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When in Doubt, Sit Them Out

Concussion Information

WIAA Concussion Policy

Updated Policy and Procedure  updated.  (PDF) 

CONCUSSION INFORMATION - When in Doubt, Sit Them Out!

A concussion is a type of traumatic brain injury that interferes with normal function of the brain. All concussions are brain injuries. The WIAA recommends avoiding the use of nicknames like “ding” or “bell ringer” to describe concussion because those terms minimize the seriousness of concussion.

A concussion is most commonly caused by a direct blow to the head, but can also be caused by a blow to the body. Even what appears to be a mild blow to the head or body can result in a concussion.  It is important to know that loss of consciousness is not required to have a concussion. In fact, less than 10% of athletes lose consciousness.

A concussion is a complex physiologic event that causes problems with brain functioning (energy use and communication between nerves), but does not cause swelling or bleeding that affects brain structure. Therefore, CT/CAT scan and MRI are usually normal in athletes with concussion. Imaging studies are not indicated for most concussions, but may be needed in some instances to rule out more severe injuries, like brain bleeds.

Research has shown that adolescent concussions take longer than previously thought to heal, with 20% of high school athletes taking over 4 weeks to fully recover. Athletes must be fully recovered before considering medical clearance to return to full participation.

There are unique concerns surrounding concussion in high school sports:

1) Adolescents get concussions more often than collegiate and professional athletes
2) Adolescents take longer than adults to heal from concussion, unlike muscular-skeletal injuries
3) Most high schools may not have access to a team physician or an athletic trainer for all of their teams & activities, thus the responsibility for identifying a possible concussion falls on athletes, coaches and parents
4) High school players may try to hide symptoms or be reluctant to admit their symptoms due to fear of removal from play

 High school injury surveillance research based on injury rates in practice and games has shown that the following sports have higher risk of concussion:  Football, Boys & Girls Soccer, Boys & Girls Ice Hockey, Boys & Girls Lacrosse, Wrestling, Girls Field Hockey, Competitive Cheer, and Boys & Girls Basketball.

Noticeable in this data is that the risk for girls is much higher than boys in the same sports; in fact, soccer & basketball carry twice the risk for concussion in girls than boys. It is unclear why girls appear to have a higher risk of concussion. 

Most importantly, concussion can happen to anyone in any sport. Concussions also occur away from organized sports in physical education class, on the playground, while skiing or snowboarding, and when involved in a motor vehicle collision.

Everyone involved with high school athletics must be alert for potential injuries on the field and be able to recognize signs and symptoms of concussion. While coaches are not expected to make a diagnosis of concussion, coaches are expected to be aware of possible injuries and understand that their athletes may have a concussion.  Any athlete with a suspected concussion should be held out of all activity until medically cleared by a healthcare provider. It is important for athletes and coaches to communicate possible injuries to the athletic trainer, parents, and teachers.

Schools should educate their athletes, coaches and parents in the preseason about the seriousness of concussion and the importance of athletes honestly reporting their symptoms and injuries.

 SIGNS AND SYMPTOMS

Signs are what can be seen by others, like clumsiness / stumbling off the field.  Symptoms are what the injured player feels, like a headache. Remember, athletes should report their symptoms, but they may not unless they are directly asked about how they feel.  Even then, it is important to consider that athletes may not be telling the truth.

These are some SIGNS concussion (what others can see in an injured athlete):

    •    • Dazed or stunned appearance
    •    • Change in the level of consciousness or awareness
    •    • Confused about assignment
    •    • Forgets plays
    •    • Unsure of score, game, opponent
    •    • Clumsy
    •    • Answers more slowly than usual
    •    • Shows behavior changes
    •    • Loss of consciousness
    •    • Asks repetitive questions or memory concerns

Concussion SYMPTOMS are often categorized into four main areas:

    1.    • Physical – This describes how they feel: headache, nausea, vomiting, dizziness, tired and loss of consciousness (which is uncommon in concussion).  Vision and balance problems are also recognized as potential signs and symptoms of a concussion
    2.    • Thinking – Poor memory and concentration, responds to questions more slowly and asks repetitive questions. Concussion can cause an altered state of awareness and thinking
    3.    • Emotions – A concussion can make a person more irritable or sad and cause mood swings
    4.    • Sleep – Concussions frequently cause trouble falling asleep and may wake athletes up overnight, which can make them more fatigued throughout the day

Injured athletes can exhibit many or just a few of the signs and/or symptoms of concussion. However, if a player exhibits any signs or symptoms of concussion, the responsibility is simple: remove them from participation. An athlete should never return to play on the same day. “When in doubt sit them out.”

It is important to notify a parent or guardian of any athlete with a suspected concussion. All athletes with a concussion must be evaluated and receive written medical clearance by an appropriate health care provider before returning to practice (including conditioning and weight lifting) or competition.

Some injured athletes may require emergency care & necessitate the activation of the Emergency Medical System (911).  If you are uncomfortable with the athlete on the sideline or unable to ensure they are going home to a safe environment, it is reasonable to activate EMS/911.  The following are other examples to activate EMS:

1) Loss of consciousness, as this may indicate more severe head injury
2) Concern for cervical spine injury
3) Worsening symptoms
4) Decreasing level of alertness
5) Unusually drowsy
6) Severe or worsening headaches
7) Seizures
8) Vomiting
9) Difficulty breathing

MANAGEMENT

If you suspect a player may have a concussion, that athlete should be immediately removed from play. The injured athlete should be kept out of play until they are cleared to return by an appropriate health care provider. If the athlete has a concussion, that athlete should never be allowed to return to activity (conditioning, practice or competition) that day. Athletes with a concussion should never be allowed to return to activity while they still have symptoms.

