2431.4	Prevention and Treatment of Sports-Related
Concussions and Head Injuries 
The following procedures shall be followed to implement N.J.S.A. 18A:40-41.1  et seq., the New Jersey Department of Education Model Policy and Guidance for Districts on the Prevention and Treatment of Sports-Related Head Injuries and Concussions, and Policy 2431.4.
 A.    	Prevention 
1.     	The following steps may be taken to prevent concussions 		and head injuries and ensure the safety of 				student-athletes:
 
a.     	Limit the number of stunts during cheerleading 		practice.
 
(1)    	When stunting is performed, spotters shall 		be used and the surface shall be soft and in 		good condition; and
 
(2)    	Safe stunting techniques shall be taught and 		student-athletes shall not be permitted to 		attempt new or difficult stunts without 			proper instruction and a coach on hand.
 
b.     	Ensure student-athletes have appropriate 			supervision during practices and a designated safe 		practice facility in good condition for the activity.
 
c.     	Ensure the use of appropriate fitted and maintained 		safety equipment.
 
		d.     	Ensure student-athletes avoid unsafe actions such 				as:
 
		(1)    	Hitting another student-athlete in the head;

 		(2)    	Using their head to contact another 					student-athlete;
 
		(3)    	Making illegal contacts; and
 
(4)    	Trying to injure or put another 				student-athlete at risk for injury.
 
e.     	Limit the amount of contact during practices. This 		may include:
 
(1)    	Limiting the amount of practice time that 		includes scrimmages or full-speed drills.
 
f.      	Teach student-athletes proper techniques and ways 		to avoid hits to the head.
 
g.     	Keep a close eye on student-athletes in positions 		that are at increased risk for concussion to help spot 		a potential concussion. 
B.    	Possible Signs or Symptoms of Concussion 
1.     	Some mild traumatic brain injuries and concussion 			symptoms may appear right away, while others may not 		appear for hours or days after the injury.  These symptoms 		may be observed by coaches, licensed athletic trainers, 		school/team physicians, school nurses, teachers, parents, 		or a teammate.  Below are a few examples of possible signs 		and symptoms of a concussion:
 
a.     	The student-athlete grabs or holds head after a play 		or      hit - “Hands to Head”;
 
		b.     	The student-athlete appears to be “shaking it off”;
 
		c.     	The student-athlete appears dazed or “foggy”;
 
d.     	The student-athlete forgets plays or demonstrates 		short term memory difficulty;
 
e.     	The student-athlete cannot recall injury or events 		just before or just after the injury;

f.      	The student-athlete answers questions slowly or 		inaccurately;
 
		g.     	The student-athlete has a headache;
		 
		h.     	The student-athlete is nauseous or is vomiting;
 
i.      	The student-athlete is experiencing balance 			problems or dizziness;
 
j.      	The student-athlete is experiencing double vision 		or changes in vision;
 
k.     	The student-athlete is experiencing sensitivity to 		light or sound/noise;
 
		l.      	The student-athlete is feeling sluggish or foggy;
 
m.    	The student-athlete is having difficulty with 			concentration and short-term memory;
 
		n.     	The student-athlete is experiencing sleep 					disturbance; and
 
o.     	The student-athlete is experiencing irritability 		and/or mood changes.
 
2.     	Any possible signs or symptoms of a concussion shall be 		reported by the student-athlete participating in a program 		of athletic competition to the coach(es), athletic trainer, 		school or team physician, school nurse, and/or parent. 
C.    	Treatment
 
1.     	Pursuant to N.J.S.A. 18A:40-41.4, a student-athlete who 		participates in a program of athletic competition and who 		sustains or is suspected of having sustained a concussion 		or other head injury while engaged in a program of athletic 		competition shall be immediately removed from the 			program of athletic competition by the staff member 		supervising the program of athletic competition.
 		2.     	The staff member supervising the student-athlete during 				the program of athletic competition shall immediately 				contact the school physician, athletic trainer, or school 				nurse to examine the student-athlete. 
3.     	Emergency medical responders (911) shall be called if the   		student-athlete is experiencing a deterioration of 			symptoms, loss of consciousness, or direct neck pain 		associated with the injury pursuant to D. below.
 
