Suspected Concussion in Seventh-Grade Basketball: Immediate Action and Return to Play
During a seventh-grade basketball unit, a student, Jordan, collides with another player while rebounding and falls, hitting the back of his head on the floor. He is awake and answers your questions but says he has a headache, feels a little dizzy, and wants to keep playing because it is just a bump. He has no visible bleeding, but you notice he is slower to respond and says the lights seem bright. The gym has 34 students, one other teacher is supervising the far side, and your school athletic trainer is at the high school. The district concussion policy requires removal from play when a concussion is suspected, notification of the school nurse and parent or guardian, and a written return-to-play clearance. Jordan's mother is at work and her phone goes to voicemail. The class has 15 minutes left before the bell.
1. What are your immediate actions in the next five minutes, and why is when in doubt, sit them out the correct standard here?
Read the worked answer
My first action is to stop the activity and remove Jordan from play. He has a headache, dizziness, and light sensitivity after a head impact, so a concussion must be suspected. I would not let him shake it off or return to the game, even though he wants to. I would keep him with me or another adult, not send him alone, and check for red flags: loss of consciousness, vomiting, worsening headache, confusion, seizure, unequal pupils, slurred speech, weakness, or unusual behavior. If any red flag appears, I would call 911. If not, I would have him sit in a quiet, supervised area and notify the school nurse and administrator. I would call his mother and document the time and attempts; if I could not reach her, I would follow the school emergency contact list. When in doubt, sit them out is the correct standard because a second impact before recovery can cause severe, sometimes fatal, brain swelling, and because PE staff cannot reliably rule out a concussion. My role is not to diagnose; it is to protect the student and hand off to the nurse and medical provider.
2. How do you manage the rest of the class and the supervision and liability concerns while caring for Jordan?
Read the worked answer
The rest of the class still needs supervision, and Jordan cannot be left alone. I would use the second teacher on the far side: signal or radio that I have an injury and need coverage, stop the class with a freeze signal, and move students to a seated area away from the incident. I would not send a student alone across the building for help; I would use the classroom phone or radio, or send two students together if that is the school protocol. I would keep Jordan in my line of sight while managing the class, or have the other teacher take the class while I stay with him. If I were alone with 34 students, I would call the office first and keep the class in a designated safe area rather than continue play. After the nurse or administrator arrives, I would complete an incident report while details are fresh: time, mechanism, symptoms, who was notified, and what was done. Liability is reduced by following the district concussion policy, documenting actions, and not making medical clearance decisions myself.
3. Describe the communication and documentation steps, and explain the return-to-learn and return-to-play progression you would require before Jordan rejoins PE.
Read the worked answer
I would notify the school nurse, the administrator, and the parent or guardian the same day, using the school incident form and concussion checklist. I would describe only what I observed, such as the impact, headache, dizziness, and light sensitivity, not a diagnosis. Before Jordan returns to PE, I would require written clearance from a health care provider and the school nurse's confirmation, consistent with district policy. Return is gradual: first return to learn, then light aerobic activity, then sport-specific non-contact activity, then full participation, with monitoring for symptom recurrence at each step. In PE, I would temporarily avoid contact, heading, and high-intensity drills, provide rest breaks and water, and check in with Jordan and the nurse. If symptoms return, he stops and the protocol resets. I would document the clearance and any accommodations, keep the information confidential, and communicate with the family about what to expect. The teacher's job is to follow the plan, not to clear the student.