Head Injury Protocol
In December of 2015, US Soccer released information about their Recognize to Recover Campaign. In that initial information, US Soccer’s Concussion Initiative Guidelines outlined recommendations for soccer organizations as well as describing what the protocols for the US Soccer Developmental Academy would be with regards to head injuries. In January of 2017, California State Law AB-2007 took effect, which outlines several steps that youth sports organizations need to take with regards to head injuries and concussions protocol for their players.
NorCal Premier will be following US Soccer and the State of California’s lead with regards to our Head Injury Prevention and Treatment Guidelines. In cases where we can, we will be following the same rules that are in place for the US Developmental Academy, and in all other cases we will be strongly encouraging clubs to take an active lead in the safety of their players.
In the spring of 2016, NorCal implemented the following:
- a no heading policy for all U11 and younger age groups
- a “no re-entry” policy for players who are removed from a game due to a suspected head injury
- a change to the NPL substitution rules to allow for the evaluation of head injuries
In the Spring of 2017, NorCal implemented the following:
- Updated Concussion Policy for all NorCal Member Clubs
- Club policy certification program
- Club policy audit program
- Recording of all head injuries during NorCal games
- Changes to PDP head injury protocol
Updated Concussion Policy
On September 23, 2016, the California Governor signed AB-2007 (“New Law”) which expanded to any youth sports organization a current law on concussion protocols that had previously applied only to high school athletic programs. The New Law, which went into effect January 1, 2017, outlines several steps that athletic programs need to take with regards to head injuries and concussion protocol for the players in its athletic programs. Any youth sports organization in the State of California that elects to offer an athletic program in one of the sports listed in the New Law shall comply with all of the following:
- An athlete who is suspected of sustaining a concussion or other head injury in an athletic activity shall be immediately removed from the athletic activity for the remainder of the day, and shall not be permitted to return to any athletic activity until he or she is evaluated by a licensed health care provider. The athlete shall not be permitted to return to athletic activity until he or she receives written clearance to return to athletic activity from a licensed health care provider. If the licensed health care provider determines that the athlete sustained a concussion or other head injury, the athlete shall also complete a graduated return-to-play protocol of no less than seven days in duration under the supervision of a licensed health care provider.
- If an athlete who is 17 years of age or younger has been removed from athletic activity due to a suspected concussion, the youth sports organization shall notify a parent or guardian of that athlete of the time and date of the injury, the symptoms observed, and any treatment provided to that athlete for the injury.
- On a yearly basis, the youth sports organization shall give a concussion and head injury information sheet to each athlete. The information sheet shall be signed and returned by the athlete and, if the athlete is 17 years of age or younger, shall also be signed by the athlete’s parent or guardian, before the athlete initiates practice or competition. The information sheet may be sent and returned through an electronic medium including, but not necessarily limited to, fax or electronic mail.
- At a minimum these materials shall include:
- Head injuries and their potential consequences
- The signs and symptoms of a concussion
- Best practices for removal of an athlete from an athletic activity after a suspected concussion
- Steps for returning an athlete to school and athletic activity after a concussion
- At a minimum these materials shall include:
- On a yearly basis, the youth sports organization shall offer concussion and head injury education, or related educational materials, or both, to each coach and administrator of the youth sports organization.
- Each coach and administrator shall be required to successfully complete the concussion and head injury education offered pursuant to paragraph (4) at least once, either online or in person, before supervising an athlete in an activity of the youth sports organization.
- The youth sports organization shall identify both of the following:
- Procedures to ensure compliance with the requirements for providing concussion and head injury education and a concussion and head injury information sheet, as contained in paragraphs (3) to (5), inclusive.
- Procedures to ensure compliance with the athlete removal provisions and the return-to-play protocol required pursuant to paragraph (1).
Responsibility of Clubs
Each NorCal club is ultimately responsible for their player’s health and safety, and should have a clear action plan in the case of all injuries. US Soccer has laid out clear guidelines for clubs, along with resources (listed below), clubs who fail to act in the best interests of their players health and safety will be ultimately liable for their actions. It is the strong recommendation of US Soccer and NorCal Premier that all clubs read the US Soccer Guidelines and ensure their club has clear action plans in place to protect players. Clubs and Coaches will bear the liability for the safety of their players and need to have clear policies and protocols in place for the handling of all injuries. Below we have provided resources for clubs to ensure that coaches are properly trained in how to recognize the signs of a concussion as well as execute a return to play procedure that will ensure that players are ready to return to competition.
Each member club shall implement its own club policy consistent with the following provision and comply with such provisions:
- A club player that is suspected of sustaining a concussion or other head injury in any training session or game (“athletic activity”) shall immediately be removed from the athletic activity and shall not be permitted to return to any athletic activity until he or she is evaluated by a licensed health care provider and receives written clearance to return to athletic activity from the health care provider (“Written Clearance”).
- If the licensed health care provider determines that the player sustained a concussion or other head injury, the player shall also complete a graduated return-to-play protocol of no less than seven days in duration under the supervision of a licensed health care provider.
The club shall notify the parent of any player who is 17 years of age or younger who has been removed from an athletic activity due to a suspected concussion or other head injury by providing to the parent a fully completed Parent Notification Form (“Notification Form”). The Notification Form shall include the time and date of the injury, the symptoms observed and any treatment provided to the player due to the injury.
- Each year at the start of the playing season, the club shall provide to each player a concussion and the Head Injury Information Sheet (“Information Sheet”). The club must receive back from the player and parent (if the player is 17 years of age or younger) a signed copy of the Information Sheet before the player is permitted to participate in any athletic activity.
- The club must offer to all club coaches and administrators on a continual basis and at the club’s expense the concussion training program as identified by NorCal Premier (“Training Program”). Each club coach and administrator must successfully complete the Training Program at least one before being allowed coach or other supervise any athletic activity.
Each club must maintain all necessary records in order to demonstrate its compliance with all aspects of the Concussion Policy (as amended) including without limitation all Parent Notification Forms, Written Clearances, Information Sheets and confirmation of completed Training Programs (“Policy Records”). Policy Records must be maintained by the club for a period of no less than five years. Notwithstanding the foregoing, any Policy Records pertaining to an individual player must be maintained by the club so long as the player is a member of that club. A club determined by NorCal not to be in compliance with this Concussion Policy (as amended) may be subject to disciplinary actions which may include but is not limited to the following: [suspension of club administrators or coaches, or suspension of the club and its players from NorCal-sponsored leagues and tournaments.]
Club Compliance Certification
No later than August 20th of each year, the President of each member club must sign and return to NorCal Premier the Compliance Certification form indicating the member club is in full compliance with all requirements of the Concussion Policy (as amended).
Club Compliance Audit
Each year NorCal will select a limited number of member clubs at random to audit their compliance with this Concussion Policy. Each member club shall cooperate with such audit and provide NorCal with access to applicable club records and documents.
Record of Head Injuries in NorCal Games
Starting with the spring 2017 season, NorCal will require all referees of NorCal-sponsored league or tournament game to report any suspected concussion or other head injury that occurs during the game. NorCal will use this information to notify the player’s club that a head injury was reported by the game referee. This referee notification is intended as a back-up check to try and ensure all suspected concussion or other head injuries are handled in accordance with this Concussion Policy. A club that has received notification of a suspected concussion or head injury directly from a coach, other club administrator, referee or parent should immediately begin compliance with the requirements of its own Club Concussion Policy as set forth above and should not wait for the referee notification to be forwarded from NorCal.
NorCal will require all PDP coaches to undergo the Training Program unless such PDP coach can demonstrate he or she has already completed the Training Program within the preceding twelve (12) months. If a suspected concussion or other head injury occurs at a PDP athletic activity and a trainer is not available to assess the player, the PDP staff will initiate the following action plan:
- The player will be immediately removed from the athletic activity and not allowed to return to play and shall not be permitted to return to any athletic activity until he or she is evaluated by a licensed health care provider and receives written clearance to return to athletic activity from the health care provider. The injured player shall also be instructed to provide the written clearance to return to play from the licensed health care provider to the player’s club.
- The coach who witnesses the incident will fill out the NorCal Head Injury Incident Report and provide a copy to the PDP Executive Admin and the PDP Director
- The PDP Executive Admin will complete a Parent Notification Form and send it to the player’s parent(s) and club officials.
- All PDP Policy Record will be kept for a period of no less than 5 years. Notwithstanding the foregoing, any Policy Records pertaining to an individual player must be maintained by NorCal so long as the player is a member of the PDP program.
- PDP will deliver an Information Sheet to each PDP player. PDP must receive back from the player and parent (if the player is 17 years of age or younger) a signed copy of the Information Sheet before the player is permitted to participate in any PDP athletic activity.
U11 No Heading Rule
To ensure that NorCal Premier is in line with the latest recommendation, we will be implementing a no heading rule for all U11 (2005 birth year this spring) and younger players. NorCal Premier will also recommend that all clubs follow the US Soccer guidelines on heading in younger age groups.
For all players 10 and younger there should be no heading in training or games. For players 11-13 years of age heading training should be limited to a maximum of 30 minutes per week with no more than 15-20 headers per player, per week.
Heading Game Rule:
When a player deliberately heads the ball in a game, an indirect free kick (IFK) should be awarded to the opposing team from the spot of the offense. If the deliberate header occurs within the goal area (6 yard box), the indirect free kick should be taken on the goal area line parallel to the goal line at the point nearest to where the infringement occurred. If a player does not deliberately head the ball, then play should continue.
No Re-Entry Protocol
In accordance with the US Soccer return to play guidelines, any player removed from the field for a suspected head injury will not be allowed to return to the field of play unless cleared by a Healthcare Professional. In practice this will mean that any player for whom a coach is called onto the field will have to leave the field and will not be allowed to return unless they are evaluated and cleared by a Certified Healthcare Professional.
Health Care Professionals:
US Soccer defines a Healthcare Professional as “a licensed health care professional such as an athletic trainer certified (ATC), or a physician (MD/DO), with a skill set in emergency care and sports medicine injuries and with knowledge and experience related to concussion evaluation and management.” It will be up to each club to decide whether they will provide a health care professional at their matches, and to ensure that their health care professional has the correct certifications to be evaluating players for head trauma. If a club plans to use a health care professional to evaluate suspected head injuries during a NorCal match, the health care professional must be presented to the referee prior to the start of the match.
*Referees will not allow the re-entry of players removed from the field of play for suspected head injuries unless they are informed of the presence of, and meet with a healthcare professional prior to the start of the match.
NPL Substitution Rule Change
NorCal Premier will amend the substitution rules in the National Premier League to mirror the change in rules in the USDA.
A substitution to remove a player suspected to have a head injury shall not count against the re-entry rules in the NPL. Thus the player entering the game for the injured player may enter without it counting towards his/her re-entry count, and the player that has been removed may re-enter the game (if cleared by a healthcare professional) for the original substitute.
US Soccer Concussion Initiative Guidelines
US Soccer Concussion Fact Sheet
US Soccer Concussion Fact Sheet for Players
US Soccer Concussion Fact Sheet for Coaches
US Soccer Concussion Fact Sheet for Parents
US Soccer Recognize to Recover Home Page
Center for Disease Control and Prevention: Heads Up Concussions in Sport
Center for Disease Control and Prevention: Heads Up Info for High School and Youth Sports