Health Policies

• The Deerfield Academy medication policy has been developed to help ensure the health and safety of all of our students. Parents must inform the DS Chen Health and Wellness Center of ALL medications and/or supplements a student takes or has in their possession during the school year by completing and, as warranted, updating the attached Student Medication List. This includes prescription, over-the-counter (OTC), and other types of medications, such as herbs, homeopathic and otherwise.
• ALL medication in a student’s possession must be labelled in English with instructions regarding proper administration and be in the original manufacturer’s packaging. 
• Students may not share their medication or accept any medications from other students.

OVER-THE-COUNTER (OTC) MEDICATIONS:

Includes all Non-Prescription Medications, including vitamins and supplements

• We recommend you NOT send your child to school with OTC medication. The Health & Wellness Center is always open and has a full array of common OTC medications that can be provided to students as clinically indicated. Please review the OTC and Stock prescription medication formulary on the Health Center section of the Deerfield website https://deerfield.edu/students/health-policies
• For students who routinely use OTC medications for recurrent conditions (i.e. headaches, cramps, reflux etc.) where frequent trips to the Health Center would be burdensome, a small amount of OTC medication (no more than 50 tablets/capsules of any OTC medication) may be sent to school with the student if it is listed on the Student Medication List.
• If the parent has any concerns or questions about their child properly taking an OTC medication they should NOT send it to school with their child and instead have the child come to the Health Center as needed to receive OTC medication from our formulary.
• OTC medications DO NOT require a Prescription Medication Order Form.

PRESCRIPTION MEDICATIONS:

• With parental permission, students may self-administer prescription medications, such as antibiotics, as long as they are not a controlled substance (i.e. a narcotic, tranquilizer or stimulant).
• Students taking prescription medications with potential neurologic or psychologic effects such as medications for a psychological condition (i.e. ADD/ADHD, Depression, Anxiety, Schizophrenia or Bipolar Disorder), a seizure disorder or migraines (i.e. levetiracetam, lamotragine, gabapentin) or are a controlled substance (i.e. a narcotic, tranquilizer or stimulant) must receive these medications through the Health Center and adhere to an additional policy called the Deerfield Academy Psychotropic and Neurologic Medication Policy. If your child takes this type of medication or you are not certain if their medications require this additional documentation, please either call the Health Center at 413-774-1600 or email nurses@deerfield.edu for further details and instructions.
• Students prescribed injectable medications must abide by the Deerfield Academy Injectable Medication Policy• For each prescription medication listed on the Student Medication List, please ask the prescribing provider to
• complete and sign the attached Prescription Medication Order Form and mail or fax it to the health center.
• If a parent has any concern about a student’s ability to safely self-administer their medication, they should ask their prescribing provider whether it is necessary for the child to take the medication while at boarding school.
• Additionally, parents may also reach out to the Health Center about supplying and dispensing the medication through the Health Center. Please understand that the Health Center wishes to be a resource for all our students and while it is our responsibility to administer medications safely, it is not the Health Center’s responsibility to make certain a child is taking their medications daily. Parents may always call the Health Center to ask how often a prescription medication supplied by the Health Center has been picked-up or taken by their child.
• Routine prescription medications (i.e. medications that are NOT controlled substances and do NOT have potential neurologic or psychotropic effects) that are ordered through the Health Center will be filled through the local pharmacy listed below unless it is after hours when an alternative pharmacy will be used. Your child’s insurance information will be shared with these pharmacies for billing purposes and parents/guardians are responsible for co-pays and other costs not covered by insurance.
• • Prescription medications may not be prescribed by a parent, guardian or family member.
• In order to avoid delays we encourage all families at the beginning of the year to set up an account with an associated credit card at the pharmacy listed below. Call the below number and say your child is going to Deerfield Academy and that you wish to set up an account. If there are any questions, ask for Lee Kimball the pharmacy manager.
  • Big Y Pharmacy
    237 Mohawk Trail, Route 2
    Greenfield, Massachusetts

Introduction

Psychotropic and neurologic medications are used for a variety of conditions. The most common psychotropic and neurologic medications used in boarding schools fall into the following categories but please understand that the below list of examples is not exhaustive. While not all psychotropic and neurologic medications are controlled substances and not all controlled substances are primarily psychotropic in nature, there is significant clinical overlap; therefore, for completeness and simplicity the regular use of these classes of medications will be covered by what is labelled as the Psychotropic and Neurologic Medication Policy. If you are unsure whether your child’s medication is covered by Deerfield Academy’s Psychotropic and Neurologic Medication Policy please call Lise Ross, our Medication Nurse, at 413-774-1600 or email her at lross@deerfield.edu

