Mus Pre-Participation Medical History Form - 2016-2017 (Page 5 of 8) in pdf

CONCUSSION

INFORMATION SHEET

FOR STUDENT-ATHLETES & PARENTS/LEGAL GUARDIANS

(Adapted from CDC “Heads Up Concussion in Youth Sports”)

Public Chapter 148, effective January 1, 2014, requires that school and community organizations sponsoring youth athletic

activities establish guidelines to inform and educate coaches, youth athletes and other adults involved in youth athletics

about the nature, risk and symptoms of concussion/head injury.

Read and keep this page.

A concussion is a type of traumatic brain injury that changes the way the brain normally works. A concussion is caused by

a bump, blow or jolt to the head or body that causes the head and brain to move rapidly back and forth. Even a “ding,”

“getting your bell rung” or what seems to be a mild bump or blow to the head can be serious.

Did You Know?

• Most concussions occur without loss of consciousness.

• Athletes who have, at any point in their lives, had a concussion have an increased risk for another concussion.

• Young children and teens are more likely to get a concussion and take longer to recover than adults.

WHAT ARE THE SIGNS AND SYMPTOMS OF CONCUSSION?

Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days or weeks

after the injury.

If an athlete reports one or more symptoms of

concussion listed below after a bump, blow or jolt to

the head or body, s/he should be kept out of play the

day of the injury and until a health care provider says

s/he is symptom-free and it’s OK to return to play.

SYMPTOMS REPORTED BY ATHLETES

SIGNS OBSERVED BY COACHING STAFF

Headache or “pressure” in head

Appears dazed or stunned

Is confused about assignment or position

Nausea or vomiting

Forgets an instruction

Balance problems or dizziness

Is unsure of game, score or opponent

Double or blurry vision

Moves clumsily

Sensitivity to light

Answers questions slowly

Sensitivity to noise

Loses consciousness, even briefly

Feeling sluggish, hazy, foggy or groggy

Shows mood, behavior or personality changes

Concentration or memory problems

Can’t recall events prior to hit or fall

Confusion

Can’t recall events after hit or fall

Just not “feeling right” or “feeling down”

Mus Pre-Participation Medical History Form - 2016-2017 Page 5

Related Articles

Related forms

Related Categories