Management of Concussion and Other Head Injuries Policy 1
METHODIST COLLEGE BELFAST
Policy Responsibility: Head of PE
Date Ratified: March 2026
Ratified by: Board of Governors
Next Reviewed Date: March 2027
Contents Introduction ...............................................................................................................................3 Aim .....................................................................................................................................3 Objective ............................................................................................................................3 Concussion .................................................................................................................................3 What is a concussion? ........................................................................................................3 What are the signs and symptoms of a concussion? .........................................................4 Action in the event of a suspected concussion..........................................................................5 Responsibility of Staff.........................................................................................................5 Responsibility of Parent/Guardian .....................................................................................5 Return to Learning and Return to Play...............................................................................6 The Graduated Return to Play Programme (Appendix 1) ..................................................6 Communication ..........................................................................................................................7 Staff ....................................................................................................................................7 Pupils and Parents/Guardians ............................................................................................7 Concussion Policy Management Team ......................................................................................8 Appendix 1: Graduated Return to Play Programme (GRTP) ......................................................9 Appendix 2: Concussion Protocol ...........................................................................................10 Sports Concussion – Off Site ............................................................................................10 Sports Concussion - in School ..........................................................................................10 Non-Sports Concussion ....................................................................................................10 Concussion outside of school ..........................................................................................11 Appendix 3: Concussion Emails...............................................................................................12 EMAIL 1 – following knock to head but no symptoms.........................................................12 EMAIL 2 – Once concussion is suspected ............................................................................13 Appendix 4: Concussion Recognition Tool ...............................................................................17 References ................................................................................................................................19
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Introduction At Methodist College, we recognise that concussions and other head injuries are serious and could result in significant brain damage or even death if not recognised and managed. It is the responsibility of staff members involved in school activities to act in accordance with this policy when the staff member recognises that a pupil may be exhibiting signs and symptoms of a concussion.
Aim The aim of the policy is to ensure that all pupils receive the appropriate standard of care following a head injury sustained during any activity or incident.
Objective To safeguard and promote the welfare of pupils by educating staff, pupils and parents/guardians to the recognition and management of concussion.
Concussion What is a concussion? Concussion is a traumatic brain injury. It is a complex process in which forces are transmitted to the brain and result in temporary impairment of brain function. Although the vast majority of concussions are resolved within two weeks, concussion can have a significant impact on the short- and long-term health of a pupil if not handled correctly. If identified and managed appropriately, long term effects can be minimised and recovery expedited. The following visual clues can indicate a possible concussion: • • • • • •
Loss of consciousness or responsiveness Lying motionless on the ground/slow to get up Unsteady on feet/balance problems or falling over/incoordination Grabbing/clutching of head Dazed, blank or vacant look Confused/not aware of what is going on around them
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What are the signs and symptoms of a concussion? The presence of any one or more of the following signs and symptoms may suggest a concussion and may occur hours or even days after the initial incident. • • • • • • • • • • • • •
Loss of consciousness Headache or pressure in the head Seizure or convulsion Dizziness or balance problems Difficulty concentrating or feeling like they are in a fog Nausea or vomiting Drowsiness, feeling slowed down, fatigued or lacking energy More emotional than normal, feelings of sadness Blurred vision or sensitivity to light and/or noise Nervous, anxious or irritable Difficulty remembering or amnesia Neck pain Not feeling “quite right”
The College’s approach to managing a concussion injury is based on the accepted principles of STOP-INFORM-REST-RETURN STOP: A pupil with a suspected concussion must be removed immediately from the activity. INFORM: A pupil with a suspected concussion must report it to a member of staff, referee, coach, teammate, friend or family member and be properly assessed and managed. REST: A pupil with a concussion must undertake a mandatory rest period as per established guidelines outlined in this policy. RETURN: A pupil with a concussion must follow a graduated return to learning and return to play programme.
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Action in the event of a suspected concussion Responsibility of Staff The member of staff responsible for the pupil at the time of the event will: •
• • •
•
•
• •
Safely and immediately REMOVE the pupil from the field of play and ensure that they do not return to play in that game even if they say that their symptoms have resolved. Note that a pupil should not be moved, other than required for airway support, if they are suspected of having a neck injury. Assign a responsible person to observe and monitor the pupil when removed. Make an initial assessment following the guidance in the Pocket Concussion Recognition Tool (Appendix 4 CTR6) Seek medical attention for the pupil from a qualified medical professional (this may be the School Nurse) if available. Parent/guardian will be advised to consider medical assessment. If any ‘Red Flags’ as outlined in the CTR6 and there is no qualified medical professional is available, consider transporting the pupil by ambulance for urgent medical assessment Contact the parent/guardian of the pupil to inform them about the incident, remind them of the College’s Concussion Policy, ask them to be alert to the symptoms of concussion and advise them to seek advice and assistance from a qualified medical professional. Advise that a responsible adult should supervise the pupil over the next 24 – 48 hours. For an incident onsite, notify the School Nurse. For an incident offsite, notify the teacher in charge of the activity and the School Nurse. The School Nurse will then inform all other staff by email on the same school day or at the start of the next school day.
