Children and adolescents are among those at greatest risk for concussion. Concussions in school can result from a fall, or any time a student's head comes into contact with a hard object, such as a floor, desk, or another student's head or body. The potential for a concussion is greatest during activities where collisions can occur, such as during physical education (PE) class, playground time, or school-based sports activities.
Students may also get a concussion when doing activities outside of school, but then come to school when symptoms of the concussion are presenting. For example, adolescent drivers are at increased risk for concussion from motor vehicle crashes.
Concussions can have a more serious effect on a young, developing brain and need to be addressed correctly. Proper recognition and response to concussion symptoms in the school environment can prevent further injury and can help with recovery.
Prevention of and Preparing for Concussions in School
Here are some steps teachers, administrators, school nurses, and coaches can take to prevent concussions in school and ensure the best outcome after concussion:
- Become educated about concussions. MomsTeam's concussion center has comprehensive, up-to-date information about all aspects of concussion, from recognition to treatment to return to play, from information about the new state laws on youth sports concussions (31 and the District of Columbia so far) to reports on the latest research, products, and tests, including free resources for teachers, parents, and students.
- Have a concussion action plan. Laws in place in a majority of states now ensure that concussions are identified early and managed correctly by requiriing immediate removal from play of student-athletes with suspected concussion and prohibiting return to play until they have been evaluated by health professionals with training in concussion evaluation and management and received written clearance to play. Some of the laws cover only public and private high school athletes. Some extend coverage to all students and to athletes playing in independent youth sports organizations. In any event, teachers and those coaching school sports should:
- look for signs and symptoms of concussion if a student on an athlete on a team you are coaching has suffered a bump or blow to the head or body;
- make sure that that the student, if a concussion is suspected during a sports practice or game, is immediately removed from play. [Remember the rule: "When in doubt, sit them out."];
- Ensure that the athlete is evaluated by a health care professional experienced in concussion management. If you are a coach, you can play an important role in the evaluation process by providing information about:
- the cause of injury and the force of the hit or blow to the head or body (remember: it is a myth that only blows directly to the head cause concussion; for an article debunking this and some other of the most widespread concussion myths and misconceptions, click here). In addition, evidence that a concussion occurred from a minor blow, especially in an athlete with a history of prior concussions, is considered an important factor in concussion management, suggesting a longer recovery time for return to play, and, in some instances, warranting consideration of retirement from contact or collision sports;
- any loss of consciousness (LOC) (passed out/knocked out), and, if so, for how long. While LOC, contrary to myth, is not required for a concussion finding (in a recent study of high school athletes with concussion was present in less than five percent of concussions), and studies show that a brief LOC (less than a minute) does not reflect injury severity or predict the length of recovery, prolonged loss of consciousness (30 seconds to a 1 minute or greater) does provide preliminary evidence for caution so that it is listed as one of the "modifying" factors that may influence management of such concussions.
- any memory loss (amnesia) immediately following injury. An athlete can experience two types of amnesia after a concussion: anterograde (reduced ability to form new memories) and/or retrograde (partial or total loss of the ability to recall events before injury). While retrograde amnesia varies with the time of measurement after injury, and because athlete often hears peers, family, and coaches discuss events surrounding the injury - making it more likely that they will subsequently falsely report remembering more about the injury - it is considered a poor measure of injury severity.1, 2 Anterograde amnesia is an important indicator of more serious injury and slower recovery.2,3
- Any seizures immediately following the injury.
- Number of previous concussions (if any)
- Create safe school environments. Make sure your school has policies and procedures to ensure that the environment is a safe, healthy place for students. Talk to all school staff and administrators and encourage them to keep the physical space safe, keep stairs and hallways clear of clutter, secure rugs to the floor, and check the surfaces of all areas where students are physically active, such as playing fields and playgrounds. Playground surfaces should be made of shock-absorbing material, such as hardwood mulch or sand, and maintained to an appropriate depth. Proper supervision of students is also important.
- Monitor the health of your student athletes. Make sure to ask whether an athlete has ever had a concussion and insist that your athletes are medically evaluated and are in good condition to participate in sports. Keep track of athletes who sustain concussions during the school year. This will help in monitoring injured athletes who participate in multiple sports throughout the school year.
Sources: Numerous, including Centers for Disease Control (CDC).
1. CollinsMW. Update: concussion. Presented at the American Orthopaedic Society for Sports Medicine 2009 annual meeting; July 9-12, 2009; Keystone, CO.
2. Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Br. J. Sports Med. 20090: 43:i76-i84
3. Halstead, M, Walter, K. "Clinical Report - Sport-Related Concussion in Children and Adolescents" Pediatrics. 2010;126(3):597-615.