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NCSOA Concussion Protocol and FAQs

What is the NCSOA's concussion protocol?

The NCSOA concussion protocol has been developed based off of direction from NFHS, CIF and the State of California: If the referee observes any player exhibiting signs, symptoms or behaviors consistent with a concussion, he or she shall immediately remove that player from the contest and the player shall not return to play. The referee shall inform the head coach of this decision and verify the name of the player so that he/she can include accurate information in the post game report to the assignor.

It is best to remind the coaches of this before the game starts.  It may be best to do so before the pre-game conference so you can clarify the policy or answer the coach's questions without the other coach and the captains waiting.

What should I do during the game if I think a player may have sustained a concussion?

Stop play and require the team to substitution the player from the game.  Inform the coach what you observed and confirm the player's name and number so you can report the information to the assignor?

What should I do after the game if I thought a player may have sustained a concussion during my game?

Report the information (including the time of the removal of the player) to the assignor via Arbiter and/or email.

What happens after I submit the information to the assignor?

The assignor notifies the school and starts the CIF mandated return to play protocol.

What do you recommend I say to the coaches regarding concussions?

NCSOA recommends that you should use something similar to this statement when reminding coaches about the concussion protocols: "If a player takes a knock to the head and shows the signs, symptoms or behaviors of a concussion, we are going to stop play and remove the player from the game and not allow him/her to return."

NCSOA recommends that you avoid making definitive statements like "If a player has a concussion" and instead use language that is consistent with the NFHS rule book "If a player shows signs, symptoms, or behaviors consistent with a concussion".

Additionally, you may find it useful to use the "head injury" instead of "concussion" and to remind coaches that the safety of the players is more important than the outcome.  Also, only a physician can diagnose a concussion, not a school trainer.

What if the school has a trainer at the site?

Use as much or as little information from the trainer as you (the referee) wants, but according to the NFHS and the State of California it doesn't matter.

The NFHS Soccer Rule book states: "Any player who exhibits signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) shall be immediately removed from the contest and shall not return to play until cleared by an appropriate health-care professional" (3.3.2.b.3).  The state of California passed a law (effective 1/1/2012) that dictates the athlete shall not be permitted to return to the athletic activity until he or she receives written clearance to return from a physician who is trained in the management of concussions and is acting within the scope of his or her practice (CA Education Code § 49475).

What if I get push back from the coach, trainer, athletic director regarding my decision to prevent ?

Explain the rules and laws that apply to the situation and if that doesn't diffuse the situation, have them or their AD contact the Executive Board ( after the game and if it still hasn't been resolved to the point you can restart the game, you'll have to deal with the dissent as you deem fit.

I don't agree with this policy.  Do I have to follow it?

Yes.  By not following this policy you are not following NFHS rules or state law.  The safety of all players should be the priority of everyone involved in high school sports.  Also, by not following these  procedures, you are making it more difficult for other officials to properly officiate future games.

What are the "signs, symptoms or behaviors consistent with a concussion"?

According to the NFHS Soccer Rule Book:

Common Signs and Symptoms of Concussion Include:
*RED FLAGS: Go to emergency department if any red flag present.

  • *Loss of consciousness (even if brief)
  • *Seizure
  • *Increasing sleepiness
  • *Worsening headache
  • *Persistent vomiting
  • Dazed or stunned appearance
  • Confusion about assignment or position
  • Forgetful, for example, doesn’t follow instructions
  • Uncertainty of game, score or opponent
  • Clumsy movements
  • Slow response to questions
  • Mood, behavior or personality changes
  • Inability to recall events prior to hit or fall
  • Inability to recall events after hit or fall
  • Balance problems or dizziness
  • Double or blurry vision
  • Sensitivity to light or noise
  • Feeling sluggish, hazy, foggy or groggy
  • Concentration or memory problems
  • Emotions of “not feeling right" or “feeling down”


AB 2127
CA Ed Code 49475
CIF Concussion Information Sheet
NFHS Suggested Management of Concussions in Sports

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