This policy sets out the way in which the School manages concussion. It covers the background to the School’s approach, how concussion is managed, and the medical assessments required to follow the protocols.
Drawing on the School’s experience of managing concussion, parents are strongly encouraged to opt into the Medical Membership described 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 relates only to rugby. Although the most common activity in which students are concussed at school is sport, many cases of concussion arise from general activity around the school and in students’ day-to-day lives off the sports pitch.
Unlike physical injuries, concussion is not always an obvious ailment to diagnose, nor to assess when cleared. The guidelines therefore advise a conservative return to activity, comprising a two-week rest period, followed by a minimum of an eight-day graduated return to activity, before a full return 24 days after the concussion. An assessment by a doctor must be carried out after the two-week rest period, and again before the full return to activity.
Management
Owing to the more complex nature of the concussion management process, the School uses a third-party concussion management database run by the medical consultancy Return2Play. All students are added to the system when they join the School. This allows the School to record a concussion and then to monitor and manage the student’s return to activity. Notes from the medical appointments are added to the system at each stage and are required in order to move the student through each stage of recovery. This ensures that all students follow the safe and recommended process. When a concussion is added, or its status is changed, an email is triggered to the student’s parents as well as to key staff in the School. The concussion is also shown on the team sheet system, so that a student who is not fit to play cannot be selected in error.
The School covers the cost of adding all students to the monitoring system.
Medical Assessments Required to Return Students to Activity
The medical assessments required after two weeks, and before the return to activity on the 24th day, may be provided by a student’s GP. The majority of parents, however, opt into a service provided by the School’s medical consultants, Return2Play. The annual cost of this service is £35 per year, when opted for now, with the cost being placed on the first school bill. This subscription provides Medical Membership of Return2Play and covers as many appointments as are required to return a student to activity. Parents may also book an appointment immediately after a suspected concussion has been added, in order to discuss the recovery process with the doctor. The system uses online appointments, which work extremely well, allowing them to take place during the evenings – and thus for parents to attend – as well as during the school day.
This arrangement allows easy access to specialist doctors who understand the concussion return guidelines.
The School strongly recommends opting into this service, as it broadly works well and the initial appointment also covers detailed education about concussion and the correct return to activity with a specialist in the field. Please note that the School has, in recent years, experienced difficulty in asking GPs to carry out the required assessments following a suspected concussion. GPs may not view guideline-compliance appointments as emergencies, which can sometimes lead to delays in obtaining appointments and in the student’s return to activity. The School also has regular contact with the Return2Play team, which allows it to advise the doctors of the specific activities that may be carried out at school, so that the correct graduated return to play guidance can be given.
Opting In
Parents who wish a student to opt into Medical Membership of Return2Play from September (£35 per year, placed on the school bill) are asked to indicate their choice via the School. Where membership is requested, the amount will be charged to the school bill, and the student will be kept registered as a medical member on an ongoing basis.
The School strongly recommends and encourages parents to opt into the Return2Play Medical Membership. Where parents choose not to opt into this cover, an injured student will still be required to follow the same pathway; however, parents will then be required to arrange the medical assessments themselves and to provide the School with evidence that these have been undertaken before the student returns to activity.
Any questions may be directed to Mr Yetman (sjhy@rgsg.co.uk).
Frequently Asked Questions
The following questions have been raised by parents in the past and may be of interest.
1. If a student is concussed out of school, can this be logged on the Return2Play system?
Yes. All concussions should be logged, irrespective of the venue or of whether the activity was school-related. Parents are able to log into the system at https://www.return2play.org.uk/, and this will automatically advise staff at the School. Usernames default to the parental email addresses registered with the School, with initial passwords being set on first use.
2. If there is no test for concussion, how do staff diagnose it?
Where a student is involved in an incident that can cause a concussion, combined with the signs and symptoms of concussion, there is a fair suspicion that a concussion is likely. In the case of concussion, suspicion equates to diagnosis.
3. A student seems fine a few days after the suspected concussion. Why can they not return to activity straight away?
The Concussion Guidelines exist because there is no test available either to diagnose a concussion or to show when it has cleared. For this reason, rest followed by a graduated return to activity is the only safe way to return to activity. The RFU leads the way in concussion education, and further information for parents about concussion is available at http://www.englandrugbyfiles.com/concussion/courses/parents/.