A player with a concussion must be carefully observed throughout the practice or competition 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, as the athlete might not have the wherewithal to understand and report worsening symptoms. Never allow the injured athlete to drive himself/herself home.

Most concussions are temporary and completely resolve without causing residual or long-term problems. About 20% of high school athletes will take longer than a month to recover.  This prolonged recovery is commonly known as Post-Concussion Syndrome (PCS).  Common PCS symptoms include headache, difficulty concentrating, poor memory, mood changes and sleep disturbances.  This prolonged recovery often leads to academic troubles, family and social difficulties.

Allowing an injured athlete to return too quickly increases the risk for repeat concussion. Repeat head injury while still recovering from a concussion may cause Second Impact Syndrome. This is a rare phenomenon occurring in young athletes that leads to rapid brain swelling, brain damage and potentially death.

Repeat concussions may increase the chance of long-term problems, such as decreased brain function, persistent symptoms and potentially chronic traumatic encephalopathy (a disorder that cause early degeneration of the brain).  It is felt that these long-term complications are very rare in high school athletes, and the risk can be minimized greatly by proper reporting and care of every concussion.

Return to Learn

A major concern with concussion in high school students is that concussion can negatively affect school performance and grades. Symptoms (headache, nausea, etc.), poor short-term memory,  poor concentration and organization may temporarily turn a good student into a problem student. The best way to address this is to decrease the academic workload, and potentially taking time off from school or going partial days (although the time missed should nearly always be less than 5 days). Injured athletes should be allowed extra time to complete homework and tests, and they should be given written instructions for homework. New information should be presented slowly and repeated. Injured athletes will need time to catch up and may benefit from tutoring. If an athlete develops worsening symptoms at school, he/she should be allowed to visit the school nurse or take a rest break in a quiet area. The school and coaches should maintain regular contact with the injured athlete’s teachers and parents to update progress.

All injured students should be removed from PE class until medically cleared.

Athletes with a concussion must return to full speed academics without accommodations before returning to sports (practice and competition).

Other Treatment Strategies

Relative rest remains an essential component of concussion treatment. It is helpful for parents to decrease stimulation at home by limiting video games, but a reduction in computer time, phone time, and TV/movies may also be helpful. “Cocoon therapy”, or avoiding all brain stimulation, has been shown to negatively impact recovery and is no longer a recommended treatment style..


Physical activity may be beneficial for recovery of injured athletes.  However, high-level activity (weight lifting, practice level training and conditioning) should still be avoided.  Simple physical exertion, like walking or stationary biking, that does not worsen symptoms may be done for short periods of time.  Any post-injury exercise plan should be authorized and overseen by an appropriate health care provider.

An athlete’s concussion can interfere with work and social events (movies, dances, attending games, etc.).  Good hydration and dietary habits and good sleep habits (8-10 hours per night) are important parts of the recovery process.  There are no medications or supplements that help speed the recovery process.

 Neuropsychological Testing

Neuropsychological testing has become more commonplace in concussion evaluation as a means to provide an objective measure of brain function. Testing is currently done using computerized neuropsychological testing (example: ImPACT, Cognigram) or through a more detailed pen and paper test administered by a neuropsychologist.  It is only a tool to help ensure safe return to activity and not as the only piece of the decision making process.

If neuropsychological testing is available, ideally a baseline or pre-injury test is completed prior to the season. This baseline should be done in a quiet environment when the athlete is well rested. It is felt that baseline testing should be repeated every one to two years for the developing adolescent brain. Multi-modal baseline evaluation assessing baseline symptoms, cognitive functioning, visual tracking, reaction time, and balance are ideal.

If there is no baseline available, the injured athlete’s computerized test scores can be compared to age established norms.  This requires a provider experienced in the use and interpretation of computerized testing. The WIAA feels that neuropsychological testing can be a very useful tool with regard to concussion management.

 RETURN TO PLAY

In order to resume activity, the athlete must besymptom free and off any pain control or headache medications that they were not taking prior to the concussion. The athlete should be carrying a full academic load without any significant accommodations for 1-2 days. Finally, the athlete must have written medical clearance from an appropriate health care provider.

The program described below is a guideline for returning concussed athletes when they are symptom free. Athletes with multiple concussions and athletes with prolonged symptoms often require a prolonged or different return to activity program and should be managed by a physician that has experience in treating concussion.

The following program allows for one step per 24 hours. The program allows for a gradual increase in heart rate/physical exertion, coordination, and then allows contact. If symptoms return, the athlete should stop activity and notify their healthcare provider before progressing to the next level.

