Niagara Catholic District School Board CONCUSSION ADMINISTRATIVE OPERATIONAL PROCEDURES
300-Schools/Students	No 303.1
Adopted Date:   December 16, 2014	Latest Reviewed/Revised Date:   April 28, 2020

In keeping with the Mission, Vision and Values of the Niagara Catholic District School Board, the following are Administrative Operational Procedures for Concussion.

PREAMBLE

 

The Niagara Catholic District School Board (Board) recognizes the importance of the health, safety and overall well-being of its students and is committed to taking steps to reduce the risk of injury. These Administrative Operational Procedures are a tool assist in the prevention, recognition and return to sport protocol for individuals who have a concussion or are suspected to have a concussion.

The Board recognizes that children and adolescents are among those at greatest risk for concussions and that while there is potential for a concussion any time there is body trauma, the risk is greatest during activities where collisions can occur, such as during physical education classes, playground time, or school- based sports activities.

 

Concussion prevention, recognition and management requires the cooperation of all partners in the school community. To ensure the safety of students while they enjoy the many benefits of being active, parents/guardians, students, volunteers, staff, and school boards must all understand and fulfill their responsibilities. It is critical to a student’s recovery that the Return to Learn/Return to Physical Activity Plans be developed through a collaborative team approach.

Increasing awareness of conditions to prevent and identify symptoms related to concussions will support the proper management of concussions, reducing increased risk. These Administrative Operational Procedures includes requirements described in Ministry of Education Policy/Program Memoranda, procedures pursuant to the Education Act and other relevant Ministry of Education materials.

 

PURPOSE

 

The Niagara Catholic District School Board recognizes concussions as a serious injury which requires appropriate follow-up measures to reduce risk of potential additional injury. Concussion awareness, prevention, identification and management are a priority for the Board. The implementation of the Board’s Concussion Administrative Operational Procedures is another important step in creating healthier schools in the Niagara Catholic District School Board.

 

DEFINITIONS

 

A concussion:

·   is a brain injury that causes changes in how the brain functions, leading to symptoms that can be physical (e.g., headache, dizziness), cognitive (e.g., difficulty concentrating or remembering), emotional/behavioural (e.g., depression, irritability) and/or related to sleep (e.g., drowsiness, difficulty falling asleep)

 

·   may be caused either by a direct blow to the head, face or neck, or a blow to the body that transmits a force to the head that causes the brain to move rapidly within the skull

·   can occur even if there has been no loss of consciousness (in fact most concussions occur without a loss of consciousness)

·   cannot be seen on X-rays, standard CT scans or MRIs

·   is a clinical diagnosis made by a medical doctor or nurse practitioner*

*  It is critical that a student with a suspected concussion be examined by a medical doctor or nurse practitioner as soon as possible.

CONCUSSION SIGNS AND SYMPTOMS

 

The first step to managing a concussion is being able to recognize common signs and symptoms. A concussion should be suspected following a blow to the head, face or neck, or a blow to the body that transmits a force to the head. It is important to recognize that one or more of the signs or symptoms of a concussion which may take hours or days to appear.

 

CONCUSSION SIGNS AND SYMPTOMS OF A CONCUSSION

 

·   Signs and symptoms may be different for everyone

·   Signs and symptoms can appear immediately after the injury or may take hours or days to emerge

·   Concussion symptoms for younger students may not be as obvious compared to older students

·   A student may be reluctant to report symptoms because of a fear that they will be removed from the activity, their status on a team or in a game could be jeopardized or academics could be impacted

·   It may be difficult for students under 10, with special education needs, or students for whom English/French is not their first language, to communicate how they are feeling

·   If student loses consciousness or signs or symptoms worsen, call 911

·   Cognitive or physical activities can cause student’s symptoms to reappear

·   Steps are not days-each step must take a minimum of 24 hours and the length of time needed to complete each step will vary based on the severity of the concussion and the student

·   The signs and symptoms of a concussion often last for 7-10 days, but may last longer in children and adolescents

·   Compared to older students, elementary school children are more likely to complain of physical problems or misbehave in response to cognitive overload, fatigue, and other concussion symptoms

·   If a student returns to activity while symptomatic, or before the brain has fully recovered, they are at an increased risk of sustaining another concussion with symptoms that can be prolonged and increased

·   Principals, supervising staff, coaches and volunteers must be very aware of students asking to return to learn and return to play too early.

