Purpose

The purpose of this policy is to safeguard the health and well-being of Hofstra University student-athletes by establishing a comprehensive concussion safety protocol in alignment with NCAA requirements and best medical practices.

Scope

This policy applies to all Hofstra University student-athletes, coaches, and athletics staff engaged in intercollegiate athletics, as well as medical professionals responsible for the evaluation and treatment of concussions.

Definitions

Sports Medicine Staff: Team consisting of the athletics health care administrator, certified athletic trainers (ATCs), head team physician, and team physicians, each of whom has training in the diagnosis, treatment, and management of concussion.

Athletics Health Care Administrator: The individual responsible for overseeing the institution’s athletic health care administration and delivery.

Head Athletic Trainer: The certified athletic trainer (ATC) in a leadership role among the various ATCs, serving as liaison between ATCs and the athletics health care administrator.

Certified Athletic Trainer (ATC): A health care professional who collaborates with team physicians to provide prevention, emergency care, clinical diagnosis, therapeutic intervention, and rehabilitation of injuries and medical conditions. ATCs work under the direction of team physicians as prescribed by state licensure statutes.

Head Team Physician: The team physician in a leadership role among the various team physicians, with final authority on all clinical judgments regarding student-athletes.

Team Physician: An M.D. or D.O. in good standing with an unrestricted license to practice medicine, possessing fundamental knowledge of on-field medical emergency care, trained in CPR and AED use, and with working knowledge of musculoskeletal injuries, medical conditions, and psychological issues affecting athletes.

Student-Athlete: A participant in an organized, competitive, varsity sport sponsored by the educational institution in which the student is enrolled.

Coach: An athletic instructor or trainer who supervises the student-athlete during participation in organized competitive sport, including head coaches, assistant coaches, strength and conditioning coaches, and managers.

Concussion: A subset of traumatic brain injury; a change in brain function following a force to the head or body, which may or may not be accompanied by temporary loss of consciousness, identified in awake individuals with measures of neurologic and cognitive dysfunction.

Traumatic Brain Injury (TBI): An alteration in brain function, or other evidence of brain pathology, caused by an external force.

Policy

Hofstra University takes the health and well-being of student-athletes very seriously. In developing this Concussion Safety Protocol, the University reviewed the requirements of NCAA Bylaws 3.2.4.18 and 3.2.4.18.1 and the Concussion Safety Protocol Checklist distributed by the NCAA Sport Science Institute. This protocol protects student-athlete health and well-being and provides the Department of Athletics Sports Medicine staff with the authority and professional discretion to act in the best interests of the student-athlete.

Traumatic brain injuries, including concussions, are inherently unpredictable and can occur despite best practices. When concussions occur, this Protocol provides a plan that protects the student-athlete and grants unquestioned authority to the Sports Medicine staff to diagnose and treat. The Protocol also recognizes the importance of a graduated return-to-learn and return-to-play process.

Preseason Education

Hofstra will distribute NCAA Concussion Safety materials annually to student-athletes, coaches, team physicians, athletic trainers, Health and Safety Committee members, educators, and the Director of Athletics. All parties will sign an acknowledgement confirming they have read and understood the materials. All acknowledgement forms will be stored for no less than seven years and will be available for review upon request by an authorized party.

The Sports Medicine staff will provide student-athletes with the NCAA Sports Science Institute Concussion Safety fact sheet and the NCAA Concussion Safety Video for Student-Athletes. After review, student-athletes will have an opportunity to ask questions and will be asked to sign the Sports Medicine Responsibility for Reporting Injuries and Illness Form and Informed Consent (Attachments B and C).

Coaches will receive the NCAA Concussion Safety: What Coaches Need to Know fact sheet. The ATC and coaches will sign an acknowledgement form after coaches have had the opportunity to ask questions and seek clarification.

In addition, all student-athletes and coaches will receive annual education regarding concussions in sport, including a review of this Protocol and updates on diagnosis and management. Education topics for coaches include:

• The rationale behind current concussion management guidelines, including prevention of catastrophic injury, prolonged post-concussive symptoms, compounding injury from additional head trauma, and potential long-term sequelae such as chronic traumatic encephalopathy.

• Recognition of the signs and symptoms of concussion.

• The requirement that any student-athlete exhibiting signs or symptoms of concussion be immediately removed from practice or play and evaluated by the Sports Medicine staff.

