C. Concussions

The Branson Athletic program takes all reasonable measures to ensure that athletes are safe during both practices and competitions. In particular, Branson maintains a robust Concussion Protocol Policy pursuant to California state law and guidelines from the Marin County Office of Education and the California Interscholastic Federation.

A concussion is a type of traumatic brain injury (TBI) that results from a bump, blow, or jolt to the head (or by a hit to the body) that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain.

Concussions affect everyone differently, and recovery is different person to person. Children and adolescents are more susceptible to concussions and take longer than adults to recover. While some research shows that the young brain can be resilient, it may also be more susceptible to the chemical changes that occur in the brain after a concussion. These changes can lead to a set of symptoms affecting the student’s cognitive, physical, emotional, and sleep functions. Most concussions get better with rest, and over 90% of students fully recover. However, all concussions should be considered serious.

Branson seeks to ensure students experience a safe return to classroom activity as well as to all forms of physical activities (including athletics and dance) after a concussion. To respond to these injuries effectively and consistently, Branson has established a Concussion Management Protocol to provide concussion education and procedures for students, parents, and school employees to follow in managing head injuries. This protocol outlines the return to academics and return to play steps after a TBI following the CIF Return to Learn (RTL) and Return to Play (RTP) guidelines.

Concussion Management Protocol

Any student who has sustained a head injury or who has any of the symptoms listed below should contact Branson’s Athletic Trainer, who is the case manager for any concussion situation, regardless of whether it has occurred during a Branson athletic event or not. After the student has been evaluated by a doctor, the student’s class dean and the Director of the Rand Learning Center will work together with the Athletic Trainer to develop a plan for the student’s gradual and safe return to full participation in academics and campus life.

All Branson students are baseline tested using ImPACT, a computer based program that tests the student’s neurocognitive functioning. In the event a student is suspected of having a concussion, a post-injury ImPACT test will be administered by the Athletic Trainer within the first 24 - 72 hours post-injury or within the first two days after the student returns to school. Both the

baseline and the post-injury test will be compared as an evaluation tool, and the results will be printed and sent with the student to their doctor’s appointment. Follow-up tests will be given to the student periodically to help determine progress. For athletes with a concussion, a final ImPACT test will be given before return-to-play.

Signs and Symptoms

Symptoms reported by the student:

● Headache or ‘pressure’ in head ● Nausea or vomiting ● Neck pain ● Trouble standing or walking ● Balance problems or dizziness ● Blurred, double or fuzzy vision ● Bothered by light or noise ● Feeling sluggish or slowed down ● Feeling foggy or groggy ● Loss of memory ● Complaints of “just don’t feel right” ● Tired or low energy ● Sadness ● Nervousness or feeling on edge ● Irritability ● More emotional ● Confused ● Concentration or memory problems ● Repeating same question or comment ● Drowsiness ● Changes in sleep patterns

Signs observed by faculty, teammates, parents, and coaches:

● Looks dizzy or spaced out ● Is confused about assignment, play, or position ● Forgets an instruction or play ● Is unsure of location, what they were doing, game, score, opponent ● Moves clumsily or awkwardly ● Answers questions slowly ● Has slurred speech ● Loses consciousness (even briefly) or passes out ● Shows change in typical mood, behavior, or personality ● Can’t recall events before or after hit or fall

Symptoms that constitute an emergency:

● One pupil is larger than the other ● Is drowsy and cannot be awakened ● A headache that does not go away and that gets worse ● Weakness, numbness, or decreased coordination ● Repeated vomiting or nausea ● Slurred speech ● Convulsions or seizures ● Cannot recognize people or places ● Becomes increasingly confused, restless, or agitated ● Has unusual behavior ● Loses consciousness (even a brief loss of consciousness should be taken seriously)

In accordance with the California Education Code Section 49475 (and California Laws AB-2007 and AB-2127), all schools that offer athletic programs are required as follows:

● To recognize signs of concussion, immediately remove the athlete from the activity for the remainder of the day, and not permit the athlete to return to play until they receive written clearance to return by a licensed healthcare provider ● Each athlete shall complete a graduated return-to-play protocol of no less than seven days in duration, under the supervision of a licensed healthcare provider. ● The graduated return-to-play protocol applies to all concussions that occur at school (athletics, physical education, other activity) and concussions that occur outside of school. ● The incident should be documented, with all forms filled out, delivered to, and signed by the respective parties. ● Parent/guardian must collect the student. (The student should not drive.) Forms should be provided to the parent/guardian. ● The student should be examined and diagnosed by a licensed healthcare provider. Due to potential conflict of interest, students need to be examined by non-family/relatives

ONLY.