4.     	A student-athlete who is removed from a program of 		athletic competition shall not participate in further 			programs of athletic competition until:
 
a.     	The student-athlete is evaluated by a physician or 		other licensed healthcare provider trained in the 		evaluation and management of concussions and 		receives written clearance from a physician trained 		in the evaluation and management of concussions 		to return to the program of athletic competition; 		and
 
(1)    	The student-athlete’s written medical 			clearance from a physician must indicate a 		medical examination has determined:
 
(a)    	The student-athlete’s injury was not a 		concussion or other head injury, the  		student-athlete is asymptomatic at 		rest, and the student-athlete may 		return to regular school activities and 		is no longer experiencing symptoms of 		the injury while conducting those 		activities; or
 
(b)    	The student-athlete’s injury was a 		concussion or other head injury and 		the student-athlete’s physician will 		monitor the student-athlete to 			determine when the student-athlete is 		asymptomatic at rest and when the 		student-athlete may return to regular 		school activities and is no longer 			experiencing symptoms of the injury 		while conducting those activities.
 
(2)    	The student-athlete’s written medical 			clearance shall be reviewed and approved by 		the school physician.
 
(3)    	A student-athlete who has suffered a 			concussion or other head injury may not 		begin the CDC’s Six-Step Return to Play 		Progression as outlined in E. below until the 		student-athlete receives a medical 			examination and provides the required 			written medical clearance to the Principal or 		designee.
 
(4)    	A written medical clearance not in 			compliance with the provisions of C.4.a. 		above will not be accepted.
 
b.     	A student-athlete who has suffered a concussion or 		other head injury returns to regular school activities 		without the need for additional support and is no 		longer experiencing symptoms of the injury when 		conducting those activities.
 
(1)    	If school is in session, a student-athlete who 		has suffered a concussion or other head 		injury must return to regular school activities 		without symptoms or need for additional 		support before returning to a program of 		athletic competition as part of the CDC’s 		Six-Step Return to Play Progression.
 
(2)    	If school is not in session, a student-athlete 		who has suffered a concussion or other head 		injury must return to their normal daily 		activities without symptoms as part of the 		CDC’s Six-Step Return to Play Progression.
 
D.    	Symptoms Requiring Immediate Medical Assessment 			(911/Emergency Evaluation)
 
1.     	The following symptoms requiring immediate medical 		assessment include, but are not limited to:
 
		a.     	The student-athlete loses consciousness;
 
b.     	The student-athlete has a headache that gets worse 		and does not go away;
 
c.     	The student-athlete is experiencing weakness, 		numbness, decreased coordination, convulsions, or 		seizure;
 
d.     	The student-athlete is experiencing repeated 			vomiting and/or intractable retching;
 
e.     	The student-athlete is slurring speech or exhibiting 		unusual behavior (disoriented);
 
f.      	The student-athlete has one pupil (the black part in 		the middle of the eye) larger than the other; and
 
g.     	The student-athlete cannot recognize people or 		places and/or gets confused, restless, or agitated.
 
E.     	CDC’s Six-Step Return to Play Progression for Students Who 		Have Suffered a Concussion or Other Head Injury
 
1.     	The return of a student-athlete to a program of athletic 		competition shall be in accordance with the CDC’s 			Six-Step Return to Play Progression recommendations 		and any subsequent changes or other updates to those 		recommendations as developed by the CDC. Recovery is 		individual.
 
a.     	As applicable, the student-athlete’s treating 			healthcare provider may guide the student-athlete 		through the return to play protocol while 			experiencing mild symptoms as part of the 			treatment.
 
b.     	In addition, the student-athlete’s treating 			healthcare provider may adjust the treatment plan 		prior to Step Six, full return to competition.
 
c.     	Clearance from a student-athlete’s physician 			trained in the evaluation and management of 			concussions is required before returning to full 		competition.
		2.     	Six-Step Return to Play Progression 
		a.     	Step 1:  Back to Regular Activities
 
	The student-athlete is back to their regular 			activities (such as school).
 
		b.     	Step 2:  Light Aerobic Activity
 
	The student-athlete shall begin with light aerobic 		exercise only to increase a student-athlete's heart 		rate.  This means about five to ten minutes on an 		exercise bike, walking, or light jogging.  No 			weightlifting at this point.
 
