Concussion Policies and Procedures

Concussion word tree

The new law, Chapter 166 of the Acts of 2010, clearly states that students who become unconscious, who suffer a concussion, or who are suspected of having suffered a concussion may not return to the competition or practice where the injury occurred. In addition, the new law states that the injured student may not engage in any extracurricular athletic activity without written authorization. Therefore, our guidance, like that of Centers for Disease Control’s Heads Up: Concussion in Youth Sports initiative, is: “Keep the athlete out of play the day of the injury and until a health care professional, experience in evaluating for concussion, says the athlete is symptom-free and it’s OK to return to play.”

The policy of the Everett Public Schools mandates that In order to participate in Everett High School Athletics or extracurricular activities, each student must:
• Present a physical from their own physician or come to the high schools sports screening prior to the start of the season.
• Complete Pre screening questionnaire with up-to- date information of any history of a concussion or head and neck injury.

 Athletic Trainer Certified (ATC) will review the pre screening questionnaire and will retain all the documentation of concussions and head/neck injury on file. The ATC will inform coaches and Athletic Director (AD) of any history of concussion and head/neck injuries.

At the beginning of each season, student athletes will be provided an informational sheet with the symptoms of concussions, reference to information available online, and a Head Injury Report form. School rules and regulations made by the ATC, AD, guidance, and administrators on concussions will appear in the student handbook.

• No student athlete will be permitted to participate in athletics and extracurricular activities unless a medical consent form, Department of Public Health’s Pre-Participation Head Injury/Concussion Reporting Form and concussion fact sheet are returned signed by the parent(s)/guardian(s) to the ATCs, unless the student athlete is 18 or older.
• All coaches and staff must be CPR and First Aid certified, and will attend a refresher course every two years. Documentation of certificates will be kept by school administration.
• All violations or non compliance of the Everett Public Schools Concussion Policy shall be reported to AD and school administration for further disciplinary actions.
• All documentations of concussions of the student athletes, including the Pre Participation Forms, Report of Head Injury Forms, medical clearance and authorization forms, and reentry plans, will be kept on file in the ATC office and copies will be sent to the AD and Administrators. The AD and administrators will keep documents of the verification of training and receipt of materials.
• All concussion forms and documents will be available in target languages and languages other than English. Translators will be available at meetings as necessary.
The Superintendent designates the Athletic Director (A.D.) as the “person in charge” of administering the regulatory requirements
1. The AD shall participate in the development of the biannual review of the policies and procedures for the prevention and management of sports related head injuries within the school district or school.

2. The AD shall complete the annual training
3. The AD must ensure that
• the training requirements for staff, parents, volunteers, coaches and students are met, recorded, and records are maintained
• all students meet the physical examination requirements prior to participation in any extracurricular activity
• all students participating in extracurricular athletic activities have completed and submitted pre participation forms of concussion history
• pre participation forms are reviewed
• report of head injury forms are completed by the parent and/or coach and reviewed by the AD, ATC, school nurse and team physician
• annual statistics are reported to the DESE.

ImPACT Testing
All student athletes participating in contact sports (football, soccer, field hockey, lacrosse, basketball, hockey, wrestling, baseball, and softball) will take the ImPACT test. This is a computerized concussion management program. These student athletes will take the ImPACT test prior to beginning the season for a baseline score. Forty-eight hours after suspecting a concussion, the student athlete will take a post injury test. After the first post injury test, the student athlete will continue to take post injury tests until they are ready to return. The ImPACT test does not take the place of seeing a physician. The student athlete must still see a physician regarding the concussion. ImPACT baselines will be renewed every two years, unless there is a change in health or certain medications, it may be less than two years. Student athletes not involved in contact sports will have the option of taking the ImPACT baseline

Head Injury Training Program
All Coaches, Band Directors, School Nurses, School / Team Physicians, Certified Athletic Trainers, Student Athletes, Marching Band members and any other affiliates of Everett High School Athletics must complete an Interscholastic Head Injury Training Program.