• Stimulants: medications used in the treatment of attention deficit disorder. Ritalin, Dexedrine, Adderall, Concerta, Focalin, Vyvanse
• Tranquilizers and sedatives: medications commonly used for acute panic attacks and insomnia. Valium, Xanax, Ativan, Klonopin, Ambien, Sonata, Trazodone
• Antidepressants and anti-anxiety medications: used in the treatment of depression and persistent anxiety, includes commonly known class of medications called SSRIs. Amitriptyline, Nortriptyline, Prozac, Zoloft, Lexapro, Celexa, Wellbutrin, Serzone, Remeron, Buspar
• Mood stabilizers: used for labile mood, bipolar disorder and occasionally for insomnia. Lithium, Depakote, Tegretol, Neurontin, Lamictal, Zyprexa, Risperdal, Seroquel, Abilify
• Anticonvulsants/Antiepileptic medications: used in the treatment or prevention of seizures. Levetiracetam (Keppra), Lamictal, Gabapentin, Trileptal
• Migraine medications: used in the treatment of migraines. Sumatriptan (Imitrex), Rizatriptan (Maxalt)

For multiple reasons the use of psychotropic and neurologic medications in a boarding school environment requires oversight and supervision. This policy outlines the expectations of the Health Center and of the school concerning the use of psychotropic and neurologic medications by Deerfield Academy students. We believe that proper and consistent use of these medications requires self-discipline that is difficult to maintain in the face of the multiple demands of a school such as Deerfield. The Health Center staff stands ready to help students and parents meet this challenge.

Policy

1. Acknowledgement of rules and parental authorization:

Parents and students must sign the Psychotropic and Neurologic Medication Agreement, acknowledging the expectations of the school concerning use of psychotropic and neurologic medications while at Deerfield and authorizing the Health Center staff to administer psychotropic medication.

2. Physician authorization:

A Prescription Medication Order Form must be fully completed by your prescribing physician for each psychotropic and/or neurologic medication your child will need during the school year. This form must be mailed or faxed to:

D.S. Chen Health and Wellness Center
Attn: Lise Ross
7 Boyden Lane
Deerfield, Massachusetts 01342
Phone: 413-774-1600 Fax: 413-772-1118

No medication will be dispensed until this form is received. The prescribing physician must renew and resubmit this order each year prior to the beginning of fall term or anytime there is a change.

3. Dispensing Medication (UPDATED for COVID-19)

All psychotropic and medications must be dispensed to students by the Health Center staff. Students may not bring psychotropic medications from home. Students may not have any psychotropic medication in their possession that has not been dispensed to them by the Health Center. Possession of psychotropic medication not dispensed by the Health Center is considered a major school rule violation and may result in disciplinary measures.

• All stimulants, tranquilizers and sedatives (Categories I & II above) are dispensed on a daily dose-by-dose basis and must be taken by the student in the Health Center. Students should NEVER have stimulants, tranquilizers or sedatives in their possession.
• All other psychotropic medications (Categories III, IV, & V) are typically dispensed weekly. Students should not accumulate medication over time. They should never be in possession of 4. more medication than is dispensed by the Health Center at one time.
• For migraine medications, students may keep 1-2 doses of their medication, and the rest of the doses are to be kept in the Health Center. This helps us monitor the frequency of migraines and address any issues the students may be experiencing.
• Any and all medication changes must include a new physician order for our records and the new prescription sent to the school pharmacy.

Designated Walk-in Times for Students to take their medications:

• Students on these medications may walk-in for their prescribed psychotropic medications only during designated times in the morning and evening.

4. Ordering, packaging and transporting medication:

• Stimulants (i.e. Adderall, Concerta , etc) and Tranquilizers/Sedatives (Categories I & II above)
  • Must have our Prescription Medication Order Form completed by the ordering home physician and submitted to D.S Chen Health and Wellness Center (Attn: Lise Ross).
  • The ordering physician will be required to mail or ePrescribe refills monthly or as needed to Genoa Healthcare.
  • The pharmacist will reach out 5-7 days to the ordering physician for refills when needed.
  • Parents must fill out appropriate insurance and co-pay information with the pharmacy.
• Antidepressants, anti-anxiety (including all SSRIs), Mood stabilizers, and Migraine medications (categories III and above)
  • Must have a Prescription Medication Order Form completed by the ordering home physician
  • Must have the ordering physician either fax, mail or e-Prescribe the prescription to the school-designated pharmacy below. The physician must include on the prescription “DA Student”
    • School-Designated Pharmacy for Psychotropic Medications:

      Genoa Healthcare
      329 Conway Street, Suite 1
      Greenfield, MA 01301
      Phone: (413) 325-0004 Fax (413) 320-4269

The school-designated pharmacy will package these medications as a one-week supply and students will pick up their medications weekly.

