File JJIF-R: Procedure for Management of Concussions and Other Head Injuries

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Procedure for Management of Concussions and Other Head Injuries

  1. If student comes to health office with suspected concussion, school nurse will investigate.

    A. With Blow to Head during school day  à Confirm Event

    B. OR, with blow to head outside school day:
    à Call home and confirm Event
    à If indicated student has seen his/her Primary Care Provider (PCP) (and a signed release is on file from parent/guardian allowing RN to talk to PCP), consult with PCP for actual diagnosis of concussion.
  1. School Nurse to Perform Assessment.

    A. If there is no school nurse or athletic trainer available to perform the assessment, then staff on duty (i.e. Health Aide, secretary, principal) will call parents and monitor student.

    B. If condition deteriorates, 911 will be called.

    C. Based on assessment, student will either: rest in health office, return to class, go home, or go to PCP.
  1. Implement concussion care plan/protocol from PCP.

    School nurse to email classroom teacher(s) and guidance.  Classroom teacher and guidance will in turn follow recommended steps outlined in School/Academic Expectations during Post-Concussion Recovery

  1. If symptoms persist in class, student will be referred back to the health office and the nurse will re-assess and update the plan of action.

School/Academic Expectations during Post-Concussion Recovery

http://www.maine.gov/doeconcussion/resources/schoolexpectations.htm

Follow these guidelines unless otherwise directed by treating healthcare professional.

Stage Goals/Key Ideas Teacher/Guidance Actions Student Actions
I Complete Rest • Contacted by school nurse
• Explanation of injury and current plan of care
 • Out of school. No School Work
• Strict limits re: use of electronics
No physical/Sports activities
II Significant deficits in processing speed, memory, etc>>>? May be vision difficulties

Cognitive activity as tolerated*
Develop list of three categories of assignments:

• Excused: not to be made up
• Accountable: Responsible for content, not necessarily, process- may have accommodations or alternate form.
• Responsible: Student will complete and be graded, when able.

Goal is to help student keep up with learning as much as possible but not necessarily to be completing assignments that are non-essential to acquisition and basic demonstration of knowledge. The longer the recovery process, the more that should be eliminated or altered.
• In school as tolerated*
• Homework as tolerated*
• Get copies of notes, handouts?
• Communicate with teachers about progress and plans
• Be patient with slow recovery. Do not push so much that symptoms occur or increase. Rest eyes and just listen, or see nurse to rest if feeling worse. Go home if symptoms still worsen.
• No physical/sports activity - including gym/PE/recess. No playing wind instrument - music class as tolerated* 
III Gradual increase of time and energy, slowing resuming workload • Prioritize assignments with student, taking into account make-up work and new work. Assist with timelines.
• Continue to use above categories.
• Provide extra help as needed regarding missed material and mastery of concepts
• Full classroom attendance as tolerated*
• Progress bak to homework completion - then tests as tolerated* - if memory is okay
• Coordinate with teachers about catching up, keeping up
• No Physical/Sports activity as above
IV Resumption of Normal Activities • Monitor completion of assignments
• Communication between teachers, parents, and guidance re: assignment completion, student's ability to work at pace of peers, and grades.
• Resume all academic activities
• Communicate with teachers/guidance re: progress toward being caught up
• Start graduated return to play with guidance from healthcare professional

    • "as tolerated" means as long as the activity does not produce or increase the concussion symptoms
    • ** Duration varies greatly from one student to another. The state a student is at is determined by the healcare professional managing the student's concussion.


    BOARD REVIEW: April 25, 2019

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