Lincoln-Sudbury Regional High School
Head Injury Protocol
At L-S, the Director of Activities and Athletics is responsible for implementing this policy in compliance with 105 CMR 200. As such, all forms, links and the most up to date version of this policy will be found on the L-S Athletics website (http://www.lsrhs.net/sites/athletics/). Currently, Art Reilly serves the district as Director of Activities and Athletics (AD).
L-S requires the Director of Activities and Athletics, the school nurses, the school physician, the school athletic trainer and all coaches to complete concussion training annually. That training is available online either through the NFHS “Concussion in Sports” training (https://nfhslearn.com/courses/38000) or the CDC “Heads Up Concussion in Youth Sports” (http://www.cdc.gov/concussion/HeadsUp/youth.html). The athletic office keeps records of the training completion and training certificates of the AD, athletic trainer and coaches. The student services office keeps records of the training completion and training certificates for the nurses and other L-S staff.
L-S requires student athletes and their parents to complete the concussion training above once per school year in which they participate in the athletic program. The records are a signed affidavit of training completion (https://www.lsrhs.net/sites/athletics/files/2012/01/Newconcussionform.pdf)
and a certificate of training. Both of these documents are stored on file in the athletic office and logged electronically on the school’s IPass system.
In addition to the Annual Training described above, student athletes must meet several requirements prior to participating in interscholastic athletics at L-S. First, any student wishing to participate in the L-S athletic program must have a physical exam certificate dated within 13 months of the starting date of the season. This certificate must be on file with the school nurses prior to the student beginning participation in the sport. If the physical exam expires during the season, the athlete will be ineligible for practice or competition until they get an updated physical exam. Finally, if the annual physical exam occurs following a diagnosed concussion the school does not accept that physical exam as clearance of the concussion. Clearance can only be obtained in a separate, specific document through a doctor, physician’s assistant, nurse practicioner or neuropsychologist.
Second, student athletes and their parents/guardians must complete and submit the “Pre-Participation Head Injury/Concussion Reporting Form” (https://www.lsrhs.net/sites/athletics/files/2012/06/preparticipation_reporting_form2.pdf)
to the athletic office prior to EVERY SPORTS SEASON in which they wish to participate. More specifically, an athlete who participates in fall, winter and spring sports in the same school year MUST turn in the “Pre-Participation” form three times, prior to each season of participation. Among other reasons, this insures that both the health office and athletic department know about head injuries that may have occurred in between seasons.
The “Pre-Participation” form requires information regarding past incidences of head injury and/or concussion. Every season, students enter this information into family ID. The athletic trainer reviews the “Yes” pre-participation forms and shares that information, sorted by sport, with each sport’s program’s head coach. The athletic director, school counselors and teachers have access to IPass, hence they are made aware of any head injuries or concussions and any accommodations granted to the student.
Regarding our school physician, that person only works with L-S in an advisory capacity. They do not practice medicine at L-S. As such, while they have access—if necessary—to student health records, including the Pre-participation forms, they do not review these forms as part of their normal practice.
Data collection and reporting
The school nurses record all reported head injuries in an Excel spreadsheet (example below).
On an annual basis they analyze the data with the Director of Activities and Athletics and look for “clusters” or trends of head injuries by activity, date, team, gender, etc… The Director of Activities and Athletics uses the data to inform staff, students and parents annually of concussions that occurred during the school year. The report will be posted on the L-S Athletics Website and will include the MDPH end-of-year report form (appendix 2) for that year. This data will be sent to the MDPH and posted on the L-S Athletics website by August 31st every year.
In addition to this data collection and reporting, if numerous head injuries occur in a particular athletic program (i.e. girls soccer), the Director of Activities and Athletics will hold a meeting with the head coach of the program to discuss their conduct of practices and games and to identify means of reducing risk of head injury.
