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Concussion Courses & Guidelines

Rugby Colorado Concussion Guidelines and Protocol

Policy

An athlete suspected to have suffered a concussion, shall be removed from practice/play and will be ineligible to practice or play until the full process below has been completed – this is for the safety and benefit of the athlete and his/her growing brain!  During this period, the athlete will appear as “Medically Ineligible” on all match reports and must not be allowed to practice, play in matches, or engage in any other physical activity.

Concussion During Match Play

  1. If an athlete is suspected to have suffered a concussion during a match, the athletic trainer (ATC) will remove the athlete from the match and notify athlete, parents (if present) & coach that athlete must be evaluated by a qualified health care provider.
  2. The ATC will fill out an online injury report describing the injury, any actions taken by the ATC, and the ATC’s recommendations regarding further assessment or treatment of the injury.  The ATC will provide parent with Rugby Colorado Concussion Clearance form.

Concussion During Practice

  1. If a suspected concussion occurs when an ATC is present, the ATC will follow the match play concussion procedures described above.
  2. If a suspected non-emergency concussion occurs at practice when an ATC is not present, the coach must immediately remove the athlete from play and not allow the athlete to return to practice that day.  Make Sure the player is not left alone.  Arrange for alternate adult supervision.  Do not allow concussed athletes to drive him/herself home.
  3. The coach shall create an online injury report to Notify Rugby Colorado of the suspected concussion as soon as possible.  The coach shall contact the medical coordinator for assistance as needed.
  4. Upon receipt of the injury report, Rugby Colorado’s Medical Coordinator will contact the parent/guardian and coach listed in the athlete’s profile to notify them of the suspected concussion and to communicate next steps.  It is vital that Parent contact information is updated and accurate in the athlete’s profile when registering.
  5. The athlete must be evaluated by a Qualified Health Care provider to properly diagnose a concussion and to be cleared for return to play. If the initial qualified health care provider’s visit results in a diagnosis of no concussion, the diagnosis must be submitted via email to Rugby Colorado’s Medical Coordinator using the Rugby Colorado Concussion Clearance Form. This form can be found and downloaded from the forms tab in the sports medicine section.
  6. Following a concussion diagnosis, a full rest and recovery period is required before the athlete will be cleared to play - this is absolutely critical to the athlete’s health and safety! World Rugby and USA Rugby require that children ages 18 and under should rest as much as possible and must stand down (not participate) from rugby-related physical activities for a minimum of two weeks following a concussion.
  7. If the athlete is symptom-free after two weeks, he/she may begin the Rugby Colorado Graduated Return To Play (GRTP) program.  Clearance from a qualified health care provider is needed to begin GRTP.  The clearance form must be submitted to Medical Coordinator prior to beginning the GRTP.
  8. The GRTP incorporates a progressive exercise program to re-introduce athletes to sport following concussion.  Each stage lasts 24 hours for children and the athlete must be without any symptoms in order to progress to the next level of activity.  Rugby Colorado’s GRTP form can be downloaded below.
  9. In order for Completion of the GRTP and return to full roster status, a signed Rugby Colorado Concussion Clearance form and all of the parents symptom scores for the athlete must be submitted to Rugby Colorado’s Medical Coordinator for processing.  Once all documentation is submitted and verified, the athlete will be cleared to play in Rugby Colorado’s system and on all match reports.
  10. Athletes are not permitted to compete until the Medical Coordinator has removed “Medical Ineligible” from their roster profile
  11. If a coach or parent suspects an athlete has suffered a concussion at any time, they should immediately contact Rugby Colorado’s Medical Coordinator and remove the athlete from play.

 

Qualified Health Care Provider

In order for an athlete to return to play after a suspicion of or suffering from concussion symptoms the athlete must see a Qualified Health Care Provider for appropriate diagnosis.

The following are approved Qualiied Health Care Providers for Colorado.

  • Doctor of Osteopathic Medicine
  • Licensed Nurse Practitioner
  • Licensed Physician Assistant
  • Licensed Doctor of Psychology with Training in Neuropsychology or Concussion Evaluation and Management
     

Snakenberg Statute

Concussion at Practice

If a player is pulled out of a practice or a match by a non-qualified individual, (e. g, coach, player, trainer, parent, etc.) due to a suspicion of concussion, but a Qualified Health Care Provider later certifies in writing that the player was not concussed, then the player is not required to go through the 14 stand down and GRTP protocol. Instead, the player’s return should follow the recommendations of the Qualified Health Care Provider.  

The athlete's parents must submit the Medical Clearance note to the Medical Coordinator via email prior to the athlete being cleared on the roster.  Once letter is submitted and confirmed the athlete will be released for play.

It is the responsibility of the coach or parent to report concussion incident to the Medical Coordinator even if the athlete does not go to the hospital.  Below are potential circumstances that would result in reporting


Referenced: Snakenberg Statute

 Suspect a Concussion when two events occur (CDC Heads Up)

1. A forceful blow to the head or body that results in rapid movement of the head or body  AND 2. Any change in the athletes behavior, thinking or physical functioning

Signs: observed by others!

