Prevention

The Valley Central School District recognizes that protecting students from head injuries is one of the most important ways of preventing a concussion. Although the risk of a concussion is present with certain types of sports, education, proper athletic equipment, and supervision will help minimize the risk(s) of injuries. The District’s equipment provided for our athletic teams are certified to meet the national safety standards approved by the National Organization for Care and Safety of Athletic Equipment (NOCSAE).

The Valley Central Athletic Coaches, Athletic Trainer and/or School Nurses will inform athletes and parents/guardians of the signs and symptoms of concussions, how these types of injuries occur, and possible long term effects resulting from such injuries. The Nurses Office/Athletic Trainer can provide supporting written informational hand-outs.

In addition, it is imperative that students recognize symptoms of a concussion and inform appropriate personnel, even if they believe they have sustained the mildest of concussions. This information should be reviewed periodically with student athletes throughout each season. Student athletes must follow the guidelines for return to school and activities. It is extremely important that all students be made aware of the importance of reporting any symptoms of a concussion to their parent/guardian and/or appropriate district staff.

The Valley Central School District’s Interscholastic Rules & Regulations and Parent/Guardian Consent form are part of the online sports registration at the beginning of each season.

Education

Concussion education will be available for all administrators, teachers, coaches, school nurses, athletic trainers, and guidance counselors. Parents/ guardians will learn about concussions during preseason sports meetings and information sheets will be available. Education should include, but not be limited to, the definition of concussion, signs and symptoms, how concussions may occur, why concussions are not detected with CT Scans or MRIs, management of the injury and the protocol for return to school, activity or interscholastic athletics. The protocols will cover all students returning to school after suffering a concussion, regardless if the accident occurred outside of school or while participating in a school activity.

The Concussion Management and Awareness Act, (specifically Chapter 496 of the Laws of 2011) requires that school coaches, physical education teachers, nurses and certified athletic trainers complete a New York State Education Department (NYSED) approved course on concussions and concussion management every two years. NYSED has approved the course Heads Up, Concussion in Youth Sports for physical education teachers and coaches.

It is a free web-based course developed by the CDC and is available at http://www.cdc.gov/concussion/HeadsUp/online training.html This is not a NYS specific training video; therefore, the scope of practice of certified athletic trainers and school nurses in NYS may differ from what is described in the training. Registered professional nurses and certified athletic trainers practicing in NYS must follow NYS laws in regards to licensing and scope of practice. Or NFHS Concussion in Sports- https://nfhslearn.com/courses/concussion-in-sports-2

Concussion Management Team

The District has established a concussion management team (CMT). The CMT includes the Athletic Director, School Nurse, Athletic Trainer, and School Medical Director.

Additional school staff such as administrators, guidance counselors, teachers, physical education teachers and coaches may participate with the CMT on an, as needed, basis. The CMT will collaborate with the private medical provider, the student and the student’s family to assist with the student’s recovery.

The CMT will

act as a liaison for any student returning to school and/or play following a
review and/or design an appropriate plan for the student while the student is
utilize the NYSPHSAA website as well as for information related to the signs and symptoms of concussions and the appropriate return to play protocols. https://www.nichd.nih.gov/news/resources/spotlight/020612-concussions

A handout describing the Concussion Management team is also available on the NYSPHSAA website. A Concussion Management Check List that has been approved and recommended by CDC will be utilized https://www.cdc.gov/headsup/index.html

The Athletic Director will coordinate training for all administrators, teachers, and coaches. Training is mandatory for all physical education teachers, coaches, assistant coaches, and volunteer coaches who work with student athletes. Training is also mandatory for all school nurses and certified athletic trainers.

Parents/Guardians need to be aware of the school district’s policy and procedures, how these injuries will ultimately be managed by school officials and what information is necessary for the school to receive from a medical provider. Students also need to be educated as a concussion is primarily diagnosed by reported and/or observed signs and symptoms. These guide the members of the team in transitioning the student back to activities.

Students should be educated about the following topics:

Preventing head injuries
Risk of concussion and risk of not reporting the sign and symptoms
Reporting signs and symptoms of a concussion to a coach, certified athletic trainer, school nurse, parent/guardian, or other staff
Asking for help and informing teachers of difficulties they experience in class and when completing assignments
Following the instructions from their private medical provider
Encouraging classmates and teammates to report injuries
Promoting an environment where reporting signs and symptoms of a concussion is considered acceptable