The athletic head injury training program must include, but not be limited to:
• The recognition of the signs and symptoms of head and neck injuries, concussions, risk of secondary injury, including the risk of second impact syndrome
• Description of the protocol for return to sports competition or practice after a head injury is sustained.
* The NFHS online “concussion in sports” must be completed by all coaches, directors, school nurses, marching band members and student athletes.
• Athletic trainers, physicians, and physician assistants involved with the evaluation and clearing of concussions must take the MDPH approved clinical training found at
• Certified athletic trainers will have a concussion awareness assembly for all coaches, directors, school nurses, and physicians. It is mandatory to attend.
• Instruction to teach coaches proper techniques on how to reduce risk for head injuries will be gone over in training
• Parents and students will be given a copy of the Head Injury and Concussion Policy and the Parent/Athlete Concussion Information Sheet. Both parents and students will have to sign and return Acknowledgement of Receipt for the policy and fact sheets.

Procedures for Attending Staff in the event of injury
• The athletic trainer will remove the injured student athlete from play and contact the parent/guardian to bring to their physician
• The ATC will fill out an accident report which will be sent to the administration building
• The ATC will fill out the Department of Public Health’s Report of Head Injury During a Sports Season Form
• The ATC will notify the AD and school nurse.

Special Circumstances:
• If there is no athletic trainer on duty, the coach will remove the athlete from play, contact the parent/ guardian to bring the student athlete to the hospital, and also contact the AD, ATC, and school nurse and fill out an accident report.
• If the coach or ATC cannot contact the parent/guardian or they cannot get there, a coach or ATC will accompany the student athlete to the hospital.
• The ATC, trainer/coach or attending person will advise the student athlete and parent/guardian that complete physical, cognitive, emotional, and social rest is very important when experiencing signs and symptoms.

Procedures for student athlete and parents:
• The student athlete must see his/her primary physician after suffering a concussion.
• The student athlete will be given a Report of Head Injury Form from the ATC or coach to bring to the physician.
• The physician will then need to give clearance for the student athlete to start the return to play protocol.
• The certified Athletic Trainer for the Everett Public Schools has the final say as to whether an athlete or band member returns to play.

Individualized Return to Play Protocol
The student athlete’s individualized return to play protocol must be supervised by either the physician or ATC. Each student will have the Department of Public Health’s Post Sports Related Head Injury Medical Clearance and Authorization Form filled out by the ATC or physician.

The following steps will be followed:
• completion of a full day of normal cognitive activities (school day, studying for tests, watching practice, interacting with peers) without any return of signs or symptoms. If no symptoms return, the next day advance to:
• light aerobic exercise, which includes walking or stationary cycling, keeping the intensity less than 70% of maximum heart rate and no resistance training. The objective of this step is to slowly raise the heart rate without any return of signs or symptoms. If no signs or symptoms return, advance to:
• sport specific exercise including skating, and/or running, no head impact activities. This step is designed to add movement while continuing to increase heart rate. If no signs or symptoms return, advance to:
• non-contact training drills and the student athlete may initiate progressive resistance training. If no signs or symptoms return, advance to:
• following medical clearance by a physician, the student athlete may participate in normal training activities. Breaks must be given, for rest and for the ATC to monitor. The objective of this step is to assess the functional skills of the student athlete. If there is still no return of any symptoms, the next day advance to:
• return to play involving normal exertion. The athlete must participate in one regular practice at this step before being allowed into a game or competition.

Note: if the student athlete experiences any signs or symptoms, he or she will be removed from further activities that cause exertion and must return to their physician. The student athlete will then return to step one of their individualized return to play protocol. The student cannot move up a step if they are taking any ibuprofen or pain relievers that may mask the symptoms of the concussion.

Re-entry to School
The student’s guidance counselor will make a graduated re-entry plan for any student athlete who has had a concussion. ATCs will inform Guidance Counselor, Athletic Director, School Principals and administrators of the injury. Guidance counselors will consult with ATC, teachers, Parents/guardians, and other administration about the student returning to a full academic schedule. If symptoms of the concussion last longer than 10 days, the students guidance counselor again will be notified and the student will be placed on a 504 plan.

Dear Parent/Guardian,

Everett Public Schools has begun utilizing an innovative program for student-athletes and members of the marching band and drama clubs. The program is called ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) and it is a computerized exam that the student takes prior to the season. If the student is believed to have suffered a head injury during competition, they re-take the exam to help determine the extent of the injury, the location of the injury, and when the injury has healed. The system is utilized throughout high schools, colleges and universities, and professional sports. It is the “Gold Standard” in recognizing and managing head injuries.