STAGE ONE:  Daily activities that do not increase symptoms (gradual reintroduction of school, work and walking). 
STAGE TWO:  Light aerobic exercise: slow to medium pace jogging, stationary cycling.  No resistance training.  This allows for increased heart rate.
STAGE THREE:  Sport-specific exercise: moderate to higher intensity running or skating drills, but no activities with risk of head impact. This allows for increased heart rate and agility/movement.
STAGE FOUR:  Non-contact training: Higher intensity aerobic fitness, and non-contact/non-collision team training drills (e.g., passing drills). May begin progressive resistance training.  This increases coordination and thinking during sport.
STAGE FIVE:  Full contact practice.  Following medical clearance, participate fully in normal training activities.  This restores confidence and allows coaches to assess functional skills.
STAGE SIX:  Full clearance / Normal game play.

 PREVENTION / RISK REDUCTION

There is nothing that truly prevents concussion. Education and recognition of concussion are the keys in reducing the risk of problems with concussion.

Wisconsin State Concussion Law (Act 172) was passed in 2011.  This law mandates distribution of preseason educational information sheets to be signed by coaches, athletes and parents.  It also recommends immediate removal of any athlete with a suspected concussion and no same day return to play.  Finally, all injured athletes require written medical clearance from an appropriate health care professional.  Research has indicated that the state law has helped improve education and awareness of concussion.

Proper equipment fit and use may reduce the risk of concussion.

 However, helmets do NOT prevent concussion. They are used to prevent facial injuries and skull fractures. Most importantly, proper technique for hitting/contact are vital, for example, athletes that lower their head while making a football tackle have a significantly higher risk for concussion and neck injuries. Athletes should never lead with their head or helmet.  Studies have shown that soccer headgear and mouthguards do not decrease concussion risk, although mouthguards are proven to decrease dental and facial trauma.

All schools should have an Emergency Action Plan. This plan can be used for any medical emergency from a concussion to a neck injury to anaphylaxis (severe allergic reaction). There should be an emergency action plan for every practice and competition area which should be practiced yearly.

The WIAA encourages every member school to promote concussion education and bring about a positive change in concussion culture by discussing this topic with all teachers, coaches, athletes and parents.  We recommend a preseason discussion with athletes and families to set forth expectations for what will happen if a student has a concussion and the steps the student must go through to return to play.  Coaches should use in-season concussions as “teachable moments” to remind teammates about the importance of reporting their injuries and supporting their injured teammate through the recovery process.

Further reading and additional education material can be obtained through the following locations:
www.nfhslearn.com (Concussion in Sports Course)
www.cdc.gov  (Heads Up Tool Kit)
www.healthykidslearnmore.com (Concussion Return to Learn Course)

Concussion Forms

Wis. State Statute:  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.   The law was amended in 2013 and the concussion information and acknowledgement must only be distributed and collected to the participant once per school year (Effective:  December 15, 2013). 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.

 

To determine compliance, schools should refer to their legal counsel and the DPI.  The WIAA information is provided for reference only and is not to be considered legal advice.

 

WIAA Condensed Info Form Docx | Doc | PDF

 

Athlete Form  Docx | Doc | PDF

Parent Form  Docx | Doc | PDF

  Spanish PDF  -  Hmong PDF

 

Parent/Athlete Acknowledge  Docx | Doc | PDF

   Spanish PDF  -  Hmong PDF

 

Concussion Waiver Form   Docx | PDF

 

Coach Form Docx | Doc | PDF
Coach Acknowledgement Docx | Doc | PDF

 

Management Docx  | Doc PDF

Sideline Assessment (SCAT2) PDF

Performance in the Classroom Docx | Doc | PDF

Concussion Signs & Symptoms

These are some SIGNS concussion (what others can see in an injured athlete):
    •    • Dazed or stunned appearance
    •    • Change in the level of consciousness or awareness
    •    • Confused about assignment
    •    • Forgets plays
    •    • Unsure of score, game, opponent
    •    • Clumsy
    •    • Answers more slowly than usual
    •    • Shows behavior changes
    •    • Loss of consciousness
    •    • Asks repetitive questions or memory concerns

Concussion SYMPTOMS are often categorized into four main areas:
    1.    • Physical – This describes how they feel: headache, nausea, vomiting, dizziness, tired and loss of consciousness (which is uncommon in concussion).  Vision and balance problems are also recognized as potential signs and symptoms of a concussion
    2.    • Thinking – Poor memory and concentration, responds to questions more slowly and asks repetitive questions. Concussion can cause an altered state of awareness and thinking
    3.    • Emotions – A concussion can make a person more irritable or sad and cause mood swings
    4.    • Sleep – Concussions frequently cause trouble falling asleep and may wake athletes up overnight, which can make them more fatigued throughout the day

Injured athletes can exhibit many or just a few of the signs and/or symptoms of concussion. However, if a player exhibits any signs or symptoms of concussion, the responsibility is simple: remove them from participation. An athlete should never return to play on the same day. “When in doubt sit them out.”

Concussion Return to Play

RETURN TO PLAY

In order to resume activity, the athlete must be symptom free and off any pain control or headache medications that they were not taking prior to the concussion. The athlete should be carrying a full academic load without any significant accommodations for 1-2 days. Finally, the athlete must have written medical clearance from an appropriate health care provider.

The program described below is a guideline for returning concussed athletes when they are symptom free. Athletes with multiple concussions and athletes with prolonged symptoms often require a prolonged or different return to activity program and should be managed by a physician that has experience in treating concussion.