• For non-US-based physicians who cannot prescribe in the United States, the home physician should complete the Prescription Medication Order Form and send it to The Deerfield Academy Health and Wellness Center.
• All psychotropic medications must be purchased through the school-designated pharmacy. We will not accept medications from outside pharmacies.
• Psychotropic medication, particularly stimulant medication, will not routinely be dispensed for use over school vacations. Parents must keep a sufficient supply at home for use during vacations.
• At the end of the academic year, current psychotropic and neurologic medications will be packaged and given to parents or if parents unable to pick up the medication will be wasted.
• If during the course of the year, the medication is changed, any discontinued medications will be destroyed.

5. Privacy and need to know:

• Confidentiality with respect to psychotropic and neurologic medication is an important issue.
• The Health Center will not notify anyone concerning which students are taking antidepressants or other non-stimulant psychotropic medicines without parent and/or student permission.
• With respect to Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder, it is helpful for those responsible in the academic setting to be fully informed of the student’s learning profile. For this reason, we routinely notify the Study Skills Coordinator/Assistant Academic Dean of students we know to be diagnosed with Attention Deficit Disorder, unless specifically asked not to do so. We have found that sharing this information is useful to the student and expected by parents.
• In the dormitory setting, we feel it is necessary at times to notify the adults responsible for the dormitory if stimulant medications are used. Specifically, the Advisor, the Faculty Resident and the Associate Faculty Resident may be notified if a student is taking stimulant medication.
• Since it is usually helpful for adults involved in the lives of students to be aware of what medications a student is taking and why, parents and students are encouraged to strategize with the Health Center staff concerning who should be notified.

6. Misuse and abuse:

• • Misuse and abuse of psychotropic and neurologic medication can be dangerous. It is a major school rule violation and will result in disciplinary action. Examples of misuse and abuse include:
  • giving or selling one’s medication to another student;
  • being in possession of an inappropriately large amount of medication;
  • taking significantly higher doses than prescribed;
  • crushing and snorting stimulant medication;
  • Bringing medication from home and not bringing it first to the Health Center.

7. Use of alcohol and illicit drugs

• Safe use of psychotropic medications is NOT compatible with the use of alcohol or illicit drugs such as marijuana.
• If concern arises that a student is using alcohol or illicit drugs while taking a psychotropic medication, urine drug testing will be performed. The results of this testing will be communicated to parents and treated as confidential medical information (i.e., it will not be released to other parties such as the Dean of Students). However, if testing is positive, a program of regular random testing will be implemented and evidence of continued use of illicit drugs or alcohol may result in a medical leave of absence from school or other appropriate and substantial responses.

8. Compliance and record keeping:

• It is the responsibility of students to pick up their medication at the Health Center and not the Health Center’s responsibility to remind them. Consistently missed doses may result in an email message being sent to the student asking them to contact the Health Center. Although taking a psychotropic medication is always a voluntary decision, responding promptly to these requests to contact the Health Center is mandatory. Failure to comply with requests to contact the Health Center or to meet with the Health Center staff may result in accountability points (APs).
• Records are kept in the Health Center of each medication pick-up and/or administration. Parents interested in a student’s record of medication pick-up are encouraged to call Daika Diefendorf, the Medication Nurse.
• Vital signs, including weight, will be assessed in the Fall and Spring terms for medication monitoring.

9. Regarding access to medications on school-sponsored off-campus trips

• During off-campus school trips, the Health Center will provide enough of the student’s medication for the duration of the trip and give it to the trip chaperone for safe-keeping.
• It is the student’s responsibility to find the chaperone at an appropriate and convenient time every day to self-administer their medication.
• All medication checked-in and checked-out of the Health Center will be documented through the Electronic Medical Record by the Medication Nurse.

10. Regarding Day Students on psychotropic and neurologic medication

• As with all Deerfield Students, Day Students should NEVER have stimulants, tranquilizers or sedatives in their possession while on campus. If a Day Student has a prescription for a stimulant, tranquilizer or sedative they take routinely or as needed (i.e. PRN) while on campus, this must be coordinated and provided through the Health Center per the above policy.
• In addition, if a Day Student is:
  • on any psychotropic medication taken at home before or after coming to campus OR
  • on a non-controlled psychotropic medication (i.e. NOT a stimulant,  tranquilizer or sedative) taken while on campus,

the details of this prescription including medication name, dosage and the frequency of administration must be included on the medication list as part of the Medication OTC and Prescription Agreement and emailed, faxed or mailed to the Health Center.