		c.     	Step 3:  Moderate Activity
 
	The student-athlete shall continue with activities to 		increase a student-athlete's heart rate with body or 		head movement. This includes moderate jogging, 		brief running,      moderate-intensity stationary 		biking, or moderate-intensity weightlifting (less 		time and/or less weight from their typical routine).
 
		d.     	Step 4:  Heavy, Non-Contact Activity
 
	The student-athlete shall add heavy, non-contact 		physical activity, such as sprinting/running, 			high-intensity stationary biking, regular 			weightlifting routine, or non-contact    				sport-specific drills (in three planes of movement).
 
		e.     	Step 5:  Practice & Full Contact
 
	The student-athlete may return to practice and full 		contact (if appropriate for the sport) in controlled 		practice.
 
		f.      	Step 6:  Competition
 
		The student-athlete may return to competition.
 
3.     	It is important for a student-athlete's parent(s), 			coach(es), and teachers to watch for concussion 			symptoms after each day's Six-Step Return to Play 			Progression activity.
 
4.     	A student-athlete should only move to the next step if they 		do not exhibit any new symptoms at the current step.
 
5.     	If a student-athlete's symptoms return or if they develop 		new symptoms, this could be a sign the student-athlete is 		overexerting. The student-athlete shall stop these 			activities and the student-athlete's medical provider 		shall be contacted.  After more rest and no concussion 		symptoms, the student-athlete can start at the previous 		step.
 
F.    	Temporary Supports for Student-Athletes with Sports-Related Head Injuries or Concussions
 
1.     	Initial rest followed by a gradual return to activity during 		healing is recommended.  Accordingly, consideration of 		the cognitive effects in returning to the classroom is also 		an important part of the treatment of sports-related 			concussions and head injuries.
 
2.     	Mental exertion increases the symptoms from 			concussions and affects recovery.  To recover, cognitive 		rest is just as important as physical rest.  Reading, 			studying, computer usage, texting, even watching movies 		if a student-athlete is sensitive to light/sound, can slow a 		student-athlete's recovery.  Managing the symptoms 		through a balance of rest and activity is the key to 			recovery.
 
a.     	The district will provide support for 				student-athletes diagnosed with a concussion.
 
b.     	The student-athlete’s health care provider will 		handle  short-term medical accommodations.
 
3.     	Collaboration between the student-athlete’s health care 		provider and the school may be necessary.  If 				accommodations are needed for an extended time, the 		district may want to consider implementing 				accommodations via a formalized 504 plan.
 
4.     	The Principal or designee may address the 				student-athlete's cognitive needs in the following ways:
 
		a.     	Limit the student-athlete’s screen time;
 
		b.     	Have the student-athlete take rest breaks as 					needed;
 
		c.     	Have the student-athlete spend fewer hours at 				school;
 
d.     	Provide the student-athlete more time to take tests 		or complete assignments. (All courses should be 		considered);
 
		e.     	Provide the student-athlete help with schoolwork;
 
f.      	Reduce the student-athlete’s time spent on the 		computer, reading, and writing;
 
g.     	Provide or grant the student-athlete early passing 		time to avoid crowded hallways; and/or
 
h.     	Allow the student-athlete extra time to complete 		tests or coursework.
 
5.     	These supports and/or short-term medical 				accommodations may be addressed in an individualized 		healthcare plan for a student-athlete who has suffered a 		concussion or other head injury.
 
6.     	Concussions affect several aspects of brain function, 			including cognition, balance and coordination, visual 		tracking and processing, behavior, and others. The 			symptoms experienced, difficulties faced, and timeline for 		recovery will vary for each individual.
 
7.     	A brief period of relative rest followed by a gradual return 		to lighter activities is generally considered the best 			"medicine" for healing concussions or other head injuries.  		This may include relative rest from both physical and 		cognitive activities.  Each injury, and therefore each 			treatment plan, is different. School personnel, in 			collaboration with the student-athlete, parents, and the 		student-athlete's health care provider, are in the best 		position to create flexible, temporary supports to meet the 		needs of each student-athlete.
G.    	Education 
1.     	The CDC offers tips for health professionals and educators 		on their website. Interscholastic Head Injury Training 		Programs are available via the CDC website or the National 		Federation of State High School Associations.
 
