Massachusetts - Concussion/head injuries: Policy requirement

Area: 
Policy Or Plan Requirements
Policy Type: 
regulation; statute
Summary: 

State law addresses concussions/return to play.

Code of Massachusetts Regulations 105 CMR 201.010: Exclusion from Play

(A) Any student, who during a practice or competition, sustains a head injury or suspected concussion, or exhibits signs and symptoms of a concussion, or loses consciousness, even briefly, shall be removed from the practice or competition immediately and may not return to the practice or competition that day.

(B) The student shall not return to practice or competition unless and until the student provides medical clearance and authorization as specified in 105 CMR 201.011.

(C) The coach shall communicate the nature of the injury directly to the parent in person or by phone immediately after the practice or competition in which a student has been removed from play for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness. The coach also must provide this information to the parent in writing, whether paper or electronic format, by the end of the next business day.

(D) The coach or his or her designee shall communicate, by the end of the next business day, with the Athletic Director and school nurse that the student has been removed from practice or competition for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness.

(E) Each student who is removed from practice or competition and subsequently diagnosed with a concussion shall have a written graduated reentry plan for return to full academic and extracurricular athletic activities.

  • (1) The plan shall be developed by the student’s teachers, the student’s guidance counselor, school nurse, licensed athletic trainer if on staff, neuropsychologist if available or involved, parent, members of the building-based student support and assistance team or individualized education program team as appropriate and in consultation with the student’s primary care provider or the physician who made the diagnosis or who is managing the student’s recovery.

  • (2) The written plan shall include instructions for students, parents and school personnel, addressing but not be limited to:

    • (a) Physical and cognitive rest as appropriate;

    • (b) Graduated return to extracurricular athletic activities and classroom studies as appropriate, including accommodations or modifications as needed;

    • (c) Estimated time intervals for resumption of activities;

    • (d) Frequency of assessments, as appropriate, by the school nurse,school physician, team physician, licensed athletic trainer if on staff, or neuropsychologist if available until full return to classroom activities and extracurricular athletic activities are authorized; and

    • (e) A plan for communication and coordination between and among school personnel and between the school, the parent, and the student’s primary care provider or the physician who made the diagnosis or who is managing the student’s recovery.

  • (3) The student diagnosed with a concussion must be completely symptom free at rest in order to begin graduated reentry to extracurricular athletic activities. The student must be symptom free at rest, during exertion, and with cognitive activity in order to complete the graduated re-entry plan and be medically cleared to play under 105 CMR 201.011.


General Laws of Massachusetts Chapter 111. Section 222: Interscholastic athletic head injury safety training program

(c) If a student participating in an extracurricular athletic activity becomes unconscious during a practice or competition, the student shall not return to the practice or competition during which the student became unconscious or participate in any extracurricular athletic activity until the student provides written authorization for such participation, from a licensed physician, licensed neurophychologist, certified athletic trainer or other appropriately trained or licensed health care professional as determined by the department of public health, to the school's athletic director.

If a student suffers a concussion as diagnosed by a medical professional, or is suspected to have suffered a concussion while participating in an extracurricular athletic activity, the student shall not return to the practice or competition during which the student suffered, or is suspected to have suffered, a concussion and shall not participate in any extracurricular athletic activity until the student provides written authorization for such participation, from a licensed physician, licensed neuropsychologist, certified athletic trainer or other appropriately trained or licensed health care professional as determined by the department of public health, to the school’s athletic director.

(d) A coach, trainer or volunteer for an extracurricular athletic activity shall not encourage or permit a student participating in the activity to engage in any unreasonably dangerous athletic technique that unnecessarily endangers the health of a student, including using a helmet or any other sports equipment as a weapon.
General Court of the Commonwealth of Massachusetts


Code of Massachusetts Regulations 105 CMR 201.010: Exclusion from Play

(A) Any student, who during a practice or competition, sustains a head injury or suspected concussion, or exhibits signs and symptoms of a concussion, or loses consciousness, even briefly, shall be removed from the practice or competition immediately and may not return to the practice or competition that day.

(B) The student shall not return to practice or competition unless and until the student provides medical clearance and authorization as specified in 105 CMR 201.011.

(C) The coach shall communicate the nature of the injury directly to the parent in person or by phone immediately after the practice or competition in which a student has been removed from play for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness. The coach also must provide this information to the parent in writing, whether paper or electronic format, by the end of the next business day.

(D) The coach or his or her designee shall communicate, by the end of the next business day, with the Athletic Director and school nurse that the student has been removed from practice or competition for a head injury, suspected concussion, signs and symptoms of a concussion, or loss of consciousness.

(E) Each student who is removed from practice or competition and subsequently diagnosed with a concussion shall have a written graduated reentry plan for return to full academic and extracurricular athletic activities.