All head injuries reported to the Health Office become part of a student’s physical and electronic health record. The electronic health record on IPass denotes past, cleared head injuries with a yellow diamond icon and current, un-cleared head injuries with a red diamond icon next to the student’s name. All staff that has access to view “activity rosters” or “class rosters” on IPass will see these diamonds and be able to click and read about the student’s head injury history. School counselors, teachers, administrators and the athletic trainer have access to IPass and are expected to review this information on regular basis. The Director of Activities and Athletics and the athletic trainer are responsible for reporting past and current head injuries or concussions to the coaches prior to the start of each sport season.
Disclosing Head Injury Data to Families
Consistent with Massachusetts Student Records Regulations, 603 CMR 23.00 and the Federal Family Educational Rights and Privacy Act Regulations, 34 CFR Part 99, parents/guardians are entitled to their child’s student records including everything relating to a reported head injury including: health office history of student’s head injury(ies) and recuperation, graduated re-entry plan, medical clearance/return to play, academic accommodations, etc... Such records must redact names of other students. Requests for student records regarding head injuries must be received and granted by the Director of Activities and Athletics. Delivery of those records may take up to ten business days and may result in billing for services from the district to the requesting parents/guardians.
In terms of disclosing information regarding a student’s head injury with staff at L-S, all students that have suffered a head injury will have a graduated re-entry meeting even if accommodations have not been recommended post head injury. The graduated re-entry meeting will be chaired by the house guidance counselors. A school nurse will be invited to the meeting as well as the student and the parents. After the graduated re-entry meeting is completed, the house guidance counselor will share with the nurse the plan, if one was needed and developed. The graduated re-entry plan will be posted on IPass, a web-based program used at the school to share information. All teachers and staff that work with the student will be notified that the student had a head injury and they should look for a graduated re-entry plan on IPass. A summary will be also shared with the student's teachers and related staff on the content of the plan.
No other staff will have access to the student's graduated re-entry plan. If the student with the head injury is an athlete, the Director of Activities and Athletics will share the plan with the student's coach(es).
The school nurses and house guidance counselors will monitor the graduated re-entry plans and the students' improvements. Any changes made to the plan will be shared as described above.
Any list generated in house to monitor students on graduated re-entry plans will be shared only with the Director of Student Services, Director of Activities and Athletics, nurses and house guidance counselors. The list will not be shared with any other staff. The administrative assistant may have a copy of this list. If any parent/guardian requests student records that may include this list, all other students' names will be redacted by the administrative staff in the Athletic Department. The administrative assistant has been trained with regard to Student Record and FERPA. Lastly, Mandated Trainings for school year 2015-2016 will explicitly state that any records requested for a student most be redacted of any other students' names regardless of the type of information that is been shared. All staff will be trained in by no later than September 1st 2015.
Coaches annually complete either the CDC “Heads Up” or NFHS “Concussion” course. Both courses detail means of minimizing risk of head injury in practices and competition. In addition, the Director of Activities and Athletics meets with head coaches when clusters of concussions occur in specific sports. The purpose of these meetings is to create awareness and revise training methods to reduce risk of future head injury. Further, per MIAA rules all coaches hired within the last five years must complete NFHS Fundamentals of Coaching and Sport-specific courses, both of which include units on head injury prevention. Finally, as part of best practice in the L-S Athletic Department coaches abide by the following:
Reporting Head Injuries or Suspected Concussions that occur in Interscholastic Athletics:
Head injuries or suspected concussions can occur during practices or competitions. The incident(s) leading to these injuries may be observed by a coach, teammates or the athletic trainer. However, in other cases, when the incident is subtle or the team activity includes numerous athletes, no one—including the athlete—may observe the injury. As such, reporting head injuries or suspected concussions that occur in Interscholastic Athletics can take a variety of routes. Regardless of the route of reporting (see the examples below), no athlete may return to practice or play the day of a head injury or suspected concussion. This is the responsibility of the athlete, witness(es) and coach.
