Concussion and Head Injury Acknowledgment and Consent
Concussion Action Plan
Concussion Fact Sheet
In compliance with House Bill 204 – “Protection of Athletes with Head Injuries Act”, Draper City has implemented a Concussion and Head Injury Awareness Policy, which requires adherence by all coaches, volunteers, parents, legal guardians, participants, and agents of Draper City.
General Concussion Description
A concussion is a brain injury, and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are potentially serious and may result in complications including prolonged brain damage and even death if not recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious.
Symptoms and signs of concussions (see traumatic head injury below) may show up right after the injury or can take hours or days to fully appear. If your athlete reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away. You cannot see a concussion and most sports concussions occur without loss of consciousness.
Nature and Risk
Continuing to participate in a sporting event after sustaining a concussion or a traumatic head injury can leave the athlete vulnerable to greater injury or death. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first. This can lead to prolonged recovery, or even severe brain swelling with devastating and even fatal consequences.
If Draper City, its agents, coaches, volunteers, parks & recreation staff, parents or legal guardians suspects a youth athlete (a child who is under the age of 18) of sustaining a concussion or traumatic head injury while participating in a sporting event, the athlete shall be removed immediately. Upon removal of an athlete suspected of sustaining a concussion or a traumatic head injury, a written medical clearance from a qualified health care provider is required before the athlete can return to participate in any sporting event.
- “Qualified Health Care Provider” means a health care provider who: (a) is licensed under Utah Code Title 58, Occupations and Professions; (b) may evaluate and manage a concussion within the health care provider's scope of practice; and (c) within three years before the day on which the written statement is made, has successfully completed a continuing education course in the evaluation and management of a concussion.
- “Sporting event” means any of the following athletic activities that is organized, operated, managed, or sponsored by Draper City such as: a game, a practice, a clinic, a sports camp, an educational class, a competition, or a tryout.
- “Traumatic head injury” means an injury to the head arising from blunt trauma, an acceleration force, or a deceleration force, with one of the following observed or self-reported conditions attributable to the injury: (a) transient confusion, disorientation, or impaired consciousness, (b) dysfunction of memory, (c) loss of consciousness, or (d) signs of other neurological or neuropsychological dysfunction, including: (i) seizures, (ii) irritability, (iii) lethargy, (iv) vomiting, (v) headache, (vi) dizziness, or (vii) fatigue.
Concussion Action Plan
What should be done when a concussion is suspected?
- Report the suspicion to the coach.
a. Look for the symptoms and signs of a concussion (see “traumatic head injury” above).
b. When in doubt, remove the athlete from play.
- Ensure that the athlete is evaluated right away. Do not judge the severity yourself; get assistance from a qualified Health Care Provider as soon as possible.
- Allow the athlete to return to play only with permission from a qualified Health Care Provider. A repeated concussion prior to recovery can increase the likelihood of further problems.
- Both coach and parent should record:
a. the cause of the head injury and with what force;
b. any loss of consciousness and for how long;
c. any memory loss immediately after the injury;
d. any seizures immediately after the injury; and
e. any other pertinent information you think will help the Health Care Provider.
Acknowledgment & Consent
Having read Draper City’s Concussion and Head Injury Awareness Policy and this Acknowledgment and Consent, I understand what a concussion is, have been informed on how to recognize the signs and symptoms of a traumatic head injury, and agree to abide by the policy. I understand and give consent that if my child, the participating athlete, is suspected of having a concussion, he/she will be removed from the sporting event and will not be permitted to continue participating in any upcoming sporting events until a qualified Health Care Provider has determined it to be safe, at which time I will provide Draper City with a written statement by a qualified Health Care Provider acknowledging my child is cleared to resume participation.