Guidelines forConcussion Managementin the School Setting
The University of the State of New YorkTHE STATE EDUCATION DEPARTMENTOffice of Student Support ServicesAlbany, New York 12234June 2012
i
Foreword
The Concussion Management and Awareness Act, specifically Chapter 496 of theLaws of 2011, requires the Commissioner of Education, in conjunction with theCommissioner of Health, to promulgate rules and regulations related to students whosustain a concussion, also known as a mild traumatic brain injury (MTBI), at school andat any district-sponsored event or related activity. These guidelines for return to schooland certain school activities apply to all public school students who have sustained aconcussion regardless of where the concussion occurred. The law also requires thatschool coaches, physical education teachers, nurses, and certified athletic trainerscomplete a New York State Education Department (NYSED) approved course onconcussions and concussion management every two years. Finally, the law requires thatstudents who sustained, or are suspected to have sustained, a concussion during athleticactivities are to be immediately removed from such activities. Students may not return toathletic activities until they have been symptom-free for a minimum of 24 hours and havebeen evaluated by, and receive written and signed authorization to return to activitiesfrom a licensed physician. Private schools have the option of adopting such policies.Private schools participating in interschool athletics with public school districts shouldcheck with their governing athletic body (e.g., New York State Public High SchoolAthletic Association, NYSPHAA; or Public School Athletic League, PSAL) to see if complying with the Concussion Management and Awareness Act is a condition of participation.The purpose of this document is to provide school district personnel,parents/guardians, students, and private health providers with information on concussionmanagement in school settings. It explains the purpose of a concussion managementprogram in schools and provides guidance for developing an effective program includingplanning, implementation, and follow-up protocols. This will assist in identifying astudent with a potential concussion, and insure that a student who has been diagnosedwith a concussion receives the appropriate care and attention at school to aid in his/herrecovery.When developing concussion management plans, districts will promote anenvironment where reporting signs and symptoms of a concussion is required andimportant. Students should be seen by their primary medical provider for diagnosis, whothen may choose to refer the student to a specialist as needed. If the student does nothave a primary medical provider, district health personnel may assist families in findingone by providing information on local clinics and/or providers along with information onpublic health insurance. Additionally, districts should be cognizant of the variousconstraints that
many students’ families
face. Although districts may assistparents/guardians with finding an appropriate medical provider, they should not requirestudents to see a district-chosen provider for a fee in order to be cleared to return toathletic activities. Per this law, any evaluation and clearance authorizing a student toreturn to athletic activities must be performed, written, and signed by a licensedphysician. Such written clearance must be sent to school for review by the districtmedical director
and is to be kept in the student’s cumulative health record
.
iiExtra-class periods of physical education (PE) means those sessions organized forinstruction and practice in skills, attitudes, and knowledge through participation inindividual, group, and team activities organized on an intramural, extramural, orinterschool athletic basis to supplement regular physical education class instruction[8NYCRR 135.1(h)]. In extra class activities, the district medical director is the finalperson to clear a student to return to such activities [8NYCRR 135.4(c](7](i]]. EducationLaw Section 902 requires all public school districts to have a director of school healthservices (commonly referred to as the medical director) who may be either a physician ornurse practitioner. In instances where a school district affiliates itself with a medicalpractice for its required health and welfare services, one physician or nurse practitionerwithin that medical practice is to be designated the medical director. The medicaldirector should be consulted when developing district policies and protocols for healthrelated matters such as concussion management.Every attempt has been made to ensure that the information and resourcescontained in this document reflect best practice in the fields of medicine and nursingpractice. Local educational agencies should review these guidelines with their counsel asnecessary to incorporate the guidance with district policy.
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