Concussion Management Protocol

If a student sustains a possible head injury during school hours, the student is to be seen by the school It is the responsibility of the supervising adult to ensure that the school nurse is notified or the student is taken to the school nurse.
The school nurse will follow the first aid protocols for a suspected head injury. The school nurse will also provide parents/guardians with oral and/or written instructions on observing the student for concussive complications that warrant immediate emergency care.
If the student sustains a possible head injury after school hours, the coach, athletic trainer or supervising adult will remove the student from the activity, follow the first aid protocols and follow the notification The supervising adult will notify the school nurse on the next school day and complete the accident report.
The school nurse will be responsible for follow-up and coordination between the student, parents/guardians, physical education teachers, coaches, athletic trainer, school medical director, and student’s health care provider.
In keeping with the law, if the student is suspected to have a concussion, either based on the disclosure of a head injury, observed or reported symptoms, or by sustaining a significant blow to the head or body, the student must be removed from athletic activity and/or physical activities (e.g. PE class, recess) and may not be returned to athletic activities until he/she has been symptom-free for a minimum of 24 hours and has been evaluated by a duly licensed physician. Ensure that students diagnosed with a concussion do not substitute mental activities for physical activities unless medical provider clears the student to do so (e.g. Due to the need for cognitive rest, a student should not be required to write a report if they are not permitted to participate in PE class by their medical provider).
When the student’s parent/ guardian has provided the physician authorization to return to activities, the school nurse/athletic trainer will review the medical provider’s written clearance for the student to begin or precede past Step 3 of RTP If the student is still experiencing symptoms, or if the medical history, concussion severity etc., concern the nurse/athletic trainer, he/she will consult with the medical director to determine if the student is ready to return. The Chief School Medical Director will make the final decision when a student will be allowed to return to physical activities.
When the medical director determines it is safe for the student to return to play, the nurse/ athletic trainer will be notified that the athlete can begin or proceed past Step 3 the return to play protocol
If the student sustains a head injury other than in a school activity, the parents/ guardians should notify the school nurse/athletic trainer and the student will not return to physical activity until they receive written and signed authorization to return to activities by the student’s health care provider (licensed physician, nurse practitioner or physician assistant).
Elementary and Secondary students who are not involved in sports, must have written authorization from their health care provider and be symptom free without medication for 7 days before returning to physical education, recess or any other physical activity at school. Due to the need for cognitive rest, a student should not be required to write a report for PE class if they are not cleared cognitively by their medical provider. The school nurse will notify the P.E. teacher that the student has sustained a concussion and is ready to return to physical activity. The P.E.teacher will remove the student from play if there are any complaints of headaches, dizziness or any other adverse reactions. The nurse will then notify the parents/guardian that the student is being removed from physical activity and discuss follow-up care with the medical provider.

Return to Play:

The NYSED Guidelines for Concussion Management in Schools (2023) have been revised to reflect the current recommendations on managing concussions. Emerging research suggests that some symptoms may be acceptable during the return to activities. The updated guidelines reflect this practice along with emphasizing that schools follow the guidance of the student’s health care provider on what symptoms are acceptable for return to activities.

Return to play following a concussion involves a stepwise progression, once the individual is symptom free for at least 24 hours. There are many risks to premature return to play including: a greater risk for a second concussion because of a lower concussion threshold, second impact syndrome (abnormal brain blood flow that can result in death), exacerbation of any current symptoms, and possibly increased risk for additional injury due to alteration in balance. No student athlete should return to play while severely symptomatic. Students are prohibited from returning to play the day the concussion is sustained. If there is any doubt as to whether a student has sustained a concussion, it should be treated as a concussion. Once the student athlete is symptom free at rest for 24 hours without pain medication and has either a signed release by the treating clinician, or has been cleared by the school nurse/school physician/athletic trainer, she/he may begin the return to play progression below (provided there are no other mitigating circumstances). The return to play will be supervised by the athletic trainer for student athletics.

As per new research, the RTP can begin with minimal symptoms, but must be stopped, if exasperated by 2 points, and cannot proceed past Step 3 without a signed release from the treating physician.

The recommended return to physical activity protocol based on The “Consensus Statement on Concussion in Sport” from the October 2022 International Conference in Amsterdam was published in June 2023 – These updates are important to school administrators to ensure that policies reflect the most current best-practice recommendations. An annual review of concussion policy and protocol is recommended, and given these consensus changes, revisions of local policy are probably warranted.

Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022.

British Journal of Sports Medicine 2023;57:695-71

Return to play: Athletes

Step 1: Symptoms-limited activity, Daily activities: —Walking, gradual reintroduction to school
Step 2: Aerobic Exercises (50%) — Stationary Bike or walk at a medium pace
Step 2B: Aerobic Exercises- Moderate (70%) — Medium to fast pace jog; Light Resistive training
Step 3: Individual sport-specific exercise—Training away from team- running, changing directions, solo training drills**activity with no chance of head impact Medical Clearance Needed to proceed: Steps 4-6 begin after resolution of all symptoms before and after physical exertion. Cognitive function has to be normal
Step 4: Non Contact training drills — High intensity including challenging drills, can integrate into team activities
Step 5: Full Contact Practice—Participate in normal training
Step 6 : Return to Sport—Normal Game Play

A gradual return to physical activity typically is done by progressing a student through levels of activity that increase in duration and/or intensity. Gradual return to activity should occur with the introduction of a new activity level every 24 hours. Brief, mild symptom exacerbation does not delay recovery. Activity that more than mildly exacerbates symptoms should be stopped. 2-point increase on a 0-10 scale compared with the pre-activity level. Current research suggests that some level of symptoms with activity is acceptable. Therefore, schools will need to follow provider orders on return to activities. This allows for aerobic rehab activities to occur even when symptoms are still present, rather than restricting physical activity until completely symptom-free. Resolution of concussion symptoms is still required prior to returning to non-contact practice.

