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Emergency Medical Services

Name:

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Health Car

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fessional

Name:

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School Staff Available During Practice

Name:

Phone:

School Staff Available During Games

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Phone:

IMPORT

ANT PHONE NUMBERS

DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

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These signs and symptoms may indicate that a concussion

has occurred.

SIGNS AND SYMPTOMS*

Signs Observed by

Coaching Staff

Appears dazed

or stunned

Is confused about

assignment

Forgets plays

Is unsure of game, score,

or opponent

Moves clumsily

Answers questions slowly

Loses consciousness

Shows behavior or

personality changes

Can’t recall events

prior to hit

Can’t recall events after hit

Symptoms Reported

by Athlete

Headache

Nausea

Balance problems

or dizziness

Double or fuzzy vision

Sensitivity to

light or noise

Feeling sluggish

Feeling foggy

or groggy

Concentration or

memory problems

Confusion

*Adapted from: Lovell MR, Collins MW, Iverson GL, Johnston KM, Bradley JP.

Grade 1 or “ding” concussions in high school athletes. The American Journal of

Sports Medicine 2004;32(1):47–54.

If you suspect that a player has a concussion, you should

take the following steps:

1. Remove athlete from play.

2. Ensure athlete is evaluated by an appropriate

health care professional. Do not try to judge the

seriousness of the injury yourself.

3. Inform athlete’s parents or guardians about the

known or possible concussion

and give them the

fact sheet on concussion.

4. Allow athlete to return

to play only with permission

from an appropriate health care professional.

ACTION PLAN

February 2005