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Concussion Protocols

Are You Ready?. Concussion Protocols.

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Concussion Protocols

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  1. Are You Ready? Concussion Protocols

  2. The Bill amends the Education Act. The amendments authorizes the Minister to make policies and guidelines respecting head injuries and concussions and sets out a list of matters that this power includes. The amendments requires boards to establish policies and guidelines respecting head injuries and concussions and requires boards to address the specified matters. The Minister is also given authority to make regulations about the same matters. The section describes when board employees or volunteers will not be liable in a civil proceeding for their acts or omissions. EXPLANATORY NOTE

  3. Bill 39 requires that every board shall establish policies and guidelines respecting head injuries and concussions in pupils • You need to decide whether your concussion document will be: • Policy • Administrative Procedure • Guideline • Protocol First Thing to consider

  4. What is the definition of a Concussion? • Bill 39 does not define “concussion” • Varying definitions of what is a “concussion” Second Thing to Consider

  5. A concussion is a common form of brain injury and can be caused by a direct or indirect hit to the head or body (for example, a check to the boards, a hit to the head or car crash). This causes a change in the brain function, which results in a variety of symptoms. With a concussion there is no visible injury to the structure of the brain, meaning that tests like MRI or CT scans usually appear normal. Think First Definition

  6. A concussion is a traumatic brain injury that disrupts the way the cells in the brain normally work and which can vary in severity and consequences. OPHEA Definition

  7. A patient with mild traumatic brain injury is a person who has had a traumatically induced physiological disruption of brain function, as manifested by one or more of the following: • Loss of consciousness for up to 30 minutes • Loss of memory for events immediately before or after the accident for as much as 24 hours • Alteration of mental state at the time of the accident (e.g. feeling dazed, disoriented, or confused) • Focal neurological deficit(s) that may or may not be transient World Health Organization Definition

  8. A concussion is a type of traumatic brain injury (TBI) that results from a bump, blow, or jolt to the head (or by a hit to the body) that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain. • DSBN used this definition for our Administrative Procedure CENTERS FOR DISEASE CONTROL & PREVENTION Definition

  9. A concussion is a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma. Medical Definition

  10. Bill 39 requires that boards distribute information to pupils, parents, guardians, board employees and volunteers about the prevention of head injuries, the identification of symptoms of concussions and the management of concussions. • Do not reinvent the wheel.Great resources are available: http://www.thinkfirst.ca/programs/concussion_resources.aspx http://www.cdc.gov/concussion/sports/resources.html Communicating Prevention of Concussions

  11. PREVENTION 1. Education for coaches, staff, parents and students to: • a) Recognize the symptoms of concussion; • b) Remove the athlete from play; • c) Refer the athlete to a physician. 2. Wearing the protective equipment appropriate for the sport engaged in: • a) Equipment should fit properly; • b) Equipment should be well maintained; • c) Equipment should be worn consistently and correctly. 3. Students should follow their coaches' rules for safety and the rules of the sport. 4. Parents need to teach their child that it is not smart to participate in sports if they received a head injury. Communicating Prevention of Concussions

  12. PREVENTION 5. It is not a badge of honour to play injured. 6. Discourage others from pressuring injured students to play. 7. Parents/coaches must not convince the child/student that he/she is "just fine". 8. Sharing of information with the school and the school coaches about any concussions the student may have suffered in the past. 9. Provide reassurance, support and request/offer academic accommodations as needed. 10. Outline the risks associated with the activity/sport for a concussion. 11. Demonstrate how the risks can be minimized e.g. teach proper sport techniques - correct tackling in football, effective positioning in soccer, how to avoid over-crowding when using the creative playground. Take attendance in class and interschool sports and instruct absent student/athletes, on previously taught safety skills, prior to next activity session. Communicating Prevention of Concussions

  13. PREVENTION 12. Document safety lessons e.g. date, time, brief content, list of students in attendance. 13. Teach skills in proper progression. 14. Enforce the rules of the sport. 15. Emphasize the principles of head-injury prevention e.g. keeping the head up and avoiding collision. 16. Eliminate all checks to the head. 17. Eliminate all hits from behind. 18. Check that protective equipment is visually inspected prior to activity and well maintained. 19. Enforce the principles of: respect for the rules of the game and practice fair play. Communicating Prevention of Concussions

  14. Appendix A – Signs and Symptoms of a Concussion Poster • Appendix B – Parent Fact Sheet – Concussion • Appendix C - Concussion Guidelines for the Teacher • Appendix D – Concussion Signs and Symptoms Checklist • Appendix E – Coach Pocket Scat 2 Test • Appendix F – Principal Responsibilities Poster • Appendix G – Request to Resume Athletic Participation: Concussion Related Injuries Communicating Prevention of Concussions

