Intent of Webinar The intent of the webinar is to provide training on the Ophea Concussion Protocol (reflects the minimum standards required by the Ministry

Intent of Webinar

The intent of the webinar is to provide training on the Ophea Concussion Protocol (reflects the minimum standards required by the Ministry of Education).

• some Boards have localized the concussion procedures , tools or forms.

• Localization changes will be addressed when possible.

• Refer to your own Board’s Concussion Protocol (if localized)

Page 1Concussion Training Webinar – March 2015

Before starting this webinar download/print the following resources:

1. Appendix C-1: Concussion Protocol: Prevention, Identification and Management Procedures - CHART 1: Steps and Responsibilities in Suspected

and Diagnosed Concussions (colour copy)2. Appendix C-2: Sample Tool to Identify a Suspected

Concussion3. Appendix C-3: Sample Documentation of Medical

Examination4. Appendix C-4: Sample Documentation for a

Diagnosed Concussion – Return to Learn/Return to Physical Activity Plan

5. Appendix C-5: Sample Concussion Prevention Strategies

6. Scenarios & Questions


Concussion Identification Management and Prevention forSchools

Purpose of Webinar

The following sample presentation has been developed for school staff as a training tool on the OPESGCP as:

• initial training; or• ongoing training.

It is important for all school staff to be familiar with whole concussion protocol.


Learning Goals/Session Objectives

Participants will:• increase awareness of concussions (definition, signs

and symptoms) and the seriousness of concussions;• become familiar with strategies for concussion

prevention;• learn about and apply the OPESGCP to identify a

suspected concussion;• learn about the management procedures for a

diagnosed concussion;• be introduced to sample tools for the identification

and management processes.


What is a Concussion?

A concussion:• is a brain injury that causes changes in how the

brain functions, leading to symptoms that can be physical (e.g., headache, dizziness), cognitive (e.g., difficulty concentrating or remembering), emotional/behavioural (e.g., depression, irritability) and/or related to sleep (e.g., drowsiness, difficulty falling asleep).

Concussion Training Webinar – March 2015 Page 6

What is a Concussion? cont’d.

A concussion:• may be caused either by a direct blow to the

head, face or neck, or a blow to the body that transmits a force to the head that causes the brain to move rapidly within the skull;

• can occur even if there has been no loss of consciousness (in fact most concussions occur without a loss of consciousness); and,

• cannot normally be seen on X-rays, standard CT scans or MRIs.


Dr. Mike Evans – Youtube video

Dr. Mike Evans – Concussion Management and Return to Learn

Question:• Identify the four categories of concussion

signs/symptoms that a student may experience.


http://www.health.gov.on.ca/en/public/programs/concussions

Dr. Mike Evans – Youtube video

Answer:• Physical Problems• Thinking Problems• Emotional Symptoms• Sleep Issues


Identification

Identification procedures are located in the Ontario Physical Education Safety Guidelines (OPESG), safety.ophea.net:―Appendix C-1 - Concussion Protocol:

Prevention, Identification and Management Procedures

―Chart 1: Steps and Responsibilities in Suspected and Diagnosed Concussion


Page 11Page 11

Common Signs and Symptoms

• Teachers/coaches/intramural supervisors must become familiar with the common signs and symptoms of a concussion.

• Note… Only a medical doctor/nurse practitioner can diagnose a concussion.

• But… Teachers/coaches/intramural supervisors can recognize signs and symptoms of suspected concussion and inform parents/guardians of the importance of evaluation by a medical doctor/nurse practitioner.

Concussion Training Webinar – March 2015

Identification – Tool to Identify a Suspected Concussion


Initial Response - Suspected Concussion


Student:

Receives a blow to the head, face or neck, or a blow to the body that transmits a force to the head, and

as a result may have suffered a concussion

Identification: Initial Response

Unconscious:

Teacher/coach/supervisor:contact parent/guardian re: the injury and of the need to pick up

student. Provide information on the injury and form to document medical examination (e.g., Appendix C-2 and

Appendix C-3 – Sample Documentation of Medical Examination; inform principal of suspected concussion).

Teacher/coach/supervisor:contact parent/guardian re: the injury and of the need to pick up

student. Provide information on the injury and form to document medical examination (e.g., Appendix C-2 and

Appendix C-3 – Sample Documentation of Medical Examination; inform principal of suspected concussion).