2.     	This training shall be completed by the school/team 			physician, licensed athletic trainer, school nurses, 			coaches, and other relevant school personnel.
 
H.    	Other Considerations
 
1.     	Educational information for student-athletes on the 			prevention of concussions shall be reviewed.
 
2.     	The importance of early identification and treatment of 		concussions to improve recovery shall be reinforced.
 
3.     	School personnel shall contact the student-athlete's 			parent and inform them of the suspected sports-related 		concussion or head injury before allowing the 				student-athlete to go home after a program of athletic 		competition.
 
4.     	School personnel shall provide the parent of the 			student-athlete with a checklist or copy of the return to 		play protocols including the requirement of written 			clearance from a physician trained in the evaluation and 		management of concussions before the         				student-athlete is able to return to a program of athletic 		competition.
 
I.      	Interscholastic Head Injury Training Program 
1.     	The district will adopt an Interscholastic Head Injury 		Training Program to be completed by the school/team 		physician, licensed athletic trainer, coaches, and other 		appropriate district personnel pursuant to N.J.S.A. 			18A:40-41.2.  The training program shall include:
 
a.     	The recognition of the signs of head and neck 			injuries, concussions, and second impact 			syndrome; and
 
(1)    	Pursuant to N.J.S.A. 18A:40-41.1.d., if a      		student-athlete sustains a second concussion 		while still having symptoms of a previous 		concussion, it can lead to the severe 			impairment and even the death of the 			student-athlete, and is referred to as 			second-impact syndrome.
 
b.     	The CDC’s Six-Step Return to Play Progression or 		any subsequent changes or other updates developed 		by the CDC.
J.      	“Return to Play Progressions” vs. “Therapeutic Progressions” 
1.     	In many cases, after the initial rest period, concussed 		individuals may be encouraged to resume limited 			activities, including light physical and cognitive activities, 		even in the presence of some continued symptoms.  This 		may be referred to as "therapeutic progressions," and 		while some of the activities may overlap with the CDC’s 		Six-Step Return to Play Progression, it is different in the 		goals and intent from "return to play."
 
a.     	“Return to play” progressions are intended to test 		the concussed individual's readiness to perform the 		activity correctly, and to do so with no symptoms.
b.     	“Therapeutic” progressions are intended to help 		the individual recover and to help them improve 		their performance and tolerance to those activities. 		This may take several days, or longer, at any given 		step.
 
c.     	“Therapeutic progressions” should be 				recommended and supervised by a health care 		provider familiar with the evaluation and 			management of concussions, and monitored by a 		team including the student-athlete, parents, health  		care provider, and school personnel.  Adjustments 		to the program should be in response to the 			student-athlete's  overall symptom load and 			progress. It should be remembered that 			student-athletes may progress at different rates for 		various aspects of their injury, such as tolerating 		light to moderate aerobic activity before tolerating 		being in the classroom, or tolerating schoolwork 		done at home before tolerating the classroom and 		school environment.  Of note, progressions in one 		aspect of the treatment plan can have a positive 		effect on other areas as the brain is returning to a 		more typical overall level of function. A successful 		treatment plan is one that can adapt appropriately 		for each student-athlete.
 
K.    	Educating the Community on the District Sports-Related Concussions 		and Head Injuries Policy
 
1.     	The Board shall review Policy 2431.4 and this Regulation 		annually, and update as necessary to ensure Policy 2431.4 		and this Regulation reflect the most current information 		available on the prevention, risk, and treatment of 			sports-related concussions and head injuries.
 
2.     	The district may provide regular education and training 		for staff including administrators, teachers, 				paraprofessionals, and school counselors regarding 			concussions and other head injuries as head injuries can 		happen at any time during the school day or outside of 		school.
 
3.     	The district is in a unique position to promote healthy 		behaviors. The district can embed education related to the 		prevention and treatment of concussions and head 			injuries through the New Jersey Student Learning 			Standards Comprehensive Health and Physical Education 		Standard 2.3 – Safety.  In addition, N.J.S.A. 18A:6-2 			requires education in accident and fire prevention and 		N.J.S.A. 18A:35-5 requires education in injury or illness 		emergencies.

Adopted:          18 December 1995, 12 December 2011
Revised            January 2006, November 21, 2011, November 19, 2012, 			March 21, 2022, April 30, 2024