  15. As soon as an injury occurs, first aid must be administered. • Do not leave the student alone; • monitor signs and symptoms for deterioration. • Do not administer medication. • Staff must be alert for symptoms that worsen over time. When a suspected concussion occurs

  16. The student should be seen in an emergency department immediately if he/she has: • One pupil (the black part in the middle of the eye) larger than the other • Drowsiness or cannot be awakened • A headache that gets worse and does not go away • Weakness, numbness, or decreased coordination • Repeated vomiting or nausea • Slurred speech • Convulsions or seizures • Difficulty recognizing people or places • Increasing confusion, restlessness, or agitation • Unusual behavior • Loss of consciousness (even a brief loss of consciousness should be taken seriously) When a suspected concussion occurs

  17. Bill 39 requires that the policies and guidelines respecting head injuries and concussions includes responsibilities of board employees, classes of board employees, or other persons who are involved in intramural or inter-school athletics or any part of the health and physical education curriculum in relation to the prevention of head injuries, the identification of symptoms of concussions and the management of concussions • Bill 39 requires that the policies and guidelines respecting head injuries and concussions includes responsibilities of other persons, in addition to board employees. (example: parents, physician etc.) Responsibilities

  18. Responsibilities of the School Board and School • Responsibilities of the Principal (Appendix F) • Responsibilities of Teaching Staff (academic, coaching, psychologists, speech language pathologists etc.) • Responsibilities of Parents/Guardians • Responsibilities of Physician/Health Care Provider • Responsibilities of the Student Responsibilities

  19. Bill 39 requires that the policies and guidelines respecting head injuries and concussions includes a process respecting when a pupil who is suspected of having sustained a concussion is to be removed from or prevented from further participating in intramural or interschool athletics or any part of the health and physical education curriculum RESTRICTING Participation in Athletics

  20. The Think First Return to Play Guidelines can be used: • A concussion is a serious event, but you can recover fully from such an injury if the brain is given • enough time to rest and recuperate. Returning to normal activities, including sport participation, is a • step-wise process that requires patience, attention, and caution. http://www.thinkfirst.ca/programs/documents/TF_Concussion_RTP_E_2012.pdf RESTRICTING Participation in Athletics

  21. Step 1: No activity, only complete rest Limit school, work and tasks requiring concentration. Refrain from physical activity until symptoms are gone. Once symptoms are gone, a physician, preferably one with experience managing concussions, should be consulted before beginning a step wise return to play process. RESTRICTING Participation in Athletics

  22. Step 2: Light aerobic exercise Activities such as walking or stationary cycling. The player should be supervised by someone who can help monitor for symptoms and signs. No resistance training or weight lifting. The duration and intensity of the aerobic exercise can be gradually increased over time if no symptoms or signs return during the exercise or the next day. Symptoms? Return to rest until symptoms have resolved. If symptoms persist, consult a physician. No symptoms? Proceed to Step 3 the next day. RESTRICTING Participation in Athletics

  23. Step 3: Sport specific activities Activities such as skating or throwing can begin at step 3. There should be no body contact or other jarring motions such as high speed stops or hitting a baseball with a bat. Symptoms? Return to rest until symptoms have resolved. If symptoms persist, consult a physician. No symptoms? Proceed to Step 4 the next day. RESTRICTING Participation in Athletics

  24. Step 4: Begin Drills without body contact. Symptoms? Return to rest until symptoms have resolved. If symptoms persist, consult a physician. No symptoms? The time needed to progress from non-contact exercise will vary with the severity of the concussion and with the player. Proceed to Step 5 only after medical clearance. RESTRICTING Participation in Athletics

  25. Step 5: Begin Drills with body contact. Symptoms? Return to rest until symptoms have resolved. If symptoms persist, consult a physician. No symptoms? Proceed to Step 6 the next day Step 6: GAME PLAY. RESTRICTING Participation in Athletics

  26. How Long Does this process take? These steps do not correspond to days! It may take many days to progress through one step, especially if the concussion is severe. As soon as symptoms appear, the player should return to rest until symptoms have resolved and wait at least one more day before attempting any activity. The only way to heal a brain is to rest it. Never return to play if THERE ARE STILL symptoms! A player who returns to active play before full recovery from the first concussion is at high risk of sustaining another concussion, with symptoms that may be increased and prolonged. RESTRICTING Participation in Athletics

  27. There are Challenges How does a parent/guardian find a doctor knowledgeable in concussions ? When dealing with concussions, it is important to see a doctor who is knowledgeable in concussion management. This might include a General Practitioner or someone such as a sports medicine specialist. The General Practitioner may be required to submit a referral to see a specialist. • Contact the Canadian Academy of Sport and Exercise Medicine (CASEM) to find a sports medical physician in your area. Toll Free: 1-877-585-2394 RESTRICTING Participation in Athletics