The following program allows for one step per 24 hours. The program allows for a gradual increase in heart rate/physical exertion, coordination, and then allows contact. If symptoms return, the athlete should stop activity and notify their healthcare provider before progressing to the next level.

STAGE ONE:    Daily activities that do not increase symptoms (gradual reintroduction of school, work and walking). 
STAGE TWO:    Light aerobic exercise: slow to medium pace jogging, stationary cycling.  No resistance training.  This allows for increased heart rate.
STAGE THREE: Sport-specific exercise: moderate to higher intensity running or skating drills, but no activities with risk of head impact. This allows for increased heart rate and agility/movement.
STAGE FOUR:  Non-contact training: Higher intensity aerobic fitness, and non-contact/non-collision team training drills (e.g., passing drills). May begin progressive resistance training.  This increases coordination and thinking during sport.
STAGE FIVE:    Full contact practice.  Following medical clearance, participate fully in normal training activities.  This restores confidence and allows coaches to assess functional skills.
STAGE SIX:      Full clearance / Normal game play.

Concussion Return to Classroom

A major concern with concussion in high school students is that concussion can negatively affect school performance and grades. Symptoms (headache, nausea, etc.), poor short-term memory,  poor concentration and organization may temporarily turn a good student into a problem student. The best way to address this is to decrease the academic workload, and potentially taking time off from school or going partial days (although the time missed should nearly always be less than 5 days). Injured athletes should be allowed extra time to complete homework and tests, and they should be given written instructions for homework. New information should be presented slowly and repeated. Injured athletes will need time to catch up and may benefit from tutoring. If an athlete develops worsening symptoms at school, he/she should be allowed to visit the school nurse or take a rest break in a quiet area. The school and coaches should maintain regular contact with the injured athlete’s teachers and parents to update progress.

All injured students should be removed from PE class until medically cleared.

Athletes with a concussion must return to full speed academics without accommodations before returning to sports (practice and competition).
 
Other Treatment Strategies

Relative rest remains an essential component of concussion treatment. It is helpful for parents to decrease stimulation at home by limiting video games, but a reduction in computer time, phone time, and TV/movies may also be helpful. “Cocoon therapy”, or avoiding all brain stimulation, has been shown to negatively impact recovery and is no longer a recommended treatment style.

Physical activity may be beneficial for recovery of injured athletes.  However, high-level activity (weight lifting, practice level training and conditioning) should still be avoided.  Simple physical exertion, like walking or stationary biking, that does not worsen symptoms may be done for short periods of time.  Any post-injury exercise plan should be authorized and overseen by an appropriate health care provider.

An athlete’s concussion can interfere with work and social events (movies, dances, attending games, etc.).  Good hydration and dietary habits and good sleep habits (8-10 hours per night) are important parts of the recovery process.  There are no medications or supplements that help speed the recovery process.


Heads Up to Schools Parents Fact Sheet
Heads Up to Schools Teachers Fact Sheet
CDC Returning to School After a Concussion

An Educator's Guide to Concussion

Concussion Courses

CONCUSSION IN SPORTS COURSE - What You Need to Know

Course will be offered at no charge. Register at NFHSLearn.com!

Available NOW!

 

Course Objectives:

  • Educate coaches, parents, officials, and students about concussions
  • Identify the signs and symptoms of concussions
  • Understand the problems associated with concussions
  • Actions to take when a concussion is present
  • Identify responsibilities of coaches, parents, officials, and students

 

The WIAA strongly encourages coaches at all levels to take this free course along with officials, parents and athletes so they have a better understanding of concussions and their effects on young, adolescent brain function.

CDC Concussion Course
 Heads Up to Clinicians: Addressing Concussion in Sports among Kids and Teens Click Here 
 

CDC Concussion Course for Health-Care Professionals - Click Here

The CDC has created online training to provide health care professionals with an overview of what they need to know about concussion among young athletes. The goal of this course, Heads Up to Clinicians: Addressing Concussion in Sports among Kids and Teens, is to prepare health care professionals to diagnose and manage concussions on the sidelines, in their office, training room, or in the emergency department. In this course health care professionals will:

  • Examine current research on what may be happening to the brain after a concussion
  • Understand why young people are at increased risk
  • Explore acute concussion assessment and individualized management of young athletes
  • Learn about the 5-Step Return to Play Progression and helping athletes safely return to school and play
  • Focus on prevention and preparedness to help keep athletes safe season-to-season
  • Receive a FREE Continuing Education Opportunity through the American College of Sports Medicine 

Wisconsin Concussion Law

Sideline to Safety Law:  Consussion Law Language


To determine compliance, schools should refer to their legal counsel and the DPI.  The WIAA information is provided for reference only and is not to be considered legal advice.
Note:  The law was amended in 2013 and the concussion information and acknowledgement must only be distributed and collected once per school year.  Effective:  December 15, 2013.
 
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
 
    •    Section 1. 118.293 (3) of the statutes is renumbered 118.293 (3) (a).
    •    Section 2. 118.293 (3) (b) of the statutes is created to read:
    ◦    118.293 (3) (b)
    ▪     1. Notwithstanding par. (a), 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.
    ▪    2. Notwithstanding par. (a), 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.
 
The state and the country are joining the WIAA in bringing concussion awareness and education policies to the forefront.