  • Appears dazed or stunned
  • Is confused about assignment or position  
  • Forgets sports plays
  • Is unsure of game, score, or opponent
  • Moves clumsily  
  • Answers questions slowly  
  • Loses consciousness (even briefly)
  • Shows behavior or personality changes
  • Can’t recall events prior to hit or fall  
  • Can’t recall events after hit or fall  

Symptoms: reported by athlete

  • Headache or “pressure” in head
  • Nausea or vomiting
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Concentration or memory problems 

USAR’s 5 R's

Policy requires that ALL rugby players, staff, parents, referees, volunteers, and even fans follow these five basic steps when dealing with suspected concussions:

1. Recognize – Learn the signs and symptoms of a concussion so you understand when an athlete might have a suspected concussion.

2. Remove – If an athlete has a concussion or even a suspected concussion he or she must be removed from play immediately.

3. Refer – Once removed from play, the player should be referred immediately to a qualified healthcare professional who is trained in evaluating and treating concussions.

4. Recover – Full recovery from the concussion is required before return to play is authorized. This includes being symptom-free. Rest and some specific treatment options are critical for the health of the injured participant.

5. Return – In order for safe return to play in rugby, the athlete must be symptom-free and cleared in writing by a qualified healthcare professional who is trained in evaluating and treating concussions. USA Rugby strongly recommends that the athlete complete the GRTP (Graduated Return to Play) protocol.

Concussion Signs and Symptoms

  • Headache
  • “Pressure in Head”
  • Neck Pain
  • Nausea or Vomiting
  • Dizziness
  • Blurred Vision
  • Balance Problems
  • Sensitivity to light
  • Sensitivity to noise
  • Feeling Slowed down
  • “Don’t feel right”
  • Difficulty Concentrating
  • Difficulty Remembering
  • Fatigue or Low energy
  • Confusion
  • Trouble Falling Asleep
  • More emotional
  • Irritability
  • Sadness
  • Nervous or Anxious

Red Flags

A Red Flag is an indication the Athlete is getting worse and should seek emergency medical attention ASAP.  If 1 or more of these syptoms occur after a bump or blow to the head immediately Call 9-1-1 or take the athlete to an emergency department.  

  • One pupil larger than the other.
  • Drowsiness or inability to wake up.
  • A headache that gets worse and does not go away.
  • Slurred speech, weakness, numbness, or decreased coordination.
  • Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).
  • Unusual behavior, increased confusion, restlessness, or agitation.
  • Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.

Concussion Roles and Responsibility

ATC

  • Provide/Administer medical care
  • Document injury on InjureFree
  • Provide Parent with Concussion Clearance/Follow Up Form
  • Inform the Parent/Guardian of the risks & red flags associated with concussions.
  • Confirm athletes are not playing while under concussion suspension.

Coach

  • Coach  reports directly to Medical Coordinator via email with incident report if an Athlete has sustained an injury
  • Alert Medical Coordinator within 24 hrs. if incident is a head injury
  • Will not allow athletes to play if not cleared on the roster or medical disquaification from play.

Parents

  • It is the role of the parent or guardian to observe the athlete for an increase in symptoms after a concussion  incident.  If symptoms worsen or any red flags listed above present take the athlete to emergency medical care ASAP.
  • To submit and complete online symptom updates via the Rugby Colorado website.
  • To submit Concussion Clearance/Follow Up form to Medical Coordinator via email (medical@rugbycolorado.com) for athlete release.

Medical Coordinator

  • Patient Follow Up
    • Medical Coordinator will email parents/guardians within 48 hours of incident with intrusctions regarding the return to play process and answer any questions.
    • Details include: Information on the Concussion Clearance/Follow Up Form completion and submission , CDC Heads Up concussion sheet, Graduated Return to Play guidelines.
  • Communicate with coaches and medical staff regarding the eligibility of the athlete if a concussion has been diagnosed. 
  • Receive and confirm Concussion Clearance/ Follow Up form for medical clearance to Return to Play. (subtmitted by the parents/guardians)
    • Once Athlete has completed all stages of the Return to Play and all documents have been submitted to the Medical Coordinator the athlete will be removed off the Medical Ineligible list and to active roster status.

 

Contact Information

Please contact the medical coordinator at Medical@rugbycolorado.com

 

Please submit all documents to the email above.  Thank you.

Graduated Return To Play

Graduated Return To Play Process (GRTP)

GRTP begins once a Qualified Health Care Provider clears the athlete and signs Concussion Clearance form and submitted to the Medical Coordinator via email from the parent/guardian of the athlete to start activities.

The athlete is monitored by his or her parents after the completion of each stage.  Monitoring includes submitting a symptom score which can be found at the top of this page or on the Rugby Colorado homepage.  Submission of symptom score must be completed prior to beginning the next stage.  

The athlete must stand down 24 hours for monitoring and be symtpom free prior to moving onto the next stage.  If the athlete becomes symptomatic the athlete returns to the stage previously completed and repeats stage after an additional 24 hours stand down.  If symptoms persist please contact Medical Coordinator to assist you in the next steps.