  28. Bill 39 requires that the policies and guidelines respecting head injuries and concussions includes measures to return a pupil who has or may have sustained a concussion to any part of the health and physical education curriculum, or his or her return to learning; POST-CONCUSSION RETURN TO LEARNING

  29. To start, identify the types of symptoms the student is experiencing. Next, try to identify specific factors that may worsen the student’s symptoms so steps can be taken to modify those factors. For example: • Do some classes, subjects, or tasks appear to pose greater difficulty than others? (compared to pre-concussion performance) • For each class, is there a specific time frame after which the student begins to appear unfocused or fatigued? (e.g., headaches worsen after 20 minutes) POST-CONCUSSION RETURN TO LEARNING

  30. Is the student’s ability to concentrate, read or work at normal speed related to the time of day? (e.g., the student has increasing difficulty concentrating as the day progresses) • Are there specific things in the school or classroom environment that seem to distract the student? • Are any behavioral problems linked to a specific event, setting (bright lights in the cafeteria or loud noises in the hallway), task, or other activity? POST-CONCUSSION RETURN TO LEARNING

  31. Talk with the student about these issues and offer support and encouragement. In consultation with the student’s heath care professional, and as the student’s symptoms decrease, extra help or support can be removed gradually. POST-CONCUSSION RETURN TO LEARNING

  32. Cognitive • Concentrate first on general cognitive skills, such as flexible thinking and organization, rather than academic content. • Focus on what the student does well and expand the curriculum to more challenging content as concussion symptoms subside. • Adjust the student’s schedule as needed to avoid fatigue: shorten day, time most challenging classes with time when student is most alert, allow for rest breaks, reduced course load. • Adjust the learning environment to reduce identified distractions or protect the student from irritations such as too-bright light or loud noises. • Use self-paced, computer-assisted, or audio learning systems for the student having reading comprehension problems. POST-CONCUSSION RETURN TO LEARNING

  33. Cognitive • Allow extra time for test/in-class assignment completion. • Help the student create a list of tasks and/or daily organizer. • Assign a peer to take notes for the student. • Allow the student to record classes. • Increase repetition in assignments to reinforce learning. • Break assignments down into smaller chunks and offer recognition cues. • Provide alternate methods for the student to demonstrate mastery, such as multiple-choice or allowing for spoken responses to questions rather than long essay responses. POST-CONCUSSION RETURN TO LEARNING

  34. Behaviour/Social/Emotional • If the student is frustrated with failure in one area, redirect him/her to other elements of the curriculum associated with success. • Provide reinforcement for positive behavior as well as for academic achievements. • Acknowledge and empathize with the student’s sense of frustration, anger or emotional outburst: “I know it must be hard dealing with some things right now.” • Provide structure and consistency; make sure all teachers are using the same strategies. POST-CONCUSSION RETURN TO LEARNING

  35. Behaviour/Social/Emotional • Remove a student from a problem situation, but avoid characterizing it as a punishment and keep it as brief as possible. • Establish a cooperative relationship with the student, engaging him/her in any decisions regarding schedule changes or task priority setting. • Involve the family in any Positive Behavior Support Plan. • Set reasonable expectations. • Arrange preferential seating, such as moving the student away from the window (e.g. bright light), away from talkative peers, or closer to the teacher. POST-CONCUSSION RETURN TO LEARNING

  36. Physical • Allow the student to go to the health room to rest (if available) if headache returns • Allow to go home if headaches persist • Use the elevator in the school (if available) • If photophobic, use of sunglasses or hat as needed • May allow student to leave early from class to avoid crowded or noisy hallways • No Physical Education class • Eat somewhere other than a noisy cafeteria POST-CONCUSSION RETURN TO LEARNING

  37. A board employee or volunteer who is involved in intramural or inter-school athletics or any part of the health and physical education curriculum is not personally liable in a civil proceeding for an act or omission if the person acts reasonably in the circumstances, in good faith and in accordance with the Act, regulations and with any policies and guidelines made under this section. No liability if person acts in good faith

  38. Children and adolescents are among those at greatest risk for concussions. The potential for a concussion is greatest during activities where collisions can occur, such as during physical education (PE) class, playground time, or school-based sports activities. However, concussions can happen any time a student’s head comes into contact with a hard object, such as a floor, desk, or another student’s head or body. Proper recognition and response to concussion can prevent further injury and help with recovery. Prevention is the only cure for Brain and Spinal Cord Injuries. CONCLUSION

  39. Thank-you Michael Langlois, CES, CRSPHealth and Safety OfficerDistrict School Board of Niagara

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