In the case of head injuries or suspected concussions observed by a coach or the athletic trainer, the respective parties must immediately remove the athlete from play and fill out a “Report of Head Injury During Sports Season” (https://www.lsrhs.net/sites/athletics/files/2015/01/in-season-report-form.pdf)
form found in the L-S website. In the case of injuries observed by teammates, those observing athletes must assume that no one else observed the incident. As such, they should reported immediately to the coach. That coach must immediately remove the athlete from play and fill out a “Report of Head Injury During Sports Season” form. In both situations described above, the head coach must fulfill the following obligations:
In the case where no one—including the athlete—notices the head injury or suspected concussion and symptoms emerge following practice or competition, the parents must call or email the head coach and the school nurses to report a head injury. Subsequently, the coach will suspend the athlete from future activity and fill out a “Report of Head Injury During Sports Season” form.
In all cases, the coach must deliver the “Report of Head Injury During Sports Season” form to the athletic office by the close of the next business day. In turn, the Director of Activities and Athletics will notify the Health Office and the athletic trainer on the same business day. Subsequently, the school nurses will enter the injury on IPass and inform the student’s housemaster and school guidance counselor. The school guidance counselor will communicate with the student’s teachers by email regarding the injury, absences and/or academic accommodations if needed/granted.
In the unlikely event that the coach, athletic trainer or school nurses observe severe symptoms, including but not limited to: sustained loss of consciousness, increased confusion, difficulty communicating, etc… an ambulance must be called. In the event that the coach, athletic trainer, or school nurses suspect the head injury is a concussion and the symptoms are manageable (minor and stable), they will contact the parents/guardians and recommend that the student athlete see their primary care physician (PCP) for a medical evaluation. The parent/guardian is responsible for taking their child to the PCP, Nurse Practitioner, Physician’s Assistant or neuropsychologist. After the medical visit, the parent/guardian shall share with the school any medical recommendations and/or diagnoses with the school. It will be in the student’s best interest, for the doctor’s note to include any recommendations for academic accommodations and/or whether the student is able to return to school fully or partially. The parent/guardian must sign a release of information for the school to be able to contact the student’s doctor. The student must be cleared for participation in sports prior to returning to extracurricular activities by a PCP, NP, PA, neuropsychologist or athletic trainer. That clearance process must incorporate completing and signing the Medical Clearance Form posted on the L-S website. (https://www.lsrhs.net/sites/athletics/files/2015/01/posthead-injury-clearance-form.pdf)
Reporting Head Injuries that occur at school or school-sponsored events NOT related to Interscholastic Athletics:
If a student suffers a head injury at school or at a school-sponsored event unrelated to participating in Interscholastic Athletics, the staff member who either witnessed or was made aware of the head injury should follow the protocol below:
Subsequently, the school nurses will enter the injury on IPass and inform the student’s housemaster and school guidance counselor. The school guidance counselor will communicate with the student’s teachers by email regarding the injury, absences and/or academic accommodations, if granted.
Reporting Head Injuries that occur outside school, school related activities and Interscholastic Athletics:
If the head injury did not occur at school or a school event, the parent/guardian must notify the Health Office and child’s Housemaster by phone or email. The parent/guardian should also complete the “Report of Head Injury During Sports Season” form regardless of whether the child is an athlete or was engaged in athletic activity at the time of the injury. This form must be delivered to the health office in person, by fax (978-639-3090) or email at the parent/guardian’s earliest convenience. The injury will be logged in on IPass as well as any recommendations made by a doctor.
Medical Clearance/Return to Play:
Regardless of where the head injury occurred with respect to the three means of reporting described above, students may not resume or begin participation in Interscholastic Athletics unless they have been medically cleared. Per 105 CMR 201, physicians, nurse practitioners, physicians assistants, neuropsychologists and licensed athletic trainers may all medically clear a student athlete for return to play by using the Medical Clearance/Return to Play form found on the athletics website.
Parents of athletes with a head injury must update the health office weekly about their child’s symptoms and progress towards recovery.
Reminder: Regardless of the different scenarios above, athletes MAY NOT return to play the day of a head injury.
