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Student and Parent Concussion Information Sheet

This consent form was developed to provide students and parents with current and relevant information regarding concussions and to comply with the Connecticut General Statues to require concussion training for coaches, a school education plan, and an informed consent form.

What is a concussion?

National Athletic Trainers Association (NATA) - A concussion is a “trauma induced alteration in mental status that may or may not involve loss of consciousness.”

Centers for Disease Control and Prevention (CDC) - “A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth.” - CDC, Heads Up: Concussion

Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious” - CDC, Heads Up: Concussion Fact Sheet for Coaches

Signs and Symptoms of a Concussion: Overview
A concussion should be suspected if any one or more of the following signs or symptoms are present, or if the coach/evaluator is unsure, following an impact or suspected impact as described in the CDC definition above.

Signs of a concussion may include (i.e. what the athlete displays/looks like to an observer):
  • Confusion/disorientation/irritability
  • Trouble resting/getting comfortable
  • Lack of concentration
  • Slow response/drowsiness
  • Incoherent/slurred speech
  • Slow/clumsy movements
  • Loses consciousness
  • Amnesia/memory problems
  • Acts silly/combative/aggressive
  • Repeatedly asks same questions
  • Dazed appearance
  • Restless/irritable
  • Constant attempts to return to play
  • Constant motion
  • Disproportionate/inappropriate reactions
  • Balance problems.

Symptoms of a concussion may include (i.e. what the athlete reports):
  • Headache or dizziness
  • Nausea or vomiting
  • Blurred or double vision
  • Oversensitivity to sound/light/touch
  • Ringing in ears
  • Feeling foggy or groggy.

State law requires that a coach MUST immediately remove a student-athlete from participating in any intramural or interscholastic athletic activity who: a) is observed to exhibit signs, symptoms or behaviors consistent with a concussion following a suspected blow to the head or body, or b) is diagnosed with a concussion, regardless of when such concussion or head injury may have occurred. Upon removal of the athlete, a qualified school employee must notify the parent or legal guardian within 24 hours that the student athlete has exhibited signs and symptoms of a concussion.

Section 3. Return to Play (RTP) Protocol Overview
Currently, it is impossible to accurately predict how long an individual’s concussion will last. There must be full recovery before a student-athlete is allowed to resume participating in athletic activity. Connecticut law now requires that no athlete may resume participation until they have received written medical clearance from a licensed health care professional (physician, physician assistant, advanced practice registered nurse (APRN), athletic trainer) trained in the evaluation and management of concussions.

Concussion Management Requirements:
  1. No athlete will be allowed to continue/return to athletic activity on the same day of concussion.
  2. If there is any loss of consciousness, vomiting or seizures, the athlete MUST be immediately transported to the hospital.
  3. Close observation of an athlete MUST continue following a concussion. The athlete should be monitored for an appropriate amount of time following the injury to ensure that there is no worsening/escalation of symptoms.
  4. Any athlete with signs or symptoms related to a concussion MUST be referred to a physician per Sacred Heart policy and obtain a note with diagnosis and academic accommodations.
  5. The athlete MUST obtain an initial written clearance from a physician directing her into a well-defined return to play (RTP) stepped protocol similar to the one outlined below.
  6. After the RTP protocol has been successfully administered (no longer exhibits any signs or symptoms or behaviors consistent with concussions), final written medical clearance is required by physician or athletic trainer (if physician stated in initial note that patient is clear after successfully completing RTP protocol) for the athlete to fully return to unrestricted participation in practices and competitions.

Medical Clearance RTP Protocol (Recommended one full day between steps):

Rehabilitation stage Functional exercise at each stage of rehabilitation Objective of each stage
1. No activity Complete physical and cognitive rest until asymptomatic. School may need to be modified. Recovery
2. Light aerobic exercise Stationary bike 15-20 minutes Increase heart rate
3. Moderate Exercise Treadmill or treadmill/bike combo and/or resistance training: 25-35 minutes Increase heart rate
4. Non-Contact Practice Sport Specific Drills Exercise, coordination and cognitive load
5. Full contact sport drills Following final medical clearance, participate in normal training activities Restore confidence and assess functional skills by coaching staff
6. Full activity No restrictions Return to full athletic participation

* If at any time signs or symptoms should worsen during the RTP progression the athlete should stop activity that day. If the athlete’s symptoms are gone the next day, she/he may resume the RTP progression at the last step completed in which no symptoms were present. If symptoms return and do not resolve, the athlete should be referred back to her/his medical provider.

  1. NFHS. Concussions. 2008 NFHS Sports Medicine Handbook (Third Edition). 2008: 77-82.
  2. Centers for Disease Control and Prevention. Heads Up: Concussion in High School Sports.
  3. CIAC Concussion Central - http://concussioncentral.ciacsports.com/

  1. Centers for Disease Control and Prevention. Injury Prevention & Control: Traumatic Brain Injury. Retrieved on June 16, 2010.
  2. Centers for Disease Control and Prevention. Heads Up: Concussion in High School Sports Guide for Coaches. Retrieved on June 16, 2014.

Convent of the Sacred Heart

An independent, Catholic school for girls K-12​,​ with ​coed ​Barat Center for Early Childhood Education
1177 King Street
Greenwich, CT 06831
Telephone 203.531.6500