The bill sponsored by Rep. Jason Fields and Sen. Alberta Darling and supported by the National Football League, the Green Bay Packers and various health care providers, was signed into law by Gov. Scott Walker Monday, April 2, 2012.

In concert with the WIAA concussion policy that has been in existence for many years, the law requires immediate removal of an individual from a youth athletic activity if symptoms indicate a possible concussion has been sustained. Subsequently, if a concussion is confirmed, individuals may only return to competition or practice after being evaluated by a trained health care provider. The health care provider is required to provide written clearance in order for the athlete to return to action.

The law requires all youth athletic organizations to educate coaches, student-athletes and parents on the risks of concussions and prohibits participation in a youth activity until a parent or guardian has returned a signed information sheet indicating they have reviewed the materials. In addition, the state Department of Public Instruction, with assistance from the WIAA, was directed to develop guidelines and other information to educate coaches, athletes and parents about the risk of concussions and head injuries in all youth sports, including club sports.

Throughout the past two decades, the WIAA medical advisory committee developed concussion information, guidelines and education materials for its membership that can be utilized by other youth sports programs to address the new law.

The law also includes provisions to protect coaches, officials or volunteers from liability if they fail to remove an athlete from competition, unless there is gross negligence or gross misconduct. There are 36 other states with a similar concussion law.  More details will be provided for member schools once the DPI and WIAA determine the necessary procedures for compliance.

Analysis by the Legislative Reference Bureau

This bill directs the Department of Public Instruction, in conjunction with the Wisconsin Interscholastic Athletic Association, to develop guidelines and other information to educate coaches and athletes and their parents or guardians about the risk of concussion and head injury in youth athletic activities. The bill defines "youth athletic activity," with certain exceptions, as an organized athletic activity in which the participants, a majority of whom are under 19 years of age, are engaged in an athletic game or competition against another team, club, or entity, or in practice or preparation for an organized athletic game or competition against another team, club, or entity.

The bill requires each person operating a youth athletic activity annually to distribute a concussion and head injury information sheet to each person who wishes to participate in the activity and prohibits a person from participating in a youth athletic activity until he or she has returned the sheet signed by the person and, if he or she is under the age of 19, by his or her parent or guardian.

The bill requires that a person who is suspected of sustaining a concussion or head injury in a youth athletic activity be removed from the activity immediately. A person who has been so removed may not participate in a youth athletic activity until he or she is evaluated by a health care provider who has been trained in the evaluation and management of concussion and head injuries and receives a written clearance to participate in the activity from the health care provider. The bill provides that if a health care provider who is a volunteer authorizes a person to participate in a youth athletic activity, he or she is immune from civil liability for any injury resulting from that act unless the act constitutes gross negligence or willful or wanton misconduct.
 

The Concussion Law

Section 1. 118.293 of the statutes is created to read:
118.293 Concussion and head injury. (1) In this section:
(a) "Credential" means a license or certificate of certification issued by this state.
(am) "Health care provider" means 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.
(c) "Youth athletic activity" means an organized athletic activity in which the participants, a majority of whom are under 19 years of age, are engaged in an athletic game or competition against another team, club, or entity, or in practice or preparation for an organized athletic game or competition against another team, club, or entity. "Youth athletic activity" does not include a college or university activity or an activity that is incidental to a nonathletic program.
(2) In consultation with the Wisconsin Interscholastic Athletic Association, the department shall develop guidelines and other information for the purpose of educating athletic coaches and pupil athletes and their parents or guardians about the nature and risk of concussion and head injury in youth athletic activities.
(3) 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.
(4) (a) 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.
(b) A person who has been removed from a youth athletic activity under par. (a) may not participate in a youth athletic activity 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.
(5) (a) Any athletic coach, official involved in an athletic activity, or volunteer who fails to remove a person from a youth athletic activity under sub. (4) (a) is immune from civil liability for any injury resulting from that omission unless it constitutes gross negligence or willful or wanton misconduct.
(b) Any volunteer who authorizes a person to participate in a youth athletic activity under sub. (4) (b) is immune from civil liability for any injury resulting from that act unless the act constitutes gross negligence or willful or wanton misconduct.
(6) This section does not create any liability for, or a cause of action against, any person.

 

Concussion Law - Act 172 - Statute 118.293

Concussion Law Questions & Answers

Updated May 15, 2014 - Coaches were not included in the new amendment.

 

Q:  When does the law take effect?

 A: The law took effect on April 17, 2012.   The law went into effect for schools and youth athletic organizations when on May 7 when the guidelines and documents were released.

 

Q: Regarding the maintenance of documentation forms related to Wisconsin Act 172 and the Concussion Management Plan.  Would you have any recommendation on how long the school should maintain the signed agreements with parents/students and coaches?  Will this be considered a health record or an athletic record?

 A:  References to signed documents in Act 172.

(3) 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. 

(b) A person who has been removed from a youth athletic activity under par. (a) may not participate in a youth athletic activity 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.

Both of these signed documents are pupil physical health records.  

118.125(1)(cm) <http://docs.legis.wi.gov/document/statutes/118.125(1)(cm)> (cm) "Pupil physical health records" means those pupil records that include basic health information about a pupil, including the pupil's immunization records, an emergency medical card, a log of first aid and medicine administered to the pupil, an athletic permit card, a record concerning the pupil's ability to participate in an education program, any lead screening records required under s. 254.162 <http://docs.legis.wi.gov/document/statutes/254.162> , the results of any routine screening test, such as for hearing, vision or scoliosis, and any follow-up to such test, and any other basic health information, as determined by the state superintendent. 