Any pupil suspected of having sustained a concussion or other head injury during a school activity must be removed safely and immediately from the activity and parents/guardians advised that the pupil should be evaluated by a qualified medical professional. The staged programme of return to learning and return to play will be to all cases of concussion. Responsibility of Parent/Guardian The parent/guardian should seek medical attention from a qualified medical professional and the 23-day the Graduated Return to Play Protocol (GRTP) or sporting activities will automatically apply. Parent/guardian should adhere to the GRTP and confirm with school at the end of the 23 days.
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Return to Learning and Return to Play Following a concussion, a pupil may have difficulties with short- and long-term memory, concentration and organisation. They will require rest while recovering from injury (e.g. avoid reading, texting, computer games, watching television) and may even need to stay home from school for a period. As pupils return to school, they may need to start with a phased return depending on how they feel. They may also benefit from a formal school assessment for limited attendance or homework if recovery from a concussion is taking longer than expected. In cases of concussion, return to learn will be graduated and may involve limitation of school and homework for a limited period of time. This will be at the discretion of the staff involved and based on the pupil’s symptoms. The College will accommodate a gradual return to full participation in academic and physical activities as appropriate, based on the recommendation of the pupil’s concussion trained medical professional and appropriate staff. In the absence of any such recommendation the 23-day protocol will automatically apply. Progression to return to learning and return to play should be determined on a case-by-case basis. And the 23 day GRPT is a minimum based on symptoms. It is advised that pupils on the GRTP have a medical assessment after 14 days to inform progression to the final stage for sport specific activities. Ongoing signs and/or symptoms at this stage will delay return to play and extend the GRTP. Medical recommendations will be shared with the relevant Head of Form, the Head of PE and staff. Factors that may affect the rate of progression include: •
previous history of concussion,
•
duration and type of symptoms,
•
age of the pupil,
•
the sport/activity in which the pupil participates.
A pupil with a history of concussion, one who has had an extended duration of symptoms, or one who is participating in a contact sport may progress more slowly.
The Graduated Return to Play Programme (Appendix 1) A record of pupils on the Graduated Return to Play Programme will be stored in the Concussion Register for staff to complete. The progress of pupils through the programme will be monitored and recorded by the appropriate member of staff. 6
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UNDER NO CIRCUMSTANCES WILL THE PUPIL BE ALLOWED TO RETURN TO COMPETITVE SPORT UNTIL THE 23-DAY PERIOD IS COMPLETED.
Communication Staff Staff should follow the advice outlined in the Concussion Protocol (Appendix 2). The teacher in charge of the activity will notify the pupil and their parents/guardians, and all school personnel involved in supporting the pupil in his/her school sport. A Concussion Email (Appendix 3) will be sent to the parent(s)/guardian(s) of the pupil. The School Nurse will inform staff of pupils who have a suspected or confirmed concussion and an updated list will be issued to staff at the start of each school week. At the start of each academic year staff will be made aware of this policy and the standards of care relating to the management of concussive injuries. They will be provided with concussion awareness training that includes recognising the signs and symptoms that may suggest a concussive or other head injury.
Pupils and Parents/Guardians Parents/guardians should report suspected or known concussion or other head injuries that occur outside of school related activities to the School Nurse. It is the responsibility of the parent/guardian to inform the school of signs and symptoms related to concussion or head injuries that are recognised while the pupil is not in school. At the start of each academic year all pupil and parents/guardians will be provided with information about: • • • • • •
The risk of concussion and other head injuries and the dangers associated with continuing to participate when a concussion or other head injury is suspected; The signs and symptoms associated with concussion and other head injuries; and The school’s protocols for: the removal of a pupil from an activity when the pupil is suspected of having sustained a concussion or other head injury, the evaluation of a concussion or other head injury, and the pupil’s return to participation in school activities, including classes.