·   Parents/guardians must report non-school related concussions

·   Return to Learn/Return to Physical Activity steps must be followed regardless of where diagnosed concussion occurred

 

DOCUMENTATION

 

If staff, in communication with the school principal, suspects head trauma or a concussion might be possible:

Appendix C1: Tool to Identify a Suspected Concussion and Appendix D2: Documentation of Medical Exam must be given to the parent/guardian and student.

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Appendix C2: Concussion Recognition Tool is a pocket sized tool that can also be used to identify a suspected concussion. If staff is not sure of the presence of one or more of these signs and symptoms of a possible concussion

 

THE DIAGNOSIS OF A CONCUSSION

 

Medical doctors and nurse practitioners are the only healthcare professionals in Canada with licensed training and expertise to diagnose a concussion; therefore, all students with suspected concussions should undergo evaluation by one of these professionals.

 

PREVENTION

 

Regardless of the steps taken to prevent injury, some injuries may occur. The severity of the injury may be mitigated by the following:

1.  Awareness and education for coaches, volunteers, staff, parents and students to:

a)  Recognize the symptoms of concussion

b)  Remove the student from play

c)  Refer the student to a medical doctor/nurse practitioner

d)  Connect Curriculum with student learning about concussions and injury prevention

2.  Wearing the school’s sport specific protective equipment:

a)  Equipment will fit properly

b)  Equipment will be well maintained

c)  Equipment will be worn consistently and correctly

d)  Equipment will meet current safety standards

e)  Damaged or expired equipment will be replaced

3.  Follow OPHEA sport specific safety guidelines and our Niagara Catholic Fair Play Code of Conduct

4.  Ensure all students receive instruction, understand and follow the sport/activity specific safety rules and skills prior to participation (e.g. eliminate all checks to the head and eliminate all hits from behind)

 

5.  Teach skills in proper progression (e.g. emphasize the principles of head-injury prevention, keeping the head up and avoiding collision)

6.  Outline the concussion risks associated with the activity/sport and demonstrate how they can be minimized e.g. teach proper sport techniques - correct tackling in football, effective positioning in soccer, use of zones for activities to avoid overcrowding.

7.  Students must follow their supervising staff/coach’s/volunteer’s safety instructions at all times

8.  Reinforce that it is extremely important not to return to learning or physical activity while still recovering from a concussion to avoid further risk of injury.

9.  Discourage parents/guardians/volunteers/teachers/coaches, school staff from pressuring recovering concussed students to play or learn before they are ready

 

10.  Parents need to reinforce with their child the importance of following the school’s safety procedures

 

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11.  Parents need to report concussion history on school medical form

12.  Provide reassurance, support and request/offer academic accommodations as needed

PROCEDURES

 

Immediate action must be taken by the individual (e.g. principal, teacher, coach) responsible for the student if the student receives a blow to the head, face or neck, or a blow to the body that transmits a force to the head. If in doubt, sit the student out and proceed with protocol.

Further to the Concussion Administrative Operational Procedures, the Board outlines the following roles and responsibilities:

 

RESPONSIBILITIES

 

Family of Schools Superintendents of Education will:

·   Perform an annual review of the Concussion Administrative Operational Procedures to ensure the procedures align with current best practice recommendations and, at a minimum, the OPHEA concussion guidelines.

·   Create a Concussion Board Report (Student Concussion Appendix A, B, C), to be completed by school principals, to track student concussions and record staff concussion education.

·   Review concussion board reports annually to ensure compliance with and effectiveness of the Administrative Procedures.

·   Ensure concussion education is made available to all school personnel and volunteers.

·   Implement concussion awareness and education strategies for students and their parents/guardians.

·   Provide support to schools and staff to ensure enforcement of Return to Learn and Return to Physical Activity Guidelines and the Board Concussion Administrative Operational Procedures.

·   Ensure that all board staff, including volunteers, involved in physical activity and supervision (includes but not limited to: recess supervision, curricular, interschool, and intramural physical activity, before and after school care), are trained to recognize signs and symptoms of a suspected concussion and what immediate action to take.