Return to play – Non-Athletes

The School Nurse and the Physical Education Teachers will be responsible for the return to play for non-athletes. The same documentation will be required from the student’s medical provider and the Chief School Medical Director will make the final decision as to when a student will return to physical activities. When the student is cleared, the school nurse will notify in writing the physical education teacher and the return to play will be initiated.

Non-Athletic RTP:

Step 1: Symptoms-limited activity, Daily activities: —Walking, gradual reintroduction to school
Step 2: Aerobic Exercises (50%) — Stationary Bike or walk at a medium pace
Step 2B: Aerobic Exercises- Moderate (70%) — Medium to fast pace jog; Light Resistive training
Step 3: Individual sport-specific exercise**activity with no chance of head impact—Training away from team- running, changing directions, solo training drills
Medical Clearance Needed to proceed: Steps 4-6 begin after resolution of all symptoms before and after physical exertion. Cognitive function has to be normal
Step 4: Non Contact training drills — High intensity including challenging drills, can integrate into team activities
Step 5: Full Contact Practice—Participate in normal PE Class
Step 6 : Return to Full—Normal Game Play

Classroom Teacher

The school nurse will notify the student’s teachers and guidance counselor that the student has sustained a concussion. Teachers should make accommodations that minimize aggravating symptoms so that the student has sufficient cognitive rest. The nurse will provide information from the private medical provider regarding limitations on the student during the recovery phase. Teachers can refer to the web sites listed below for more information.

Students transitioning into school after a concussion might need academic accommodations to allow for sufficient cognitive rest. These include, but are not necessarily limited to:

Shorter school day
Rest periods
Extended time for tests and assignments
Copies of notes
Alternative assignments
Minimizing distractions
Permitting student to audiotape classes
Peer note takers
Provide assignments in writing
Refocus student with verbal and nonverbal clues

With written documentation from the medical provider, a 504 Plan may need to be initiated until the student has recovered from the concussion.

Information Sources and Accommodations for Classroom Teacher

Teachers should make accommodations that minimize aggravating symptoms so that the student has sufficient cognitive rest. The nurse will provide information from the private medical provider regarding limitations on the student during the recovery phase. Teachers can refer to the following web sites for more information:

State University of NY Concussion in the Classroom
Educators Guide to Concussion in the Classroom
Centers for Disease Control – Returning to school after concussion

As per The “Consensus Statement on Concussion in Sport” from the October 2022 International Conference in Amsterdam Revised strategies for return-to-learn . Prolonged absence from school has been determined to be detrimental to concussion recovery, as well as to overall wellness.

Therefore, it is recommended that students return to school as soon as tolerable. Even if minimal learning is taking place, return to school, before return to learn, improves recovery. Adjustments to mitigate symptom triggers (i.e., Billed hat or sunglasses if sensitive to lights, taking frequent breaks, postponing tests), and half-day attendance can help students better tolerate the school environment.

Concussion Signs and Symptoms for Classroom Teacher

Physical Symptoms

Headache
Neck pain
Nausea
Lack of energy and constantly feeling physically and mentally tired
Dizziness, light-headedness, and a loss of balance
Blurred or double vision and sensitivity to light
Increased sensitivity to sounds
Ringing in the ears
Loss of sense of taste and smell
Change in sleep patterns especially waking up a lot at night

Cognitive Symptoms

Difficulty concentrating and paying attention
Trouble with learning and memory
Problems with word-finding and putting thoughts into words
Easily confused and losing track of time and place
Slower in thinking, acting, reading, and speaking
Easily distracted
Trouble doing more than one thing at a time
Lack of organization in everyday tasks

Social and Emotional Symptoms

Mood changes including irritability, anxiousness, and tearfulness
Decreased motivation
Easily overwhelmed
More impulsive
Withdrawn and wanting to avoid social situations especially if there is a lot of people

Cross-ref: 5200-R, Cocurricular and Extracurricular Programs Regulation

Ref: 8 NYCRR §135.4 8 NYCRR §136.5
Education Law §305(42)
Adoption date: March 11, 2002

Revised: September 24, 2012
Reviewed: May 22, 2017
Revised: September 14, 2026
Reviewed: June 11, 2026
Adopted: Sept. 14, 2026