Cache Valley Cup 2011 - Concussion Protocol
We, the committee of the Cache Valley Cup believe that the safety of participants is of the utmost
importance. As such, we have established a Concussion Protocol in accordance with Utah Legislature
House Bill 204: Protection of Athletes With Head Injuries Act. In the event that a participant sustains a
head injuring during play the following procedure will be followed:
1. The injured player will immediately be removed from play and taken to the onsite medical
station.
2. The injured player will then be evaluated by an athletic trainer, from the IHC Sports Medicine
Program, for signs/symptoms of a concussion or traumatic head injury
a. Traumatic head injury - an injury to the head arising from blunt trauma, an
acceleration force, or a deceleration force, with one of the following observed or
self-reported conditions: transient confusion, disorientation, impaired
consciousness, dysfunction of memory, loss of consciousness, signs of other
neurological or neuropsychological dysfunction including seizures, irritability,
lethargy, vomiting, headache, dizziness, or fatigue
b. After a concussion, the brain needs time to heal. While the brain is still healing,
the injured player is much more likely to have a second concussion. Second or
later concussions can cause damage to the brain. (R e t r i e v e d f r o m
h t t p : / / w w w . c d c . g o v / c o n c u s s i o n / H e a d s U p / y o u t h . h t m l )
3. If upon evaluation, the athletic trainer determines that the injured player is exhibiting
signs/symptoms of a concussion or traumatic head injury, then the participant will be NOT be
allowed to participate in further tournament play UNTIL,
a. The injured player is evaluated and cleared to resume participation by a qualified
health provider
AND
b. The injured player submits a letter, written by a qualified health provider, to the
Tournament Director, Allan Haycock. The letter MUST include the following:
1. The injured player is cleared to resume participation in the
Cache Valley Cup Tournament
2. The health care provider clearing the injured player has,
within three years before the day on which the written
statement is made, successfully completed a continuing
education course in the evaluation and management of a
concussion
By signing this form I acknowledge that I have received a written copy of this policy and that I have read, understand
and agree to abide by the above stated concussion protocol.

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