The St. Charles Center and local school districts continuously work together to provide a comprehensive concussion protocol for high school athletes. The focus is on protecting student-athletes from further injury and ensuring that they are able to return to school and sports safely. In fact, the Oregon State legislature passed Max’s law in 2010 for this very reason. Specifically, the law requires that all Oregon school districts develop and maintain a concussion protocol. We agree! Our protocol uses the most up-to-date, evidence-based research and guidelines available. Ensuring that concussed student-athletes in Central Oregon receive the best care possible is our number one priority.
Athletic trainers in concussion protocol
Studies show that schools without athletic trainers have fewer reported concussions. At first, this sounds confusing. However, we know that concussions in school sports happen at the same rate everywhere, but when athletic trainers are present, athletes report concussions more often. This is important. When student-athletes do not tell someone that they are injured, they do not receive immediate or appropriate care. In addition, a concussed athlete is more likely to continue playing. The result is a higher risk of more serious injuries, like Second Impact Syndrome.
As many as 50% of concussions are not reported. And, up to 80% of people who have a concussion do not know they have a concussion. Therefore, it is crucial that athletic trainers are present to observe, evaluate and appropriately manage suspected concussions when they occur. Athletic trainers are allied health care professionals recognized by the American Medical Association (AMA). Their training and education in concussion management is comprehensive. In the high school sports setting, athletic trainers are the first providers present to identify and evaluate injured student-athletes. They also serve as integral members of the post-injury concussion management team. Finally, as part of the concussion protocol, they are an important part of the return-to-play decision process. The presence of certified athletic trainers is crucial at sports practices and games.
Our high school concussion protocol
In collaboration with Bend-La Pine, Crook County, Jefferson County, and Sisters school districts, we establish the evaluation and treatment standards and procedures for sports-related concussions. The hallmark of the concussion protocol is the school-based concussion management team. The team consists of the athletic trainer, school nurse, school counselor and athletic administration. Concussion management teams work together to evaluate, communicate and monitor the progression of the student as they recover from a concussion.
Before a concussion event occurs, student-athletes participate in baseline testing using the Sway Medical platform, a mobile concussion management tool that replaces the previously used ImPACT test. Sway Medical is an FDA-cleared Class II medical device that utilizes the built-in motion sensors of mobile devices to assess balance and cognitive functions, including reaction time, visual processing speed and memory. High school athletes in high-risk sports, such as basketball, football, soccer and wrestling, receive free baseline testing administered by their athletic trainer. This baseline test, conducted every two years—typically during the freshman and junior years—establishes an athlete’s normal brain function and balance metrics in a non-injured state. In the event of a suspected concussion, athletes undergo a sideline or follow-up assessment using Sway, which takes less than five minutes and provides objective data for comparison with baseline results. These comparisons aid athletic trainers and health care professionals in making informed treatment and return-to-play decisions. Sway’s mobile accessibility allows for rapid testing anywhere, eliminating the need for computer labs and enabling efficient, accurate evaluations. Once all student-athletes have their baseline test data, the following concussion protocol establishes procedures for recognition, evaluation and management of concussions by all involved parties—coaches, students, parents, athletic trainers and school nurses.
STEP 1: INJURY OCCURS
Either the athletic trainer and/or coach observe the injury or the student-athlete reports it. At the point that a suspected concussion has occurred, the injured athlete is immediately removed from play.
STEP 2: INJURY EVALUATION
The athletic trainer evaluates the injured student using the SCAT-5 assessment tool. The SCAT-5 is the standardized concussion assessment tool used to evaluate possible concussions.
Based on the evaluation, the athletic trainer assesses whether a concussion has occurred.
No student who displays symptoms of a possible concussion will return to play the same day.
STEP 3: INJURY REFERRAL
Once a concussion is confirmed, the athletic trainer contacts the parents with take-home instructions for follow-up care, observation cues, red flag symptoms to watch for, and instructions for referral.
Oregon State law mandates that all high school student-athletes receive clearance from a physician prior to returning to sports. Therefore, the athlete receives recommendation for referral to a medical provider specializing in concussion assessment and treatment.
The athletic trainer contacts the concussion management team at the school to inform them of the concussion.
STEP 4: INJURY FOLLOW-UP CARE
The concussion management team monitors a gradual return to daily activities, school and exercise.
This includes the development of a return-to-learn plan and specific academic accommodations, if needed, based on the specific symptoms and issues of the injured student-athlete.
Together, the athletic trainer and parents monitor the development and improvement of symptoms on a daily basis.
The concussed student-athlete should refrain from all physical activity immediately following injury. Once their condition begins to improve, they may resume low-level activity, such as walking or riding a stationary bike at a low heart rate.
Once the injured person is symptom free, attending school full-time without accommodations, and their SWAY scores are normal, they may begin the return-to-play protocol.
STEP 5: RETURN-TO-PLAY
In order to return to play, the injured student must complete all steps of a graduated exercise progression, and receive written clearance from a health care professional.
Graduated return-to-play progression: Injured students must complete each step without a return of symptoms before progressing to the next step. If symptoms return during a step, the student should rest for 24 hours and then resume activity a step below the level where the symptoms occurred.
Symptom-limited activity: Relative rest for 48-72 hours. Low intensity physical and mental activity at a level that does not exacerbate current symptoms. This also applies to the return-to-learn process and may include recommendations to stay home and limit school hours and homework. Gradual reintroduction of light activity while limiting symptoms.
Light aerobic exercise: Walking or stationary bike at low to moderate intensity; no contact, resistance or weight training.
Sport-specific exercise: Sprinting, dribbling basketball or soccer; no helmet or equipment, no head impact activities.
Non-contact training: More complex drills in full equipment. Weight training or resistance training may begin.
**Before moving to the next stage, the athlete must fully recover, be medically cleared and in school full-time without accommodations, and have normal SWAY scores.
Full-contact practice: Participate in normal, full-contact training activities.
Unrestricted return-to-participation/full competition: Game play against opposing team.
It is important to note that if your child is currently playing OSAA sports at a high school we serve, you have already agreed to abide by this protocol by signing your school paperwork.
