HEADS UP: IHSAA Concussion Management

Concussion Management

Iowa Code Section 280.13C states, in part,

2c. Emergency medical care provider means the same as defined in section 147A.1.

2d. Extracurricular interscholastic activity means any dance or cheerleading activity or extracurricular interscholastic activity, contest, or practice governed by the Iowa High School Athletic Association or Iowa Girls High Athletic Union

2e. Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or licensed athletic trainer licensed by a board designated under section 147.13.

4b. For school years beginning on or after July 1, 2018, each school district and nonpublic school shall provide to the parent or guardian of each student in grades seven through twelve, a concussion and brain information sheet as provided by the Department of Public Health, Iowa High School Athletic Association and Iowa Girls High School Athletic Union. The student and student’s parent or guardian shall sign and return a copy of the concussion and brain injury information sheet to the student’s school prior to the student’s participation in any extracurricular interscholastic activity.

5a. If a student’s coach, contest official, or licensed health care provider, or an emergency medical provider observes signs, symptoms, or behaviors consistent with a concussion or brain injury in an extracurricular interscholastic activity, the student shall be immediately removed for participation.

5b. A student who has been removed from participation shall not recommence such participation in any dance or cheerleading activity, or activity, contest, or practice governed by the Iowa High School Athletic Association or Iowa Girls High Athletic Union until the student has been evaluated by a licensed health care provider trained in the evaluation and management of concussions and other brain injuries and the student has received written clearance to return to or commence participation from the licensed health care provider.

IHSAA & IGHSAU Recommended Protocol

When a Student Has Sustained a Concussion or other Brain Injury

as Defined in Iowa Code Section 280.13C

1. No student shall return to play/competition or practice (RTP) on the same day s/he sustained a concussion or brain
2. A licensed health care provider as defined in Iowa Code Section 13C should evaluate a student suspected of having a concussion or brain injury on the same day the injury occurs.
3. After receiving medical clearance by a licensed health care provider as defined in Iowa Code Section 280.13C, RTP shall follow a stepwise protocol with provisions for delayed RTP based upon the return of any signs or
4. Education of contest officials, school coaches and other appropriate school personnel, contestants, parents, and licensed health care
   • The Iowa High School Athletic Association and Iowa Girls High School Athletic Union will provide educational materials related to concussions and brain injuries developed by the CDC and other organizations knowledgeable about concussions. 

5. Removing students who exhibit signs, symptoms, & behaviors of a concussion or brain injury from participation, and their return to
   • Coach Removal – If the student’s coach observes signs, symptoms, or behaviors consistent with a concussion or brain injury, during any kind of participation, i.e. practices, scrimmages, contests, etc., the student shall be immediately removed from participation and shall not return until the school’s designated representative receives written clearance to return from a licensed health care provider as defined in Iowa Code 13C.

• • Contest Official Removal – If a contest official observes signs, symptoms, or behaviors consistent with a concussion or brain injury, during scrimmages, contests, etc., the student shall be immediately removed from participation and a designated contest official at the contest/event must receive the written clearance to return from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in that contest/event, including an event that takes place over multiple days.
  • Before allowing a student who has been exhibiting signs, symptoms, & behaviors of a concussion to return to participation (practice and/or competition), licensed health care providers as defined in Iowa Code 280.13C shall follow the return to participation protocol as provided in Chapter 54 of the Iowa Administrative Code.

6. At events where the Iowa High School Athletic Association or Iowa Girls High School Athletic Union have provided licensed health care providers as defined in Iowa Code 280.13C, those licensed health care providers have final authority regarding RTP when a student has exhibited signs, symptoms, and behaviors consistent with a concussion.

Concussion or Other Brain Injury Return-To-Play Protocol

The Public Health Department hereby adopts new Chapter 54, “Concussion or Other Brain Injury Return-to-Play Protocol,” Iowa Administrative Code. These rules are intended to implement Iowa Code section 280.13C.

641—54.2(280) Definitions. For the purpose of these rules, the following definitions shall apply.

“Asymptomatic” means the student is no longer showing signs, symptoms, or behaviors consistent with a concussion or other brain injury.

“Contest” means an interscholastic athletic game or competition.

“Extracurricular interscholastic activity” means any dance or cheerleading activity or extracurricular interscholastic activity, contest, or practice governed by the Iowa High School Athletic Association or the Iowa Girls High School Athletic Union that is a contact or limited contact activity as identified by the American Academy of Pediatrics.

“Licensed health care provider” means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board designated under Iowa Code section 147.13.

“Medical clearance” means written clearance from a licensed health care provider releasing the student following a concussion or other brain injury to return to or commence participation in any extracurricular interscholastic activity.

“Rest” means a recovery state at which physical and cognitive activities are reduced or removed with the intent to eliminate the signs, symptoms, or behaviors of brain injury.

“Return-to-learn plan” means the plan developed by personnel of a school district or accredited nonpublic school based on guidance developed as required under Iowa Code section 280.13C(6)“b” to provide adjustments or accommodations as the student returns to the classroom.