·   Ensure that information on the Concussion Administrative Operational Procedures is shared with the school community, including organizations that use the school facilities, such as community sports organizations and licensed child-care providers operating in schools of the Board where applicable.

·   Ensure each elementary and secondary school implements the Return to Learn and Return to Physical Activity Plan (Appendix E1, E2 )

Principals will:

·   Abide by the Concussion Administrative Operational Procedures.

·   Ensure staff, volunteers, parents/guardians, and students are aware of the Concussion Administrative Operational Procedures and understand their roles and responsibilities.

·   Ensure the Concussion Administrative Operational Procedures is followed by all school staff (including occasional staff/support staff, recess supervisors), parents/guardians, students, and volunteers.

·   In honour of Rowan’s Law Day, provide training for staff and coaching volunteers by the last Wednesday in September every school year beginning September 2020, and repeat as necessary. The Rowan’s Law Day Toolkit for Schools contains sample tools to recognize Rowan’s Law Day in schools and to encourage conversation and raise awareness among students, staff and the school community about concussion safety. See Appendix H

·   Provide annual concussion training for relevant school staff utilizing the Ophea’s Concussion  Identification, Management, and Prevention for Schools 2019/20. The e-Learning module was developed to increase awareness and understanding of concussion and of the methods and strategies

 

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to be used for identification and appropriate management of concussions. The module also includes strategies and resources to assist in the education of concussion prevention. This e-Learning module is intended for all school staff including educators, administrators, and support staff

·   Ensure the Concussion Recognition Tool is included in occasional teacher lesson plans and field trip folders.

·   Share concussion information with students and their parents/guardians.

·   Ensure lessons on Head Trauma/Concussion Awareness are delivered annually to all students.

·   Ensure OPHEA safety guidelines are being followed.

·   Work as closely as possible with students, parents/guardians, staff, volunteers, and health professionals to support concussed students with their recovery and academic success.

·   Maintain up to date emergency contact and telephone numbers.

·   Complete concussion Board report (OSBIE/Appendix I, Student Concussion) as each injury occurs and for each term/semester.

·   Attempt to obtain parental/guardian cooperation in reporting all non-school related concussions.

·   Ensure concussion information is readily available to all school staff and volunteers.

·   Ensure that all incidents are recorded, reported and filed as required by this Administrative Guideline, as appropriate, and with an OSBIE incident report form.

·   For students who are experiencing difficulty in their learning environment as a result of a concussion, coordinate the development of an Individual Education Plan (IEP). See the revised OPHEA Strategies released by OPHEA for Return to Learn Strategies/Approaches.

·   Approve any adjustments to the student’s schedule as required.

·   Alert appropriate staff about students with a suspected or diagnosed concussion.

·   Prior to student return to school, ensure completion and collection of the following documentation:

·   Documentation of Medical Examination Form (Appendix D2)

·   Documentation for a Diagnosed Concussion – Return to Learn/Return to Physical Activity Plan (Appendices E1, E2)

·   File above documents) (Appendices D2, E1, E2) in student’s OSR and provide copy to appropriate school staff.

·   Once concussion is diagnosed, appoint a staff member to act as the student’s liaison to ensure adequate communication and coordination of student’s needs.

·   Ensure Parent/Guardian complete ‘Acknowledgement of Risk/Permission to Participate Form

·   Ensure Parent/Guardian has been notified of any suspected concussion during the school day the incident occurred at the first reasonable opportunity.

If the Parent/Guardian refuses a physician consultation and/or refuses to adhere to the concussion admin procedure the Principal will:

·   Discuss parental concerns (e.g. documentation fees) surrounding the process and attempt to address these concerns

·   Provide rationale for the required steps of the Concussion Administrative Procedure

·   Include parent/guardian and their child in every step of the recovery process

·   Provide parents with concussion information to increase their awareness and knowledge

·   Re-iterate the importance of obtaining an official diagnosis from trained physician

·   Explain to parent/guardian if staff feels immediate medical attention is required that they are obligated to call 911 even on parent refusal

·   Inform parent/guardian that school is obligated to follow the steps of the “Return to Learn” and “Return to Physical Activity” process

·   Have parent sign off Appendix E1 and E2 - If unsuccessful in acquiring full parental cooperation seek support from Senior Administration

School Staff (Includes administration staff, teaching staff, support staff, coaches, volunteers, etc.) will:

·   Attend and complete concussion training (e.g. staff meeting, online, workshop, read concussion package, etc.).

