms of concussion, how concussions may occur, why concussions are not detected with CT Scans or MRI's, managament of the injury and the protocol for return to school and return to activity or interscholastic athletics. The protocols will cover all students returning to school after suffering a concussion regardless if the accident occurred outside of school or while participating in a school activity. Each school utilizes a School-based Intervention Team (SBIT) to address all concerns related to concussions other than athletic return to play.

Concussion Management Team
The District will assemble a concussion management team (CMT). The CMT will consist of adminstrators, school psychologist, athletic director, school nurse, athletic trainer and/or school physician. The District's CMT should coordinate training for all adminstrators, teachers, coaches and parents. Training should be mandatory for all coaches, assistant coaches and volunteer coaches that work with these student athletes regularly. In addition, information related to concussions should also be included at parent meetings or in information provided to parents at the beginning of sports seasons. Parents need to be aware of the school district's policy and how these injuries will ultimately be managed by school officials.

Training should include:  signs and symptoms of concussions, post concussion and second impact syndromes, return to play and school protocols, and available area resources for concussion management and treatment. Particular emphasis should be placed on the fact that no athlete will be allowed to return to play the day of injury and also that all athletes should obtain appropriate medical clearance prior to returning to play or school.

The CMT may act as an advisory group for a student returning to play following a concussion. When deemed necessary, the CMT will review and/or design an appropriate plan for the student while the student is recovering.

Return to Play Protocol
Return to play following a concussion involves a stepwise progression once the individual is symptom free. There are many risks to premature return to play including:  a greater risk for a second concussion because of a lower concussion threshold, second impact syndrome (abnormal brain blood flow that result in death), exacerbation of any current symptoms, and possibly increased risk for additional injury due to alteration in balance. These NYSPHAAc current returns to play recommendations are based on the most recent international expert opinion. No student athlete should return to play while symptomatic. Students are prohibited from returning to play the day the concussion is sustained. If there is any doubt as to whether a student has sustained a concussion, it should be treated as a concussion. Once the student athlete is symptom free at rest for 24 hours and has a signed release by the treating clinician, she/he may begin the return to  play progression below (provided there are no other mitigating circumstances).
Day 1:  No exertion activity until medically cleared and asymptomatic for 24 hours.
Day 2:  Begin low-impact activity such as walking, stationary bike, etc.
Day 3:  Initiate aerobic activity fundamental to specific sport such as skating, running, etc.
Day 4:  Begin non-contact skill drills specific to sport such as dribbling, ground balls, batting, etc.
Day 5:  Full contact in practice setting.

Each step should take 24 hours so that an athlete would take approximately one week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise. If any post concussion symptoms occur while in the stepwise program, then the student should drop back to the previous asymptomatic level and try to progress again after a further 24-hour period of rest has passed.
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Eric Knuth
45 East Elizabeth Street
Skaneateles, NY 13152