“Return-to-play” means the gradual, step-wise approach to returning a student to participation in any extracurricular interscholastic activity following a concussion or other brain injury.

641—54.3(280) Return-to-play protocol. The following return-to-play step-wise process shall begin when the student who has been removed from participation in any extracurricular interscholastic activity governed by the Iowa High School Athletic Association or the Iowa Girls High School Athletic Union is no longer showing signs, symptoms, or behaviors consistent with a concussion or other brain injury for a minimum of 24 hours and has received written medical clearance from a licensed health care provider to return to or commence such participation.

54.3(1) Return-to-play process. Each step shall take a minimum of 24 hours.

If the student shows signs, symptoms, or behaviors consistent with a concussion or other brain injury at any step of the return-to-play protocol, the student must stop the activity and the student’s licensed health care provider and parent or guardian shall be contacted.

If the student shows signs, symptoms, or behaviors consistent with a concussion or other brain injury during this process, an additional 24-hour period of rest shall take After the 24-hour period of rest, the student shall drop back to the previous level when the student showed no signs, symptoms, or behaviors consistent with a concussion or other brain injury and begin the progression again.

• Step 1: Athlete has received written medical clearance from a licensed health care provider to begin the return-to-play process, AND the athlete is back to regular activities, including school, without experiencing any concussion signs, symptoms, or behaviors for a minimum of 24 hours.
• Step 2: Low impact, light aerobic exercise. Walking or stationary cycling at slow to medium pace. No resistance/weight training.
• Step 3: Basic exercise, such as running in the gym or on the field. No helmet or other equipment.
• Step 4: Noncontact, sport-specific training drills (dribbling, ball handling, batting, fielding, running drills) in full equipment. Resistance/weight training may begin.
• Step 5: Full contact practice and participation in normal training activities.
• Step 6: Contest participation.

Application of Iowa Code Section 280.13C

By Sport

Coach Removal

When a student’s coach removes a student from any kind of participation due to observing signs, symptoms, or behaviors consistent with a concussion or brain injury the student shall not return until designated school personnel have received written clearance to return from a licensed health care provider as defined in Iowa Code 280.13C.

Contest Official Removal

(Information below is only listed for sports where contest officials have jurisdiction; therefore, not all sports are listed.

When an official removes a student from participation, the following procedures are used:

Fall Sports

• Cross Country:
  • If a contest official removes a student with signs, symptoms, or behaviors consistent with a concussion or brain injury from participation, the contest referee must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in the meet.
    • As long as the meet is in progress, the written clearance to return shall be presented to the referee and the referee shall determine the student’s return to competition.
• Football:
  • If a contest official removes a student with signs, symptoms, or behaviors consistent with a concussion or brain injury from participation, the contest referee must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in that contest/event.
    • If the contest is in progress, the written clearance to return shall be presented to the referee during a time when the clock is stopped.
    • If the event is between contests, i.e. between lower level and varsity contests, the written clearance to return may be presented to the referee before the next contest begins.
• Swimming & Diving:
  • If a contest official removes a student with signs, symptoms, or behaviors consistent with a concussion or brain injury from participation, the contest referee must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in that contest/event.
    • If the event is in progress, the written clearance to return shall be presented to the referee after a race has finished and before the next race has begun.
    • If the contest is between events, i.e. between lower level and varsity contests, the written clearance to return may be presented to the referee before the next event begins.
    • For multiple day events when the contest referee may not be the same throughout the entire event, the contest referee on the day the student was removed will make a verbal report about the injury to the tournament manager. The tournament manager will be responsible to report the incident to the referee(s) of the contest(s) in which the student may participate on subsequent days of the event. The referee(s) of future contests during this event must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation.
• Volleyball:
  • If a contest official removes a student with signs, symptoms, or behaviors consistent with a concussion or brain injury from participation, the contest referee must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in that contest/event.
  • If the contest is in progress, the written clearance to return shall be presented to the referee during a dead ball situation
  • If the event is between contests, i.e. between lower level and varsity contests, the written clearance to return may be presented to the referee before the next contest begins.
  • For multiple day events, i.e. conference tournament, when the contest referee will not be the same throughout the entire event, the contest referee on the day the student was removed will make a verbal report about the injury to the tournament manager. The tournament manager will be responsible to report the incident to the referee(s) of the contest(s) in which the student may participate on subsequent days of the event. The referee(s) of future contests during this event must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation.