• The requirement that any student-athlete suspected of or diagnosed with a concussion be withheld from participation for the remainder of that day.

• The Hofstra University evaluation process for traumatic brain injuries.

• The Hofstra University return-to-play progression and decision-making process.

Pre-Participation Assessment

Each Hofstra varsity student-athlete will receive a pre-participation baseline concussion assessment using the Sport Concussion Assessment Tool – 6th Edition (SCAT6) prior to participating in practice or competition. The assessment includes a brain injury and concussion history, symptom evaluation, cognitive assessment, balance evaluation, and physician determination of clearance or need for additional consultation.

Should a student-athlete sustain a concussion, the team physician, in consultation with the head team physician and athletics health care administrator, will determine on a case-by-case basis whether a new baseline assessment should be conducted at six months or beyond. Special consideration will be given to athletes with a complicated or multiple concussion history.

Recognition and Diagnosis of Concussion

For every NCAA varsity competition, a member of the Sports Medicine staff will be present—defined as on site at the campus or arena of competition—for the following contact and collision sports: basketball, field hockey, lacrosse, soccer, and wrestling. For every NCAA varsity practice in these sports, a member of the Sports Medicine staff will be available—defined as immediately reachable by telephone, messaging, email, or other immediate communication means, with the ability to arrange for prompt evaluation.

Signs that warrant immediate removal from the field include actual or suspected loss of consciousness, seizure, tonic posturing, ataxia, poor balance, confusion, behavioral changes, and amnesia. The Sports Medicine staff will be allowed adequate time (up to 10–15 minutes) to conduct a multimodal screen using the SCAT6.

Any student-athlete identified with signs, symptoms, or behaviors consistent with concussion will be immediately removed from practice or competition. The initial evaluation will use the SCAT6 and include a symptom assessment, physical and neurological exam, cognitive assessment, balance exam, and clinical assessment for spinal trauma, skull fracture, and intracranial bleed. If a concussion is confirmed, the student-athlete will be removed from practice or play for the remainder of that calendar day and will not return without full clearance from a team physician.

Post-Concussion Management

Student-athletes requiring immediate transport for advanced medical care include those with a Glasgow Coma Scale below 13 on initial assessment, or below 15 at two or more hours post-assessment, and those experiencing prolonged loss of consciousness, focal neurological deficits, repetitive emesis, persistently diminished or worsening mental status, other neurological signs or symptoms, or spine injury. These situations are managed under the Sports Medicine Emergency Action Plan (Attachment I).

Immediate removal from play and assessment for possible transport to a local hospital or trauma center is required when any of the following are present:

• Neck pain or tenderness.

• Seizure or convulsion.

• Double vision.

• Loss of consciousness.

• Weakness or tingling/burning in more than one arm or in the legs.

• Deteriorating conscious state.

• Vomiting.

• Severe or increasing headache.

• Increasingly restless, agitated, or combative behavior; Glasgow Coma Scale score below 15.

• Visible deformity of the skull.

Any student-athlete diagnosed with a concussion will follow up with their athletic trainer on a daily basis for serial reassessment using the SCAT6 Symptom Evaluation. The student-athlete will be evaluated by a team physician as soon as reasonably possible to develop a treatment plan, with regular follow-up to modify the plan as needed.

Any student-athlete with a known or suspected concussion will undergo at least one additional serial evaluation before being released to a responsible adult, who will be asked to remain with the student-athlete for 6–12 hours and to report any red flags—including confusion, increasing headache, excessive drowsiness, or other concerning symptoms—to the Sports Medicine staff. The student-athlete and responsible adult are required to read and sign the Sports Medicine Concussion Instructions (Attachment A).

A team physician will evaluate any student-athlete with atypical presentation, persistent symptoms, or prolonged recovery (defined as greater than two weeks) to consider additional diagnoses and management options, which may include post-concussive syndrome, sleep dysfunction, migraine or other headache disorders, mood disorders such as anxiety and depression, or ocular or vestibular dysfunction.

Return-to-Play Protocol

Before clearance for return to play, a student-athlete must complete a stepwise progression managed by a team physician, following the SCAT6 Return-to-Play management plan. Each step must be completed without worsening or new symptoms, and only one stage may be completed per calendar day. If symptoms worsen, the athlete returns to the previous step. The six stages are:

1. Symptom-limited activity – Daily activities that do not provoke symptoms, aimed at gradual reintroduction of academic and daily tasks.