 

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·   Ensure that the Acknowledgement of Risk/Permission to Participate Appendix A distributed, completed and signed by parent prior to student participation in a sport.

·   Ensure age-appropriate concussion education, including prevention, is included for all students participating in activities that could result in a concussion.

·   Every school year, Confirmation must be received from parents, students, coaches, and trainers (which includes both school staff and volunteers) that a Concussion Code of Conduct has been reviewed prior to any participation in board-sponsored interschool sports. (Appendix G1, G2, G3)

·   Be able to recognize signs, symptoms and respond appropriately in the event of a concussion see Appendix C1: Tool to Identify a Suspected Concussion Appendix C2 Pocket Concussion Recognition Tool Follow current OPHEA safety guidelines and implement risk management and injury prevention strategies.

·   Learn about concussions, including prevention strategies, signs and symptoms, concussion management and student roles and responsibilities, throughout applicable curriculum such as:

-OPHEA’s Concussion Awareness Resources

·  Rowan’s Law E Booklets for students 15 years old and up (which includes student athletes, parents, coaches, official, or Educators.

·   Make sure that occasional teaching staff are updated on concussed student’s condition.

 

Parents/Guardians will:

·   Insure that any equipment used by their child meets up to date safety standards.

·   Review with your child the concussion information that is distributed through the school (e.g. learn signs and symptom of concussion (Appendix A).

·   Every school year, provide confirmation to the school that they and their child(ren) have reviewed the Concussion Code of Conduct prior to any participation in board-sponsored interschool sports.

·   Learn about concussions, including prevention strategies, signs and symptoms, concussion management and student roles and responsibilities, throughout applicable curriculum such as:

·  OPHEA’s Concussion Awareness Resources

- Rowan’s Law E Booklets for students 15 years old and up (which includes student athletes, parents, coaches, official, or Educators.

·   Reinforce concussion prevention strategies (e.g. Student Code of Conduct with your child.

·   Understand and follow parent/guardian roles and responsibilities in the Administrative Procedures.

·   In the event of a suspected concussion, ensure child is assessed as soon as possible by physician/nurse practitioner, optimally on the same day.

·   Cooperate with school to facilitate Return to Learn and Return to Physical Activity.

·   Follow physician/nurse practitioner recommendations to promote recovery.

·   Be responsible for the completion of all required documentation.

·   Support your child’s progress through recommended Return to Learn and Return to Physical Activity Guidelines.

·   Collaborate with school to manage suspected or diagnosed concussions appropriately.

·   Report any non-school related concussion or suspected concussion to the principal (Return to Learn/Return to Physical Activity guidelines will still apply)

Students will:

·   Learn about concussions, including prevention strategies, signs and symptoms, concussion management and student roles and responsibilities, throughout applicable curriculum such as:- OPHEA’s Concussion Awareness Resources

·   -Rowan’s Law E Booklets for students 10 years old and Under

·   -Rowan’s Law E Booklets for students 11 – 14 years of age

·   -Rowan’s Law E Booklets for students 15 years old and up

·   Every school year, provide confirmation to the school that they have reviewed the Concussion Code of Conduct prior to any participation in board-sponsored interschool sports.

 

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·   Immediately inform school staff of suspected or diagnosed concussions occurring during or outside of school.

·   Inform school staff if you experience any concussion related symptoms (immediate, delayed or reoccurring).

·   Remain on school premises until parent/guardian arrives if concussion is suspected

·   Communicate concerns and challenges during recovery process with staff concussion liaison, school staff, parents/guardians, and health care providers.

·   Follow concussion management strategies as per medical doctor/nurse practitioner direction and Return to Learn/Return to Physical Activity Guidelines.

Physician and/or other health care professionals will:

·   Assist in the development of an individualized Academic and Physical Concussion Management Plan.