Graduated Return to Play
Any student athlete diagnosed with a concussion will complete a graduated return to play protocol with our certified athletic trainer prior to resuming participation in athletics. This protocol begins after the health office and trainer receive a medical clearance/return to play form referenced above. The student may not begin practicing or competing in interscholastic athletics until the certified athletic trainer certifies they have completed this protocol
Graduated Re-Entry Meeting/Plan:
Any student diagnosed with a concussion will have a graduated re-entry plan to return to full academic and/or extracurricular activities. The student diagnosed with a concussion must be completely symptom free at rest in order to begin graduated re-entry to extracurricular/athletic activities. In addition, the school must receive an Acute Concussion Evaluation (ACE) form--or the equivalent--from the student’s physician
School guidance counselors will schedule a re-entry meeting for any student that suffered a head injury that prevented the student from coming to school (6 or more days). The team will include the school guidance counselor, the Housemaster, parents/guardians, the student and nurses. A certified athletic trainer, a neuropsychologist or any other relevant staff may also participate in the re-entry plan meeting and its development. Teachers will be invited to the re-entry meeting if this meeting may result in the development of a 504 plan. The team must use the Lincoln Sudbury Regional High School Graduated Re-Entry Plan and must follow the Four Stages of Recovery as stated in the graduated re-entry plan.
If a student has an Individualized Education Program (IEP), the student’s liaison shall be invited too. If the team determines that the head injury is severely impacting the student’s ability to perform major life activities, the re-entry meeting may be combined with the development of a 504 plan, if the parents/guardians are in attendance and agree to have the 504 meeting at that time.
The team must consult with the physician overseeing the student’s recovery.
The Re-Entry Plan should include, although is not limited to:
Protocol for a Re-Entry Plan that May Result in a Section 504 Plan
A head injury may be a disability under Section 504. The question that will determine if the head injury has resulted in a disability under Section 504 will be if such head injury substantially limits a major life activity.
Even if the impairment is expected to last less than 6 months, it may still be substantially limiting, therefore, the team may develop a 504 plan. Impairments that may last a short period of time may not be covered under Section 504 if they are not sufficiently severe. The decision as to if a student is eligible for Section 504 shall be determined on a case-by-case basis. If a student is determined eligible for a 504 plan after a head injury, then, when the symptoms subside, the team may reconsider eligibility.
The Re-Entry Plan team should follow the Section 504 Protocol for determining eligibility as follows:
The school guidance counselor chairs the meeting. Please note that the Re-Entry meeting may be merged into a Section 504 meeting. At the meeting the Team will be responsible for:
The Team may find a student eligible, postpone the determination of eligibility, or find no eligibility after completing these steps.
Eligible Student: If the Team determines that the student is eligible for a Section 504 Plan, the school guidance counselor, in collaboration with the parents/guardians and the rest of the Team write the plan. The school guidance counselor will submit a final draft of the plan to the Director of Student Services for review. Upon approval, the plan is mailed/emailed to the parents/guardians for signature. Although the law does not require parents/guardians’ signature to start providing accommodations protected under Section 504, it is Lincoln-Sudbury Regional High School best practice to secure such signature prior to implementation. Upon receipt of parents/guardians agreement of the 504 Plan, the school guidance counselor assures that the information is communicated through Student Services to teachers and monitors progress. A copy of the 504 Plan is also posted on IPass. The plan is reviewed annually or when there is evidence that the presenting disability no longer affects the student’s ability to access their education. If the student is determined eligible for Section 504, the school guidance counselor will complete a 504 Plan Form.
Postponed Determination of Eligibility: A decision may be postponed while the Team assesses recommended strategies and data collection. For example, collecting data on the actual amount of extended time requested and used may guide informed decisions regarding eligibility.
No Eligibility: If the Team determines that the student does not qualify for accommodations/services under Section 504, the school guidance counselor will communicate the decision orally and in writing to the parent and the student will have only a Graduated Re-Entry Plan instead of a Section 504.
Examples of Accommodations after a Head injury:
The Director of Activities and Athletics, coaches, athletic trainers, nurses, teachers, school guidance counselors, parents/guardians and student athletes may be subject to penalties if they fail to meet the expectations described in this policy. For school staff those penalties may include:
For parents/guardians and student athletes those penalties may include:
Appendices – links & URLs for important forms are below