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Guidelines for Concussion and Head Injury

1. At the beginning of a season for a youth athletic activity, the person operating the youth athletic activity shall distribute a concussion and head injury information sheet to each person who will be coaching that youth athletic activity and to each person who wishes to participate in that youth athletic activity. No person may participate in a youth athletic activity unless the person returns the information sheet signed by the person and, if he or she is under the age of 19, by his or her parent or guardian.

A public or private school is not required to distribute an information sheet to a pupil enrolled in the school who wishes to participate in a youth athletic activity operated by the school during a school year, and a pupil enrolled in the school may participate in that youth athletic activity without returning an appropriately signed information sheet for that activity, if the pupil has returned an appropriately signed information sheet for another youth athletic activity operated by the school during the same school year.

A 118.293(3)(b)A private club is not required to distribute an information sheet to a person who wishes to participate in a youth athletic activity operated by the private club, and a person may participate in that youth athletic activity without returning an appropriately signed information sheet for the activity, if the person has returned an appropriately signed information sheet to the club within the previous 365 days.

What is a concussion?

A concussion is a type of traumatic brain injury that interferes with normal functioning of the brain (changes how the cells in the brain normally work). A concussion can be caused by a bump, blow, or jolt to the head or body. Basically, any force that is transmitted to the head causing the brain to literally bounce around or twist within the skull can result in a concussion. Over 90% of concussions do not involve loss of consciousness It is important to note that a concussion can happen to anyone in any sport or athletic activity.

Concussion affects people in four areas of function:

  1. Physical – This describes how a person may feel: headache, fatigue, nausea, vomiting, dizziness, etc.
  2. Thinking – Poor memory and concentration, responds to questions more slowly, asks repetitive questions. Concussion can cause an altered state of awareness.
  3. Emotions - A concussion can make a person more irritable and cause mood swings.
  4. Sleep – Concussions frequently cause changes in sleeping patterns, which can increase fatigue.

Signature Sheets to be returned to coach or athletic director before athlete participates:

2. An athletic coach, or official involved in a youth athletic activity, or health care provider shall remove a person from the youth athletic activity if the coach, official, or health care provider determines that the person exhibits signs, symptoms, or behavior consistent with a concussion or head injury –OR– the coach, official, or health care provider suspects the person has sustained a concussion or head injury.

Common Symptoms Reported by Athlete:

  • Headache
  • Nausea
  • Balance problems
  • Dizziness
  • Double or fuzzy vision
  • Sensitivity to light or noise
  • Feeling mentally foggy
  • Concentration or memory problems
  • Confusion
  • Ringing in the ears

Signs, Symptoms, or Behaviors Consistent with Concussion:

(What others can see in an injured athlete)

  • Appear dazed or stunned
  • Change in level of consciousness or awareness
  • Confused about what to do
  • Forgets play(s)
  • Memory loss/amnesia
  • Unsure of score, game, opponent
  • Clumsy
  • Slow to answer questions or follow directions
  • Changes in behavior or personality
  • Loss of consciousness
  • Asks repetitive questions
  • Can’t recall events before or after hit/ blow

If an athlete exhibits any of the signs, symptoms, or behavior consistent with a concussion or head injury –OR– you simply suspect the person has sustained a concussion or head injury the athlete must be removed from all physical activity immediately. Injured athletes can exhibit many or just a few of the signs, symptoms, or behaviors consistent with a concussion or head injury. A health care provider must evaluate the athlete for concussion. An athlete that has been removed from a youth athletic activity because of a determined or suspected concussion or head injury may not participate again until he or she is evaluated by a health care provider and receives written clearance from the health care provider to return to the activity. No athlete should be allowed to return to play from concussion on the same day.

  • Not every athlete removed from play will be concussed. It may be appropriate to remove an athlete to error on the side of safety. If a concussion is suspected, the athlete must be evaluated by a health care provider. If health care provider rules out a concussion during a side-line assessment, the athlete can be returned to play if written clearance is provided. “When in doubt, hold them out”.

The appearance of signs, symptoms and behavior of a concussion may be immediate, or maybe delayed several hours, days, or even weeks after the event. It is imperative to notify the parent or guardian when an athlete is removed from play because they are thought to have a concussion.

Most concussions are temporary and they resolve without causing residual problems. Concussion symptoms in children and adolescents take longer than symptoms in adults to resolve. It is not uncommon for symptoms in young athletes to last a few weeks. These symptoms of headache, difficulty concentrating, poor memory and sleep disturbances can result in academic troubles among other problems. Concussion symptoms may even last weeks to months (post-concussion syndrome).

When you suspect and/or confirm that a player has a concussion or head injury:

  1. Immediately remove the athlete from play.
  2. Ensure that the athlete is evaluated by a trained health care provider.
  3. Inform the athlete’s parents or guardians about the suspected and/or confirmed concussion. If a trained health care provider is not available on site at the time of the injury, provide parents/guardians with recommendations on health care providers in the area that can evaluate for a concussion.
  4. A person who has been removed from a youth athletic activity because of a determined or suspected concussion or head injury may not participate again until he or she is evaluated by a health care provider and receives written clearance from the health care provider to return to the activity.

A player recovering from a concussion must be carefully observed to be sure they are not feeling worse. Even though the athlete is not playing, never send a concussed athlete to the locker room alone and never allow the injured athlete to drive home.

Some injured athletes will require emergency care. Anytime you are uncomfortable with an athlete on the sideline, it is reasonable to activate the Emergency Medical System (911). The following are reasons to activate the EMS, as any worsening signs or symptoms may represent a medical emergency:

  1. Loss of consciousness, this may indicate more serious head injury
  2. Decreasing level of alertness
  3. Unusually drowsy
  4. Severe or worsening headache
  5. Seizure
  6. Persistent vomiting
  7. Difficulty breathing

3. A person who has been removed from a youth athletic activity may not participate in a youth athletic activity (practice or competition) until he or she is evaluated by a health care provider and receives a written clearance to participate in the activity from the health care provider.

It is recommended that persons operating the youth athletic activity maintain records of all athletes removed from play for suspected and/or confirmed concussions and corresponding written clearances provided by health care providers to return to physical activity. It is further recommended that coaches maintain baseline testing data for all athletes (if available*) during all practices and competitions. This information can then be provided to health care providers after injury.

*There is no requirement that youth athletic organization complete baseline testing.
Sports Concussion Assessment Tool 2 (SCAT2)

The law defines a "Health care provider" as a person to whom all of the following apply:

  1. He or she holds a credential that authorizes the person to provide health care.
  2. He or she is trained and has experience in evaluating and managing pediatric concussions and head injuries.
  3. He or she is practicing within the scope of his or her credential.

Contact persons operating youth athletic activity and/or coaches for recommendations of health care providers in your area.

It is recommended that person operating a youth athletic activity follow a return to play (activity) progressive physical activity program after the athlete has received medical clearance, have been symptom free, and are off any pain control medications. Such programs can be found on the Wisconsin Interscholastic Athletic Association (WIAA) or the National Federation of State High School Associations (NFHS) websites.

If symptoms of a concussion recur, or if concussion signs and/or behaviors are observed at any time during the return to activity program, the athlete must discontinue all activity and be re-evaluated by a health care provider.

These clearance forms may be used by youth athletic activity organizations. Letters from treating health care providers should also be accepted.

Concussion/Head Injury Frequently Asked Questions & Answers

DPI/WIAA Suggested Concussion Management Example

Concussions and School Performance

Additional Resources

For questions about this information, contact DPI Sped Team (608) 266-1781