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Concussion Management Updates: Frequently Asked Questions

The purpose of this document is to facilitate and support the efforts of NCAA member institutions to comply with applicable divisional concussion safety legislation. In early 2015, the Concussion Safety Protocol Committee created the Concussion Safety Protocol Checklist (Checklist) to encourage and support institutional compliance with industry best practices and applicable concussion legislation. Consistency with the Checklist is now specifically referenced as part of the requirements in each of the three divisional manuals. The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS) recently approved an updated version of the Checklist and, while the NCAA has, through its governance process, relaxed many of the legislative requirements related to submission and reporting deadlines in response to the impact on schools resulting from the COVID-19 pandemic, member schools still need to ensure that institutional concussion management practices are consistent with applicable legislative and policy requirements and should incorporate a thorough analysis of the recent updates to the Checklist and any other concussion-related legislative and policy changes as part of that process. Specifically, schools should carefully review and understand the most recent updates to the Checklist, and related concussion management legislation, policies and guidance, and work with applicable institutional personnel to ensure any necessary adjustments to their concussion management practices are properly and timely implemented. In this Frequently Asked Questions document we have provided responses to some of the most anticipated membership questions related to those institutional review and update activities.

Q1. Have there been any legislative or policy updates related to concussion management since 2020?

A1. No. There have been no changes to divisional legislation related to concussion management since the publication of the last frequently asked question in 2020. However, as a reminder, a portion of Division I Constitution 3.2.4.20.1 (Concussion Safety Protocol) was updated in 2019 to require that an institution's Concussion Safety Protocol must be consistent with the Checklist. In addition, the Interassociation Recommendations: Preventing Catastrophic Injury and Death in Collegiate Athletes, which contain content specific to concussion management, were unanimously endorsed by the NCAA Board of Governors and announced as Association-wide policy under the Uniform Standard of Care Procedures in the summer of 2019and all three divisions are required to comply with those materials.

Q2. Has the Checklist been updated since 2020?

A2. Yes. CSMAS approved updates to the Checklist at its most recent committee meeting in February of this year. These changes became effective immediately upon approval.

Q3. How is the Checklist updated?

A3. The NCAA Board of Governors designated CSMAS to prescribe the process and format recommendations related to applicable concussion legislation. The Concussion Safety Advisory Group (CSAG) was created by CSMAS for the purposes of providing focused review and advice around emerging developments in concussion science and policy, including those that may warrant an update to the Checklist and related policy and educational materials. CSAG meets annually in the spring to review and discuss available research data and accepted industry practices and how they may impact Checklist content. At its February 2021 meeting and based on input from the CSAG, CSMAS approved several minor changes to the Checklist.

Q4. How do I know what has changed with the Checklist?

A4. The updated version of the Checklist can be accessed here. All updated content has been highlighted so that changes from the previous version can be easily identified.

Q5. Aside from the legislative and policy updates described in Item Q1 above and the updates to the Checklist, are there any other legislative or policy requirements related to concussion management that we should review or be aware of?

A5. Yes. While certain details of applicable concussion legislation vary depending on division, and each school should carefully review all legislative and policy requirements related to concussion management, all three divisions require that the following provisions be included as part of a school’s concussion management plan:

  • An annual process that ensures student-athletes are educated about the signs and symptoms of concussions. Student-athletes must acknowledge that they have received information about the signs and symptoms of concussions and that they have a responsibility to report concussion-related injuries and illnesses to a medical staff member;
  • A process that ensures a student-athlete who exhibits signs, symptoms or behaviors consistent with a concussion shall be removed from athletics activities (e.g., competition, practice, conditioning sessions) and evaluated by a medical staff member (e.g., sports medicine staff, team physician) with experience in the evaluation and management of concussions;
  • A policy that precludes a student-athlete diagnosed with a concussion from returning to athletics activity (e.g., competition, practice, conditioning sessions) for at least the remainder of that day; and
  • A policy that requires medical clearance for a student-athlete diagnosed with a concussion to return to athletics activity (e.g., competition, practice, conditioning sessions) as determined by a physician (e.g., team physician) or the physician’s designee.

Q6. Who is responsible for assuring the implementation of applicable concussion management updates at my institution?

A6. Independent Medical Care legislation in all three divisions requires the designation of an Athletics Health Care Administrator (AHCA) who independently oversees the administration and delivery of athletics health care on behalf of the institution. While we anticipate that the creation and implementation of any necessary concussion management changes and practices may require input from a variety of institutional medical and other personnel, it is reasonable to consider these activities as part of the broader administration and delivery of health care at each institution.

Q7. What is the NCAA Concussion Protocol Template and why was it created?

A7. To facilitate and support member compliance with concussion legislation, CSMAS approved a Concussion Safety Protocol Template (Template) that includes all components of the Checklist. The Template is available for download in Microsoft Word format and allows schools to individualize certain areas of the document and to otherwise modify the Template to accommodate and reflect individual needs and practices.

Q8. Which institutions can access and use the Template?

A8. The Template is available to every NCAA member institution and may be utilized by institutional staff as an educational and compliance tool.

Q9. Where can I find a copy of the Template and does it reflect the most recent Checklist updates?

