As the leader of a group of young people, the coach assumes a significant responsibility for helping to insure their health and well-being.  A great deal of emphasis must be placed on training and conditioning, first aid, injury prevention and management, proper use of equipment, and maintenance of safe playing areas.
                                    
                                    
                                   Below is a summary of some major points to consider in the care and prevention of athlete injuries and is not intended to be all inclusive.
                                    
                                    
                                        There are three categories of heat illness, and the student-athlete may not sustain all
                                        three in order.
                                    
                                    
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                                            Definition of Concussion, Concussion Facts
                                            
                                                A concussion is an injury to the brain as a result of a force or jolt
                                                applied directly or indirectly to the head, which produces a range of
                                                possible symptoms and may or may not involve a loss of consciousness.
                                                80-90% of concussions occur without loss of consciousness. Recognition
                                                and proper management of concussions when they first occur can help
                                                prevent further injury, prolonged recovery, or even death (secondary
                                                impact syndrome). Concussions are also called mild traumatic brain
                                                injuries (MTBI). Concussions can occur in any sport, including:
                                                Baseball, Basketball, Cheerleading, Equestrian, Field Hockey, Football,
                                                Gymnastics, Ice Hockey, Lacrosse, Rugby, Soccer, Softball, Volleyball,
                                                and Wrestling. The potential for concussions is greatest in athletic
                                                environments where collisions or significant falls are common.
                                                Environmental factors also can cause injury. For example, a player may
                                                collide with an unpadded goalpost or trip on an uneven playing surface.
                                                Sometimes people do not recognize that a bump, blow, or jolt to the head
                                                can cause a concussion. As a result, student-athletes may receive no medical
                                                care at the time of the injury, but they may later report symptoms such
                                                as headache and dizziness. These symptoms can be a sign of a concussion
                                                and must be carefully evaluated.
                                             
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                                            Signs and Symptoms of Concussion
                                            
                                                Concussion results in a range of physical, cognitive, emotional and
                                                sleep-related symptoms. Duration of symptoms can vary from person to
                                                person and may last for as short as several minutes and last as long as
                                                several days, weeks, months or even longer in some cases. Knowledge of
                                                the full range of signs (what you can see) and symptoms (what the
                                                student-athlete reports) are important. One or more of these signs and
                                                symptoms following a blow or jolt to the head may indicate that a
                                                concussion has occurred. Concussions can also occur with no obvious
                                                signs or symptoms right away. Any of the symptoms listed in the table
                                                below should be taken seriously. Student-athletes, who experience any of these
                                                signs or symptoms after a bump, blow, or jolt to the head should be kept
                                                from practice or game play until cleared by a qualified health care
                                                professional.
                                             Signs Observed by Coaching Staff Symptoms Reported by Student-athlete
                                                - Appears dazed or stunned; Headache
- Is confused about assignment; Nausea
- Forgets plays; Balance problems or dizziness
- Is unsure of game, score, or opponent; Double or fuzzy vision
- Moves clumsily; Sensitivity to light or noise
- Answers questions slowly; Feeling sluggish
- Loses consciousness; Feeling foggy or groggy
- Shows behavior or personality changes; Concentration or memory
                                                    problems
- Can't recall events prior to hit; Confusion
- Can't recall events after hit
 
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                                            Return to Play after a Concussion
                                            
                                         The student-athlete should never return to play competitive sports activities (practice or games) while experiencing any lingering or persisting symptoms of a concussion, no matter how slight. The student-athlete must be completely symptom free at rest and with physical exertion (e.g. sprints, non-contact aerobic activity) and cognitive exertion (e.g. studying, schoolwork) prior to return to sports activities. Given the potential of the student-athlete with a concussion to minimize symptoms to expedite their return to play, objective data in the form of formal neuropsychological testing and balance testing may be used as a criterion for safe return to play. Student-athletes cannot return to play until written clearance is provided by a qualified health care professional (e.g., physician or certified athletic trainer). As with any injury, return to play following a concussion should occur gradually and systematically.  It is Maryland law (13A.06.08.06) that athletes who have suffered a concussion must complete the 6 step Return to Play Protocol once they have been released by a doctor and prior to fully returning to practices and games.  The return to play protocol requires gradually increasing exertion and close monitoring of their response to treatment. Student athletes should be monitored for symptoms and cognitive function carefully during each stage of increased exertion. 
                                             
                                                Progression is allowed to the next level of exertion if the student-athlete is asymptomatic at the current level. A specific return-to-play (RTP) protocol outlining gradual increase in activity has been established by the Concussion in Sport Group.
                                             
                                              Premature return to play from a concussion can have serious consequences including a significantly higher risk for re-injury, prolonged recovery, and an increased risk for a catastrophic outcome, second impact syndrome, which results in death. Prevent these poor outcomes by delaying the athlete's return to the activity until the player receives appropriate medical evaluation and approval for return to play. 
                                             
                                                Please refer to the  resources on concussions from cdc.gov/HEADSUP.  These resources are for coaches, athletes, and parents. 
                                             
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                                            On-Field / Sideline Assessment & Action
                                            
                                                If student-athlete exhibits any sign of concussion or reports any
                                                symptom, they are to be removed from practice or play. When in doubt,
                                                keep the player out of play and seek an evaluation from a qualified
                                                health care professional trained in concussion assessment and
                                                management. The coach is not to try to judge the severity of the injury.
                                                Health care professionals have a number of different methods that they
                                                can use to assess the severity of concussion.
                                             
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                                            Managing Concussion with no Loss of Consciousness
                                            
 
 
                                                First aid:
                                             
                                                - Remove student-athlete from activity until a qualified health care
                                                    professional can evaluate them (i.e. physician, certified athletic
                                                    trainer, and neuropsychologist).
- Monitor student-athlete for sign and symptoms every 5 minutes.
- Contact the parent/guardian.
- If signs/symptoms worsen, activate the emergency medical system,
                                                    call 911.
 
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                                            Managing Concussion with Loss of Consciousness
                                            
 
                                                Signs: Student-athlete does not respond to external stimuli
                                                (i.e., voice or touch).
                                             First aid:
                                                - Activate emergency medical system and call 911 immediately.
- Contact parent/guardian.
- Monitor student-athlete's vital signs and keep head and spine immobilized
                                                    and wait for emergency personnel.
- If and when student-athlete regains consciousness, monitor for
                                                    signs/symptoms every 5 minutes and maintain head and spine
                                                    immobilization.
 
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                                            Coach Report of Concussion to Athletic Trainer
                                            
                                        Any coach who suspects a student-athlete has suffered a concussion, must notify the parent and provide the Acute Concussion Evaluation (ACE) form.  This form will be completed by the student-athletes physician and returned to the school nurse.
 
A concussion that is identified by a coach must be reported to the school nurse and Athletic Director for appropriate follow-up with the student and primary care professional.
                                                 
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                                            Communication with Parent/Guardians
                                            
                                                On the day of the injury, inform the student-athlete's parents/guardians about
                                                the known or possible concussion and give them the fact sheet on
                                                concussion. Make sure they know that the student-athlete should be seen by a
                                                qualified health care professional.