• Any Day Student on a psychotropic and/or neurologic medication(s) who goes on a school-sponsored trip will have to abide by Section 9 of the above policy.

General:

• All students with a medical condition requiring an injectable medication must abide by the following policy in order to be allowed to use injectable medications while attending Deerfield Academy.
• Students may be allowed to self-administer injectable medications once appropriate documentation is received from the parent/guardians and prescribing provider.
  • Parent/Guardian and student must complete and sign Deerfield Academy’s “OTC and Prescription Medication Policy and Agreement” including information regarding the prescribed injectable medication and any history of side effects.
  • All medication must be labelled by a pharmacy in English with clear and easy to follow instructions. Additional documentation and clarification may need to be provided by the prescriber as requested by the Health Center.
• The sharing of prescribed injectable medications with other students is a violation of the Deerfield Academy OTC and Prescription Medication Policy and would result in notification of the Student Life Office regarding response.
• Vitals, including weight and/or labs may be periodically obtained on all students on injectable medications per the Health Center’s clinical discretion

Injectable Medications Administered Daily:

• Students who self-administer injectable medications on a daily basis may be approved by the Director of Medical Services to administer these in their room after they have:
  • demonstrated to Health Center staff they are able to do so properly AND
  • the parent/guardian has provided written or verbal permission to the Health Center for their child to self-administer the injectable medication.
• If a student is allowed to self-administer an injectable medication in their dorm room, it is preferable that it be contained within a reusable injectable pen as opposed to the use of individual syringes and needles.
• Disposal: Safe and appropriate disposal of needles and administration devices is the responsibility of the student and family. If a sharps/biohazard disposal container is not provided by the manufacturer of the administration device, an appropriate sharps/biohazard disposal container may be obtained from the Health Center. When the sharps/biohazard disposal container is full or near full the student will bring it to the Health Center for safe disposal. At NO time may hypodermic needles, other sharps or biohazard material be inappropriately stored or disposed of in the student’s room or elsewhere on campus.
• If the parent/guardian would prefer their student to self-administer their medication at the Health Center, a daily appointment for this purpose will be scheduled for the student. Parents are encouraged to speak with their student or call the Health Center to determine their student’s compliance with these appointments.
• Students with insulin-dependent diabetes will also be covered by this policy but are not required to demonstrate administration proficiency if their disease and its treatment is well established.
• The Director of Medical Services has final authority in deciding whether a student may or may not self-administer a medication outside the Health Center. 

Injectable Medications Administered Less Frequently (Weekly, Biweekly etc.):

• Students who are prescribed injectable medications on a non-daily basis will be scheduled an appointment at the Health Center to come and self-administer their medication.
• These medications will be stored at the Health Center and additional doses may not be stored in the student’s room.
• Communication and Compliance:
  • Please understand that the Health Center wishes to be a resource for all our students and while it is our responsibility to make certain medications are administered safely, it is not the Health Center’s responsibility to make certain a child is taking their medications daily. Parents may always call the Health Center to ask how often their student is attending their appointments to self-administer their injectable medication(s).
  • Specifically, in regards to immunomodulatory agents (e.g. interleukin inhibitors, TNF-blocking agents, Monoclonal antibodies), if there is a pattern of the student missing their doses at the Health Center, the Health Center will reach out to the parent/guardian to make them aware and partner with them in how to encourage compliance.

Please contact the Deerfield Academy Health and Wellness Center with any questions. 413-774-1600

Deerfield Academy and its Health Center wish to be a resource for students with severe allergies that potentially result in anaphylaxis. In order to minimize the risk of anaphylaxis Deerfield has the following policy:

• Epinephrine auto-injectors will be located at designated sites throughout campus including the Health Center and Dining Hall. Full list may be obtained through Security.
• During the fall term, all students prescribed an epinephrine auto-injector by their home medical provider will meet with either the School Physician or Nurse Practitioner to review their medical history and Allergy Action Plan.
• At the beginning of the academic year, a list of students with a history of anaphylaxis secondary to food allergies is compiled by the Health Center and shared with the Dining Hall Director so that reasonable attempts can be made to label foods containing these allergens. This list is resubmitted to the Dining Hall during the school year when the Health Center is made aware of a new significant allergy.
• If a student with a history of anaphylaxis presents to the Health Center with allergic symptoms they are managed in accordance with the Health Center’s standing orders for anaphylaxis which includes clinical evaluation and intervention, reviewing the student’s Allergy Action Plan, contacting the School Physician or Nurse Practitioner on call immediately and informing the parents as soon as possible.
• If an epinephrine auto injector is administered, per Massachusetts state regulations (CMR 210.100) emergency services (911) will be contacted and the student will be transported to a local emergency room for observation and treatment
• For each episode of anaphylaxis on campus, an Anaphylaxis Incident Report is completed by Health Center staff which includes the student’s presentation, medical intervention and an evaluation of how to minimize future exposures and risk.
• Parents/Guardians are required to:
  • include on the submitted Deerfield Academy Health forms all their child’s allergies.
  • submit an Allergy Action Plan from their home physician if there is a history of anaphylaxis.
  • send their child to campus with an epinephrine auto-injector that is not expired.
  • ensure their child knows how to and can self-administer the epinephrine auto-injector .
• Students prescribed an epinephrine auto-injector are required to carry it at ALL TIMES including school-sponsored trips off-campus. They should inform their resident Faculty about their allergy at the beginning of the year and let them know where their epinephrine auto-injector is located.

