Appendix E: Applicable State and Federal Laws

(Adapted from the University of the State of New York, State Education Department, Office of Student Support Services: Guidelines for Concussion Management in the School Setting. [Last updated January 2014])

Student athlete

Students should be encouraged to communicate any symptoms promptly to district staff and/or parents/guardians, as a concussion is primarily diagnosed by reported and/or observed signs and symptoms. It is the information provided by students about their signs and symptoms that guides the other members of the team in transitioning them back to activities. The amount and type of feedback reported by the student will be dependent on age and other factors. Therefore it is recommended that students:

Be educated about the prevention of head injuries.
Be familiar with signs and symptoms that must be reported to the coach, certified athletic trainer, school nurse, parent/guardian, or other staff.
Be made aware of the risk of concussion and be encouraged to tell their coach, parent/guardian, certified athletic trainer, school nurse or other staff members about injuries and symptoms they are experiencing.
Be educated about the risk of severe injury, permanent disability, and even death that can occur with re-injury by resuming normal activities before recovering from a concussion.
Follow instructions from their private medical/health care provider.
Be encouraged to ask for help and to inform teachers of difficulties they experience in class and when completing assignments.
Encourage classmates and teammates to report injuries.
Promote an environment where reporting signs and symptoms of a concussion is considered acceptable and is encouraged.

Parents and guardians

When students are diagnosed with a concussion, it is important that the parent/guardian communicates with both the health care professional and the school. Therefore, it is recommended that parents/guardians:

Be familiar with the signs and symptoms of concussions. This may be accomplished by reading pamphlets, Web-based resources, and attending meetings and education sessions before their child’s involvement in athletic activities.
Be familiar with the requirement that any students suspected of having a concussion must immediately be removed from athletic activities.
Be familiar with any concussion policies or protocols implemented by the local or regional board of education.
Be made aware that concussion symptoms that are not addressed can prolong concussion recovery.
Provide any forms and written orders from the health care professional to the school nurse and the athletic trainer or coach in a timely manner.
Monitor their child’s physical and mental health as they transition back to full activity after sustaining a concussion.
Report concerns to their child’s health care professional and the school as necessary.
Communicate with the school to assist in transitioning their child back to school after sustaining a concussion.
Communicate with school staff if their child is experiencing significant fatigue or other symptoms during or at the end of the school day.
Follow the health care professional’s orders at home regarding return to activities.

School administrator

School administrators and/or their designees should ensure that the district’s policies on concussion management are communicated and implemented. Administrators may choose to designate a school concussion management team to oversee that district policies are enforced and protocols are implemented. Therefore, administrators should:

Review the district’s concussion education plan with all staff.
Arrange for the mandatory professional development regarding concussion management for staff and/or parents.
Provide guidance to district staff on districtwide policies and protocols for emergency care and transport of students suspected of sustaining a concussion.
Ensure that plans are developed and implemented to meet the needs of individual students diagnosed with a concussion and consult with the school medical advisor, school nurse, and (if any) a certified athletic trainer.
Enforce district concussion management policies and protocols.
Encourage parents/guardians to communicate with the school nurse and teachers if their child is experiencing significant fatigue or other symptoms during or at the end of the school day.
Invite parent/guardian participation in determining their child’s needs at school.
Encourage parents/guardians to communicate with the health care professional on the status of their child and their progress with return to school activity.
Ensure that coaches, athletic directors and athletic trainers inform the school nurse or medical advisor of any student who is suspected of or has been diagnosed with a concussion.

School medical advisor

The school medical advisor, who is a physician, plays a very important role in setting policies and procedures related to identifying students who may have sustained a concussion, along with postconcussion management in school. Therefore, the medical advisor should:

Collaborate with district administration and the school nurse supervisor in developing concussion management policies and protocols.
Assist district staff by acting as a liaison to the student’s medical provider when necessary.
Attend 504 and concussion management team meetings when necessary or requested.
Clear all students returning to athletic activities. This can be done at the discretion of the medical advisor either by reviewing a private medical provider’s clearance, or personally assessing the student.
Work with the concussion management team to monitor the progress of individual students with protracted recovery, multiple concussions, and atypical recovery.
Encourage school health personnel (such as school nurses and certified athletic trainers) to collaborate and communicate with each other about all students who are involved in athletic activities and are suspected of having or are diagnosed with a concussion.
Participate in professional development activities as needed to maintain a current knowledge base.

Licensed health care professional

Licensed health care professionals trained in the evaluation and management of concussions provide orders and guidance that determine when students are able to begin transitioning back to school and activities. Therefore, they should:

Provide written orders regarding restrictions and monitoring for specific symptoms that the health care professional should be made aware of by family and/or district staff members.
Provide the district with a written graduated return to activity schedule to follow, or approve use of the district’s graduated return to activity schedule, if appropriate.
Readily communicate with the school nurse, certified athletic trainer, or school medical advisor to clarify orders.
Provide written clearance for return to full activities (coaches shall not permit such student athlete to participate in any supervised team activities involving physical exertion, including, but not limited to, practices, games or competitions, until such student athlete receives written clearance to participate in such supervised team activities involving physical exertion).

