Concussion Management
This page explains how we manage concussion at the School. There are sections on background, management and the medical assessments required to follow the protocols.
From our experience, we highly recommend that you opt into the Medical Membership offered below at a cost of £35 per year. The service has worked extremely well and feedback from staff and parents who have used it has been overwhelmingly positive.
Background
Several years ago, the School adopted the Sport and Recreation Alliance guidelines for the treatment of concussion in education settings. The guidelines are supported by the major sporting governing bodies as well as numerous respected medical groups, including the Royal College of Emergency Medicine and the Society of British Neurological Surgeons.
It is a common misconception that concussion is only related to rugby. Although the most common activity to be concussed in at school is sport, we see many cases of concussion from general activity around the school and in pupils’ day-to-day lives off the sports pitch.
Unlike physical injuries, concussion is not always obvious to diagnose or to assess when cleared. The guidelines therefore advise a conservative return to activity, including a 2-week rest period, followed by a minimum 8-day graduated return to activity before a full return 24 days after the concussion. An assessment by a doctor is required after the 2-week rest period and again before the full return to activity.
Management
Due to the complex nature of concussion management, we use a third-party database run by the medical consultancy Return2Play. All pupils are added to the system when they join the School. This allows us to log a concussion and then monitor and manage the pupil’s return to activity. Notes from medical appointments are added at each stage and are required to move the pupil through each stage of recovery, ensuring all pupils follow the safe, recommended process. When a concussion is added or the status is changed, an email is triggered to the pupil’s parents and to key staff. The concussion is also shown on our team sheet system, so a pupil who is not fit to play cannot be selected in error.
We cover the cost of adding all pupils to the monitoring system.
Medical Assessments Required to Return Pupils to Activity
The medical assessments required after 2 weeks, and before the return to activity on the 24th day, can be provided by your GP. However, the majority of parents opt into the service provided by our medical consultants, Return2Play. The annual cost of this service is £35 per year, when opted for now, with the cost placed on the first school bill. This subscription provides Medical Membership of Return2Play and covers as many appointments as are needed to return a pupil to activity. You can also book an appointment immediately after a suspected concussion has been added, to talk through the recovery process with the doctor. Online appointments work extremely well, allowing them to take place during the evenings so parents can attend, as well as during the school day.
This gives easy access to specialist doctors who understand the concussion return guidelines.
We highly recommend opting into this service, as the initial appointment also covers detailed education about concussion and the correct return to activity with a specialist in the field.
Please note, we have had difficulty in recent years asking GPs to carry out the required assessments following a suspected concussion. GPs may not view guideline compliance appointments as emergencies, which can lead to delays in getting appointments and returning pupils to activity. We also have regular contact with the Return2Play team, which allows us to advise the doctors of specific activities carried out at school, so the correct graduated return to play guidance can be given.
Action
Please indicate below if you would like your child to opt into Medical Membership with Return2Play from September (£35 per year – placed on the school bill).
If requested, this amount will be charged to the school bill and we will keep you registered as a medical member on an ongoing basis.
As a school, we strongly recommend and encourage parents to opt in to the Return2Play Medical Membership. If you choose not to opt in, your child will still have to follow the same pathway if injured, but you will be required to arrange medical assessments yourself and provide the School with evidence that these have been undertaken before your child returns to activity.
If you have any questions, please get in touch with Mr Yetman (sjhy@rgsg.co.uk).
FAQs
These frequently asked questions have been raised by parents in the past, so may be of interest.
1. If my child is concussed out of school, can I log this on the Return2Play system?
Yes, all concussions should be logged, regardless of the venue or whether the activity was school-related. Parents can log into the system at https://www.return2play.org.uk/, which automatically advises staff at the School. Usernames default to the parental email addresses registered with the School, with initial passwords set on first use.
2. If there is no test for concussion, how do staff diagnose it?
If a pupil is involved in an incident that can cause a concussion, combined with signs and symptoms of concussion, we have a fair suspicion that a concussion is likely. In the case of concussion, suspicion equates to diagnosis.
3. My child seems fine a few days after the suspected concussion. Why can’t they return to activity straight away?
The Concussion Guidelines exist because there is no test available to diagnose a concussion or to show when one has cleared. For this reason, rest followed by a graduated return to activity is the only safe way to return. The RFU lead the way in concussion education and further information for parents is available here: http://www.englandrugbyfiles.com/concussion/courses/parents/
4. What education will you provide for my child about concussion?
All pupils watch the RFU Headcase Video: https://www.englandrugby.com/participation/playing/headcase. Pupils in the Fourth Form and above also complete the online player training module: http://www.englandrugbyfiles.com/concussion/courses/players/. Pupils registered as Return2Play Medical Members receive further education at the appointment after their 2-week rest period.
5. My child doesn’t play in a rugby team, so is it worth getting medical membership?
Although our greatest number of concussions relate to rugby, concussions can occur in all sports and in many day-to-day activities around the school. All pupils follow the concussion management guidelines regardless of cause, so for your ease we recommend that all pupils register as Medical Members of Return2Play.