·   Monitor recovery process and modify concussion management plan as required.

·   Complete required documentation (Appendices D2, F).

·   If symptoms persist beyond 10 days, referral may be made to brain injury specialist.

STEPS AND RESPONSIBILITIES IN SUSPECTED AND DIAGNOSED CONCUSSIONS  

INITIAL RESPONSE

Unconscious Student (or when there was any loss of consciousness)

 

 

If the Student is Conscious

Action

1. Stop the activity immediately

2. Initiate school Emergency Action Plan Appendix D1

3. When safe to do so, remove student from current activity/game

4. Conduct an initial concussion assessment of the student using Appendix C1: Tool to Identify a Suspected Concussion or Appendix C2 Pocket Concussion Recognition Tool

If A Concussion Is Suspected- If in Doubt, sit them Out

 

 

 

Action

1.   Staff Initiates a precautionary withdrawal of student from physical activity

2.   School Staff: ·   informs parent/guardian (or emergency contact) of the incident ·   provides a signed copy of Appendix C1: Tool to Identify a Suspected Concussion, retaining a copy for school records. ·   Explains to parent/guardian (or emergency contact) that student should be monitored for 24- 48 hours after the incident as concussion symptoms may take hours or days to emerge. If any signs or symptoms appear, the student needs to be examined by medical doctor or nurse practitioner as soon as possible on the same day and results shared with principal before return to school.

3. School Staff informs the Principal/Designate if symptoms appear during learning or any activity

4. If symptoms appear proceed with Action items under “If a concussion is suspected”

 

Action

1. The Parent/Guardian provides the school a signed copy of Appendix C1: Tool to Identify a Suspected Concussion

2. The student has been monitored for 24-48 hours after the incident and has been medically cleared after a successful examination by a Doctor or Nurse Practitioner

Background Information on the Concussion Recovery Process

A student with a diagnosed concussion needs to follow an individualized and gradual Return to School Plan (RTS) and Return to Physical Activity Plan (RTA). In developing the Plan, the RTS process is individualized to meet the particular needs of the student, as there is not a pre-set plan of strategies and/or approaches to assist a student returning to their learning activities. In contrast the RTPA Plan follows an internationally recognized graduated approach.

 

The management of a student concussion is a shared responsibility, requiring regular communication between the Collaborative Team* and outside sports team (where appropriate).

* The Collaborative Team consists of the student, parents/guardians, staff and volunteers working with the student with consultation from the student’s medical doctor or nurse practitioner and/or other licensed healthcare providers (for example, nurses, physiotherapists, chiropractors and athletic therapists).

 

There are two parts to a student’s RTS and RTPA Plan. The first part of the plan occurs at home (refer to the

Concussion Management - Home Preparation for Return to School (RTS) and Return to Physical Activity

 

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(RTPA) Plan ( Appendix E 1 ) ) and prepares the student for the second part which occurs at school (refer to the School Concussion Management – Return to School (RTS) and Return to Physical Activity (RTPA) Plan ( Appendix E 2 ) ).

 

·   This Plan does not replace medical advice.

1.   The home part of the plan begins with the Parent/Guardian communicating the diagnosis to school principal. Reporting non-school related concussions aswell.

2.   The school principal or designate will communicate information on the stages of RTS and RTPA Plan that occur at home.

3.   The stages of the plan occur at home under the supervision of the parent/guardian in consultation with the medical doctor/nurse practitioner and/or other licensed healthcare providers.

4.   A student moves forward to the next stage when activities at the current stage are tolerated and the student has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms.

5.   If symptoms return , or new symptoms appear at any stage in the Home Preparation for RTSand RTPAPlan,the student returnstopreviousstagefora minimum of 24 hours and only participates in activities that can be tolerated.

6.   If at any time symptoms worsen , the student/parent/guardian contacts medical doctor/nurse practitioner or seeks medical help immediately.

7.   While the RTS and RTPA stages are inter-related they are not interdependent. Students do not have to go through the same stages of RTS and RTPA at the same time.

8.   A student must not return to vigorous or organized physical activities where the risk of re- injury is possible, until they have successfully completed all stages of the Return to School Plan. Early introduction of some low intensity physical activity in controlled and predictable environments with no risk of re-injury is appropriate.