GRTP is specific for athletes 13 and up.

For athletes under the age of 13, the athlete should follow the qualified health care professional recommendations with regard to GRTP.

General guidelines may be found above and all youth athletes have to follow Colorado Rugbys GRTP.  All necessary documentation must be submitted before athlete is cleared on the roster and can return to play.

Graduated Return To Play Process

Stage

Restrictions

Exercise

Outcome

Stage 1

No Contact/ Low Intensity

- Bike or Jog 10 minutes

- Rest 5 minutes

- Check for symptoms

- Bike or Jog 10-20 minutes

Parents Monitor Athlete and submit symptom score on RCO website

24 hr rest and monitor

Stage 2

No Contact/ Moderate Intensity

- Bike or Jog 5 minutes

- Check for symptoms

- Complete both circuits in order

- Circuit #1- complete 3 rounds

- 10 BW squats/10 Situps/10 push ups/ Rest 5 minutes

- Check for symptoms

- Circuit #2- complete 3 rounds: 10 burpees, 10 jumping jacks, 10 mtn. climbers

Parents Monitor Athlete and submit symptom score on RCO website

24 hr rest and monitor

Stage 3

No Contact/ High Intensity/ No touch rugby/Bag Drills/Tackling/ Live Play/100% Sprinting

- Active/Dynamic Warm Up

- Max 90 mins

- Running, passing, catching drills

- Conditioning Circuit:

-Multidirectional 10 yard box run: jog forward, side shuffle right, back peddle, side shuffle left. Complete 4 rounds of 4 reps: 2 start on left/2 on right (16 total)/ Rest 5 minutes

-Check for symptoms

- Circuit #1- complete 3 rounds

- 15 BW squats/20 Situps/15 push ups/ Rest 5 minutes

- Check for symptoms

- Circuit #2- complete 3 rounds: 15 burpees, 20 jumping jacks, 15 mtn. climbers

Parents Monitor Athlete and submit symptom score on RCO website

24 hr rest and monitor

Stage 4

No Contact/ High Intensity/ Sport Specific

- Tackle pad burpee and poach

- Sprint and drop/pop

- Passing 10 minutes: 40 right passes/40 left passes

Circuit #1 Complete 3 rounds:

Burpee w/ mtn climber: At bottom, complete 3 mtn climbers on each leg x 10

Push Up with hand walk out: after push up walk hands in front of body 2 movements each hand then return to hands under shoulders for another push up complete 8

Squat and then jump squat: regular squat followed by a second squat where athlete jumps in the air.  Complete 10 (20 total squats)

Parents Monitor Athlete and submit symptom score on RCO website

24 hr rest and monitor

Stage 5

Restricted Contact/ High Intensity/ Sport Specific

Can participate in practice and contact drills.  No scrimmage contact or full contact.  Tackle drills, buddy tackling exercises, 100% sprinting and conditioning.

Parents Monitor Athlete and submit symptom score on RCO website

24 hr rest and monitor

Stage 6

Full Contact

Full Practice

No S&S, Qualified Health Care Provider can clear Athlete.

Rugby Concussion Resources and Free Concussion Education Online programs

Colorado State Concussion Legislation

SENATE BILL 11-040

Jake Snakenberg Bill

USAR Concussion Policy

USA Rugby stipulates stand down time and return to play protocols that must be followed by all athletes that play under the USAR registration.  USA Rugby take a proactive stance on teaching coaches on proper methods to identiy risks that lead to concussions and how to properly intervene.  

Below is a link that will provide more information from USAR as well as a video to explain the process.

USAR Website for position statement and Video with explanation

https://www.usarugby.org/concussions/

https://www.youtube.com/watch?v=WTMX6OQbiOo#action=share

World Rugby Graduated Return To play and Concussion Policy

World Rugby oversees operations and criteria for sanctioned rugby programs around the world.  Below is a link to the website that will provide more insight on concussion recovery and the science behind it.

Below is the Graduated Return to Play Policy that WR has isssued.

Centers for Disease Control and Prevention (CDC)

To help ensure the health and safety of young athletes, CDC developed the Heads Up: Concussion in Youth Sports initiative to offer information about concussions to coaches, parents, and athletes involved in youth sports. The  Heads Up initiative provides important information on preventing, recognizing, and responding to a concussion.

There is now a free app available as well as the coarse below.

Heads Up: Concussion in Youth Sports Course (Free)

National Federation of State High School Associations (NFHS) Concussion in Sports Course (Free)

The NFHS has teamed up with the Centers for Disease Control and Prevention (CDC) to educate coaches, officials, parents and students on the importance of proper concussion recognition and management in high school sports.

This course highlights the impact of sports-related concussion on athletes, teaches how to recognize a suspected concussion, and provides protocols to manage a suspected concussion with steps to help players return to play safely after a concussion.

Each state's requirements for concussion management are included as part of the course.

Click the link below to complete now! 

http://nfhslearn.com/courses/61064/concussion-in-sports