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Main photo by Salome King, Tec Voc Photography
Concussions are not just in the domain of contact sports; they can occur on the playground, on the job or during virtually any other activity.
"Although sports-related concussions receive a lot of media and research attention, we see a significant number of youth who sustain injuries as a result of motor vehicle accidents, assaults, falls and other schoolyard accidents," said Dr. Michael Ellis, a neurosurgeon and Medical Director of the Pan Am Concussion Program. "Therefore it is very important that all sport and school stakeholders are educated on the signs and symptoms of concussion and know what to do if a concussion is suspected."
Dr. Ellis was a key consultant on the Winnipeg School Division's new Concussion Protocol. The document was introduced to aid administrators and staff in the management of students who have sustained a suspected concussion as the result of participating in school and sport activities. The protocol is based on Parachute Canada's recently published Canadian Guideline on Concussion in Sport.
"This protocol will be applied to any situation where a student is suspected of sustaining a concussion, whether it occurs in athletic events, recess or elsewhere," said WSD Phys. Ed. Consultant David Bard. "There has been increased information about concussions in the media in recent years, and obviously parents, students, teachers and coaches are all very concerned that they are handled properly."
There are three important components to the protocol; the first key area is concussion awareness.
"All school and sport stakeholders including students, parents, teachers and coaches must have a fundamental awareness about the signs and symptoms of concussion and be aware of their roles and responsibilities in instances when a student is suspected of having sustained a concussion," Dr. Ellis said.
The key role of WSD staff is to optimize the evaluation and management of concussions, rather than providing a diagnosis. If a student is suspected of sustaining a concussion, they must be referred to a medical professional for examination.
"Childhood and adolescence is a time when the brain is undergoing development and may be more vulnerable to head trauma. Therefore it is important that all students with a suspected concussion are immediately removed from the activity they are participating in and are referred to a physician, nurse practitioner or physician assistant for medical assessment," Dr. Ellis said.
The staff/administrative focus should be on communication.
"If I am teaching or coaching a student who is suspected of having a concussion, I want to facilitate communication so parents and other adults are aware of their responsibilities as well," Mr. Bard said. "Communication between all of the stakeholders—the student, the parents, the doctors, the teachers and coaches—is vital to this working."
When it comes to sports, the protocol recommends pre-season/annual concussion education for all stakeholders: students, parents, coaches, officials, teachers, trainers and licensed healthcare professionals. This education should include information on the definition of a concussion, possible mechanisms of injury, common signs and symptoms, steps that can be taken to prevent concussions and other injuries, steps to take when an athlete has suffered a suspected concussion or more serious head injury, return-to-school/sport strategies and return-to-sport medical clearance requirements.
Once a student has been diagnosed with a concussion, the protocol outlines specific return-to-school and return-to-sports strategies to manage post-incident recovery and incorporates the use of standardized medical assessment and clearance letters that help facilitate clear communication between medical, school, and sport stakeholders.
"It is important that all athletes with a suspected or diagnosed concussion undergo proper medical management and receive written medical clearance prior to returning to activities with a risk of head injury," Dr. Ellis said.
The return-to-school process is a series of gradual steps designed to reintroduce students to typical activities. For example, during stage 1, the student is kept at home and attempts activities that do not cause further concussion symptoms. Students may read, text or have screen time starting at intervals of 5-15 minutes and gradually increasing the duration. In stage 2, students take on homework, reading or other cognitive activities in the home, before returning to school part-time in Stage 3.
"As the student returns to normal activity at school, there will be heightened observation of that student by teachers, coaches and other staff," Mr. Bard said. "The student has to be symptom-free before they can begin the next stage."
The return-to-sport strategy has similar graduated steps, with students taking on symptom limiting activities before working their way up to light aerobic activity, non contact drills, etc. on the way to resuming full participation.
"We are always learning more about how to best manage concussions. The majority of youth who sustain a concussion will make a complete recovery if managed by their primary care provider with a brief period of rest followed by a gradual return to normal school and sport activities," Dr. Ellis said. "However, approximately 30-40% will develop persistent symptoms that are ideally managed by physicians and multi-disciplinary healthcare professionals with clinical training and experience in traumatic brain injuries."
Dr. Ellis said a standardized protocol is important step towards optimizing the recognition and management of concussions that occur during school activities.
"I am very delighted that Pauline Clarke and the Winnipeg School Division have taken such an important leadership role in developing a standardized concussion protocol for their schools. Because the Winnipeg School Division Concussion Protocol is based on Parachute's recently published Canadian Guideline on Concussion in Sport, this will ensure that all students are managed according to national best practice guidelines. It is my sincere hope that all school divisions and schools in Manitoba will develop similar concussion protocols based on this standard."
For more information on the WSD Concussion Protocol, click here.