9.   Progression through the Plan is individual; timelines and activities may vary.

10.   Prior to the student returning to school the principal will identify and inform members of the collaborative team and designate a staff member to serve as the main point of contact for the student and the collaborative team.

 

INSTRUCTIONS

·   Review the activities (permitted and not permitted) at each stage prior to beginning the Plan.

·   Check ( ✔ ) the boxes at the completion of each stage to record student’s progress through the stages.

·   A student may progress through the RTS stages at a faster or slower rate than the RTPA stages.

·   When the student has successfully completed all stages of the Home Preparation for RTS and RTPA Plan, parent(s)/guardian(s) must sign and date this form.

·   Communicate to the school principal/designate that the student is ready to begin the school portion of the RTS and RTPA Plan ( Appendix E 2 ).

 

Action

1.   The Parent: ·   Communicates the diagnosis to school principal and returns the completed and signed Appendix D2: Documentation of Monitoring /Medical Assessment Form for a Diagnosed Concussion. ·   Also reports non-school related concussions . For the student who is participating in activities outside of the school, communication is essential between the parent/guardian/student, activities supervisor and the collaborative team members.

2.   The Principal: ·   Provides parent/guardian Appendix E1: Concussion Management – Home Preparation for Return to School (RTS) / and Return to Physical Activity (RTPA) Plans form ·   Indicates to the Parent and School Staff that: a)   The student must Successfully and gradually advance through Stage1 and Stage 2 of the RTS and RTPA at home prior to returning to school b)   The Student must be symptom free or improved prior to returning to school c)   Appendix E1 must be completed and signed before student can return to school. d)   All Staff will work collaboratively with the parent/guardian as a collaborative team in order to ensure parent/guardian understands the plan, addressing their questions, concerns, and working with parent/guardian to overcome any barriers. ·   Ensures that all related written documentation of the incident and results of the medical examination are filed (e.g. in the student’s OSR).

3.   The Parent: ·   completes Appendice E1: Home Preparation for return to School /Return to Physical Activity: ·   Keeps student home for cognitive rest (no school, no homework, no texting, no screen time) and physical rest (restricting recreational/leisure and competitive physical activities) until student is feeling better. ·   Once symptoms start to improve, gradually increases mental activity (limit activities such as reading, texting, television, computer, and video games that require concentration and attention to 5-15 minutes). ·   If moderate symptoms return, stops activity and allow student 30 minute break to resolve symptoms. ·   If symptoms don’t resolve, returns to complete cognitive rest. Continue to gradually increase mental activity and monitor symptoms.

4.   The Parent: ·   Continues to provide cognitive and physical rest at home for at least 24-48 hours (or longer) until student’s symptoms are improving or they are symptom free. ·   Ensures that the student should be able to complete 1-2 hours of mental activity (e.g. reading, homework) at home for one to two days before attempting return to school.

5. The Principal: □   Informs all school staff (e.g. classroom teacher, educational resource teacher, physical education teachers, intramural supervisors, recess supervisors, coaches) and volunteers who work with the student of the diagnosis.

6.   The Principal: ·   identifies and creates a Collaborative Team (i.e. principal, concussed student, their parents/guardians, school staff and volunteers who work with the student, and the student’s medical doctor/nurse practitioner) ·   Designates a school staff member of the team as the “Concussion Liaison” to serve as the main point of contact for the student, the parent/guardians, or other school staff & volunteers who work with the student, and the medical doctor or nurse practitioner.

7. The Principal: □ Meets with Collaborative Team to review potential cognitive and emotional/behavioural difficulties student may experience, explain how these symptoms can impact learning and identify strategies/approaches to manage these symptoms. See Appendix B: Return to Learn Strategies/Approaches for a list of appropriate accommodations.

8. The Principal: □ Ensures the Collaborative Team understands the importance of not placing undue pressure on concussed student to rush through the return to learn/physical activity steps to avoid prolonged or increased symptoms. Return to learn should proceed slowly and gradually

The student will now Advance to PHASE 2 – Appendix E2

The student will gradually return to school and gradually progress through the following RTS and RTPA Stages.