Parents/guardians of a child with a history of Anaphylaxis must complete this form.

It is normal throughout the course of adolescent development for young people to have questions or concerns regarding eating, weight, exercise, and body image. We believe it’s critical for teenagers to have access to appropriate and accurate resources in order to address these concerns. These issues can also occasionally develop into patterns of unhealthy thoughts and behaviors, in which case more robust medical and mental health support is required. In order to address the entirety of these concerns, the D.S. Chen Health and Wellness Center provides access for our students to a variety of mental, medical and nutritional resources.

Eating disorders typically develop during adolescence, have serious long term health consequences, and are potentially life-threatening. Fortunately, eating disorders are also treatable when addressed early, holistically and with the appropriate level of therapy, support and intervention. In regards to students with known or suspected eating disorders, the health center is dedicated to working with our students and their families, primary care providers and outside specialists in recognizing, evaluating and managing these conditions.

If a student is demonstrating a concerning pattern of eating, restriction, exercise or purging, a health care provider or a counselor will discuss these concerns with the student and/or their parent/guardian so that these issues may be addressed as quickly as possible to ensure the best chance for a full recovery and prevent any long term health consequences.

Assuming the student in question is medically stable, a therapeutic plan will be developed by the health team in consultation with the student and family. It is the Academy’s expectation that the student will actively engage in and follow the provided therapeutic plan and timeline. The plan will include, but not be limited to, regular appointments with a counselor, nutritionist, nursing and health care provider.

It is important to understand that the D.S. Chen Health and Wellness Center does not provide the same level of expertise and treatment found at an eating disorder program (such as Walden or Centers for Discovery) or provided by an Adolescent Specialist (a pediatrician who is board-certified and specializes in the treatment of eating disorders). Therefore, a student known or suspected to have an eating disorder may be required by the Medical Director as a condition to remain in or return to the Academy have a full evaluation by a pediatrician board certified in Adolescent Medicine, a licensed eating disorder clinic/center, or other appropriate clinical program/facility approved by the Medical Director to clarify their diagnosis and make recommendations regarding the most appropriate course of treatment. The timing and clinical urgency of this evaluation will be determined by the Medical Director. If the need for evaluation is urgent but cannot be obtained in a timely manner, the student will require a Medical Leave until it is obtained. The family (or student if ≥ 18 years old) will be required to sign a medical release prior to their visit to any aforementioned provider or program so information – including their evaluation and recommendations – may be freely shared and communicated. If the recommendation from the specialist or program is for a level of care not compatible with the student remaining actively enrolled at Deerfield Academy and fulfilling their academic and extracurricular expectations, a Medical Leave will be necessary to allow the student to complete the entirety of their recommended treatment plan prior to their return to campus. We fully appreciate that conversations about Medical Leaves and the prospect of missing classes and campus life can bring up uncertainty and feelings of frustration. Even so, considering the serious long term and potentially fatal complications of this illness, it is far more important for a student to take the necessary time away from campus to fully establish themselves on the road to recovery as opposed to choosing a less intense and less effective route of treatment.

If a student cannot or does not comply with the treatment plan set forth by the health center, is not actively and genuinely engaged in treatment, shows evidence of mental or physical decline, or is assessed by the Medical Director to require a level of care outside the health center’s scope of practice, this is indicative that a higher level clinical evaluation and care will be necessary and a Medical Leave will most likely be required to receive appropriate care.

If a student with the above concerns is ever felt to be clinically unstable or to need inpatient hospitalization per AAP criteria (see below) or provider’s clinical assessment, health center staff will immediately contact a local hospital and/or emergency services for triage and evaluation.