Winter Sports

• Basketball:
  • If a contest official removes a student with signs, symptoms, or behaviors consistent with a concussion or brain injury from participation, the contest referee must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in that contest/event.
    • If the contest is in progress, the written clearance to return shall be presented to the referee during a time when the clock is stopped.
    • If the event is between contests, i.e. between lower level and varsity contests, the written clearance to return may be presented to the referee before the next contest begins.
    • For multiple day events, i.e. conference tournament, when the contest referee will not be the same throughout the entire event, the contest referee on the day the student was removed will make a verbal report about the injury to the tournament manager. The tournament manager will be responsible to report the incident to the referee(s) of the contest(s) in which the student may participate on subsequent days of the event. The referee(s) of future contests during this event must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation.
• Swimming:
  • If a contest official removes a student with signs, symptoms, or behaviors consistent with a concussion or brain injury from participation, the contest referee must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in that contest/event.
    • If the event is in progress, the written clearance to return shall be presented to the referee after a race has finished and before the next race has begun.
    • If the contest is between events, i.e. between lower level and varsity contests, the written clearance to return may be presented to the referee before the next event begins.
    • For multiple day events when the contest referee may not be the same throughout the entire event, the contest referee on the day the student was removed will make a verbal report about the injury to the tournament manager. The tournament manager will be responsible to report the incident to the referee(s) of the contest(s) in which the student may participate on subsequent days of the event. The referee(s) of future contests during this event must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation.
• Wrestling:
  • If a contest official removes a student with signs, symptoms, or behaviors consistent with a concussion or brain injury from participation, the head contest referee, or his/her designee, must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in that contest/event.
    • For dual meets, clearance to return shall be presented to the head contest referee before the match resumes. Injury time is NOT extended for a student with signs, symptoms, or behaviors consistent with a concussion or brain injury.
    • For one-day events when the head contest referee may change during the event (multi-dual meets & tournaments), written clearance to return shall be presented to the head contest referee, or his/her designee, before the student participates again that day. The designee may be the host administrator, head event official, designated on-site licensed medical professional, etc. The student’s coach, or other school-designated representative, is responsible for providing the written clearance to return to head contest referee, or his/her designee. The head contest referee, or designee, will then notify the other contest officials that written clearance to return has been received.
    • For multiple day events when the head contest referee may change during the event, the head contest referee on the day the student was removed will make a verbal report about the injury to the tournament manager. The tournament manager will be responsible to report the incident to the referee(s) of the contest(s) in which the student may participate on subsequent days of the event. The referee(s) of future contests during this event must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation.

Spring and Summer Sports

• Baseball/Softball:
  • If a contest official removes a student with signs, symptoms, or behaviors consistent with a concussion or brain injury from participation, the umpire- in-chief must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in that contest/event.
    • If the contest is in progress, the written clearance to return shall be presented to the umpire-in-chief during an opportunity for a legal substitution.
    • For one-day events when the umpire-in-chief may change during the event (local high school tournaments), written clearance to return shall be presented to the umpire-in-chief, or his his/her designee, before the student participates again that day. The designee may be the host administrator, designated on-site licensed medical professional, etc. The student’s coach, or other school-designated representative, is responsible for providing the written clearance to return to the umpire-in-chief, or his/her designee. The umpire-in-chief, or his/her designee, will then notify the other contest umpires that written clearance to return has been received.
  • For multiple day events when the umpire-in-chief may change during the event, for example the state tournament, the umpire-in-chief on the day the student was removed will make a verbal report about the injury to the tournament manager. The tournament manager will be responsible to report the incident to the umpire-in-chief(s) of the contest(s) in which the student may participate on the subsequent days of the event. The umpire- in-chief(s) of future contests during this event must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation.
• Soccer:
  • If a contest official removes a student with signs, symptoms, or behaviors consistent with a concussion or brain injury from participation, the contest referee must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in that contest/event.
    • If the contest is in progress, the written clearance to return shall be presented to the referee during an opportunity for a legal substitution. For those contests using a three-person crew, the center official shall be designated as the head referee. The center official will need to receive the written clearance for return to play. For those contests using a two-person crew, one official shall be required to be the head referee. The head referee in the two-person crew shall be responsible for receiving the written clearance.
    • For one day events when the head contest referee may change during the event (local high school Saturday tournaments), written clearance to return shall be presented to the head contest referee, or his his/her designee, before the student participates again that day. The designee may be the host administrator, head event official, designated on-site licensed medical professional, etc. The student’s coach, or other school-designated representative, is responsible for providing the written clearance to return to the head contest referee, or his/her designee. The head contest referee, or his/her designee, will then notify the other contest officials that written clearance to return has been received.
    • For multiple day events when the head contest referee may change during the event, for example the state tournament, the head contest referee on the day the student was removed will make a verbal report about the injury to the tournament manager. The tournament manager will be responsible to report the incident to the referee(s) of the contest(s) in which the student may participate on the subsequent days of the event. The referee(s) of future contests during this event must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation.
• Track and Field:
  • If a contest official removes a student with signs, symptoms, or behaviors consistent with a concussion or brain injury from participation, the contest referee must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation in the meet.
    • As long as the meet is in progress, the written clearance to return shall be presented to the referee and the referee shall determine the student’s return to competition.
    • For multiple day events when the contest referee may not be the same throughout the entire meet, the contest referee on the day the student was removed will make a verbal report about the injury to the tournament manager. The tournament manager will be responsible to report the incident to the referee(s) of the contest(s) in which the student may participate on subsequent days of the meet. The referee(s) of future contests during this meet must receive written clearance from a licensed health care provider as defined in Iowa Code 280.13C before the student can return to participation.

Record Keeping

Health records, such as written clearance to return to participation, should become part of a student’s cumulative fil kept by the school.