Student’s Symptoms Are Improving

 

 

·   Phase 2 of the RTS/RTPA Plan occur at school and where appropriate the RTPA part of the plan may occur during school activities or outside activities

 

The Principal: ·   Communicates Each of the stages of Phase 2 of the RTS and RTPA plans to the Collaborative Team. ·   Reviews the roles of the Collaborative Team Members. ·   Works with the Collaborative Team to determine the most appropriate RTS learning strategies and/or approaches required by the student based on the post-concussion symptoms. ·   Emphasizes to the Collaborative team the shared responsibility if the student experiences any return of symptoms. ·   Emphasizes   to   the   parent/guardian   that   communication   is   essential   between   the parent/guardian/student, activities supervisor and the collaborative team members if the student is participating in activities outside of school.

STAGES OF PHASE 2 ·   Stages are not days – each stage must take a minimum of 24 hours. ·   The length of time needed to complete each stage will vary based on the student and the severity of the concussion. ·   A student who has no symptoms when they return to school must progress through all of the RTS stages and RTPA stages and remainsymptom free for a minimum of 24 hours in each stage prior to moving to the nextstage. ·   Completion of the plan may take 1-4 weeks.

THE STUDENTS PROGRESSION THROUGH EACH STAGE: ·   The Collaborative Team will closely monitor student for the return of any concussion symptoms and/or deterioration of work habits and performance. ·   A student moves forward to the next stage when activities at the current stage are tolerated and the student has not exhibited or reported a return of symptoms, new symptoms, or worsening symptoms. ·   Astudent’s progressionthroughthestages of RTSis independent fromtheirprogression through the RTPA stages. ·   Medical clearance by a doctor/nurse practitioner is required prior to beginning Stage 5 of RTPA ( Documentation for Medical Clearance Appendix F). 1.   Until a student has successfully completed all stages in the RTS plan they must not participate in the following physical activities where the risk of re-injury is possible: ·   full participation in the physical education curricular program; ·   intramural activities; ·   full participation in non-contact interschool activities; or ·   participation in practice for a contactsport. 2.   Upon completion of the RTS and RTPA Plan, this form is returned to the principal or designate for filing in the OSR.

 

Return to School (RTS) Stages	Return to Physical Activity (RTPA) Stages
Eachstagemustlast aminimum of 24 hours.	Eachstagemustlast aminimum of 24 hours.
RTS Stage 3a –Return to school for 2 hours   Student begins with an initial length of time at school of 2 hours.   The individual RTS Plan is developed by Collaborative Team following the student conference and assessment of the student’s individual needs determining possible strategies and/or approaches for student learning   Activities permitted if tolerated by student ·   Activities from previous stage	RTPA –Stage 3 Simple locomotor activities/sport- specific exercise to add movement. Activities permitted if tolerated by student ·   Activities from previous stage (20-30 minutes walking/stationary cycling/elliptical/recreational dancing at a moderate pace) ·   Simple individual drills (e.g., running/throwing drills, skating drills in hockey, shooting drills in

·   Ministry of Education, Policy/Program Memorandum 158, School Board Policies on  Concussion

·   Ontario Physical Education Safety Guidelines (OPHEA)Guidelines

·   Parachute Canada

APPENDICES

 

Appendix A   Concussion Information for Parents and Students  Appendix B    Return to Learn Strategies Approaches  Appendix C1   Tool to Identify a Suspected Concussion  Appendix C2   Pocket Concussion Recognition Tool

Appendix D1   EMERGENCY ACTION PLAN FOR CONCUSSION

Appendix D2   Documentation of Monitoring Medical Assessment Form

Appendix E1   Concussion Management -Home Preparation for Return to School (RTS) and Return  to Physical Activity (RTPA) Plan

Appendix E2   School Concussion Management - Return to School (RTS) and Return to Physical  Activity (RTPA) Plan

Appendix E3    School Concussion Management Plan Reference Guide  Appendix F   Documentation for Medical Clearance

Appendix G1   Student code of Conduct  Appendix G2   Code of conduct parent

Appendix G3   Code of Conduct for Coach and Staff (2)  Appendix H   Concussion Awareness Resources for School Staff

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