From the American Academy of Pediatrics Criteria for Inpatient Hospitalization in Eating Disorders,

• Heart Rate < 50 beats/minute; < 45 beats/min while asleep
• Systolic Blood Pressure < 90 mm Hg
• Orthostatic changes in pulse (> 20 beats/minute) or blood pressure (> 10 mm Hg)
• Arrhythmia
• Hypothermia (Temperature < 96⁰F)
• < 75% ideal body weight or ongoing weight loss despite intensive management
• Body fat < 10%
• Refusal to eat
• Failure to respond to outpatient treatment
• Syncope
• Serum Potassium < 3.2 mmol/L
• Serum Chloride < 88 mmol/L
• Esophageal tears or hematemesis
• Suicide Risk
• Bloody or Intractable vomiting

The student will not be allowed to return to campus until they have been evaluated at the local hospital, have complied with and completed all recommended treatment and vital signs are stable or other reason for emergency transfer has been resolved. If the family chooses not to comply with recommended evaluation treatment then a Medical Leave will be mandated until such treatment or appropriate alternative evaluation and treatment approved by the Medical Director is obtained.

Our overriding principle at the D.S. Chen Health and Wellness Center is always to provide robust and holistic support to our student body so that they might be their healthiest selves and realize growth and success while at Deerfield Academy and beyond. Our aim, therefore, is to assess and support any student who might be struggling with disordered eating behaviors, and to help them and their families access the most effective and long-lasting treatment possible, be that on or off campus.

References:

The Identification of Eating Disorders in Children and Adolescents; David S. Rosen and the Committee on Adolescence; Pediatrics December 2010, 126 (6) 1240-1253; DOI: https://doi.org/10.1542/peds.2010-2821  https://pediatrics.aappublications.org/content/126/6/1240

National Eating Disorder Association (NEDA) Level of Care Guidelines

https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients

Introduction

A concussion is a brain injury caused by a direct or indirect hit to the head causing temporary neurologic impairment. Deerfield Academy, through the Athletic Department and D.S Chen Health and Wellness Center, has evolved a robust program to minimize the impact of concussions on Deerfield Academy students.  This policy statement outlines our overall approach to concussions, which includes efforts to:

• Educate coaches, athletes, parents and the school community to both minimize the occurrence of concussions in sports and to identify concussions promptly and accurately
• Obtain baseline neurocognitive testing for all students
• Provide individualized clinical decision-making consistent with current standards of care in the management of concussions, including the return-to-play decision
• Provide reasonable educational adjustments to student’s academic responsibilities when indicated

General Principles:

1. All Deerfield Academy healthcare personnel (nurses, physician, nurse practitioner and athletic trainers), athletic administration (Athletic Director and Assistant Athletic Directors) and coaches will undergo annual education and training with respect to concussions.
2. All Deerfield Academy students and their parents will undergo education and training with respect to concussions prior to participation in athletic competition.
3. All Deerfield Academy students will undergo baseline neurocognitive testing prior to participation in athletic competition.
4. The Head Athletic Trainer will coordinate the process of verification that all students have undergone an education program and baseline neurocognitive testing prior to participation in athletics.
5. All Deerfield Academy coaches will remove students with a suspected head injury immediately from play and refer them to an athletic trainer or the Health and Wellness Center for evaluation. This evaluation will utilize the Deerfield Academy Concussion Management Protocol as a guideline for providing care to students with suspected or diagnosed concussion.
6. The School Physician and the staff at the D.S. Chen Health and Wellness Center will work with teachers, advisors and school administrators to ensure that reasonable educational adjustments are provided when indicated to concussed students.
7. The Medical Director, Head Athletic Trainer, the Athletic Director and Director of Nursing will review and update this Concussion Policy and the Concussion Management Protocol yearly.

Deerfield Academy Concussion Management Protocol

Although all medical care and decision-making should be individualized, this Protocol describes our standard approach to managing a suspected or diagnosed concussion at Deerfield Academy. 

INITIAL HEAD INJURY EVALUATION:

A student suspected of sustaining a concussion will be evaluated after the head injury as soon as is feasible by a healthcare professional.

1. 1. For students with a head injury during athletic events this evaluation typically occurs on the sideline or elsewhere by an athletic trainer. If the Athletic Trainer suspects a concussion, they refer the student to the D.S. Chen Health and Wellness Center. Otherwise, students with a head injury may present directly to the health center to be evaluated by a nurse.
   2. A student with a head injury shall not return to athletic or exertional co-curricular activities until medically cleared by the athletic trainer or school physician covering the contest or practice.  At away games, it may be the home team’s trainer or physician.  Athletes with a concern for head injury may not be cleared to return to play by a coach, a parent, guardian or a spectator (even if the spectator or parent is a trained healthcare professional).
   3. The athletic trainer will notify the Health Center of any head injury suspected to be a concussion.
   4. A student with a suspected head injury will be sent or transported to the Heath Center for further evaluation during or soon after the conclusion of the game/practice.
   5. If an away game or arrival at the D.S. Chen Health and Wellness Center is delayed for other reasons, serial follow-up evaluation(s) will be conducted by the Athletic Trainer as clinically indicated. 
   6. Any student evaluated by the health center staff for a suspected concussion will have an evaluation by the School Physician or Nurse Practitioner scheduled within the following 48 hours. Student will be instructed to call his/her parents/guardian to report what happened and their general status.