Marin County Schools’ protocol for students with possible concussions includes standard reporting and tracking forms. The supervising adult starts the process, with the Athletic Trainer as the main informational point of contact. A student who has begun the concussion protocol must not participate in any athletics or physical activity until they have received written clearance from their licensed healthcare provider.

Standard Reporting and Tracking Forms

Return to Learn Protocol

When a student has sustained a concussion or is believed to have sustained a concussion, the School will approve their return to classroom instruction is not automatic and will be based on the medical guidance received from healthcare providers. Medical professionals will be asked to evaluate the student and stage the student’s concussion according to the chart below. The stage of concussion dictates the rate at which, and the degree to which, a student can return to classroom instruction.

Return to Play Protocol

Schools will send the end Return to Play Progress form to the student’s licensed healthcare provider and begin a gradual return to activity based on a licensed healthcare provider’s instructions. ● Schools may accept the Return to Play Prescription or other form signed by student’s licensed healthcare provider as clearance as long as they do not permit return to play earlier than the district’s own Return to Play Clearance form.

The Return to Play Protocol progression is adapted from the International Concussion Consensus Guidelines and CIF Concussion Return to Play Protocol. Summary is described in Stages 1-4, below. ● A student’s medical provider may recommend more restrictions, but not fewer restrictions. ● If student’s medical provider recommends fewer restrictions than Stages 1-4 below, Branson’s Head Athletic Trainer, Amanda Boivin, will contact the medical provider for clarification and further documentation.

● Each student must be kept from any exertive activity beyond 15 minutes of walking (Step 1) for the first and second day after the concussion. ● The student may not resume any physical activity beyond 15 minutes of walking until the student tolerates normal academics. Exception: If back-to-normal academics have not been achieved by two weeks post-concussion, a physical activity program can be prescribed by the student’s managing physician in conjunction with school health, physical education and athletic staff.

The progression for physical activity cannot exceed the following steps:

Stage 1

Limited activity for 5-10 minutes that is designed to increase the student’s heart rate (e.g., exercise bike, walking, light jogging); No weight lifting, jumping or hard running. As student will be resting at home for at least 24 hours after experiencing symptoms of concussion, do not start Stage 1 until at least 48 hours after head injury with symptoms of concussion.

Stage 2A Light aerobic activity. Student can attempt 10-15 minutes of brisk walking or stationary biking under direct supervision by the designated school representative.

Stage 2B Moderate activity, with limited body and head movement. May go 20-30 minutes, but be reduced from typical routine for age. (e.g., moderate jogging, brief running, moderate intensity stationary biking, and moderate intensity weightlifting)

Stage 2C Strenuous aerobic activity including running or stationary biking for 30-45 minutes or weight lifting up to 50% of max weight.

Stage 2D Heavy, non-contact activity (closer to what would be in the student’s typical routine), but non-contact. (e.g., running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills). At this stage, may add some cognitive component to practice.

Stage 3

Begin with limited contact practice. Controlled contact drills are allowed, but no scrimmaging. Then progress to full contact practice but no competition. Prior to

beginning this stage, make sure that student receives written licensed healthcare provider approval.

Stage 4

Full contact and full activity can be resumed. Then, after written clearance from student’s licensed healthcare provider, student may return to competition.

No student is permitted to move from one stage to the next, unless there has been an absence of symptoms or signs. Refer to CIF Return to Play Protocol for details.

1. Athletic Trainer will document performance in each stage and report this to

Administrative Designees. Athletic Trainer may communicate with the student’s licensed healthcare provider, as necessary.