Concussion Protocols for Schools: Signs, Recovery Plans & Teacher Support

What School Nurses Need to Know About Concussions

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As school nurses, we know that head injuries happen—whether it’s on the playground, during sports, or just from an accidental fall. March is Brain Injury Awareness Month, making it the perfect time to refresh our knowledge on concussion protocols, return-to-learn and return-to-play plans, and how to support teachers in accommodating students post-concussion. Let’s dive in!

Recognizing the Signs of a Concussion

A concussion is a mild traumatic brain injury (TBI) that can occur after a blow to the head or a sudden jolt. While some symptoms appear immediately, others can take hours or even days to develop.

Common Signs & Symptoms:

• Physical: Headache, dizziness, nausea, sensitivity to light or noise, balance problems

• Cognitive: Confusion, trouble concentrating, memory issues, slowed thinking

• Emotional: Irritability, mood swings, anxiety, depression

• Sleep-Related: Sleeping more or less than usual, trouble falling asleep

As school nurses, we cannot diagnose concussions, but we play a key role in recognizing symptoms and making sure students receive proper care. If a student shows any of these signs after a head injury, it’s essential to remove them from activity immediately, contact their parents, and urge medical follow-up as soon as possible. When in doubt, always refer them for further evaluation.

Best Practices for Return-to-Learn & Return-to-Play Plans

Returning to normal activities too soon can make concussion symptoms worse. That’s why gradual reintegration is key.  After an official diagnoses, many doctor's or athletic trainers will provide guidelines similar to the below-

Return-to-Learn:

• Start with shortened school days or reduced workload

• Minimize screen time (computers, tablets, smartboards)

• Provide extra breaks as needed

• Allow extra time for assignments and tests

• Reduce bright lights and noise exposure in the classroom

Return-to-Play:

• Students should be completely symptom-free before returning to sports

• Follow a stepwise approach, increasing activity levels gradually

• Always get medical clearance before full participation in sports

• Monitor for any return of symptoms

Educating Teachers on Concussion Recovery

Teachers play a crucial role in helping students recover, but many don’t realize how much a concussion can impact learning. As a school nurse, you can help by:

• Explaining common symptoms and how they affect students in the classroom

• Providing classroom accommodation tips (e.g., reducing screen time, modifying workloads, allowing movement breaks)

• Encouraging open communication between teachers, parents, and medical providers

Final Thoughts

As school nurses, we’re often the first line of defense in identifying concussions and guiding students through recovery. By recognizing symptoms early, ensuring gradual reintegration into learning and sports, and educating school staff, we can help students heal safely and effectively.

Have you implemented a great concussion protocol in your school? If so, please share your experiences in the comments below!

 Check out these other popular DOASN blog posts & product links.

Concussions in the School Setting

Concussions and The School Nurse

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Hopefully Helpful School Nurse Tip: Each year thousands of student athletes are diagnosed with a concussion. These blog posts were written to help the school nurse help those students.

What is a concussion?

It won't take long before a student enters your school nurse office and notifies you they have been diagnosed with a concussion. It is important that your student understands what this diagnosis means and as a school nurse you have the opportunity to educate your student.  A textbook definition from the Centers for Disease Control and Prevention is: 

"A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells." (CDC, 2021)

However, that is a very technical and medical definition- will your student understand what that actual means?  It is OK to give an actual medical definition, but then follow it up with easy to use words and terms that your student will understand. This will depend on the grade level, age, and compression level of your student. 

What are common symptoms of a concussion?

Although school nurses are not allowed to diagnose a concussion, they should be able to recognize and refer for signs and symptoms of a potential concussion caused by a recent head injury. As a school nurse you'll want to know your school district's protocol when dealing with a student who has suffered a head injury at school or comes to school with a concussion diagnosis.  Do you know what signs and symptoms to look for?  For a review of signs and symptoms related to a concussion read this CDC article titled Concussion Signs and Symptoms. 

Are concussions serious?

Although concussions might not be life threatening, the side effects can be serious. Many students recovery within a few weeks, but others might need a few months or even longer to make a complete recovery!

                                     

What classroom accommodations can be made to support a student with a concussion?