Student:

UNCONSCIOUS

Student:

UNCONSCIOUS

Teacher/coach/supervisor:

Stop activity – initiate emergency action plan and call 911


Stop activity – initiate emergency action plan and call 911


Identification: Initial Response cont’d

Unconscious: Concussion Suspected

• EMS transports student to hospital for medical examination

• Principal informs staff of suspected concussion• Parent/Guardian returns document of medical

examination to principal (e.g., Appendix C-3 – Sample Documentation of a Medical Examination)





Conscious:

Student:

CONSCIOUS

Student:

CONSCIOUS


Stop activity – initiate emergency action plan


Stop activity – initiate emergency action plan

Page 17Concussion Training Webinar – March 2015 Page 17


Conscious: Initial Concussion Assessment

A “Tool to Identify a Suspected Concussion” is used.

The teacher/coach/intramural supervisor completes the form.

Page 18


Conduct initial concussion assessment (e.g., Appendix C-2 – Sample Tool to

Identify Suspected Concussion)


Conduct initial concussion assessment (e.g., Appendix C-2 – Sample Tool to

Identify Suspected Concussion)


Identification: Signs and Symptoms Present

Conscious:

Teacher/coach/supervisor:contact parent/guardian re: the injury and of the need to pick up student.

Provide information on the injury and form to document medical examination (e.g., Appendix C-2 and Appendix C-3 – Sample

Documentation of Medical Examination; inform principal of suspected concussion

Teacher/coach/supervisor:contact parent/guardian re: the injury and of the need to pick up student.

Provide information on the injury and form to document medical examination (e.g., Appendix C-2 and Appendix C-3 – Sample

Documentation of Medical Examination; inform principal of suspected concussion

Student:

does not return to play that day

Student:

does not return to play that day

Parent/guardian: informed that student is to be examined by

medical doctor or nurse practitioner as soon as possible that day

Parent/guardian: informed that student is to be examined by

medical doctor or nurse practitioner as soon as possible that day

Student:

Concussion Suspected

Student:

Concussion Suspected

Concussion Training Webinar – March 2015Page 19

Identification: No Signs or Symptoms Present

Conscious:

Student:

may resume full participation in physical activity

Student:

may resume full participation in physical activity


contact parent/guardian and provide information of the injury and importance of continued monitoring

(e.g., Appendix C-2)


contact parent/guardian and provide information of the injury and importance of continued monitoring

(e.g., Appendix C-2)

Parent/guardian:

Continued monitoring for 24-48 hours

Parent/guardian:

Continued monitoring for 24-48 hours

Student:

Concussion NOT Suspected

Student:

Concussion NOT Suspected


Implementation Identification Procedures

Check your knowledge in the following scenarios.



Scenario A:In a ball hockey game during Physical Education class, two students rush for the ball and collide. As Kate lunges and reaches for the ball in an attempt to shoot on goal, she slips and falls head first onto Satinder’s knee. Kate collapses onto the floor, lying on her side with eyes closed and motionless for approximately 30 seconds. She does not respond when students call her name. As you approach, her eyes open, she moans and starts to get up.

See next slide for questions.



Determine if Kate should be suspected of having a concussion.

1. Which concussion pathway should you follow?a) Consciousb) Unconscious

See next slide for answers.



Answer:b) Unconscious Pathway

• Key points to determine concussion pathway: Kate lies motionless and unresponsive

for approximately 30 seconds; = loss of consciousness (physical sign

on “Tool to Identify a Suspected Concussion”);



Scenario B:During an intramural soccer game, Reilly pushes Sam in an attempt to get the ball. Sam trips on a small rock hidden by the grass in the field and falls forward, smashing his chin on the ground. As you approach, Sam sits up and blood streams from the split in his chin. He panics, gets up and staggers towards you, almost falling again complaining of dizziness. During the Initial Response procedures, you learn that Sam is feeling dizzy and can’t remember the sport he was playing.




Determine if Sam should be suspected of having a concussion.

1. Which concussion pathway should you follow?a) Conscious – Concussion Not Suspectedb) Conscious – Concussion Suspectedc) Unconscious

See next slide for answer.



