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Protocol For Addressing Concussions

Brain Injury Protocol During School Hours

  1. A student will be sent to the school nurse for assessment after any significant bump, blow or jolt to the head which occurs during the school day.
  2. The school nurse or designee will observe the student for signs and symptoms of a concussion or other brain injury.
  3. Classroom teacher will be notified and will consult with school nurse if any signs or symptoms of concern are identified during class.
  4. Student’s parent(s) or legal guardian will be notified of the injury and observations by the school nurse, or other designee during the school day, or by a coach if it occurs before or after school during an extracurricular.
  5. If signs or symptoms of concussion are not present, student may remain in school but should not participate in any sports or recreational activities on the day of the injury. Observe student for 24-48 hours and if signs or symptoms develop then parents will be notified and student will need to be evaluated by an outside healthcare provider.
  6. Student will return to school nurse immediately if symptoms of concussion occur at any time after the injury.

Brain Injury Protocol Outside of School Hours

  1. The student will be removed from activity immediately.
  2. Assess and monitor for signs and symptoms of concussion.
  3. Coach or sponsor must notify a parent/ guardian of the head injury right away, before the student leaves practice or event.
  4. Regardless of whether or not a concussion has been diagnosed, a student athlete should never return to sports or activities on the same day a head injury occurred.
  5. Coach or sponsor will notify school nurse and athletic director if any student experiences a head injury during a practice or competition.

Diagnosed Concussion:  Return to Learn
Returning to school should be determined by the student support team, parents and healthcare provider, based on each individual student’s symptoms. A plan will be devised and may include accommodations such as: no school, shortened school days, allotted rest periods, decreased assignments, or no screen time throughout the healing process. If symptoms reoccur after returning to school, brain activity should be decreased (rest time, school day lessened, etc.) Students should be performing at their academic baseline (symptom-free) before returning to athletics.

If concussion symptoms reappear at any time during return to learn and/or play, the student should cease activity and be re-evaluated by the school nurse, licensed athletic trainer and/or other healthcare professional.

Diagnosed Concussion:  Return to Learn

Graduated return-to-school strategy






Daily activities at home that do not give the child symptoms

Typical activities of the child during the day as long as they do not increase symptoms (e.g. reading, texting, screen time). Start with 5-15 minutes at a time and gradually build up

Gradual return to typical activities


School activities

Homework, reading or other cognitive activities outside of the classroom

Increase tolerance to cognitive work


Return to school part-time

Gradual introduction of schoolwork. May need to start with a partial school day or with increased breaks during the day

Increase academic activities


Return to school full-time

Gradually progress school activities until a full day can be tolerated

Return to full academic activities and catch up on missed work


**All students will be placed on the RTL protocol based on their symptoms upon their return to school OR as directed by their health care provider.

Diagnosed Concussion: Return to Play (Athletes only)

  1. A student athlete should never return to play (competition or practice) on the same day of a diagnosed or suspected concussion.
  2. A licensed healthcare provider (defined above) should evaluate the student on the same day the injury occurs, whenever possible.
  3. A post concussion assessment should be completed by the student athlete and healthcare provider.
  4. A student may return to activity once they: are asymptomatic for concussion at rest, asymptomatic for concussion with exertion (physical and mental), and must have written clearance from a licensed healthcare provider. Clearance by a licensed medical professional is required by Iowa Code.
  5. Once all criteria above are met, the student should progress back to full activity following the step by step process outlined below, also unless otherwise defined by provider:

Step 1: Complete physical and cognitive rest

  • No exertional activity until asymptomatic
  • Stay home from school or limit school hours as needed

Step 2: Return to school full time

Step 3: Low impact, light aerobic exercise

  • This step should not begin until student is no longer having any concussion related symptoms and has been cleared by the treating licensed healthcare provider.
  • Student may begin brisk walking, light jogging, swimming or riding an exercise bike at less than 70% maximum performance heart rate
  • No weight or resistance training permitted at this time.

Step 4: Basic exercise, such as running in gym or on field

  • No helmet/ equipment

Step 5: Non-contact, sport-specific training drills;

  • Includes dribbling, ball handling, batting, fielding, running drills, etc.
  • Weight training can begin

Step 6: Following medical clearance, full contact practice or training permitted

Step 7: Normal activity or competition in a contest is permitted

Prior to returning to full practice, a post concussion assessment must be completed by the student athlete and must have comparable results to their baseline exam. This will be at the discretion of the school nurse, the athletic trainer, or the same health care provider who diagnosed the concussion.