KANSAS STATE HIGH SCHOOL ACTIVITIES ASSOCIATION
RECOMMENDATIONS FOR COMPLIANCE WITH THE KANSAS SCHOOL SPORTS HEAD INJURY PREVENTION ACT AND IMPLEMENTATION OF THE NATIONAL FEDERATION SPORTS PLAYING RULES RELATED TO CONCUSSIONS
The following language appears in all National Federation sports’ rules books:
“Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health care professional.”
The Kansas Legislature has enacted the School Sports Head Injury Prevention Act (hereinafter the “Kansas Act”) effective July 1, 2011:
New Sec. 17. (a) This section shall be known and may be cited as the school sports head injury prevention act. (b) As used in this section:
(1) ‘‘School’’ means any public or accredited private high school, middle school or junior high school.
(2) ‘‘Health care provider’’ means a person licensed by the state board of healing arts to practice medicine and surgery.
(c) The state board of education, in cooperation with the Kansas state high school activities association, shall compile information on the nature and risk of concussion and head injury including the dangers and risks associated with the continuation of playing or practicing after a person suffers a concussion or head injury. Such information shall be provided to school districts for distribution to coaches, school athletes and the parents or guardians of school athletes.
(d) A school athlete may not participate in any sport competition or practice session unless such athlete and the athlete’s parent or guardian have signed, and returned to the school, a concussion and head injury information release form. A release form shall be signed and returned each school year that a student athlete participates in sport competitions or practice sessions.
(e) If a school athlete suffers, or is suspected of having suffered, concussion or head injury during a sport competition or practice session, such school athlete immediately shall be removed from the sport competition or practice session.
(f) Any school athlete who has been removed from a sport competition or practice session shall not return to competition or practice until the athlete is evaluated by a health care provider and the health care provider provides such athlete a written clearance to return to play or practice. If the healthcare provider who provides the clearance to return to play or practice is not an employee of the school district, such health care provider shall not be liable for civil damages resulting from any act or omission in the rendering of such care, other than acts or omissions constituting gross negligence or willful or wanton misconduct.
(g) This section shall take effect on and after July 1, 2011.
The KSHSAA offers the following guidelines and recommendations for compliance with the Kansas Act and for implementation of the NFHS playing rule related to concussions:
1. If a student suffers, or is suspected of having suffered a concussion or head injury during a sport competition or practice session, the student: (1) must be immediately removed from the contest or 47 practice and (2) may not again participate in practice or competition until a health care provider has evaluated the student and provided a written clearance for the student to return to practice and competition. The National Federation and the KSHSAA recommend that the student should not be cleared for practice or competition the same day the concussion consistent sign, symptom or behavior was observed.
2. What are the “signs, symptoms, or behaviors consistent with a concussion”? The National Federation rule lists some of the signs, symptoms and behaviors consistent with a concussion. The U.S. Department of Human Services, Centers for Disease Control and Prevention has published the following lists of signs, symptoms and behaviors that are consistent with a concussion:
SIGNS OBSERVED BY OTHERS SYMPTOMS REPORTED BY ATHLETE
● Appears dazed or stunned
● Is confused about assignment
● Forgets plays
● Is unsure of game, score, or opponent ● Moves clumsily
● Answers questions slowly
● Loses consciousness
● Shows behavior or personality changes
● Cannot recall events prior to hit
● Cannot recall events after hit
● Balance problems or dizziness
● Double or fuzzy vision
● Sensitivity to light or noise
● Feeling sluggish
● Feeling foggy or groggy
● Concentration or memory problems
These lists may not be exhaustive
3. What is a “Health Care Provider”? The Kansas Sports Head Injury Prevention Act defines a health care provider to be “a person licensed by the state board of healing arts to practice medicine and surgery.” The KSHSAA understands this means a Medical Doctor (MD) or a Doctor of Osteopathic Medicine (DO).
4. The first step to concussion recovery is cognitive rest. Students may need their academic workload modified or even be completely removed from the classroom setting while they are initially recovering from a concussion as they may struggle with concentration, memory, and organization. Students should also avoid the use of electronic devices (computers, tablets, video games, texting, etc.) and loud noises, as these can also impair the brain’s recovery process. Trying to meet academic requirements too early after sustaining a concussion may exacerbate symptoms and delay recovery. Any academic modifications should be coordinated jointly between the student’s medical providers and school personnel. No consideration should be given to returning to physical activity until the student is fully integrated back into the classroom setting and is symptom free. Rarely, a student will be diagnosed with post-concussive syndrome and have symptoms that last weeks to months. In these cases, a student may be recommended to start a non-contact physical activity regimen, but this will only be done under the direct supervision of a healthcare provider.
5. Return to Play or Practice Clearance Requirements:
A. The clearance must be in writing and signed by a health care provider.
B. The National Federation and the KSHSAA recommend the clearance should not be issued on the same day the athlete was removed from play.
C. The National Federation and the KSHSAA recommend that a student who has been removed from a practice or competition because the student suffered, or was suspected of suffering, a concussion or head injury should complete a graduated return to play protocol following medical clearance before returning to unrestricted practice or competition. The National Federation has included the following graduated protocol in its Suggested Guidelines for Management of Concussion in Sports. In most cases, the athlete will progress one step each day. The return to activity program schedule may proceed as below following medical clearance:
Step 1: Light aerobic exercise - 5 to 10 minutes on an exercise bike or light jog; no weight lifting, resistance training, or any other exercises.
Step 2: Moderate aerobic exercise - 15 to 20 minutes of running at moderate intensity in the gym or on the field without a helmet or other equipment.
Step 3: Non-contact training drills in full uniform. May begin weight lifting, resistance training, and other exercises.
Step 4: Full contact practice or training.
Step 5: Full game play.
If symptoms of a concussion reoccur, or if concussion signs and/or behaviors are observed at any time during the return to activity program, the athlete must discontinue all activity and be re-evaluated by their health care provider.
This is simply a suggested protocol. The appropriate health care provider who issues the written clearance may wish to establish a different graduated protocol.
6. Parents and students ARE REQUIRED to complete a Concussion & Head Injury Information Release Form and turn it into the school prior to the student participating in any athletic or spirit practice or contest each school year. Schools are required to have such form on file before a student may participate in a practice or competition.
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