What to include in a concussion protocol for schools and sports teams
A section-by-section guide, written by a board-certified sports neurologist, to the parts every school, district, club, or team concussion protocol should cover, and why each one matters when an athlete gets hurt.
Last reviewed: June 30, 2026 by Dr. Neil J. Patel, MD, MBA (board-certified in Neurology and Brain Injury Medicine; fellowship-trained in Sports Neurology).
A concussion protocol is the program-wide document that defines how your organization recognizes, removes, evaluates, and clears an athlete after a suspected head injury. Rather than hand out a fill-in-the-blank file to adopt sight unseen, this guide walks through the sections a defensible protocol contains, so you can build or review your own with your administration and, ideally, a medical advisor who knows your state's law. A generic downloadable template is easy to sign and forget; a protocol your program actually understands and can follow under pressure is what protects athletes.
The sections a concussion protocol should include
A strong school or team protocol covers the full arc from suspected injury to full return. Below is what belongs in each section and the reasoning behind it.
1. Education and acknowledgment
State up front who must receive concussion education each year (coaches, athletes, and parents or guardians) and how you document it. The section should require a signed acknowledgment on file before participation, confirming each party received and reviewed the information. This is the part most state laws explicitly mandate, and the paper trail is what demonstrates your program took its duty seriously.
2. Recognition and immediate removal
Spell out the rule in plain language: "when in doubt, sit them out." Any athlete with a suspected concussion is removed from play immediately and not returned to play or practice the same day. List the common signs and symptoms so a coach or official can act without a physician present, and make clear that removal is not a judgment call to be overridden by the athlete, a parent, or the score.
3. Emergency action and red flags
Separate the medical emergencies from routine suspected concussions. This section lists red-flag signs (loss of consciousness, worsening headache, repeated vomiting, seizure, neck pain, increasing confusion or agitation) that require activating your emergency action plan and calling 911 rather than sidelining and monitoring. Every athlete-facing setting should know the difference.
4. Evaluation by a healthcare provider
Define who evaluates the athlete and when. The protocol should call for assessment by an appropriate licensed healthcare provider and reference a standardized tool (such as the SCAT6 for on-field and clinical assessment) where applicable. Name the type of provider your state authorizes so there is no ambiguity about whose evaluation counts.
5. Return-to-learn
Academics come before athletics. This section describes a graduated return to the classroom with temporary accommodations (reduced screen time, extended deadlines, rest breaks) coordinated between the family, school staff, and the treating provider. An athlete should be managing a full academic load before completing return to sport.
6. Return-to-play (the graduated protocol)
Lay out the internationally recognized stepwise progression: symptom-limited activity, light aerobic exercise, sport-specific exercise, non-contact training drills, full-contact practice, and return to competition. Each step is held for a minimum period, the athlete must remain symptom-free to advance, and any return of symptoms drops them back a stage. Full return requires written medical clearance from the authorized provider.
7. Documentation and record-keeping
Describe exactly what gets recorded and where it is kept: an injury and clearance log for the program, the standardized evaluation, the return-to-learn plan, and the signed return-to-play clearance for each athlete. Consistent documentation is both good clinical practice and your evidence that the protocol was followed.
8. Roles and responsibilities
Assign each step to a named role (athletic director, coach, athletic trainer, school nurse, team physician) so nothing falls through the cracks when an injury happens. Ambiguity about "who was supposed to" is where protocols fail in practice.
9. Annual review and sign-off
Concussion guidance and state law both change. Commit to reviewing the protocol at least once a year, record the review date and who approved it, and update it when consensus statements or your state's requirements are revised.
Customizing these sections to your state
Two points vary by state and your protocol's wording must match them exactly: who is allowed to clear an athlete to return, and any mandatory waiting period before return is permitted. Confirm both against your state's youth-sports concussion law before finalizing.
See the state-by-state breakdown: Youth concussion return-to-play rules by state.
The protocol vs. the return-to-play form
These are two different documents and a complete program uses both. The protocol (policy) is the program-wide rulebook whose sections this guide describes. The return-to-play form is the single clearance document a provider signs for one athlete at the end of recovery.
See the companion guide: the concussion return-to-play form and what it should capture.
Want a neurologist to review your policy?
Dr. Patel builds and reviews program-level concussion policies for schools and athletic organizations, aligned to your state's law and current consensus.
Frequently asked questions
What sections should a concussion protocol include?
At minimum: education and acknowledgment, recognition and immediate removal, emergency action and red flags, evaluation by a healthcare provider, return-to-learn, graduated return-to-play with written clearance, documentation, assigned roles, and an annual review. Each is covered above.
What is the difference between a concussion protocol and a return-to-play form?
A concussion protocol (or policy) is the program-wide document that defines how your school or team recognizes, removes, evaluates, and clears athletes. A return-to-play form is the single clearance document a provider signs for one athlete. You need both.
How do I make sure a protocol meets my state's concussion law?
Build the protocol around current consensus, then cross-check the two things that vary by state: which provider is authorized to clear an athlete, and any mandatory waiting period before return. Confirm both against your state's youth-sports concussion law before adopting.
Can a coach or athletic director adopt a protocol without a physician?
A program can adopt its protocol administratively. Return-to-play clearance itself must be signed by the medical professional your state authorizes. For a defensible program, having a sports neurologist review your final policy is recommended.