As the sports season winds down at the high school I am finally getting to the various emails I have received. I do truly enjoy the many stories and questions I get here, often times they are very learned for me; which translates to more information for you the reader.
I picked out one such email and gained permission to reprint it here. The sole purpose of this email is to get feedback about the return to learn aspect of concussions. Tom would like you to give it a read and make comments below.
———-
Return To Learn in the High School
I am an athletic trainer in a high school in the north suburbs of Chicago. We have a concussion program in place and see about 80 concussion a year in our athletics. I am fortunate to have some control over the return to learn side of concussions in my school. I have found that this is essential in order to properly manage a concussion. I find when physicians only see an athlete once and set accommodations for a determined amount of time, it does a disservice. The same is true if the time between physician evaluations is too long, especially when kids are kept out of school for long periods of time. I find many concussion students don’t need to be out of school, and those that do usually have their symptoms decrease significantly within 1-3 days. Many times concussions progress rapidly and accommodations are not needed or can be quickly decreased. Sometimes they are needed and need to be adjusted based on what symptoms the student has when they return to school.
The shotgun approach for accommodations does not work well. When schools receive a general accommodations sheet, the accommodations tend to not be followed by the school or the student. Student and teachers are looking for clear instructions. Students need to be evaluated regularly and counseled through the concussion with specific accommodations based on current symptoms and evaluation. I think the athletic trainer is the person best equipped to manage the return to learn side of concussions in the high school. It seems to work best when the physician and the athletic trainer coordinate together to handle the return to learn side of concussions. Schools need to have an in-school healthcare professional monitor concussions, communicate with the treating physician, counsel the concussed athlete and manage school accommodations.
I would be interested in hearing physicians and other secondary school athletic trainers view on this subject.
Tom O’Connell, ATC, LAT
The Concussion Blog 
Schools that typically hire an ATC also have on staff a School Nurse with an RN degree, and in larger schools have as many as three per building. I have sat in on a number or RTL sessions where the school RN is the quarterback/coordinator of all the stakeholders including the ATC.
This makes great sense as these health care professionals are much more familiar with the whole-child year long, if you will. Many parents actually keep confidential medical information from their child’s coaches and ATCs (I don’t condone but this is the fact and their right) out of fear of being cut from the team etc. This is a very real and rarely discussed issue (for another time) and many afflictions, etc do not need to be shared with the coach or ATC but a need to be shared with the school nurse.
More and more school nurses need continuing education w/ additional concussion training. RN college educators with masters and PhDs in nursing (my sister is one ) are giving courses that schools are now demanding of all RNs including subs.
Here is a paragraph from the school nurses association Position Statement:
As the student returns to school after a concussion, the school nurse has a significant role in supporting the student. The school nurse collaborates with the parents, school staff, special service providers, the health care professionals, and the student in providing accommodations as the student transitions back to school. A collaborative team approach with all stakeholders involved provides for the best management of the student’s post-concussion (CDC, 2010c). The school nurse can initiate an accommodation plan/health care plan based on input from the health care professionals and school staff to provide the cognitive rest and support needed during recovery. Accommodations during the recovery process may include modifying or limiting school activities (Halstead et al., 2010; Majerske et al., 2008; CDC, 2010c). The accommodations may include allowing rest during the school day, postponing testing until symptom-free, pacing homework or assignments, limited physical exertion, and physical accommodations, as needed. The school nurse can provide on-going monitoring of post-concussion symptoms and act as a liaison with stakeholders. For students who have persistent symptoms, the school nurse can work with the provider and family to facilitate a Section 504 Plan and/or a referral for special education evaluation as needed. Read more>> http://ow.ly/NSk9a
Hope this helps.
Thanks for responding Brooke. I agree the school nurse should be a key person in the concussion team, but my experience is that they many times lack the education and experience. I agree more education is needed, especially since our knowledge of concussions is changing rapidly. We know not all concussion occur in athletic and many students experience them, so the school nurse would be an ideal leader of the concussion team. My point is all too often students are not counseled through the concussion because there is not a leader with the education and know how.
Unfortunately, parents do sometimes keep medical information from coaches and ATCs. I think you will find parents are also not always forthcoming with nurses. It is not ideal in either situation.
The SNA position statement is admirable. I hope they continue to provide educational opportunities for school nurses to give them the resources to be the leaders for concussion management in schools.
I think we agree there needs to be a team to manage a concussion in schools, however that works for the individual school. The key is concussed student athletes need to be closely monitored and counseled through the concussion duration.
School RN. Of course. Budgets are growing in this field and It seems that in majority of schools the RNs office is in the wing with all administrative offices for a many very good purposes.
Sorry to be jumping in a little bit late…
Here we had two full-time healthcare providers on campus (3 next year) in our school. We will have two full-time Certified Athletic Trainers and a full-time School Nurse. I won’t say that I have more power than the school nurse or vice versa. But the fact is our administrators listen to US when it comes to concussions. Our Academic Dean wants nothing to do with making up tests, etc until he gets the blessing from the health staff that the kid is ready to do so. Every time a kid suffers a concussion, an email goes out from either the school nurse or myself. On that email is each teacher that student has, the two of us, the Academic Dean, and that student’s guidance counselor. This is regardless of whether the student is one of our athletes or not.
But the Nurse’s Office and the Athletic Training Room work hand-in-hand. We share information back and forth regularly and freely. We also consult each other on a regular basis. I send her general medicine and she sends me musculoskeletal and concussions. It’s about being a part of the HealthCare Team.
This brings up another discussion of where the Athletic Trainer belongs with regards to organizational flowchart, but we’ll save that for another day..
Prevention is surely better than cure? As a Brit, I am amazed by the practice of head butting as a means of complimenting a good run, catch, interception etc. Calvin Cook was hit on the helmet more than twenty times when he scored a touchdown for his college team. 31/10/16.
The helmet protects the skull and skin from injury, but does very little to protect the brain. The skull is alike to a closed bottle, and the brain swirls around inside like pickled onions in vinegar. Tilt the bottle and the onions hit the side of the bottle. Likewise the brain is mobile within the skull, and lateral movement places brain tissue under stress.
It is interesting that recent theories of brain trauma considers the autoimmune response set up when brain fluids enter the bloodstream. This is evident many years later in explayers with a history of concussion.
Severe head trauma will cause concussion in the short term, but what about the long term effects of minor trauma?
Another study of interest was the changing tackle practices when students trained helmet free.
I know that if twenty people attempted to hit Calvin Cook without him wearing a helmet, his response would have been very different.