Discussion on concussions and appropriate protocol continues in school district | Guest Column

—Submitted by San Juan Island School District Concussion Committee

(This is part two of a two-part series)

The San Juan Island School District and the sports community are in the process of improving procedures for concussions.

It is clear we needed to have a uniform education and evaluation program to better address youth concussions. A public school-based group was established last spring and assigned the following tasks:

1. Teach the community about concussions, the process of removal from play, medical management, and emphasizing coach and parent education and responsibility. Reinforce coach training programs are already in place. Focus on helping parents understand the need to make coaches, medical providers, and teachers aware of all head injuries not just those sustained in organized sports.

2. Perform preseason screening to establish cognitive baselines that allow rapid accurate assessment of mental status following a suspected concussion. Such tools do not diagnose but simply determine the need to exclude an injured participant from play pending appropriate medical assessment. The use of such tools allows coaches to depersonalize exclusion from play.

3. Formalize policies and procedures for return to play and for structured modification of the academic program of an injured player.

4. Work with others in the community to establish an island-wide data base that allows for tracking while ensuring appropriate privacy protection.

To meet these four goals, talks to various sports groups and schools have begun and public presentations of nationally recognized films will be scheduled in the near future. We are also implementing a proven screening protocol.

The King-Devick visual tracking system is being piloted at Friday Harbor High School. This instrument is a validated, inexpensive, and easily administered tool that uses eye movements and a number display. It is quick and easily administered and a proven assessment of clear mental function. If a concussion is suspected, the test is quickly re-performed and compared to the pre-season baseline. If there is a significant deviation, they will be immediately be removed.  Only when a medical provider clears the athlete and notifies the Athletic Director, can practice and play can be resumed. If there is any question regarding the player’s mental status, they will be removed regardless of the test result.

There are now established assessments for medical providers to more objectively evaluate concussions and their course. These have most often been used in academic centers but are now moving towards broad application.

These include the Sport Concussion Assessment Tool Version 3 and the Balance Error Scoring System. Like the King-Devick, these are standardized and simply administered tests that guide the provider, the coaches, and the teaching staff in assessing the student’s recovery.

We will individualize both a modified academic program and a structured return to play. If a child sustains a severe injury, has had multiple events, or has an unusually long recovery period a referral to the Concussion Clinic at Children’s Hospital will occur.

Once these procedures are debugged at the high school, the next goal will be to disseminate them island-wide to all our community sports and youth activity organizations.  The more information we all have, and by consistently applying best practices, the better outcomes will be for our children with concussions.