2. Light aerobic exercise – Walking or stationary cycling at slow to medium pace; no resistance training. Goal: increase heart rate.

3. Sport-specific exercise – Running or skating drills; no head impact activities. Goal: add movement.

4. Non-contact training drills – Harder training drills such as passing; may begin progressive resistance training. Goal: exercise, coordination, and increased cognitive demand.

5. Full contact practice – Following medical clearance, normal training activities. Goal: restore confidence and allow coaching staff to assess functional skills.

6. Return to play – Normal game play.

Prior to Stage 5, the student-athlete must meet with the athletics health care administrator, head team physician, or a predetermined team physician designee for clearance before resuming full contact practice.

Return-to-Learn

Once a student-athlete is diagnosed with a concussion, the head athletic trainer will serve as the point person within the Athletics Department to navigate return-to-learn, with direction from the athletics health care administrator and head team physician. The head athletic trainer will contact the associate dean for the Center for University Advising, who will notify the student-athlete’s instructors of possible absences and needed accommodations.

Key requirements of the return-to-learn process include:

• No classroom activity on the same day a concussion is sustained.

• The student-athlete should remain at home or in their residence hall if unable to tolerate light cognitive activity.

• A gradual return to classroom participation once the student-athlete can tolerate 30–45 minutes of cognitive activity without return of symptoms.

• For classes longer than 60 minutes, the associate dean will communicate with the professor to arrange appropriate breaks.

• Successful return to full classroom and academic activity is required before the student-athlete may begin the return-to-play protocol.

• Academic adjustments and accommodations will be discontinued once the return-to-play protocol is complete.

Academic modifications may remain in place for up to two weeks. If symptoms persist beyond two weeks, the athletics health care administrator or head team physician will convene a multidisciplinary team that may include the athletics health care administrator, head team physician, team physicians, certified athletic trainers, coaches, a psychologist, a neuropsychologist, a faculty athletic representative, an academic counselor, and the director of Hofstra University’s Student Access Services Office or designee.

Concussion and mild traumatic brain injury are covered under the Americans with Disabilities Act Amendments Act of 2008 (ADAAA). The Student Access Services Office is the campus office responsible for providing disability services and will take an active role in complex or prolonged return-to-learn cases.

Reducing Exposure to Head Trauma

Hofstra University takes a safety-first approach to all sports and maintains a comprehensive head-exposure reduction management plan. Practice activities are conducted in compliance with NCAA rules, monitored by the Office of NCAA Education and Compliance Services. All certified athletic trainers and coaches are CPR and AED certified and receive annual updates on student-athlete health and safety. Hofstra purchases and reconditions certified protective equipment in accordance with NOCSAE standards.

The University provides ongoing education to coaches and student-athletes on safe play, proper technique, and removing the head from contact. Hofstra adheres to the NCAA Inter-Association Consensus: Independent Medical Care for College Student-Athletes Best Practices and aims to reduce gratuitous contact across all sports.

The University’s Health and Safety Committee, appointed by the Office of Student Affairs, conducts an annual review of the Health and Safety Program and this Concussion Safety Protocol. The committee includes university administrators, athletic administrators, the athletics health care administrator, head team physician, head athletic trainer, coaches, student-athletes, faculty athletic representative, academic advisors, and legal counsel.

Administrative Compliance

Hofstra University submits the Concussion Safety Protocol with Emergency Action Plan to the NCAA annually, accompanied by a written certificate of compliance signed by the athletics health care administrator or school representative. The Sports Medicine staff and Department of Athletics will review and update this Protocol annually based on current best practices and updated NCAA guidance.

The Hofstra Sports Medicine staff maintains the highest standards of record keeping and provides data to the NCAA’s Sports Science Institute through Athletic Trainer Systems (ATS), the electronic medical records system currently in use.

This Protocol is consistent with the return-to-play guidelines described in Section IX(A) of the Settlement Agreement dated November 18, 2019, in In re: National Collegiate Athletic Association Student-Athlete Concussion Injury Litigation (Arrington).

Related Policies and References

Hofstra Sports Medicine

Concussion Safety Protocol and Attachments