Answer:b) Conscious Pathway – Concussion

Suspected

• Key points to determine concussion pathway: one or more signs/symptoms

observed/reported (i.e., he reported that he was dizzy); and

Sam responded incorrectly to one of the memory function questions (i.e., he didn’t know what sport he was playing)Concussion Training Webinar – March 2015 Page 27

Page 28

Implementation Identification ProceduresScenario C:During a tag game at recess, Louis is one of the last people to be caught. Faking to one side and sprinting away, he turns to check that Addison is not following him and runs into the basketball net pole. You are supervising the playground and hear the sound of Louis’ head hitting the pole. He pauses, shakes his head and then continues playing. Worried that he might have a concussion after such a hard collision, you call him over to question him.After using the Tool to Identify a SuspectedConcussion you can’t find anything wrong with him.




Determine if Louis should be suspected of having a concussion.

1. Which concussion pathway should you follow?a) Conscious – Concussion Not Suspectedb) Conscious – Concussion Suspectedc) Unconscious



Page 30


Answers:a)Conscious Pathway - Concussion Not

Suspected• Key points to determine concussion

pathway: Louis is conscious and never lost

consciousness; No signs were observed nor symptoms

relayed from Louis; and Louis correctly answered the memory function

questions.


Diagnosis

Concussion


Management Procedures for a Diagnosed Concussion

Principal informs school staff of concussion and establishes collaborative team identifying designated school staff lead

Principal informs school staff of concussion and establishes collaborative team identifying designated school staff lead

Parent/guardian: report back to school principal (e.g., Appendix C-4 – SampleDocumentation for a Diagnosed

Concussion – Return to Learn/Return to Physical Activity Plan: Step 1)

Parent/guardian: report back to school principal (e.g., Appendix C-4 – SampleDocumentation for a Diagnosed

Concussion – Return to Learn/Return to Physical Activity Plan: Step 1)

Return to Learn/Return to Physical Activity – Step 1

(home)

Student: complete cognitive and physical rest

Return to Learn/Return to Physical Activity – Step 1

(home)

Student: complete cognitive and physical rest

Student:

Returns to School

Student:

Returns to School


Collaborative Team

Manages Return to Learn and Return to Physical Activity

Collaborative Team is led by the school principal and includes:

• the concussed student;• her/his parents/guardians;• school staff and volunteers (e.g., coaches) who

work with student; and• the medical doctor/nurse practitioner.

Page 33Concussion Training Webinar – March 2015 Page

Return to Learn/Return to Physical Activity – Step 1- Rest

Cognitive and Physical Rest at Home• Continues for a minimum of 24 hours until

symptoms improve or student is symptom free as determined by parent and student

“Given that children and adolescents spend a significant amount of their time in the classroom, and that school attendance is vital for them to learn and socialize, full return to school should be a priority following a concussion”Davis GA, Purcell LK. The evaluation and management of acute concussion differs in young children. Br J Sports Med. Published Online First 23 April 2013 doi:10.1136/bjsports-2012-092132 (p. 3)


Return to Learn/Return to Physical Activity

Symptoms are Improving

Symptom Free

+

Student:

Returns to School

Student:

Returns to School

Return to Learn – Step 2a (with symptoms)

Student: requires individualized classroom strategies and/or approaches, see Appendix C-1, TABLE 2: Return to Learn Strategies/Approaches


Student: requires individualized classroom strategies and/or approaches, see Appendix C-1, TABLE 2: Return to Learn Strategies/Approaches

Parent/Guardian: report progress to school principal (e.g., Appendix C-4: Step 2a)

Return to Learn – Step 2b (symptom free)

Student: begins regular learning activities



Return to Physical Activity – Step 2 (home)

Student: individual light aerobic physical activity only

Return to Physical Activity – Step 2 (home)

Student: individual light aerobic physical activity only



Step 2a: Symptoms are Improving

• Collaborative team lead identifies student’s symptoms and responses to learning activities― Develops appropriate strategies/approaches

to meet student’s needs• School staff and volunteers need to be aware of

student’s cognitive and emotional/behavioural difficulties


Return to Learn Strategies

Return to Learn Strategies/Approaches

• Located in Appendix C-1, pgs. 14 and 15 • Lists Cognitive Difficulties and

Emotional/Behavioural Difficulties that may be experienced by students



Step 2b: Symptom Free after Step 2a• Parents/Guardians communicate that student is

symptom free and ready to move on to Step 2b – Return to Learn and Step 2 – Return to Physical Activity

Step 2b: Symptom Free after Step 1• Parents/Guardians communicate student is

symptom free and is returning to school• Student proceeds directly to Step 2b - Return to

Learn and Step 2 – Return to Physical Activity• Progress monitored by the collaborative team


Return of Concussion Signs/Symptoms

Concussion signs/symptoms can reoccur during cognitive and physical activities•Student must be closely monitored for:

― return of signs/symptoms;―deterioration of work habits and performance.