GENERAL PRINCIPLES OF CONCUSSION MANAGEMENT:

The cornerstone of concussion management is initial relative physical and cognitive rest followed by graduated return to academics and athletics as tolerated.

1. • Stages of Concussion Recovery:
     Relative Cognitive/Physical Rest → Return to Learn (RTL) → Return to Play (RTP)
   • When a concussed student is allowed to return to non-athletic school activities such as classes and other academic pursuits, they are responsible for disengaging from said activities if symptoms worsen or new symptoms occur. It is also their responsibility to report these exacerbations to the Health Center. 
   • Concussed students will have regular follow ups with the Health Center until they have completed the concussion protocol. At each visit to the Health Center the student will fill out a concussion symptom checklist.
   • Completion of the protocol and medical clearance by the School Physician or by the Athletic Trainer working with the School Physician is required before the student can return to athletic activity. 

STAGE 1: RELATIVE COGNITIVE/PHYSICAL REST:

After a head injury evaluation by the school nurse, the student will be admitted to the Health Center for observation and relative cognitive rest until they are evaluated by the School Physician or Nurse Practitioner.

1. 1. All head injury evaluations completed by a nurse must be reported to the School Physician.
   2. If the nurse suspects that, based on their head injury evaluation, the risk of concussion is low, the student may leave the health center after the nurse discusses the case with a physician or nurse practitioner.
   3. Headache and other concussive symptoms may be treated with over-the-counter medications per Health Center standing orders. 
   4. Vital signs and neurologic status are obtained and documented by nursing staff per standing orders.
   5. Any symptoms suggestive of intracranial injury or bleed (listed below) must be immediately reported by the nurse to the School Physician or Nurse Practitioner and/or 911 will be called per the nurse’s clinical discretion.
      1. worsening headache
      2. recurrent vomiting
      3. seizures or convulsions
      4. weakness, slurred speech or focal neurological deficit (i.e. hearing loss or facial droop)
      5. worsening mental status, confusion, agitation or loss of consciousness
      6. worsening drowsiness or inability to wake up
      7. one pupil larger than the other on exam.
   6. The School Physician or nurse practitioner will be scheduled to evaluate the student within 48hrs of their initial presentation.
   7. During the physician or nurse practitioner’s initial visit the following will be completed:
      1. A medical and neurological assessment will be made (this evaluation typically does not involve neuro-imaging, which is only obtained when specific criteria are met)
      2. The clinician will communicate with the student’s parents/guardian
      3. The clinician will communicate with the relevant school personnel concerning the status of the student.
      4. Arrangements for follow-up clinical evaluation will be made
   8. During the first 1-3 days after evaluation and/or injury, a concussed student will be placed on relative cognitive and physical rest per the physician’s or nurse practitioner’s orders.
      1. Concussed students will spend most of the academic day and night resting at the health center.
      2. After co-curricular they may be discharged for the evening with the expectation they will return at curfew.
      3. They will be instructed to avoid screens, not go to classes, not do strenuous exercise and not do any academic work.
      4. Concussions can be isolating; therefore, as tolerated and at the discretion of the nurse on duty, the student will be encouraged to leave the health center periodically to go on walks, be with friends and stay socially engaged.
      5. Students typically eat meals at the Health Center but may eat walk-through meals at Dining Hall at the discretion of the nurse if symptoms not exacerbated by noise.

STAGE 2: RETURN TO LEARN (RTL):

After 1 – 3 days of relative cognitive rest, the student will be allowed to return to academic work and exercise in a graduated manner as tolerated.

1. 1. They will be allowed to return to classes as tolerated and are instructed to return to the Health Center to rest if their symptoms worsen or new symptoms arise.
   2. The School Physician will work with teachers, the Advisor, the Office of the Academic Dean and other relevant school personnel to see that concussed students who experience difficulty with concentration and/or academic effort receive appropriate academic assistance and modifications until symptoms have improved/resolved. 
   3. During weekday co-curricular time, all concussed students will
      1. Participate in Return to Play activities supervised by the Athletic Trainers as tolerated.
      2. Attend a designated study hall to help them have enough time to complete their academic work with appropriate cognitive pacing. If they are significantly symptomatic during this time, they may come to the Health Center to rest.

