• Concussions: The Invisible Injury

    Student and Parent Information Sheet

    Facts about concussions according to the

    Center for Disease Control (CDC)

    l An estimated 4 million people under age 19 sustain a head

    injury annually. Of these approximately 52,000 die and

    275,000 are hospitalized.

    l An estimated 300,000 sports and recreation related

    concussions occur each year.

    l Students who have had at least one concussion are at

    increased risk for another concussion.

    In New York State in 2009, approximately 50,500 children

    under the age of 19 visited the emergency room for a traumatic

    brain injury and of those approximately 3,000 were hospitalized.

    Requirements of School Districts


    l Each school coach, physical education teacher, nurse, and

    athletic trainer will have to complete an approved course on

    concussion management on a biennial basis, starting with the

    2012-2013 school year.

    j School coaches and physical education teachers must

    complete the CDC course.


    j School nurses and certified athletic trainers must complete

    the concussion course. (http://preventingconcussions.org)


    l Provide concussion management information and sign off

    with any parental permission form.

    l The concussion management and awareness information or

    the State Education Department’s web site must be made

    available on the school web site, if one exists.

    Removal from athletics:

    l Require the immediate removal from athletic activities of any

    pupil that has or is believed to have sustained a mild

    traumatic brain injury.

    l No pupils will be allowed to resume athletic activity until

    they have been symptom free for 24 hours and have been

    evaluated by and received written and signed authorization

    from a licensed physician. For interscholastic athletics,

    clearance must come from the school medical director.

    j Such authorization must be kept in the pupil’s permanent

    heath record.

    j Schools shall follow directives issued by the pupil’s

    treating physician.


    Symptoms of a concussion are the result of a temporary

    change in the brain’s function. In most cases, the symptoms of a

    concussion generally resolve over a short period of time; however,

    in some cases, symptoms will last for weeks or longer. Children

    and adolescents are more susceptible to concussions and take

    longer than adults to recover.

    It is imperative that any student who is suspected of having

    a concussion is removed from athletic activity (e.g. recess, PE

    class, sports) and remains out of such activities until evaluated and

    cleared to return to activity by a physician.

    Symptoms include, but are not limited to:

    l Decreased or absent memory of events prior to or immediately

    after the injury, or difficulty retaining new information

    l Confusion or appears dazed

    l Headache or head pressure

    l Loss of consciousness

    l Balance difficulties, dizziness, or clumsy movements

    l Double or blurry vision

    l Sensitivity to light and/or sound

    l Nausea, vomiting and/or loss of appetite

    l Irritability, sadness or other changes in personality

    l Feeling sluggish, foggy or light-headed

    l Concentration or focusing problems

    l Drowsiness

    l Fatigue and/or sleep issues – sleeping more or less than usual

    Students who develop any of the following signs, or if signs

    and symptoms worsen, should be seen and evaluated immediately

    at the nearest hospital emergency room.

    l Headaches that worsen

    l Seizures

    l Looks drowsy and/or cannot be awakened

    l Repeated vomiting

    l Slurred speech

    l Unable to recognize people or places

    l Weakness or numbing in arms or legs, facial drooping

    l Unsteady gait

    l Change in pupil size in one eye

    l Significant irritability

    l Any loss of consciousness

    l Suspicion for skull fracture: blood draining from ear or

    clear fluid from the nose

    Concussion definition

    A concussion is a reaction by the brain to a jolt or force that can be transmitted to the head by an impact or blow occurring anywhere

    on the body. Essentially a concussion results from the brain moving back and forth or twisting rapidly inside the skull.

    State Education Department’s Guidance for

    Concussion Management

    Schools are advised to develop a written concussion management

    policy. A sample policy is available on the NYSPHSAA web

    site at www.nysphsaa.org. The policy should include:

    l A commitment to reduce the risk of head injuries.

    l A procedure and treatment plan developed by the district

    medical director.

    l A procedure to ensure proper education for school nurses,

    certified athletic trainers, physical education teachers,

    and coaches.

    l A procedure for a coordinated communication plan among

    appropriate staff.

    l A procedure for periodic review of the concussion

    management program.

    Return to Learn and Return to Play


    Cognitive Rest: Activities students should avoid include, but are

    not limited to, the following:

    l Computers and video games

    l Television viewing

    l Texting

    l Reading or writing

    l Studying or homework

    l Taking a test or completing significant projects

    l Loud music

    l Bright lights

    Students may only be able to attend school for short periods of

    time. Accommodations may have to be made for missed tests and


    Physical Rest: Activities students should avoid include, but are

    not limited to, the following:

    l Contact and collision

    l High speed, intense exercise and/or sports

    l High risk for re-injury or impacts

    l Any activity that results in an increased heart rate or

    increased head pressure

    Return to Play Protocol once symptom free for 24 hours and

    cleared by School Medical Director:

    Day 1: Low impact, non strenuous, light aerobic activity.

    Day 2: Higher impact, higher exertion, moderate aerobic activity.

    No resistance training.

    Day 3: Sport specific non-contact activity. Low resistance weight

    training with a spotter.

    Day 4: Sport specific activity, non-contact drills. Higher resistance

    weight training with a spotter.

    Day 5: Full contact training drills and intense aerobic activity.

    Day 6: Return to full activities with clearance from School Medical


    Any return of symptoms during the return to play protocol, the

    student will return to previous day’s activities until symptom free.

    Concussion Management Team

    Schools may, at their discretion, form a concussion management

    team to implement and monitor the concussion management policy

    and program. The team could include, but is not limited to, the


    l Students

    l Parents/Guardians

    l School Administrators

    l Medical Director

    l Private Medical Provider

    l School Nurse

    l Director of Physical Education and/or Athletic Director

    l Certified Athletic Trainer

    l Physical Education Teacher and/or Coaches

    l Classroom Teachers

    Other Resources

    l New York State Education Department


    l New York State Department of Health



    l New York State Public High School Athletic Association


    l Center for Disease Control and Prevention


    l National Federation of High Schools

    www.nfhslearn.com – The FREE Concussion Management course

    does not meet education requirement.

    l Child Health Plus



    l Local Department of Social Services – New York State

    Department of Health


    l Brain Injury Association of New York State


    l Nationwide Children’s Hospital – Concussions in the



    l Upstate University Hospital – Concussions in the Classroom



    l ESPN Video – Life Changed by Concussion


    l SportsConcussions.org


    l American Association of Neurological Surgeons



    l Consensus Statement on Concussion in Sport – Zurich