NIAA and NFHS Guidelines on Management of Concussions

NIAA and NFHS Guidelines on Management of Concussions




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 In its various sports playing rules, the National Federation of High Schools (NFHS) has implemented a standard rule change in all sports dealing with concussions in student-athletes:


Any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health-care professional. (Please see NFHS Suggested Guidelines for Management of Concussion included in this document or in the Appendix, located in the back of each NFHS Rules Book).


The NIAA has adopted these guidelines and defined the following parameters to guide NIAA registered officials and member school representatives in implementing this change:


What is the role of contest officials in administering the new rule?

·         Officials are to review and know the signs and symptoms of concussion and to direct immediate removal of any athlete who displays these signs or symptoms.

·         Officials have no other role in dealing with this rules change.


Who decides if an athlete has been concussed (has had a concussion)?

·         An MD (Medical Doctor), DO (Doctor of Osteopathy), PA (Physician’s Assistant), ARNP (Advanced Registered Nurse Practitioner) or LAT (Licensed Athletic Trainer), Paramedic or School Nurse is empowered to make the on-site determination that an athlete has received a concussion.

·         If any one of these individuals has answered “yes” and determined that there has been a concussion, that decision is final.


Can an athlete return to play on the same day as he/she receives a concussion?

·         No, under no circumstances can that athlete return to play in that event that day.


Once the day has been completed, who can issue authorization to return to practice / competition in the sport?

·         Once a concussion has been diagnosed by one of the above listed on-site providers, only an MD or DO can authorize subsequent return to play, and such shall be in writing to the administration of the school.

·         School administration shall then notify the coach as to the permission to return to practice or play.


Fundamental Reminders about this change

·         It has always been the ultimate responsibility of the coaching staff, in all sports, to ensure that players are only put into practice or contests if they are physically capable of performing.

·         If an athlete has been removed from play by an official who suspects a concussion has occurred and no appropriate healthcare professional is available to evaluate his/her condition, the player may not return to play that day.



NFHS Suggested Concussion Management by Health Care Professionals

 (Once it has been determined that a player has been concussed)


1.       No athlete should return to play (RTP) or practice on the same day of a concussion.

2.       Any athlete suspected of having a concussion should be evaluated by an appropriate health-care professional that day.

3.       Any athlete with a concussion should be medically cleared by an appropriate health-care professional prior to resuming participation in any practice or competition.

4.       After medical clearance, return to play should follow a step-wise protocol with provisions for delayed return to play based upon the return of any signs or symptoms.


Other Resources

·         The NFHS has developed a new 20-minute online coach education course – Concussion in Sports – What You Need to Know, the NFHS Suggested Guidelines for Management of Concussion in Sports brochure, the NFHS Sports Medicine Handbook, materials from the CDC Heads Up program and other materials should all be made available to officials, parents, athletes and schools.

NFHS Suggested Guidelines for Management of Concussion in Sports (NEW) 

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