Plymouth Regional High School CONCUSSIONS AND HEAD INJURIES POLICY Pursuant to RSA 234, this policy will apply to all competitive athletic activities as identified by the administration. Athletic Director or Administrator in Charge of Athletic Duties Updating: Each spring, the athletic director or designee shall review any changes that have been made in procedures required for concussion and head injury management or other serious injury by consulting with the NHIAA or the District’s on-call physician, if applicable. If there are any updated procedures, they will be adopted and used for the upcoming school year. Identified Sports: Identified sports include all NHIAA-sanctioned activities, including cheer/dance squads, and any other district-sponsored sports or activities as determined by the district. Coach Training: All coaches shall undergo training in head injury and concussion management at least once every two years by one of the following means: (1) through viewing the NHIAA sport-specific rules clinic; or (2) through viewing the NHIAA concussion clinic found on the MHSA Sports Medicine page at www.mhsa.org. Parent Information Sheet: On a seasonal basis, a concussion and head injury information sheet shall be distributed to the student-athlete and the athlete's parent/guardian prior to the studentathlete's initial practice or competition. This information sheet may be incorporated into the parent permission sheet that allows students to participate in extracurricular athletics. Coach’s Responsibility: A student-athlete who is suspected of sustaining a concussion or head injury or other serious injury in a practice or game shall be immediately removed from play. Protocol For Return To Play No member of a school athletic team shall participate in any athletic event or practice the same day he or she: 1. Exhibits signs, symptoms or behaviors symptomatic of a concussion; or 2. Has been diagnosed with a concussion. No member of a school athletic team shall return to participate in an athletic event or training on the days after he/she experiences a concussion unless all of the following conditions have been met: 1. The student no longer exhibits signs, symptoms or behaviors consistent with a concussion, at rest or with exertion; 2. The student is asymptomatic during, or following periods of supervised exercise that is gradually intensifying; and 3. The student receives a written medical release from a licensed health care provider. The District may limit a student-athlete’s participation to “Graduated Return to Play” standards and protocol, as determined by the student’s treating health care provider. Copyright © 2008, New Hampshire School Boards Association. All rights reserved. NHSBA sample policies are distributed for resource purposes only, intended for use only by members of NHSBA Policy Services. Contents do not necessarily represent NHSBA legal advice or service, and are not intended for exact publication.

Concussion Awareness and Education The Board expects and directs the administration to implement concussion awareness and education into the district’s physical education and/or health education curriculum. The administrative decision will take into account all relevant considerations, including time, resources, access to materials, and other pertinent factors. Academic Issues in Concussed Students In the event a student is concussed, regardless of whether the concussion was a result of a school-related or non-school-related activity, school district staff should be mindful that the concussion may affect the student’s ability to learn. In the event a student has a concussion, that student’s teachers will be notified. Teachers should report to the school nurse if the student appears to have any difficulty with academic tasks that the teacher believes may be related to the concussion. The school nurse will notify the student’s parents and treating physician. Administrators and district staff will work to establish a protocol and course of action to ensure the student is able to maintain his/her academic responsibilities while recovering from the concussion. Section 504 accommodations may be developed in accordance with applicable law and board policies. This policy shall also apply to Physical Education Activity. Administrative Responsibilities: The Superintendent or his/her designee will keep abreast of changes in standards regarding concussion, explore staff professional development programs relative to concussions, and will explore other areas of education, training and programs. First Reading: August 21, 2012 Second Reading: September 18, 2012 Third Reading and Approval: October 16, 2012

Copyright © 2008, New Hampshire School Boards Association. All rights reserved. NHSBA sample policies are distributed for resource purposes only, intended for use only by members of NHSBA Policy Services. Contents do not necessarily represent NHSBA legal advice or service, and are not intended for exact publication.

CONCUSSION OR HEAD INJURY RETURN TO PLAY FORM Student Name:_____________________________ DOB:__________________ Grade:________ Date of Injury:______________________________ Health Care Provider Medical Clearance and Written Authorization to Return to Play I, ____________________________________with Health Care License #_________________ (print health care provider name)

of___________________________________________________________________________ (print business name and address)

by signing this Concussion or Head Injury Return to Play Form certify the following: 1. I am licensed, certified, or otherwise statutorily authorized by the State of New Hampshire to provide medical treatment and am trained in the evaluation and management of concussions. 2. I examined the above named student on the date listed below. 3. I explained to the student and the student’s parent/guardian the nature and risks of concussions or head injuries, including the risks of continuing to play and practice after sustaining a concussion or head injury. 4. I have medically cleared the above named student to return to play and practice without any restrictions. 5. The above named student has my written authorization to return to play and practice. ___________________________________________

____________

Signature of licensed physician

Date

Parent/Guardian or Adult Student Written Permission to Return to Play I, _________________________________am the parent/guardian or the adult student (print name of parent/guardian or adult student)

who was removed from play at a practice or game because of a suspected concussion or head injury. By signing this Concussion or Head Injury Return to Play Form, I certify the following: 1. The student was evaluated by a health care provider, who is listed above and has received written medical clearance to return to play and practice. 2. The health care provider has explained the nature and risk or concussions and head injuries, including the risk of continuing to play and practice after sustaining a concussion or head injury. 3. I understand, acknowledge, and accept the risks of the student returning to play and practice. 4. I understand and acknowledge that the student cannot return to play and practice without written permission. 5. I give my written consent and permission for the student to return to play and practice. ___________________________________________

______________

Signature of parent, guardian or adult student

Date

Copyright © 2008, New Hampshire School Boards Association. All rights reserved. NHSBA sample policies are distributed for resource purposes only, intended for use only by members of NHSBA Policy Services. Contents do not necessarily represent NHSBA legal advice or service, and are not intended for exact publication.

CONCUSSION AND HEAD INJURY POLICY.pdf

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