School nurse

The school nurse (registered nurse) is the primary health care professional in the school environment and is responsible for the coordination of care for all students. He or she communicates with the health care professional, medical director, parent/guardian, and district staff, collects written documentation and orders, and assesses students’ progress in returning to school activities. Therefore, the school nurse should:

Assess students who have suffered a significant fall or blow to the head or body for signs and symptoms of a concussion and determine if any signs and symptoms of concussion warrant emergency transport to the nearest hospital emergency room per district policy.
Refer parents and guardians of students believed to have sustained a concussion to their health care professional for evaluation.
Provide parents and guardians with oral and/or written instructions (best practice is to provide both) on observing the student for concussive complications that warrant immediate emergency care.
Use the health care professional’s orders when developing an individualized health care plan or an emergency care plan for staff to follow.
Ensure proper communication (as guided by FERPA and school district policies) to teachers, coaches, athletic trainers, athletic directors and other school staff that a student is suspected of or has sustained a concussion.
Monitor and assess the student’s return to school activities, assessing the student’s progress with each step and communicating with the health care professional, school medical advisor, certified athletic trainer, parent/guardian, and appropriate district staff when necessary.
Collaborate with the concussion management team in creating accommodations if it is determined that a 504 plan is necessary.
Assist in educating students and staff in concussion management and prevention.

Director of physical education and/or athletic director (AD)

The director of physical education provides leadership and supervision for physical education (PE) class instruction, intramural activities, and interscholastic athletic competition within a school district’s total physical education program. In many districts there may be an athletic director solely in charge of the interscholastic athletic program. The director of physical education and/or the athletic director must be fully informed about district policies regarding concussion management. They should educate PE teachers, coaches, parents/guardians, and students about such policies. The director of PE and/or the athletic director often act as the liaison between district staff and coaches. Therefore, the director of PE and/or athletic director should:

Ensure that informed consent forms are distributed to and collected from the parents and legal guardians of student athletes involved in intramural or interscholastic athletic activities. Such informed consent form shall include, at a minimum, a summary of the concussion education plan and a summary of the local or regional board of education’s policies regarding concussions.
Inform the school nurse, certified athletic trainer, or medical advisor of any student who is suspected of or has been diagnosed with a concussion.
Ensure that any student identified as potentially having a concussion is not permitted to participate in any athletic activities until written clearance is received from a licensed health care professional trained in the evaluation and management of concussions.
Ensure that game officials, coaches, PE teachers, or parents/guardians are not permitted to determine whether a student with a suspected head injury can continue to play.
Educate coaches on the school district’s policies on concussions and care of injured students during interscholastic athletics, including when to arrange for emergency medical transport.
Assist in educating students, parents/guardians and staff in concussion management and prevention.
Enforce district policies on concussions including training requirements for
coaches and certified athletic trainers.
Advocate for a certified athletic trainer to be present during athletic activities.

Certified athletic trainer (ATC)

State Legislation

School districts have a responsibility to be knowledgeable about all relevant state and federal laws and how they affect school policies on all aspects of concussion education, prevention, and management.

Public Act No. 14-66: An Act Concerning Youth Athletics and Concussions http://www.cga.ct.gov/2014/act/pa/pdf/2014PA-00066-R00HB-05113-PA.pdf

Connecticut General Statutes (C.G.S.)10-212a Administration of Medications in Schools. This statute pertains to the administration of medications in the school setting. It addresses who may prescribe medications and who may administer medications in the school setting.

The Regulations of Connecticut State Agencies Section 10-212a-1 through 10-212a-10 Administration of Medications by School Personnel and Administration of Medication During Before- and After-School Programs and School Readiness Programs. These regulations provide the procedural aspects of medication administration in the school setting. The regulations include definitions within the regulations; the components of a district policy on medication administration; the training of school personnel; self-administration of medications; handling, storage and disposal of medications; supervision of medication administration; administration of medications by coaches and licensed athletic trainers during intramural and interscholastic events; administration of medications by paraprofessionals; and administration of medication in school readiness programs and before- and after-school programs.

Federal Legislation

Certain federal laws may also be relevant to school districts’ responsibilities for meeting the needs of students with concussions. The following information regarding these laws is adapted from the Connecticut State Department of Education’s Clinical Procedure Guidelines for Connecticut School Nurses - Part A: Legal Issues – Educational (2013).

