Suspected Concussion in Flag Football
You teach 9th-grade PE. During a flag-football unit, 28 students are playing on a field with two games. Student R. collides with another player, falls, and hits the back of the head on the turf. R. gets up slowly, says 'I just got my bell rung,' and wants to keep playing because it is the last 10 minutes and R. is a starting quarterback. You observe R. holding the side of the head, squinting, and saying the field 'looks fuzzy'; R. also says he feels nauseated. There is no athletic trainer on site. The school has a concussion policy: any student suspected of a concussion is removed from play, evaluated by a health care provider, and may return only with written clearance. R.'s parent is not answering the phone; the emergency contact is an aunt. The other student is fine. The class has 10 minutes left and the next class is waiting.
1. What should you do in the first five minutes, and what should you avoid?
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Remove R. from play immediately and keep him supervised. Do not accept 'I'm fine' or 'bell rung' as clearance. Check responsiveness, breathing, and obvious bleeding; ask simple orientation questions and observe for worsening headache, repeated vomiting, drowsiness, confusion, seizure, unequal pupils, or weakness. If any red flag is present, call 911. If a neck injury is possible, do not move him unless he is in danger. Call the school nurse and office, keep the other 27 students supervised by a second adult or move them away, and do not let R. drive or walk home alone. Avoid giving painkillers, telling him to 'shake it off,' or letting him return to the last 10 minutes. The immediate decision is not return-to-play; it is removal, monitoring, and escalation. Document the time and symptoms while they are fresh.
2. How do you handle return-to-play and return-to-learn given the school policy and the missing parent?
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The school policy requires written clearance from a licensed health care provider before any return to PE or sports. That means no same-day return, no partial participation, and no verbal 'he's okay' from a coach or parent. Ask the office to keep calling the parent and the emergency-contact aunt; if no guardian can be reached and R. needs evaluation, the school administrator should arrange transport according to district policy. Send written information home about the suspected concussion and the return-to-learn steps. Return-to-learn usually comes before return-to-play: reduced screens, rest breaks, and gradual academic load, coordinated by the nurse and counselor. In PE, provide a quiet alternative assignment until clearance. Do not accept a note that says only 'may return to sports' without a provider's evaluation; follow the district form. The judgment is to resist pressure from the student, the next class, and the game situation.
3. What preventive and instructional changes would you make for the rest of the flag-football unit, and how do you teach students to report symptoms?
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Change the game before the next class: no blocking or screening at the line, a two-second rule for pulling flags, a speed limit in the secondary, and separation between games. Teach and practice safe tagging rather than collisions; check the field for hazards and set boundaries away from walls or goals. Increase supervision by splitting the class into smaller games with student referees who enforce the no-contact rule. Teach symptom reporting explicitly: 'If you hit your head, feel foggy, have a headache, or feel sick, tell the teacher and sit down; you will not lose points for reporting.' Use a buddy check and a posted concussion protocol. Avoid claiming that a rule change eliminates risk. The instructional aim is to normalize reporting and reduce high-risk contact, not to diagnose or to 'toughen up' students.