  • (1) The plan shall be developed by the student’s teachers, the student’s guidance counselor, school nurse, licensed athletic trainer if on staff, neuropsychologist if available or involved, parent, members of the building-based student support and assistance team or individualized education program team as appropriate and in consultation with the student’s primary care provider or the physician who made the diagnosis or who is managing the student’s recovery.

  • (2) The written plan shall include instructions for students, parents and school personnel, addressing but not be limited to:

    • (a) Physical and cognitive rest as appropriate;

    • (b) Graduated return to extracurricular athletic activities and classroom studies as appropriate, including accommodations or modifications as needed;

    • (c) Estimated time intervals for resumption of activities;

    • (d) Frequency of assessments, as appropriate, by the school nurse,school physician, team physician, licensed athletic trainer if on staff, or neuropsychologist if available until full return to classroom activities and extracurricular athletic activities are authorized; and

    • (e) A plan for communication and coordination between and among school personnel and between the school, the parent, and the student’s primary care provider or the physician who made the diagnosis or who is managing the student’s recovery.

  • (3) The student diagnosed with a concussion must be completely symptom free at rest in order to begin graduated reentry to extracurricular athletic activities. The student must be symptom free at rest, during exertion, and with cognitive activity in order to complete the graduated re-entry plan and be medically cleared to play under 105 CMR 201.011.


General Laws of Massachusetts Chapter 111. Section 222: Interscholastic athletic head injury safety training program

(c) If a student participating in an extracurricular athletic activity becomes unconscious during a practice or competition, the student shall not return to the practice or competition during which the student became unconscious or participate in any extracurricular athletic activity until the student provides written authorization for such participation, from a licensed physician, licensed neuropsychologist, certified athletic trainer or other appropriately trained or licensed health care professional as determined by the department of public health, to the school’s athletic director.

If a student suffers a concussion as diagnosed by a medical professional, or is suspected to have suffered a concussion while participating in an extracurricular athletic activity, the student shall not return to the practice or competition during which the student suffered, or is suspected to have suffered, a concussion and shall not participate in any extracurricular athletic activity until the student provides written authorization for such participation, from a licensed physician, licensed neuropsychologist, certified athletic trainer or other appropriately trained or licensed health care professional as determined by the department of public health, to the school's athletic director.

(d) A coach, trainer or volunteer for an extracurricular athletic activity shall not encourage or permit a student participating in the activity to engage in any unreasonably dangerous athletic technique that unnecessarily endangers the health of a student, including using a helment or any other sports equipment as a weapon.
General Court of the Commonwealth of Massachusetts


Code of Massachusetts Regulations 105 CMR 201.006: School Policies

(A) All school districts and schools must have policies and procedures governing the prevention and management of sports-related head injuries within the school district or school. The School Committee or Board of Trustees, consulting with the Board of Health where appropriate, shall adopt policies and procedures governing the prevention and management of sports-related head injuries within the school district or school following development of a proposal by a team consisting, at a minimum, of a school administrator, school nurse, school or team physician if on staff, athletic director, licensed athletic trainer if on staff, neuropsychologist if available, guidance counselor, and teacher in consultation with any existing school health/wellness advisory committee. Policies and procedures must address sports-related head injuries occurring in extracurricular athletic activities but may be applied to all head injuries in students. Review and revision of such policies and procedures shall occur as needed but at least every two years. At a minimum, these policies shall include:

  • (1) Designation, by the superintendent or head master, principal or school leader, of the person responsible for the implementation of these policies and protocols, either the Athletic Director or other school personnel with administrative authority;

  • (2) Annual training of persons specified in 105 CMR 201.007 in the prevention and recognition of a sports-related-head injury, and associated health risks including second impact syndrome utilizing Department-approved training materials or program, and documentation of each person's completion of such training;

  • (3) Documentation of physical examination prior to a student's participation in extra-curricular athletic activities on an annual basis, consistent with 105 CMR 200.100(B)(3) and information for students participating in multiple sports seasons that documentation of one physical examination each year is sufficient;

  • (4) Procedure for the school to obtain and ensure review, prior to each sports season, of current information regarding an athlete's history of head injuries and concussions using either the Department Pre-participation Head Injury/Concussion Reporting Form For Extracurricular Activities (Pre-participation Form), or school-based equivalent;

  • (5) Procedure for medical or nursing review of all Pre-participation Forms indicating a history of head injury;

  • (6) Procedure for the school to obtain and ensure timely medical or nursing review of a Department Report of a Head Injury During Sports Season Form (Report of Head Injury Form), or school-based equivalent, in the event of a head injury or suspected concussion that takes place during the extracurricular activity season;

  • (7) Procedure for reporting head injuries or suspected concussions sustained during extra-curricular athletic activities to the school nurse and licensed athletic trainer, if on staff;

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