HomeMy WebLinkAboutOCDSB 910 Appendix D Tool to Identify a Suspected ConcussionAppendix D: OCDSB 910 Tool to Identify a Suspected Concussion
Student Name:
Time of Incident:
Date:
Supervisor/Coach/Staff member reporting incident:
When a possible concussion event is observed by, or reported to, a staff member
during the instructional day, that staff member should conduct an assessment following
steps A to B3 of the Tool to identify a Suspected Concussion, prior to sending the
injured student to the office. Office Staff will administer and document the steps in the
process as outlined below, seeking additional information from the supervising staff
member if required.
When the possible concussion event occurs at an extracurricular event, outside of the
instructional day, the supervisor/coach will follow, and document, the steps within this
tool.
Identification of Suspected Concussion: If after a jarring impact to the head, face or
neck or elsewhere on the body, an impulsive force is transmitted to the head
(observed or reported), and the individual (for example, teacher/coach) responsible for
that student suspects a concussion, the Steps within this tool must be taken
immediately.
Step A: Red Flags Signs and Symptoms
Check for Red Flag sign(s) and or symptom(s).
If any one or more red flag sign(s) or symptom(s) are present, call 911, followed by
a call to parents/guardians/emergency contact.
OCDSB 910 (June 2020)Page 1
Red Flag Signs and Symptoms:
Double vision
Increasingly restless, agitated or combative
Deteriorating conscious state
Loss of consciousness
Step B: Other Signs and Symptoms
If Red Flag(s) are not identified, continue and complete the steps (as applicable) and
Step E: Communication to Parents/Guardians.
Step B1: Other Concussion Signs
Check visual cues (what you see).
Balance, gait difficulties, motor incoordination, stumbling, slow laboured movements
Disorientation or confusion, or an inability to respond appropriately to questions
Step B2: Other Concussion Symptoms Reported (What the Student is Saying)
Check what students report feeling.
Seizure or convulsion Neck pain or tenderness
Severe or increasing headache Vomiting
Weakness or tingling/burning in arms or legs
OCDSB 910 (June 2020)Page 2
Blank or vacant look
Facial injury after head trauma
Lying motionless on the playing
surface (no loss of consciousness)
Balance problems
Blurred vision
Difficulty concentrating
Difficulty remembering
Dizziness
“Don’t feel ri ght”
Drowsiness
Fatigue or low energy
Feeling slowed down
Feeling like "in a fog"
Headache
onal More emoti
irritable More
Nausea
Nervous or anxious
“Pressure in head”
Sadness
Sensitivity to light
Sensitivity to noise
If any sign(s) or symptom(s) worsens call 911
Slow to get up after a direct or indirect hit to the head
Step B3: Conduct Quick Memory Function Check
Questions may need to be modified for very young students, the situation/activity/sport
and/or students receiving special education programs and services. Failure to answer
any one of the questions correctly indicates a suspected concussion. Record student
responses.
Is it before or after lunch?
What activity/sport/game are we playing now?
What field are we playing on today?
What is the name of your teacher/coach?
What room are we in right now?
What school do you go to?
Page 3OCDSB 910 (June 2020)
concussion; therefore, all students with a suspected concussion must
undergo evaluation by one of these professionals. In rural or northern
regions, the medical assessment may be completed by a nurse with
pre-arranged access to a medical doctor or nurse practitioner.
●The parents/guardians must be provided with a completed copy of this tool and a
copy of OCDSB 908 Concussion Medical Assessment Form.
●The teacher/coach informs the principal of incident.
Step C: When sign(s) are observed and/or symptom(s) are reported, and/or the student
fails to answer any of the Quick Memory Function questions correctly
Actions required:
●a concussion should be suspected;
●the student must stop participation immediately and must not be allowed to return
to play that day even if the student states that they are feeling better; and
●the student must not:
○leave the premises without parent/guardian (or emergency contact) supervision;
○drive a motor vehicle until cleared to do so by a medical doctor or a nurse
practitioner;
○take medications except for life threatening medical conditions (for example,
diabetes, asthma).
●The teacher/coach informs the parent/guardian that the student needs an urgent
medical assessment (as soon as possible that day) by a medical doctor or nurse
practitioner.
○Medical doctors and nurse practitioners are the only healthcare
professionals in Canada with licensed training and expertise to diagnose a
Step D: If there are no signs observed, no symptoms reported, and the student
answers all questions in the Quick Memory Function Check correctly but a
possible concussion event was recognized by teacher/coach.
Actions required:
●The student must stop participation immediately and must not be allowed to return
to play that day even if the student states that they are feeling better. Principals
must be informed of the incident.
●The teacher/coach informs the parent/guardian of the incident and that the student
attends school and requires continued monitoring for 24 hours as signs and or
symptoms can appear hours or days after the incident:
○If any red flags emerge call 911 immediately.
○If any other sign(s) and/or symptom(s) emerge, the student needs an urgent
medical assessment (as soon as possible that day) by a medical doctor or nurse
practitioner.
○The parent/guardian communicate the results of the medical assessment to the
appropriate school personnel using OCDSB 908 Concussion
Medical Assessment Form.
○If after 24 hours of monitoring no sign(s) and or symptom(s) have emerged, the
parent/guardian will inform the school and he student will be permitted to
resume physical activities. Medical clearance is not required.
OCDSB 910 (June 2020)Page 4
Step E: Communication to Parents/Guardians
Summary of Suspected Concussion Check – Indicate appropriate results and follow-up
requirements.
Your child/ward was checked for a suspected concussion (that is, Red Flags,
Other Signs and Symptoms, Quick Memory Function Check) with the following
results:
Other concussion sign(s) were observed and/or symptom(s) reported and/or
the student failed to correctly answer all the Quick Memory Function questions.
Red Flag sign(s) were observed and/or symptom(s) reported and emergency medical
services (EMS) called.
No sign(s) or symptom(s) were reported, and the student correctly answered all
of the questions in the Quick Memory Function Check but a possible concussion event
was recognized. Student attends school, no physical activity, with continued
monitoring at school and home for 24 hours. Continued monitoring is required
(consult Step D).
Teacher/Coach/Intramural Supervisor signature:
Forms for parents/guardians to accompany this tool:
OCDSB 908 Concussion Medical Assessment Form
Parent/Guardian must communicate to the principal/designate the results of
the 24-hour monitoring period:
Results of the Medical Assessment
No concussion sign(s) and/symptom(s) were observed or reported after
the 24 hours monitering period.
The personal information on this form is collected under the authority of the Education Act (R.S.O. 1990
c.E2), and in accordance with the Municipal Freedom of Information and Protection of Privacy Act
(RSO. 1990 c.M56), as amended. It will be used for the management of student learning and wellbeing,
and for education related purposes such as administration, communication, and data reporting. In
addition, the information may be used or disclosed to comply with legislation, for compelling
circumstances affecting health and safety, or discipline related to law enforcement matters. Questions
or concerns should be directed to the school principal or the District’s Freedom of Information
Coordinator, Ottawa-Carleton District School Board, 133 Greenbank Road, Ottawa, Ontario K2H 6L3,
Telephone 613-596-8211. CONFIDENTIAL WHEN COMPLETED.
OCDSB 910 (June 2020)Page 5
Concussion sign(s) and/symptom(s) were observed or reported after the 24
hours monitering period. Symptoms listed below:
Parent/Guardian signature:
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