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Concussion Policy Management Team The Principal will appoint a Concussion Policy Management Team which may include, but will not necessarily be limited to: the School Nurse, the Pastoral Vice Principal, the Head of Pastoral Care, the Head of PE, the Director of Rugby, Teachers in Charge of Sport. The team will: • • •
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oversee the implementation of this policy and the related standards of care for concussive head injuries; ensure that appropriate training is provided for staff; review and update the policy and associated procedures on an annual basis.
METHODIST COLLEGE BELFAST
Appendix 1: Graduated Return to Play Programme (GRTP)
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Appendix 2: Concussion Protocol Sports Concussion – Off Site Once a concussion is suspected 1. Coach should contact the parent/guardian and explain the concussion, the 48-hour delay and recommend medical assessment. At the earliest opportunity: 2. Email the School Nurse with the name of the pupil and include the relevant Head of Sport 3. Fill in the Concussion Register 4. Complete the MCB Accident Report Form for all suspected concussions. 5. Email a GRTP form to the parent/guardian – EMAIL 1 if concussion is not confirmed, then EMAIL 2 once it is confirmed. 6. Assist the pupil to complete the protocol 7. Ask for confirmation from parent/guardian that GRTP completed after the 23 days
Sports Concussion - in School 1. Send the pupil to the School Nurse who will email all staff and contact a parent/guardian 2. The nurse will complete the Concussion Register and complete the MCB Accident Report Form for all suspected concussions. 3. The School Nurse will send EMAIL 1 if concussion is not confirmed, then EMAIL 2 once it is confirmed. 4. The School Nurse will add the pupil name to the Concussion Register and manage the GRTP if the pupil does not play for a school team. GRTP for school team players should be managed by their coach or Head of Sport
Non-Sports Concussion 1. Send the pupil to the School Nurse; she will email staff and contact a parent/guardian using EMAIL 2. 2. If you were on duty, ensure the MCB Accident Report Form for all suspected concussions is completed 3. The nurse will complete the Concussion Register and print a GRTP form and give it to the pupil along with the concussion letter (or email to parent/guardian)
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4. The nurse will manage the GRTP if the pupil does not play for a school team. GRTP for school team players should be managed by the parent/guardian and assisted by their coach or Head of Sport Concussion outside of school If you find out, or ‘hear rumours’ that a pupil has been concussed at home: 1. Email the details to the School Nurse and the Head of PE 2. The School Nurse will email all staff and contact a parent/guardian 3. The School Nurse will complete the Concussion Register and print a GRTP form send EMAIL 2. 4. The School Nurse will manage the GRTP if the pupil does not play for a school team. GRTP for school team players should be managed by the parent/guardian and assisted by their coach or Head of Sport. 5. Consideration should be given to the Safeguarding and Child Protection Policy. Note: 1. The Concussion Register is located: My Computer → Staff → PE & Games → Concussion 2. The School Nurse will send out a weekly Concussion email 3. An MCB Accident Form can now be completed online. Please ask the School Bursar when you require access to this.
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Appendix 3: Concussion Emails
EMAIL 1 – following knock to head but no symptoms Subject: Possible Concussion Email 1 Dear Parent/Guardian As discussed, symptoms of concussion can take 48 hours to develop. Symptoms are listed before: • • • • • • • • • •
Loss of consciousness, Seizure or convulsion Balance problems Nausea or vomiting Drowsiness Player is more emotional Irritability Sadness Fatigue or low energy More nervous/anxious Difficulty concentrating
• • • • • • • • • • • •
Don’t feel right Difficulty remembering Headache Dizziness Feeling slowed down “Pressure in head” Blurred vision Sensitivity to light Amnesia Feeling like “in a fog” Confusion Sensitivity to Noise
Please inform the school if any of the symptoms present. Contact should be made by replying to this email It is our recommendation that they be checked by a medical professional to assess the severity of the injury. Until symptoms have disappeared they should not be allowed to drive, use tablets/phones/computers, or indeed attend school. If your child develops any of the following red flags during this period, you should seek urgent medical assistance: Neck pain -Deteriorating conscious state -Increasing confusion or irritability -Severe or increasing headache -Repeated vomiting -Unusual behaviour change -Seizure or convulsion -Double vision- Weakness or tingling/ burning in their arms and legs. Should you have any further questions, please contact the school nurse or the Head of PE. Regards
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EMAIL 2 – Once concussion is suspected Dear Parent/Guardian THIS EMAIL OUTLINES THE ACTION THAT PARENTS/GUARDIANS MUST COMPLETE BEFORE PUPILS CAN RETURN TO FULL CONTACT RUGBY. The letter at the end of this email must be signed and returned. As previously discussed, your son/daughter has a suspected concussion and will now enter the Graduated Return to Play protocol. Date of Concussion: Earliest date of return: Key Points of GRTP Policy 1. Initial Rest Period o
14 days of symptom-limited physical activity (light exercise only, no strenuous activity).