The exam takes about 20-30 minutes and is non-invasive. The program is set-up as a “video-game” type format. What it is doing is giving the brain a preseason physical of its cognitive abilities. It tracks information such as memory, reaction time, procession speed, and concentration. It is simple and actually most that take it enjoy the challenge of the test. The exam has gained recognition around the world.

If a concussion is suspected, the test is re-taken and the information can be used to better determine the athlete’s recovery from the concussion. The test data is shared with your family physician, and a sound decision can be made as to when return-to-play is appropriate and safe. If an injury of this nature occurs, we will be in contact with you to discuss all of the details, large and small.

It is stressed that there is no invasive work being done with this program. This gives us the best available information in preventing brain damage that can occur with multiple concussions. The athletic trainers, along with the schools administration and coaches are trying to keep your child’s health and safety at the forefront of their athletic experience. Please send the bottom half of this sheet back, with the appropriate signatures, with your child. If you have any questions please feel free to contact us or visit 


Christie Belfort and Rachel Loan

EHS Athletic Trainers
617-394-2490 ext 4205   



Permission for the use of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)

I have read the above information. I have been given an opportunity to ask questions and my questions have been answered. I agree to allow my child to participate in the ImPACT Concussion Management Program. 

Name of the Student: _______________________________________________________________________________


Sport(s): ___________________________________________________________________________________________


Signature of the Student: _________________________________________________________ Date:_____________


Signature of the Parent:___________________________________________________________ Date:______________

Based on mechanism of injury and evaluation, it is believed that ______________________________________has suffered a concussion while participating __________________________________________ an Everett High School athletic practice/event on _________


The following are instructions to care for this athlete over the next few days.

• Do not drive a vehicle
• No physical activity
• Limit texting, computer use, and video games
• Do not drink alcohol
• Do not take Aspirin or Ibuprofen (Advil, Motrin). Tylenol may be acceptable if authorized by the certified athletic trainer or team physician
• Sleep is alright, but if the athlete is experiencing moderate to severe symptoms someone should check on him/her periodically


Signs and symptoms of a concussion:

Signs and symptoms of a concussion do not always present right away. Some may not present until hours after the initial trauma. Due to this fact, you should be aware of possible signs and symptoms that may indicate a significant concussion.

1. Physical: Headache / Emotional: Difficulty remembering / Sleep: More than normal
2. Physical: Fatigue / Emotional: Difficulty concentrating / Sleep: More than normal
3. Physical: Dizziness, sensitivity to light; feeling slowed down, feeling in a fog / Emotional: Sadness, feeling emotional / Sleep: Drowsiness, trouble falling asleep
4. Physical: Sensitivity to noise, slowed reaction times / Emotional: Nervousness
5. Physical: Nausea, altered attention / Emotional: Anxiety
6. Physical: Balance problems, amnesia, loss of conscious

If any of the following occur, seek medical attention as soon as possible:

• Persistent or repeated vomiting
• Convulsions/seizure
• Difficulty seeing, any weird movements of the eyes, one pupil is larger than the other
• Restless, irritability, or drastic changes in emotional control
• Difficulty walking
• Difficulty speaking, slurred speech, repeating sentence or words
• Progressive or sudden impairment of consciousness
• Bleeding or drainage of fluid from the nose or ears


_____________________________________        _________________________

Certified Athletic Trainer Signature                         Date

DATE: __________________

Everett High School

Athletic Department

Attn: Athletic Trainer

100 Elm Street

Everett, MA 02149



Dear Parent and/or Guardian:


During a recent game and/or practice, your son/daughter received a head injury/concussion. Your son/daughter has been removed from athletic participation until medically cleared by a physician AND athletic trainer. The following is a brief account of the incident. Please sign and return form. Feel free to contact us at __________________if you have further questions and/or concerns regarding your son’s/daughter’s head injury/concussion.




ATHLETE’S NAME: ______________________________________________________________


SPORT: _________________________________________________________________________


INJURY DATE: ___________________________________________________________________










Athletic Trainer: