Implementing a Concussion Protocol in Campus Recreation – with no AT’s involved

February 16, 2017

Jason J. Linsenmeyer, PhD

Oklahoma State University

Assistant Director of Recreation Programs

Recent reports from professional, collegiate, and high school sports regarding concussions are alarming. These reports and discussions held at conferences led the Rec Sports Program to begin conversations with their Health Services professionals on ways to help students at Oklahoma State University (OSU).

I did not know our Director of University Health Services (UHS) prior to the conversations about concussions.  I sent him a message with my concerns for students participating in intramural and sport clubs, and he indicated he shared my mind-set about protecting students, and if needed, helping them return to participate.

In an initial meeting, the Director of UHS and two of his doctors were present and we discussed the possibilities.  Everyone in this meeting agreed that there was a need, and that we should proceed in finding a way to help those students who exhibit signs of a concussion.  The director and his doctors went to work on this by reaching out to colleagues and others in the health services profession.  Initial drafts were formed for the concussion protocol and edits made along the way.  In my experience the staff at UHS has been more than willing to help and assist in implementing the protocol.  This model may work at your school if you have similar resources available.

The relationship formed led to UHS staff attending our student staff trainings and providing further insight in potential concussions.  This relationship has also led to the Director of UHS and I submitting and being accepted to present on our concussion protocol at the American College Health Association (ACHA) conference during late May in Austin, Texas.

Developing our Concussion Protocol

Partnering with Health Services, the Department of Wellness at OSU implemented a concussion protocol for intramural and sport club programs in the spring of 2015, designed to help individuals who may have sustained a concussion to resume active participation.

Note that our concussion protocols do not involve Athletic Trainers.

One of the main goals in developing the concussion protocol was to keep the process clear and simple by organizing into 3 steps: Recognize, Remove & Report, Return.

Step 1: Recognize the signs.
If an on-site supervisor observes any signs listed on our ‘Concussion Recognition Cards’ (e.g. appears dazed or confused, unsure of game, cannot recall events, etc.) then for his/her safety, that individual will be removed from all intramural and sport club participation.   No arguments!

Step 2: Remove the individual, report the incident.
Once the individual is removed from the game, he/she is not permitted to participate until he/she has received a signed return-to play-form from his/her medical care provider. The on-site supervisor fills out the front sheet of the concussion packet with information about the injury and documents any signs or symptoms he/she observed. The injured participate is notified that he/she is not eligible to participate in any intramural or sport club related events until the medical care provider has completed and signed the return to play form. In the event of unconsciousness or other severe signs or symptoms, emergency medical services is notified immediately.

The incident report is filed and the participant is ‘red-flagged’ in the system. Red flag is removed when ‘return to play’ permission received.

Step 3: Return to play.
Once the injured participant provides a copy of the return to play form signed by his/her medical care provider, his/her IM League status will be changed from ineligible due to concussion protocol to eligible to play. The return to play form has no confidential or personal health care information listed; therefore, this form is kept on file.

The importance of student training

OSU provides on-site supervisors at all intramural events, home sport club games, and some club practices, hence effective training of student supervisors on the new concussion protocol is vital. Part of our training program incorporates online trainings provided through the National Federation of State High School Association (NFHS:, which provides two free online training courses on concussions (‘Concussion in Sports’ and ‘Concussion for Students’). Both training modules are approx. one hour in length, and attendees receive a certificate of completion. Anyone can create an account with NFHS – then sign in and download the trainings.

Concussion training is mandatory and required for all on-site supervisors before they are eligible to work. (CPR/AED and first aid certifications are also required). Health Services professionals at OSU also attend these trainings to help student staff better understand the importance of this protocol.

Training Logistics

The staff concussion training program is split into two parts. The first part involves a review of the concussion recognition cards and the UHS concussion protocol.  Using these cards, the signs observed and the symptoms that may be reported by the injured participant are discussed.  Also, each page of the UHS concussion protocol is discussed.

The second part of the training is participation in the ‘Concussion in Sports’ NFHS course.  Currently, the entire staff views this training as one body and discusses issues that may arise concerning our program.

The training program is provided at the beginning of each semester.  After the training has concluded, all supervisors are expected to read and sign a ‘concussion signature form’. For sport clubs, we address concussions each semester through a meeting to discuss our protocol and procedures.  Starting this semester (Spring 2017) all clubs had to read and sign the concussion form following our overview of our concussion protocol.


In the fall of 2016, eight individuals were removed from play as a result of the new concussion protocol. Five of these individuals were participating in intramural flag football and the other three were involved in sport clubs (rugby and volleyball). While some claimed that they felt fine and wanted to continue playing in the game, all could appreciate that the concern for their health and safety was the top priority. All students were cleared by their medical care providers to participate again – but each with a varying timeframe.

The Rec Sports Program at OSU will continue to seek improved ways to keep our students safe while participating in intramural and sport club events.


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