There are many appropriate and suggested classroom accommodations that can be made when a student is diagnosed with a concussion. Sometimes the physician or athletic trainer might even provide you or the classroom teachers with accommodations when they provide the diagnosis. Other times the school nurse will only receive the written diagnosis. When this happens, what are you accepted to do?  Is the school nurse supposed to notify the student's classroom teacher/s or the student's school counselor?  Each school or school district should have a written concussion protocol to follow in this situation. 

A brief concussion protocol example might be something like this:

1. School Nurse receives documentation that student has been diagnosed with a concussion
2. School Nurse notifies classroom teachers and school counselor that the "concussion protocol" has been started
3. School Nurse asks for or receives updates from students, parents, classroom teachers, and/or school counselor as needed
4. School Nurse might need to inform athletic trainer or physician of received updates
5. School Nurse receives documentation the Return To Learn is complete
6. School Nurse notifies classroom teachers and school counselor that the "return to learn" has been completed
7. School Nurse asks for or receives updates from students, parents, classroom teachers, and/or school counselor as needed
8. School Nurse might need to inform athletic trainer or physician of received updates
9. School Nurse receives documentation the Return To Play is complete
10. School Nurse notifies classroom teachers and school counselor that the "return to play" has been completed
11. School Nurse asks for or receives updates from students, parents, classroom teachers, and/or school counselor as needed
12. School Nurse might need to inform athletic trainer or physician of received updates

The above are only brief suggestions ... as a school nurse you'll want to check on your school district's specific policies and procedures regarding concussion.  If your district doesn't have one, then you might want to work on creating one to use at your school when needed.

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NEED HELP CREATING A CONCUSSION PROTOCOL / POLICY / PROCEDURE? 

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THREE CONCUSSION PROTOCOL / CLASSROOM SUGGESTION SLIDES

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• 3 fully editable slides for the following concussion situations:
• Concussion Protocol Starting
• Return To Learn
• Return To Play

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• Save as PNG or JPG in order to insert into the body of an email

School Nurse Concussion Resources:

CDC HEADS UP to schools

CDC HEADS UP to schools for School Nurses

Trends in Emergency Department Visits for Contact Sports–Related Traumatic Brain Injuries Among Children — United States, 2001–2018
Weekly / July 10, 2020 / 69(27);870–874

What do I do now?

It's fall & I'm a new school nurse- What do I do? 

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Hopefully Helpful School Nurse Tip: I'm a maker of lists!  I do this because I think I'll remember all of the details, but I know I won't remember all of the details. So, this post lists a few items I completed during a random month in 2016- October!

1. By now you've should have a handle on your new student required health paperwork & you should have all forms turned in or students on an approved schedule.  I keep track of my "in-series" kiddos on a Google drive sheet!  
2. My typical weekly follow up cases include- doctor related PE excuse notes, concussion status, & vision and hearing re-screens.  For these situations I use the old-school "piles on my desk" tracking system!  I will say the piles are organized, clipped together, and labeled; for now this sort of system seems to work :)
3. I'm getting ready to schedule the yearly dental clinic.  We usually see 80-100 students over a span of three days.
4. I'm also re-vamping the system I use to track IEP students who have a primary or secondary label of OHI & would love to hear if any of you have a system already in place- please share :)  *update- in 2020 I came up with a Google sheet. You can download it for FREE here.
5. I'm also enjoying the GREAT, WARM weather we've been having in Illinois & look forward to watching the CUBS WIN game 7 tonight!!

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PSA on Concussions

"Heads Up" on Concussions for The School Nurse

Hopefully Helpful School Nurse Tip: Each year thousands of student athletes are diagnosed with a concussion. These blog posts were written to help the school nurse help those students.

Concussion Facts

• 135,000 sports/recreation-related TBIs, including concussions, among children ages 5 to 18 are treated in US Emergency Rooms each year. (MMWR July 2007)

• Athletes who have ever had one concussion are at increased risk for more concussions.

• Children and teens are more likely to get a concussion and take longer to recover than adults.

FREE resources from the CDC...click here

The CDC has created free tools for youth and high school sports coaches, parents, athletes, and health care professionals that provide important information on preventing, recognizing, and responding to a concussion.

FREE Heads Up Online Training...click here

click here for another post on concussions in the classrooms

See below (or click HERE) for a $5 Concussion newsletter option.