 

This kind of pupil physical health record is also a behavioral record, which can be maintained no longer than one year after a student graduates or leaves the school district, unless written consent by the parent or adult student is obtained.

 

A school district may choose to destroy a pupil record it determines it no longer needs.  However, once it is gone, it is gone and the district no longer has that documentation, if there are questions in the future.

 

Q:  From what I can gather each school district will be required to have a written concussion management plan in place due to the new state law.  I am trying to find out when the plans need to be in place and ready to go.  Would you be able to provide me with some additional information on this question.

 A: A school is not required to have a written concussion plan.  We would recommend it and we have a sample on the concussion page.  The law states you must hand out information sheets to your coaches, parents, and persons, including athletes, participating in the athletic activity each season, and collect an acknowledgement of receipt that is signed by the coach, the athlete or other person participating in the athletic activity,  If the athlete or other person participating in the athletic activity is under the age of 19, the parent or guardian must sign the receipt  WIAA rules require parental approval for all students.

 

Amended:  The concussion information is annual.  You must hand out the information materials and collect the signed acknowledgements at the beginning of the school year or at the beginning of a season for a particular athletic activity.  Each athlete and parent must complete the form.   Handing out the information at the beginning of the school year to all persons who will be participating in an athletic activity does now meet the law’s requirements.  Similarly, handing out the information only one time to a student who participates in multiple athletic activities does now meet the requirements of the law.  Effective:  December 16, 2013.

 

Q: Does 2011 Wisconsin Act 172 apply to physical education classes?  

A: DPI’s interpretation is that, since the law refers to coaches of youth athletic activities and not classroom physical education educators, it does not apply to  physical education classes.  Under this interpretation, the distribution of information and collection of signed acknowledgements of receipt are not required in physical education classes but may be used. School personnel may wish to consult with their district legal counsel for advice applicable to local school programs involving sports and physical activity.   

 

Q:  Do student/athletes that take part in summer open gyms, weight rooms and summer leagues need to have a parent slip and student slip signed on the concussion information?

 A:  The law only applies to a "youth athletic activity" as defined in the law.  "Youth athletic activity" means an organized athletic activity in which the participants, a majority of whom are under 19 years of age, are engaged in an athletic game or competition against another team, club, or entity, or in practice or preparation for an organized athletic game or competition against another team, club, or entity. "Youth athletic activity" does not include a college or university activity or an activity that is incidental to a nonathletic program.

For open gyms and weight rooms, no distribution of materials and collection of signed acknowledgements are  necessary since no competition is involved and they are recreational/training sessions.  The law also applies to practices and preparation for an organized athletic activity or competition.  A season begins on the date of the first practice for the particular athletic activity.  The law also applies to summer leagues and informational materials must be distributed and signed receipts must be collected.

 

Q:  Do our "competitive club" teams such as bowling, trap shooting, chess, forensics, dance, academic decathlon, etc. fall under the law? 

A:  The law defines youth athletic activity as, “... an organized athletic activity in which the participants, a majority of whom are under 19 years of age, are engaged in an athletic game or competition against another team, club, or entity, or in practice or preparation for an organized athletic game or competition against another team, club, or entity. "Youth athletic activity" does not include a college or university activity or an activity that is incidental to a nonathletic program.

If the activity is considered an athletic activity, then yes, the law applies.  We do not consider any of those listed as fitting within the definition of athletic activity.  While bowling is not a WIAA recognized sport, best advice would be to include bowling as a youth athletic activitiy.  For cheer, pom, and dance,   if the squads/teams compete and are in your athletic department, the law applies.  If they only support your athletic teams and do not compete, the law does not apply.

 

Q:  What about the adult who is volunteering their time to help coach?

A: If a person coaches, whether paid or unpaid (volunteering), they would need to receive and acknowledge receipt of concussion information.

 

Q:  We run a camp in which any and all interested athletes may come to participate.  Should we provide information sheets to coaches, parents, and athletes?

A:  As part of best practices, we advise providing concussion information materials and collect signed acknowledgements of receipt.

 

Q: When it comes to students partaking in the "5 contact" days with coaches actually present, I'm assuming that ALL involved in these would have to have the information sheets and acknowledgement sheets signed? (parent, student, coach) 

A:  As part of best practices, we advise providing concussion information materials and collect signed acknowledgements of receipt.   

 

Q:  If a parent and athlete and coach sign off on these for the summer contact days, say in football, would they then be good to go for the fall season or would they still need a new, updated signature for fall sports?  (same for basketball, soccer, etc.)

A:  No, As stated above, you must hand out the information materials and collect the signed acknowledgements at the beginning of the season for an athletic activity.  Doing this at any other time does not meet the law’s requirements.

 

Q:  Can the acknowledgment (Coaches) be on a sheet combined with acknowledgement of several items (check box)?

A: Yes.  This practice is fine as long as the district (or youth organization) maintains records, and could provide proof it followed the law, and as long as the acknowledgement is done at the beginning of the particular athletic season.  

 

Q:  When you have multi-sport athletes, can they sign annual information sheets or must they do one for each season?  