A9. Yes. We have revised the Template to reflect the most recent changes to the Checklist and the updated version of the Template can be accessed here. All updated content has been highlighted so that changes from the previous version can be easily identified.

Q10. Will there be Checklist changes in the future?

A10. The NCAA Sport Science Institute (SSI) will continue to work with CSMAS and the corresponding CSAG at least annually to identify and review information that may inform recommendations about future Checklist changes.

Q11. How does the Checklist and other legislative and policy requirements relate to the certification requirement arising from the Arrington settlement?

A11. While many of the member obligations in Section IX.A of the Settlement Agreement are similar to or overlap with certain existing NCAA health and safety legislation, policies and guidance materials, each set of obligations is distinct from and, in some instances, different from the other. Compliance with one set of obligations should not be deemed to automatically or entirely satisfy compliance with the other. Therefore, it is important to consult with school legal counsel and other risk management staff as necessary to fully understand these differences and to evaluate your institutional practices and compliance with respect to the member obligations as they relate to the Arrington matter and applicable NCAA legislation, policy and guidance. Additional detailed information about institutional obligations related to the Arrington matter, and the differences between those and NCAA legislative requirements, has been provided to all member institutions by email in the form of two Frequently Asked Questions documents, which can be found here.

Q12. I have a question not covered here. Who can I contact?

A12. If you have reviewed the content of this FAQ and cannot find the answer, please email the Sport Science Institute at: ssi@ncaa.org.


Additional Considerations for Division I Schools

Q13. Are Division I autonomy schools still required to submit a concussion management protocol for review by the Concussion Safety Protocol Committee?

A13. No, not at this time. NCAA legislation requires all Division I institutions to participate in a Concussion Safety Protocol review each year. A waiver of this submission requirement was approved for the 2020 reporting year due to the impacts of COVID-19. In anticipation of a continuing burden on institutional resources across divisions as athletics health care personnel manage and support heavy practice, competition and championship schedules, and in recognition of the availability of the Checklist, corresponding Template and other NCAA educational resources, the CSMAS recommended that the waiver be extended for the 2021 reporting year. As was previously communicated to all Division I institutions by email, the NCAA Division I Council Coordination Committee recently approved the recommendation and extended the original waiver for the 2021 reporting year such that no protocol submission will be required for the 2021 academic year. The waiver does not change an institution’s obligation to maintain an appropriate concussion management plan, including a Concussion Safety Protocol that is consistent with the Checklist. 

Q14. If the May 1 protocol submission deadline has been waived, what is the new deadline for Division I autonomy schools to submit their institutional protocols for review?

A14. The 2021 submission deadline has been waived and it is not anticipated that a new submission 2021-22 deadline will be established. We will communicate that information about submission activities to occur after that time frame as that information becomes available.

Q15. Can my institution utilize the Template that was created to conform to the updated Checklist?

A15. Yes. The Template may be used by every NCAA member institution as an educational and compliance tool.

Q16. My institution submitted its protocol in 2019 for review and the Concussion Safety Review Committee confirmed that it was consistent with the Checklist. Do we need to do anything this year?

A16. Division I Constitution 3.2.4.20.1 (Concussion Safety Protocol) was updated in 2019 to require that a Division I institution's Concussion Safety Protocol must be consistent with the Checklist. Because the 2021 Checklist includes material updates, you should carefully review these changes and other relevant legislative and policy requirements and work with applicable institutional medical and other staff to identify and incorporate any necessary adjustments to your concussion management protocol and practices.

Q17. I understand that the May 1 submission deadline has been waived; but can we still submit our updated concussion protocol to the Concussion Safety Protocol Committee for review and feedback?

A17. No. Due to the travel and other resource restrictions and impacts resulting from the COVID-19 pandemic, neither the Concussion Safety Protocol Committee nor its designated subcommittee that has historically reviewed Division I non-autonomy opt in submissions will be convening for or conducting protocol review activities at this time. However, the NCAA SSI staff is committed to providing membership with all of the tools and information necessary to identify applicable updates to concussion management practices resulting from the recent Checklist changes and will work, in conjunction with CSMAS as applicable, to respond to all membership questions on the topic. Specific questions about the Checklist or the recent updates should be directed to ssi@ncaa.org.

Q18. I understand that the protocol submission deadline has been waived. Do we still need to sign the annual Compliance Certification Form?

A18. Yes. Division I Constitution 3.2.4.20.1-(g) still requires that a written certificate of compliance signed by the institution’s AHCA be included in the institution’s Concussion Safety Protocol. We recommend that the signed form is kept on file in the office of the institution’s AHCA along with a current copy of the concussion safety protocol and other concussion management materials.

Q19. Is there a specific Compliance Certification Form that my AHCA needs to use to meet the legislative requirement?

A19. No. However, to facilitate and support member compliance with this requirement, the NCAA has developed a standard Compliance Certification Form. A blank copy of the form is included as Exhibit A to the Template and can also be accessed here. We recommend that your AHCA print, sign and keep the form on file in his or her office along with a current copy of the concussion safety protocol and other concussion management materials. While not legislatively required, DII and DIII institutions may also elect at their discretion to keep a written certification on file and those schools can use the sample certification form for this purpose as well.

Updated: April 2021