Iowa Athletic Pre-Participation Physical Examination Form Page 3
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3A FACT SHEET FOR PARENTS AND STUDENTS
HEADS UP: Concussion in High School Sports
The Iowa Legislature passed a new law, effective July 1, 2011, regarding students in grades 7 – 12 who participate in
extracurricular interscholastic activities. Please note this important information from Iowa Code Section 280.13C,
Brain Injury Policies:
(1) A child must be immediately removed from participation (practice or competition) if his/her coach or a contest offi cial observes
signs, symptoms, or behaviors consistent with a concussion or brain injury in an extracurricular interscholastic activity.
(2) A child may not participate again until a licensed health care provider trained in the evaluation and management of concussions and
other brain injuries has evaluated him/her and the student has received written clearance from that person to return to participation.
(3) Key defi nitions:
“Licensed health care provider” means a physician, physician assistant, chiropractor, advanced registered nurse
practitioner, nurse, physical therapist, or athletic trainer licensed by a board.
“Extracurricular interscholastic activity” means any extracurricular interscholastic activity, contest, or practice,
including sports, dance, or cheerleading.
What is a concussion?
Signs Reported by Students:
A concussion is a brain injury. Concussions are caused by a
• Headache or “pressure” in head
bump, blow, or jolt to the head or body. Even a “ding,” “getting
•Nausea or vomiting
your bell rung,” or what seems to be a mild bump or blow to the
•Balance problems or dizziness
head can be serious.
•Double or blurry vision
•Sensitivity to light or noise
What parents/guardians should do if they think
•Feeling sluggish, hazy, foggy, or groggy
their child has a concussion?
•Concentration or memory problems
1. OBEY THE NEW LAW.
•Confusion
a. Keep your child out of participation until s/he is cleared to
•Just not “feeling right” or is “feeling down”
return by a licensed healthcare provider.
b. Seek medical attention right away.
PARENTS:
2. Teach your child that it’s not smart to play with a concussion.
How can you help your child prevent a concussion?
3. Tell all of your child’s coaches and the student’s
Every sport is different, but there are steps your children can take
school nurse about ANY concussion.
to protect themselves from concussion and other injuries.
• Make sure they wear the right protective equipment for their
What are the signs and symptoms of a concussion?
activity. It should fi t properly, be well maintained, and be worn
You cannot see a concussion. Signs and symptoms of concussion
consistently and correctly.
can show up right after the injury or may not appear or be noticed
• Ensure that they follow their coaches’ rules for safety and the
until days after the injury. If your teen reports one or more symptoms
rules of the sport.
of concussion listed below, or if you notice the symptoms yourself,
• Encourage them to practice good sportsmanship at all times.
keep your teen out of play and seek medical attention right away.
Signs Observed by Parents or Guardians:
STUDENTS:
• Appears dazed or stunned
If you think you have a concussion:
•Is confused about assignment or position
• Tell your coaches & parents – Never ignore a bump or
•Forgets an instruction
blow to the head, even if you feel fi ne. Also, tell your coach if
•Is unsure of game, score, or opponent
you think one of your teammates might have a concussion.
•Moves clumsily
• Get a medical check-up – A physician or other licensed
•Answers questions slowly
health care provider can tell you if you have a concussion, and
•Loses consciousness (even briefl y)
when it is OK to return to play.
•Shows mood, behavior, or personality changes
• Give yourself time to heal – If you have a concussion,
•Can’t recall events prior to hit or fall
your brain needs time to heal. While your brain is healing,
•Can’t recall events after hit or fall
you are much more likely to have another concussion. It is
important to rest and not return to play until you get the OK
Information on concussions provided by the Centers for Disease
from your health care professional.
Control and Prevention.
For more information visit:
IT’S BETTER TO MISS ONE CONTEST THAN THE WHOLE SEASON.
IMPORTANT: Students participating in interscholastic athletics, cheerleading and dance; and their parents/guardians; must annually sign the acknowl-
edgement below and return it to their school. Students cannot practice or compete in those activities until this form is signed and returned.
We have received the information provided on the concussion fact sheet titled, “HEADS UP: Concussion in High School Sports.”
Student’s Signature
Date
Student’s Printed Name
Parent’s/Guardian’s Signature
Date
Student’s Grade
Student’s School
May2012-CE
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