A:  Yes.  The distribution of concussion information materials and collection of signed receipt acknowledgment materials must occur before the athlete participates.

 

Q:  Can the information sheet be distributed electronically?  

A:  It can be done this way if there is a way to track and confirm receipt of the information materials to parents, athletes, and coaches.

 

Q:  Does the law require any additional training for coaches other than the info sheet and signed receipt of understanding?

A:  No, but best practice and suggested additional training for coaches should be considered by the school administration.  It is highly recommended.

 

Q:  If a person coaches multiple sports can he or she receive info one time per year?

A:  No. The amendment only addressed pupils.  The distribution of concussion information materials and collection of signed receipt acknowledgment materials must occur before the person coaches each season.  In addition, the distribution of information materials and collection of signed receipt acknowledgements are required for each ‘employer/youth athletic event organization’. For example, if  a high school baseball coach coaches for the school district and another youth athletic activity such as an American Legion Post, the coach must receive concussion information materials and  acknowledge receipt of such materials from both the school district and the American Legion Post.  

 

Q: Does the law state that if an athlete is diagnosed with three concussions or any specific number of concussions, they can no longer participate? 

A:  The law does not provide a specific number.  The appropriate health care provider would provide that advice.  The law states:  (b) A person who has been removed from a youth athletic activity under par. (a) may not participate in a youth athletic activity 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. 

 

Q:  Does the law require any training or info dissemination for officials?

A:  No, but please review  the materials WIAA created for officials as a best practice. 

 

Q:  Is imPACT baseline testing required by the state law?

A:  No. The law does not require or even refer to baseline (ImPACT) testing. 

 

Q:  What is the actual text of the "Sideline to Safety" act?

A:  2011 WISCONSIN ACT 172

An Act to amend 119.04 (1); and to create 118.293 of the statutes; relating to: concussions and other head injuries sustained in youth athletic activities.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

Section 1. 118.293 of the statutes is created to read:

118.293 Concussion and head injury. (1) In this section:

(a) "Credential" means a license or certificate of certification issued by this state.

(am) "Health care provider" means 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.

(c) "Youth athletic activity" means an organized athletic activity in which the participants, a majority of whom are under 19 years of age, are engaged in an athletic game or competition against another team, club, or entity, or in practice or preparation for an organized athletic game or competition against another team, club, or entity. "Youth athletic activity" does not include a college or university activity or an activity that is incidental to a nonathletic program.

(2) In consultation with the Wisconsin Interscholastic Athletic Association, the department shall develop guidelines and other information for the purpose of educating athletic coaches and pupil athletes and their parents or guardians about the nature and risk of concussion and head injury in youth athletic activities.

(3) 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.

(4) (a) 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.

(b) A person who has been removed from a youth athletic activity under par. (a) may not participate in a youth athletic activity 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.

(5) (a) Any athletic coach, official involved in an athletic activity, or volunteer who fails to remove a person from a youth athletic activity under sub. (4) (a) is immune from civil liability for any injury resulting from that omission unless it constitutes gross negligence or willful or wanton misconduct.

(b) Any volunteer who authorizes a person to participate in a youth athletic activity under sub. (4) (b) is immune from civil liability for any injury resulting from that act unless the act constitutes gross negligence or willful or wanton misconduct.

(6) This section does not create any liability for, or a cause of action against, any person.

Section 2. 119.04 (1) of the statutes, as affected by 2011 Wisconsin Acts 10 and 32, is amended to read:

119.04 (1) Subchapters IV, V and VII of ch. 115, ch. 121 and ss. 66.0235 (3) (c), 66.0603 (1m) to (3), 115.01 (1) and (2), 115.28, 115.31, 115.33, 115.34, 115.343, 115.345, 115.365 (3), 115.38 (2), 115.445, 118.001 to 118.04, 118.045, 118.06, 118.07, 118.075, 118.076, 118.10, 118.12, 118.125 to 118.14, 118.145 (4), 118.15, 118.153, 118.16, 118.162, 118.163, 118.164, 118.18, 118.19, 118.20, 118.223, 118.225, 118.24 (1), (2) (c) to (f), (6), (8), and (10), 118.245, 118.255, 118.258, 118.291, 118.293, 118.30 to 118.43, 118.46, 118.51, 118.52, 118.55, 120.12 (4m), (5), and (15) to (27), 120.125, 120.13 (1), (2) (b) to (g), (3), (14), (17) to (19), (26), (34), (35), (37), (37m), and (38), 120.14, 120.21 (3), and 120.25 are applicable to a 1st class city school district and board.

 

Concussion Prevention

There is nothing that truly prevents concussion. Education and recognition of concussion are the keys in reducing the risk of problems with concussion. Proper equipment fit and use may reduce the risk of concussion. However, helmets do NOT prevent concussion. They are used to prevent facial injuries and skull fractures. Most importantly, proper technique for hitting/contact are vital, for example, athletes that lower their head while making a football tackle have a significantly higher risk for concussion and neck injuries. Athletes should never lead with their head or helmet.All schools should have an Emergency Action Plan. This plan can be used for any medical emergency from a concussion to a neck injury to anaphylaxis (severe allergic reaction. There should be an emergency action plan for every practice and competition area which should be practiced yearly. The WIAA encourages every member school to promote concussion education and bring about a positive change in concussion culture by discussing this topic with all teachers, coaches, athletes and parents.

