Concussion Protocol
During the academic year, the Nobles Concussion Protocol supports the academic, physical, and emotional well-being of a student that has been diagnosed by a physician with a concussion, and is in coordination with the recommendations of the involved overseeing physicians. The School Nurses and Athletic Trainers will lead a concussion management team and work together to relay all pertinent medical information relating to the student’s head injury throughout the student’s recovery. A concussion management team (CMT) for each student will include the following:
Middle School
Middle School Head, School Nurse, Director of Sports Medicine, Middle School Counselor, Student’s advisor, Class Dean
Upper School
Upper School Head, Dean of Students, School Nurse, Director of Sports Medicine, Upper School Counselor, Student’s advisor, Class Dean
Step 1: Notification and Precaution
Whether an accident that results in concussion symptoms occurs during a Nobles-sponsored activity or outside of school, the nurses or athletic trainers need notification of the injury as quickly as possible. Once notified, email correspondence of the injury will be sent to the CMT and teachers in order to properly support the student until further evaluation occurs. Close assessment of the student by Nobles Health office and/or Office of Sports Medicine will determine whether a physician referral and evaluation are required. If this is judged as necessary then the School Nurse or Athletic Trainer will communicate the directive to the parent. Academic accommodations will be initiated and the student will be withheld from Noble’s afternoon program activity.
Step 2: Physician Diagnosis
Nobles requires written documentation from the student’s physician or concussion specialist regarding evaluation and diagnosis of the head injury. A concussion diagnosis and treatment plan will trigger the next steps of the protocol in coordination with any recommendations from the doctor. Not all concussion management plans will be the same and some concussion management plans may incorporate light physical exertion into the management of the injury as supported by recent concussion research.
Nobles and its representatives reserves the right to always treat all suspected injuries, including concussions and concussion precautions, conservatively, erring on the side of caution, and at the discretion of the Health Office and Office of Sports Medicine.
Step 3: Return to Academics/Academic Accommodations
The time it takes to recover from a concussion varies for each student. The general progression to return fully to academics involves moving through the Rest, Passive Learning, and Active Learning recovery stages. The CMT implements plans that include educational accommodations based on reported symptoms and in coordination with any recommendations by his/her doctor. In the early portion of this step, a school counselor will meet with the student to discuss challenges that can present themselves within a concussion recovery. Continuous communication between the CMT, parents, student, and physician allows for updated information that may necessitate changes to the academic plan during the student’s recovery.
Step 4: Return to Nobles Afternoon Program Participation
Once academically cleared (full day of school, a regular load of academic work, eligible for testing, etc.) and symptom-free the student may begin the Return to Physical Activity Progression aspect of the protocol that is managed by the athletic trainers. This step in the student’s return to their afternoon program must be accompanied with a letter/note from the overseeing physician that clears the student to do so. This may be obtained before or after the Return to Physical Activity Progression has been initiated.
The progression will consist of 5 days of supervised physical exertion that is designed to provoke symptoms if the student is still concussed. Upon successful completion (no return of symptoms ,or setbacks) and in conjunction with the written clearance from the student’s physician, concussion specialist, the student is eligible to participate fully (*including contests). A parent will finalize with an agreement (verbal or written) for her/his child to return fully to Noble’s physical activity. This step must be completed BEFORE the student is permitted to return fully to practice or competition.
*A student’s first full day of return to sport may NOT be a game or contest against an opposing school. They must complete a full and regular practice while remaining symptom-free before returning to competition.
Athletic Training
The Nobles athletic training room is a health care facility available to the entire Nobles community to receive treatment, care, and preventative assistance as well as rehabilitation for activity related injuries. The athletic trainers are responsible for providing services in an attempt to maintain the athlete’s level of competition to its highest degree.
Taping
The taping area is probably the busiest area of the training room. Each sport has equal access to this area and order is usually established by a simple first-come-first-serve basis. Occasionally, preference will be given to those athletes who need to get to a contest over those who need to get to practice if there is a tight time line.
Evaluation
Student athletes who enter the athletic training room, for either an injury evaluation or to work on returning to competition from an injury, will often times start on one of the seven tables in our evaluation and rehab area.
Injury evaluations take place after all teams have been taped and prepared for practices and games. This is to ensure that proper time can be taken without interruptions. Emergency cases will always take top priority.
Sports Medicine
Nobles’ Sports Medicine Department believes in a philosophy of compassionate care for all its student athletes.
The Office of Sports Medicine is comprised of the director of sports medicine as well as one full-time athletic trainer, and various part-time/per diem athletic trainers who help cover the schools various on-campus events. All athletic trainers are nationally certified and licensed by the Massachusetts Board of Professional Licensure. The certified athletic trainers work under the supervision of the school’s team physician as well as affiliated orthopedic practices. The mission of the Office of Sports Medicine is to provide the highest quality care to the entire Noble and Greenough School community.
The sports medicine staff will work closely with the coaching, strength and conditioning, and outside medical staff to provide an appropriate treatment and rehabilitation plan for every student athlete who requests our assistance. Effective communication between the Office of Sports Medicine, student athlete, coaching staff, parents and outside medical providers allows the student to be returned to activity as quickly and safely as possible.
We are committed to providing medical coverage to participants in the athletic and afternoon programs under the following domains as established by the National Athletic Training Association (NATA) and Board of Certification (BOC):
Injury/Illness Prevention and Wellness Protection
Educating participants and managing risk for safe performance and function.
Clinical Evaluation and Diagnosis
Implementing standard evaluation techniques and formulating a clinical impression for the determination of a course of action.
Immediate and Emergency Care
Employing standard care procedures and communicating outcomes for efficient and appropriate care of the injured.
Treatment and Rehabilitation
Reconditioning participants for optimal performance and function.
Organizational and Professional Health and Well-being
Understanding and adhering to approved organizational and professional practices and guidelines to ensure individual and organizational well-being.
Sports Medicine Relationships
Nobles is proud to have built affiliate relationships with two of the top hospitals in the country: Boston Children’s Hospital and Massachusetts General Hospital. In the event of an emergency or need of an office visit due to a lingering injury, the Nobles’ Office of Sports Medicine will work with the appropriate physician to assist you with getting an appointment as soon as possible – often within 24 hours.
If rehabilitation is necessary the sports medicine staff will work closely with the physicians and outside medical team to support you through your recovery.