4. What concussion education does the School provide for students?
All students watch the RFU Headcase video, located at https://www.englandrugby.com/participation/playing/headcase, with students in the Fourth Form and above completing the online player training module at http://www.englandrugbyfiles.com/concussion/courses/players/. Students registered as Return2Play Medical Members receive further education at the appointment following their two-week rest period.
5. A student does not play in a rugby team, so is it worth obtaining medical membership for them?
Although the greatest number of concussions relate to rugby, concussions can be sustained in all sports and also in many day-to-day activities around the school. All students follow the concussion management guidelines irrespective of cause, and so, for ease, the School recommends that all students register as Medical Members of Return2Play.
6. A student is already registered on the Return2Play system by their rugby club. Is it necessary 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 student’s return to activity.
7. If a student is not joined as a Medical Member of Return2Play and is concussed, can they still see the Return2Play doctor for assessments?
Yes. The assessments may be booked via the Return2Play doctor. The cost depends on the specific doctor and is likely to be approximately £120 plus VAT.
8. Are students without medical membership of Return2Play treated differently from those who have it at the time of the concussion incident?
No. All students 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 student to activity, rather than the medical care itself.
9. If parents have private medical insurance, why would this additional service be needed?
The Return2Play medical membership provides the medical assessments required to meet the requirements of the concussion guidelines. These are conveniently carried out in school or online.
10. Will a student’s GP be able to provide the appointments required to return them to activity?
GPs are able to provide the appointments, although some have indicated that 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, with extensive knowledge of the guidelines and of the injury, and they will issue the graduated return-to-activity programme that the School can use. If a doctor has questions about specific school activities, they have direct contact with the School. An appointment may also be booked as soon as a suspected concussion has been added to the system, in order to discuss the student’s best route to recovery.
12. What data does the School send to Return2Play?
In order to create accounts and to send emails to parents and students, parental names and email addresses are sent to Return2Play. Student name, email address and date of birth are also sent. Where a student is not joined as a Medical Member, parents will not receive any communication from Return2Play apart from the concussion notification emails, nor will any other data be used.
13. How does the School ensure that any data sent to Return2Play is secure?
As with all third-party providers, the School has a data agreement with Return2Play that has been scrutinised and approved by the School’s IT Department. Full details of the Return2Play service, together with the terms & conditions and privacy policy, can be found at www.return2play.org.uk. The School’s privacy notice can be found on the School website at www.rgsg.co.uk.
Concussion – RGS Guildford’s Position Statement and Return2Play Details
At RGS Guildford, student welfare, both on and off the sports field, is taken extremely seriously. Following thorough research into the issue, the School has a comprehensive policy to ensure that, if a student sustains a concussion at school or while representing the School in a fixture, they receive the appropriate management. The School meticulously follows 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 concussions can also occur in other sports and, indeed, outside of sport. In fact, 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 injuries are managed properly, it also shows that everyone needs to have some knowledge of this area.
How the Return2Play Online System Supports Gold-Standard Care
- Live injury register. A live register of all students’ current fitness to play sport is accessible to staff. This ensures that an injured player is not put at risk of being played. The register also allows the School to track current injuries and to audit previous injuries.
- Injury logged. As soon as a player’s concussion has been logged onto the system, Return2Play automatically sends a notification to every team that the student plays for, as well as to key staff within the School and any additional recipients that the parents choose to add. Return2Play also issues medical advice regarding warning signs to look out for and explains the recovery guidelines.
- Two weeks’ rest. The player must first complete a mandatory two-week rest period. During this period, the Return2Play system can be used to record symptoms and to check that the player is making a good recovery. This information is passed to the doctor, so that they have as much information as possible about the injury.
- Medical assessment. An appointment may be booked for the student at a local clinic run by one of Return2Play’s approved sports-friendly doctors. For maximum convenience, webcam clinics are available in the evenings.
- Graduated Return to Play (GRTP). If the doctor is satisfied, they will approve the student to start the GRTP phase of recovery. During this phase, Return2Play issues advice on how the player can gradually build up the level of exercise and contact to which they are exposed.
- 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.
- Return to sport. If the doctor is satisfied that a full recovery has been made, they will issue a certificate through the system. This is then automatically sent to everyone who has an interest in the player, so that the student can return to playing, safe in the knowledge that they have received the gold-standard level of care.
The School recommends that students become Medical Members of the Return2Play Concussion Management Scheme. In recent years, the School has found it increasingly difficult to obtain the relevant assessments for sports concussion protocols outside this scheme.