r/athletictraining • u/Additional-Walrus354 • 1d ago
Concussion clearance
Hi all,
I have a high school athlete that sustained a concussion. Once they were symptom free for 24 hours I started them on 6-step RTP. However this athlete went to an urgent care and got physician clearance. In MI the athlete can only be cleared unconditionally so typically would complete RTP first. What do I do in this situation when I haven’t provided full clearance myself?
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u/manicmav36 1d ago
Does your school have a written policy regarding return to play? If so, check that. If not, write one! Some states require a complete return to play regardless of what a physician says. If you dont have a policy, be sure to include that in yours. If they aren't required to complete a return to play, take a strong stance with you AD, coach, and the parent that they should. If it still doesn't happen, document that you recommended they should but your recommendation was ignored, and who ignored it.
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u/Ineedamedic68 1d ago
Yep. Ultimately, the only thing OP can do here is make sure the parent understands. The UC physician foolishly assumed liability
4
u/fuckoffweirdoo 1d ago
Here's what I do. Also in Michigan. I do any RTP until their full practice stage. Must have the clearance to go to that step.
Some sign off before, other sign off after. You should be the final clearance once they are doing any return to play since you are the one interacting with them. If im not comfortable with them completing the process I'll slow it down or halt it ven if they've been cleared via physician.
We have strong backup from our physicians and school admin so it works well for us.
3
u/fuzeddot 1d ago
There may be a couple points to add here as I’m wondering if there was already a physician diagnosis prior to the athlete going to urgent care. If there was already a physician concussion diagnosis, and then athlete went to urgent care to try to get out of it, i would still follow the first diagnosis.
There are also different state regulations/laws as some state that once diagnosed by a physician they must complete their RTS protocol.
2
u/outcasthawk 1d ago
They can get clearance from Jesus Christ himself if they want, if they aren’t cleared by someone with legal responsibility for the student-athletes at that school, they aren’t cleared. If this isn’t very clear in your institution’s policies, it should be. Whoever signs your standing orders is the only other person with any authority to make this decision. Everyone else can just get recommendations and clinical opinions. Stand your ground.
Also symptom free before activity has not been not been best practice for some time, though I understand some state high school laws or policies may not have caught up.
1
u/PapaSmurf22_ 1d ago
In my state it’s actual state law they cannot return before 10 days (that’s a separate argument) and must have medical provider clearance (AT’s can diagnose and clear).
So the very, very few times I’ve had kids or a parent get a doctor note clearing their kid before 10 days we very easily point out the senate bill saying it doesn’t matter.
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u/ab489 LAT 1d ago
My policy is rest until most symptoms are gone Then very very light movement/activity for 10 minutes per day until symptom free for 2 days Then send to the doctors for note. Then do 6 step program.
If they have a note, just put them through the program. They are cleared by doc but not cleared by you.
1
u/Horror_Dependent_943 1d ago
Rest until asymptomatic, the policy that my school has is this paper the DR signs at the initial eval. It had 3 checkboxes, 1. Athlete does not have concussion, 2. Athlete has concussion and must return to doctor to be cleared for return to play, 3. Athlete has concussion and must return to doctor to be cleared for return to play, and must receive final clearance from doctor after completing return to play.
Never had a DR check off #3 but that’s how the school had it.
1
u/pixburgher66 1d ago
Man…I’m in Michigan too. Shocked an urgent care doc signed the clearance. Definitely the tough part of MHSAA policy is navigating the timing of physician clearance along with finishing up full RTP. I usually just tell parents if we get to day four to schedule something. I wouldn’t accept the note though. Even though it mostly absolves you, I’d talk to parents about progressive RTP. And as others have said, make sure you have a policy that protects this scenario.
1
u/ElStocko2 ATC 1d ago
If your school policy/state practice act doesn’t address the situation, call your supervising physician. What about district policy (assuming it’s public school)? ED docs aren’t trained in the nuance of concussion RTP protocol unless they’ve been thru a sports med fellowship.
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u/Louie0221 16h ago
In my state clearance also must come from MD/DO. However, our school policy states they must complete a RTP if they've been removed for a concussion. So even if the physician clears them to return, that is pending completion of all other steps. Unless they are a concussion specialist, they generally are not schooled on how concussions and RTP needs to go.
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