Three federal laws—Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA), and the Individuals with Disabilities Education Act (IDEA)—may have application in some situations involving concussions. Section 504 covers qualified students with disabilities who attend schools receiving federal financial assistance. Section 504 would be implicated if a student with a concussion were determined to have a disability. A student would have a disability if the student is determined to: (1) have a physical or mental impairment that substantially limits one or more major life activities; or (2) have a record of such an impairment; or (3) is regarded has having such an impairment. Section 504, together with the IDEA, requires that school districts provide a free, appropriate, public education (FAPE) to qualified students who have a physical or mental impairment that substantially limits one or more major life activities.

Major life activities as defined in the Section 504 regulations include functions such as caring for oneself, performing manual tasks, walking, seeing, speaking, breathing, learning, and working. This list is not exhaustive. In the Americans with Disabilities Act Amendments Act (ADAAA), Congress provided additional examples of activities that are major life activities including eating, sleeping, standing, lifting, bending, reading, concentrating, thinking, and communicating. Congress also provided a nonexhaustive list examples of “major bodily functions” that are major life activities, such as functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.

It is the responsibility of the Section 504 team to determine eligibility criteria and placement as outlined in the regulations. To determine a child’s qualification, an individualized assessment of the child is required. If qualified, the child is entitled to receive a free, appropriate, public education, including related services. These services should occur within the child’s usual school setting with as little disruption as possible to the school and the child’s routines, in a way that ensures that the child with the disability is educated to the maximum extent possible with his or her nondisabled peers.

A certified athletic trainer, under the supervision of a qualified physician, can assist the medical advisor and athletic director (or director of PE) by identifying a student with a potential concussion. The certified athletic trainer can also evaluate the concussed student’s progress in return to athletic activities and postconcussion care based on the licensed health care professional’s provider orders and/or district protocol. Therefore, in collaboration with the school nurse, certified athletic trainers should:

Evaluate student athletes who may have suffered a significant fall or blow to the head or body for signs and symptoms of a concussion when present at athletic events.
Observe for late onset of signs and symptoms of a concussion and refer as appropriate.
Evaluate the student to determine if any signs and symptoms of concussion warrant emergency transport to the nearest hospital emergency room per district policy.
Refer parents/guardians of student athletes believed to have sustained a concussion to their health care professional for evaluation.
Provide parents/guardians with oral and/or written instructions (best practice is to provide both) on observing the student for concussive complications that warrant immediate emergency care.
Monitor the student’s return to school activities, evaluating the student’s progress with each step.
Review the written statement to clear a student for return to activities.
Assist in educating students, parents/guardians and staff in concussion management and prevention.
Inform the school nurse or medical advisor of any student who is suspected of or has been diagnosed with a concussion.

Coach

Coaches are typically the only district staff at all interscholastic athletic practices and competitions. It is essential that coaches are well informed regarding possible causes of concussions along understand the signs and symptoms. Coaches should always put the safety of the student first. Therefore, coaches should:

Remove any student who has taken a significant blow to head or body, or presents signs and symptoms of a head injury immediately from play. Public Act No. 14-66: An Act Concerning Youth Athletics and Concussions requires immediate removal of any student suspected to have sustained a concussion.
Contact the school nurse or certified athletic trainer for assistance with any student injury.
Send any student exhibiting signs and symptoms of a more significant concussion to the nearest hospital emergency room via emergency medical services (EMS).
Inform the parent/guardian of the need for evaluation by their medical/health care provider.
Provide the parent/guardian with written educational materials on concussions along with the district’s concussion management policies.
Inform the school nurse, certified athletic trainer, athletic director (or PE director) of the student’s potential concussion. This is necessary to ensure that the student does not engage in activities at school that may complicate the student’s condition prior to having written clearance by a licensed health care professional.
Ensure that students diagnosed with a concussion do not participate in any athletic activities until written authorization has been received from the licensed health care professional trained in the evaluation and management of concussions.
Inform the school nurse or medical advisor of any student who is suspected of or has been diagnosed with a concussion.

Teacher/school counselor/school psychologist

Teachers, school counselors, and school psychologists can assist students in their recovery from a concussion by making and coordinating the implementation of accommodations that minimize aggravating symptoms so that the student has sufficient cognitive rest. They should refer to district protocols and licensed health care provider orders in determining academic accommodations. Section 504 plans may need to be considered for some students with severe symptoms requiring an extended timeframe for accommodations. The school professionals should be aware of the processing issues a student with a concussion may experience. A student who has a concussion will sometimes have short-term problems with attention and concentration, speech and language, learning and memory, reasoning, planning, and problem solving. Students transitioning into school after a concussion might need academic accommodations to allow for sufficient cognitive rest. These include, but are not limited to:

shorter school day;
rest periods;
extended time for tests and assignments;
provision of copies of notes;
alternative assignments;
minimizing distractions;
permitting student to audiotape classes;
peer note takers;
providing assignments in writing; and
refocusing student with verbal and nonverbal cues.

Adapted from Guidelines for Concussion Management in the School Setting.