6. My child is already registered on the Return2Play system by their rugby club. Do we need to register again?
Return2Play is being used by an increasing number of clubs. Only one account is required, as all registered organisations can access the information about a linked pupil’s return to activity.
7. If I don’t join my child as a Medical Member of Return2Play and they get concussed, can they still see the Return2Play doctor for assessments?
Yes, you can book the assessments via the Return2Play doctor. The cost depends on the specific doctor and is likely to be about £120 plus VAT.
8. Are pupils without medical membership of Return2Play treated differently from those who have it at the time of the concussion incident?
No, all pupils receive the same first aid and immediate medical care at the time of any suspected concussion. The Return2Play medical membership covers the medical assessments required to return a pupil to activity, rather than the medical care.
9. We have private medical insurance, so why would we need this additional service?
The Return2Play medical membership provides the medical assessments to meet the requirements of the concussion guidelines. These are conveniently done in school or by video call.
10. Will my GP be able to provide the appointments required to return my child to activity?
GPs are able to provide the appointments, although some have indicated they are not familiar with the return to activity guidelines. They may charge to write the letter or note required by the School to update the system. Some practices are not willing to provide the two appointments required by the guidelines.
11. Why is the Medical Membership of Return2Play a benefit?
The appointments take place in school or online. The doctors are experienced in managing concussions, have extensive knowledge of the guidelines and the injury, and will issue the graduated return to activity programme that the School can use. If the doctor has questions about specific school activities, they have direct contact with the School. You can also have an appointment as soon as a suspected concussion has been added to the system, to discuss your child’s best route to recovery.
12. What data do you send to Return2Play?
To create accounts and send emails to parents and pupils, parental names and email addresses are sent to Return2Play. Pupil name, email address and date of birth are also sent. If you do not join your child as a Medical Member, you will not receive any communication from Return2Play apart from the concussion notification emails, nor will any other data be used.
13. How do you ensure that any data sent to Return2Play is secure?
As with all third-party providers, we have a data agreement with them that has been scrutinised and approved by our IT Department. Full details of the Return2Play service, as well as terms & conditions and privacy policy, can be found at www.return2play.org.uk. The School’s privacy agreement can be found on the School website at www.rgsg.co.uk.
Concussion — RGS Guildford’s Position Statement & Return2Play Details
At RGS Guildford, pupil welfare, both on and off the sports field, is taken extremely seriously. After thorough research into the issue, we have a comprehensive policy to ensure that if a pupil sustains a concussion at school, or while representing the School in a fixture, they receive the appropriate management. We meticulously follow cross-sport guidelines on the return to play process after a concussion, including the requirement of assessment by a doctor and the undertaking of the Graduated Return to Play process.
While there is good awareness of concussion in sports such as rugby, it is becoming increasingly apparent that they can also occur in other sports and, indeed, outside of sport. Data from the Royal College of Emergency Medicine suggests that children under 12 are more likely to sustain a concussion in the playground than on the sports field. While this hopefully reassures parents that sport is safe, particularly when we manage injuries properly, it also shows that we all need to have some knowledge of the area.
How the Return2Play Online System Helps Us Provide Gold Standard Care
1. Live injury register
A live register of all our pupils’ current fitness to play sport is accessible to staff. This allows us to ensure that, if injured, a player is not put at risk of being played. The register also allows us to track current injuries and audit previous injuries.
2. Injury logged
As soon as a player’s concussion has been logged onto the system, Return2Play automatically sends a notification to every team that your child plays for, as well as key staff within the School and any additional recipients that you choose to add. Return2Play will also issue you with medical advice regarding warning signs to look out for and explain the recovery guidelines.
3. Two weeks rest
The player must first have a mandatory two-week rest period. During this period, the Return2Play system can be used to record symptoms and check that a player is making a good recovery. This information is passed on to the doctor, so they have as much information as possible about your child’s injury.
4. Medical assessment
You can book an appointment for your child at a local clinic run by one of Return2Play’s approved sports-friendly doctors. For maximum convenience, there are webcam clinics available in the evenings.
5. Graduated Return To Play (GRTP)
If the doctor is happy, they will approve your child to start the GRTP phase of recovery. During this phase, Return2Play will issue advice on how the player can gradually build up the level of exercise and contact they are exposed to.
6. Final medical assessment
Before any player can be declared safe to return to full contact play, they must first be assessed by the doctor again.
7. Return to sport
If the doctor is satisfied that a full recovery has been made, they will issue a certificate through the system, which is then automatically sent to everyone who has an interest in the player, so they can get back to playing safe in the knowledge that they have received the gold standard level of care.
The School recommends that pupils become Medical Members of the Return2Play Concussion Management Scheme. We have found it increasingly difficult to obtain the relevant assessments for sports concussion protocols outside of this scheme in recent years.