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OCDSB 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 Deteriorating conscious state Red Flag Signs and Symptoms: Double vision Increasingly restless, agitated or combativeLoss 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 Slow to get up after a direct or indirect hit to the head  Step B2: Other Concussion Symptoms Reported (What the Student is Saying)  Check what students report feeling.  Balance problems  Blurred vision  Difficulty concentrating  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) 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 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: ○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. 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