If concussion signs/symptoms return:•a medical examination is required (medical doctor/nurse practitioner);•the parents/guardians complete Return of Symptoms form.•Student returns to step as determined by medical doctor/nurse practitioner


Return to Physical Activity – Steps 2 and 3

Symptom Free

Return to Physical Activity – Step 3 (school)

Student: individual sport specific physical activity only


Student: individual sport specific physical activity only

+





Return to Physical Activity – Step 2

(home)

Student: individual light aerobic physical activity

only

Return to Physical Activity – Step 2

(home)

Student: individual light aerobic physical activity

onlyParent/Guardian: report progress to school principal (e.g., Appendix C-4: Step 2b/Step 2)


Return to Physical Activity – Steps 4, 5 and 6


Student: activity with no body contact


Student: activity with no body contact

Parent/Guardian: report back to school principal - include written documentation from medical doctor or nurse practitioner to indicate the student remains symptom free and able to return to full participation (e.g., Appendix C-4: Step 4)

Teacher: inform parent of completion of Step 4 (e.g.,

Appendix C-4: Step 4)

Teacher: inform parent of completion of Step 4 (e.g.,

Appendix C-4: Step 4)


Student: full participation in non-contact sports – full practice for contact sports


Student: full participation in non-contact sports – full practice for contact sports

Return to Physical Activity – Step 6 (school)Student: full participation in all physical activity

(including contact sports)

Return to Physical Activity – Step 6 (school)Student: full participation in all physical activity

(including contact sports)Concussion Training Webinar – March 2015 Page 41

Question A

Alex has a few concussion symptoms, but is progressing well through the Return to Learn plan developed by the school. She/he would love to be active. When can she/he participate in DPA or intramural activities?



Answer to A

DPAAlex can participate:when he/she is symptom free (has

completed Step 2a of Return to Learn Plan);

After he/she has completed Step 2 of the Return to Physical Activity Plan;

If the DPA activities meet the criteria of Step 3 of Return to Physical Activity Plan.


Answer to A cont’d

Intramural Sport/ActivitiesAlex can participate:when he/she is symptom free (has

completed Step 2a); After he/she has completed Steps 2-4 of

the Return to Physical Activity Plan;After examined and “cleared” for non-

contact physical activity by medical doctor/nurse practitioner.


Question B

After Step 1 – physical and cognitive rest, Ryan has no signs or symptoms. He/she desperately wants to play in the tournament this weekend. At which step can Ryan fully participate in the volleyball games (non-contact interschool sport)?


.


Answer B

Play in volleyball tournament? successfully completed Step 4 of Return

to Physical Activity Plan; examined and “cleared to participate” by

a medical doctor or nurse practitioner


Prevention

“…there is evidence that education about concussion leads to a reduction in the incidence of concussion and improved outcomes from concussion…”

(Delaney, Lacroix, Leclerc, & Johnston, 2000; Goodman & Gaetz, 2002; McCrea, Hammeke, Olsen, Leo, & Guskiewicz, 2004).

.


Prevention

• Curriculum Connections• Resources:

Safety.ophea.net – Appendix C-5: Sample Concussion Prevention Strategies

Safety.ophea.net - The Generic Section and sport/activity pages of all modules.

Localized board prevention strategies


Prevention Cont’d

Culture of Safety Mindedness

When planning activities teacher/coach/intramural supervisor must:

• be familiar with Board’s Concussion policy;• review with students;

― background concussion information, and― ways to minimize the risk of concussion

around the school and in physical activities and sports.


Prevention – Pre-Activity

Prior to physical activity and/or prior to the sport season teachers/coaches/intramural supervisors should:• be knowledgeable of safe practices in the

sport/activity, (e.g., rules and regulations and specific sport/activity pages in the OPESG);

• Be familiar with risks of concussion/potential injuries associated with the activity/sport and ways to minimize those risks.


Prevention – During Activity

Strategies that should be used during a unit of physical education and/or sport season or intramural activities:• Teach skills and techniques in proper

progression);• Encourage students/athletes to follow rules

of play and to practice fair play.


Questions?

• Website: safety.ophea.net• Email: [email protected]


Documents

Intent of Webinar The intent of the webinar is to provide training on the Ophea Concussion Protocol (reflects the minimum standards required by the Ministry