2. Gradual Increase in Activity o
Over the next 9 days (up to day 23), activity levels are slowly increased under supervision.
3. Medical Assessment o
Best practice recommends a doctor’s assessment around day 9 after the concussion to confirm recovery and ensure it’s safe to return to contact sports.
o
Booking this appointment early is advised.
4. Multiple Concussions o
If this is the second or subsequent concussion in the same calendar year, you should seek advice from a medical specialist experienced in sportsrelated concussion.
It is our recommendation that they be checked by a medical professional to assess the severity of the injury. Until symptoms have ceased, your child should not be allowed to drive, use tablets / phones / computers, or indeed attend school. Should you feel that your child requires additional support with returning to the demands of school please contact their Head of Year. Please see some information from IRFU regarding return to learn.
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Stage 1
Name Daily activities that do not result in more than a mild exacerbation of symptoms
2
School activities
3
Return-to-school parttime
4
Return-to-school full-time
Activity Typical activities during the day (e.g., reading) while minimising screen time. Start with 5–15 min at a time and increase gradually Homework, reading, or other cognitive activities outside of the classroom Gradual introduction of schoolwork. May need to start with a partial school day or with greater access to rest breaks during the day Gradually progress school activities until a full day can be tolerated without more than mild* symptom exacerbation.
Goal Gradual return to typical activities
Increase tolerance to cognitive work Increase academic activities
Return to full academic activities and catch up on missed work
Graduated Return to Play Below is a graduated return to play programme as recommended by the IRFU.
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During Stages 1 – 3 of the GRTP players can progress with activities once: • Symptoms at rest are less than 7 out of a maximum of 10 on the symptom scale. • Only mild (if any exacerbation of symptoms occurs (less than a 2-point increase from score at rest) • Any symptom exacerbation resolves in less than 60 minutes (brief) The Symptom scale as set out by the IRFU is below.
During Stages 1 – 3 symptoms should be <7/10 on the scale at rest, prior to activity. During the activity, mild symptom exacerbation is allowed once it is less than a 2-point increase from the pre-activity rating and resolves within 60 minutes. If symptoms are exacerbated more than this, that activity should be stopped, and players should try again the following day. Other activities that did not provoke symptoms may be continued. Players should be symptom free and medically cleared before progressing to Stage 4. During Stages 4–6 players should be symptom-free at rest and after activity. If any signs or symptoms develop during the activities in Stages 4–6, the player should stop and return to Stage 3 until symptom-free. It is not feasible for school staff to fully conduct rehabilitation stages 1 – 4; these should be done by the player at home while being supervised by a parent/guardian, or can be player led at school training in conjunction with the coach. To progress to Stage 6 of the GRTP the school will require written confirmation from a parent/guardian that your child is fit to resume sporting activity. Best practice recommends an assessment by a medical professional at this stage to confirm recovery (or METHODIST COLLEGE BELFAST 15
otherwise) from the injury and to check there is no reason not to return to contact sport. Pupils MUST be symptom free to progress to this stage. The required permission is at the end of this document and should be copied, completed and returned to info@methody.org.
Further advice is available at www.patient.co.uk/health/head-injury-instructions . If you have any queries, please contact either Head of Department PE or the School Nurse 02890205205. Return to Play Permission
EMAIL/LETTER TO BE SIGNED BY PARENT/GUARDIAN and returned to your coach following Stage 5.
Dear Sir/Madam
RE --------------------------- (PUPIL NAME) --------------------------------(FORM). My son /daughter had a suspected concussion on ------------------. In line with the School Policy, I have monitored their condition closely over the 48 hours following the injury and during the first 5 stages of the graduated return to play protocol. I confirm that during this period, stages 1 to 5 of the Graduated Return to Play Protocol have been followed. I understand that it is recommended that I have sought medical clearance and my son/daughter is symptom free prior to returning to contact. In line with school policy my son/daughter will now progress through to Stage 6 – Normal Play.
Yours faithfully
(PARENT/GUARDIAN NAME):
(PARENT/GUARDIAN SIGNATURE):
(Date):
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Appendix 4: Concussion Recognition Tool
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References
1. 2. 3. 4.
DE Circular 2014/12 UK Concussion Guidelines for Non-Elite (Grassroots) Sport – ‘If In Doubt, Sit Them Out’ The Concussion Recognition Tool (CRT6TM) Article 17 of the Education and Libraries (Northern Ireland) Order 2003
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