 

Concussions and Officials

The law requires immediate removal of an individual from a youth athletic activity if symptoms indicate a possible concussion has been sustained. Subsequently, if a concussion is confirmed, individuals may only return to competition or practice after being evaluated by a trained health care provider. The health care provider is required to provide written clearance in order for the athlete to return to action.

  Officials are affected by the following section of the law: Section 1. 118.293 of the statutes is created to read: 118.293 Concussion and head injury.  (4) (a) 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.

Everyone involved with high school athletics must be alert for potential injuries on the field and be able to recognize signs and symptoms of concussion. While coaches are not expected to make a diagnosis of concussion, coaches are expected to be aware of possible injuries and understand that their athletes may have a concussion.  Any athlete with a suspected concussion should be held out of all activity until medically cleared by a healthcare provider. It is important for athletes and coaches to communicate possible injuries to the athletic trainer, parents, and teachers.

Schools should educate their athletes, coaches and parents in the preseason about the seriousness of concussion and the importance of athletes honestly reporting their symptoms and injuries.
 
SIGNS AND SYMPTOMS

Signs are what can be seen by others, like clumsiness / stumbling off the field.  Symptoms are what the injured player feels, like a headache. Remember, athletes should report their symptoms, but they may not unless they are directly asked about how they feel.  Even then, it is important to consider that athletes may not be telling the truth.

These are some SIGNS concussion (what others can see in an injured athlete):

    •    • Dazed or stunned appearance
    •    • Change in the level of consciousness or awareness
    •    • Confused about assignment
    •    • Forgets plays
    •    • Unsure of score, game, opponent
    •    • Clumsy
    •    • Answers more slowly than usual
    •    • Shows behavior changes
    •    • Loss of consciousness
    •    • Asks repetitive questions or memory concerns

Concussion SYMPTOMS are often categorized into four main areas:

    1.    • Physical – This describes how they feel: headache, nausea, vomiting, dizziness, tired and loss of consciousness (which is uncommon in concussion).  Vision and balance problems are also recognized as potential signs and symptoms of a concussion
    2.    • Thinking – Poor memory and concentration, responds to questions more slowly and asks repetitive questions. Concussion can cause an altered state of awareness and thinking
    3.    • Emotions – A concussion can make a person more irritable or sad and cause mood swings
    4.    • Sleep – Concussions frequently cause trouble falling asleep and may wake athletes up overnight, which can make them more fatigued throughout the day

The law also includes provisions to protect coaches, officials or volunteers from liability if they fail to remove an athlete from competition, unless there is gross negligence or gross misconduct. Injured athletes can exhibit many or just a few of the signs and/or symptoms of concussion. However, if a player exhibits any signs or symptoms of concussion, the responsibility is simple: remove them from participation. An athlete should never return to play on the same day. “When in doubt sit them out.”

If you suspect a player may have a concussion, that athlete should be immediately removed from play. The injured athlete should be kept out of play until they are cleared to return by an appropriate health care provider. If the athlete has a concussion, that athlete should never be allowed to return to activity (conditioning, practice or competition) that day. Athletes with a concussion should never be allowed to return to activity while they still have symptoms.

A player with a concussion must be carefully observed throughout the practice or competition 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, as the athlete might not have the wherewithal to understand and report worsening symptoms. Never allow the injured athlete to drive himself/herself home.

A physician or LAT may evaluate an athlete for concussion.  If they determine that the athlete is not displaying the signs of a concussion or does not have a concussion, the athlete may return to play.  If they determine that the athlete is displaying the signs of a concussion or does in fact have a concussion, the athlete may not return to play (with or without a note) that day.

WIAA Sports Medical Advisory Council identifies a physician and licensed athletic trainer (LAT) under the direct supervision of a physician as an appropriate health care professional for determining return to play other than the same day.  The state law is broader in the definition of appropriate health care provider.

NFHS Concussion Management

The NFHS Sports Medicine Advisory Committee strongly recommends the following protocol for Concussion management:
    •    No athlete shall return to play or practice on the same day of a concussion.
    •    Any athlete suspected of having a concussion shall be evaluated by an appropriate health-care professional that day.
    •    Any athlete with a concussion shall be medically cleared by an appropriate health-care professional prior to resuming participation in any practice or competition.
    •    After medical clearance, return to play shall follow a step-wise protocol with provisions for delayed return to play based upon the return of any signs or symptoms.
NFHS Concussion Rule in the sport rule book:  Any player who exhibits signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the game and shall not return to play until cleared by an appropriate health-care professional.  NFHS Guidelines to Concussion Management.
 
NOTE:  The WIAA rule:  A student who displays symptoms of concussion and/or is rendered unconscious shall not return to practice or competition during the same day.  The  student shall not return to practice or competition until approved in writing by an appropriate health care professional.

 

Resources

Concussion What Must Be Done

The law requires all youth athletic organizations to educate coaches, athletes and parents on the risks of concussions and head injuries and prohibits participation in a youth activity until the athlete and parent or guardian has returned a signed agreement sheet indicating they have reviewed the concussion and head injury informational materials. The law requires immediate removal of an individual from a youth athletic activity if symptoms indicate a possible concussion has been sustained. 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.  

Wis. DPI Concussion Guidelines