NEUROCOGNITIVE TESTING:

Post-Injury neurocognitive testing is not required per Deerfield Academy’s Concussion Policy and Protocol; however, the School Physician or Nurse Practitioner may consider neurocognitive testing to assist with clinical decision making if they feel it is warranted.

STAGE 3: RETURN TO PLAY (RTP)

1. 1. Generally, each stage of Return to Play will take one day, so a student should take at least 5 days to proceed through the full rehabilitation protocol.
   2. Students are not allowed to complete more than one stage of RTP per day.
   3. Students will be started on the RTP protocol per the physician/nurse practitioner’s discretion, typically on days 2 – 4 after initial injury.
   4. Students may advance through Stages 1 – 3 of the RTP protocol if they can tolerate each stage without worsening symptoms or development of new symptoms.
   5. Students may not advance to Stage 4 (non-contact practice) until they are asymptomatic during and after completing Stage 3.
   6. If the athlete develops new symptoms or worsening symptoms during a stage of RTP, he/she should stop exercising. After approximately 24 hours, he/she may restart Return to Play at the stage they became symptomatic or, if exertional symptoms were significant, the previous RTP stage, per Athletic Trainers’ discretion.

*similar alternative activities may be prescribed at Athletic Trainer’s discretion

** for non-sports related concussions or concussed students not involved in a team sport, the athletic trainers will use the Objectives outlined to advance said students with a customized RTP similar to that of an athlete.

FINAL CLEARANCE FROM PROTOCOL:

The student may not return to athletic competition until medical clearance has been provided by the School Physician or Athletic Trainers.

1. Clearance typically requires:
   1. No further concussive symptoms at rest or under cognitive or exertional load
   2. successful completion of a graded exercise program (RTP) including a non-contact practice without return of symptoms
2. Once the student has fully completed the concussion protocol this information will be emailed or otherwise communicated directly to relevant faculty/employees by the Athletic Trainers or School Physician.

Students with specific medical conditions may have access to their smartphones during assessments if approved by the Director of Medical Services. If the student does not need their phone for medical reasons it should remain in their backpack or in an area designated by the proctoring teacher away from the student’s workspace.

These students will be provided with the same amount of time to complete an assessment as other students. If they need to use their phone to address a medical issue, their time to take the assessment should be extended by the amount of time they use to address the medical issue.

During the assessment, the phone should only provide alerts related to the student’s medical condition and do so in a manner that does not distract other students. Alerts related to texting, phone calls or other app notifications should be silenced prior to starting the assessment.

If a student needs medical access to their phone during an assessment, they should first inform their teacher/proctor that they need to access the phone for medical reasons. They should then obtain their phone and step out of view of the academic material and in full view of the teacher proctoring the assessment while they address the medical issue. Once the student no longer needs their phone, they should inform the proctoring teacher that they are done and return it to their backpack or other designated place outside the workspace prior to restarting their assessment.

After accessing their phone, if the student needs to continue monitoring their phone for a more extended amount of time (e.g. more than 2 – 3 minutes) they should check in with their teacher/proctor to determine if they can do so at the student’s desk while continuing with the assessment OR they should continue to pause the assessment until the student has fully addressed the medical issue. This decision will be made by the proctoring teacher. If the teacher proctoring the assessment feels that the student may continue with the assessment while monitoring their phone, the student should place the phone face up on their workspace so the proctoring teacher can confirm it is being used only for medical purposes. When their phone is no longer needed, the student should return it to their backpack or other designated place outside the workspace.

At Deerfield Academy, a refrigerator is provided in each residence hall’s common room so that students can store items requiring refrigeration. We do not permit refrigerators in individual student rooms (See Rules and Expectations for Deerfield Academy Students, Section 4.11); however, occasionally there is a medical reason where an individual refrigerator should be permitted. The following is the policy to help clarify this process:

• Refrigerator permits will be granted only by the school physician on a limited case-by-case basis for those students who have a medical condition where having access to particular foods or medications requiring refrigeration is necessary in order to prevent a potentially life-threatening or incapacitating complication.
• The school physician has sole authority to grant a refrigerator permit.
• In order to be considered for a medical exemption for a refrigerator, documentation must be provided by a medical provider (medical provider is defined as either a MD, DO, MB BCh, NP or PA) requesting the refrigerator and must include a diagnosis, not a symptom (for example “Crohn’s Disease”, not “intestinal issues”) and the potential life-threatening or incapacitating complication.
• The refrigerator permit will last for the remainder of the academic year unless otherwise noted and must be renewed annually.
• Occasionally there will be certain requirements (i.e. follow-up appointments with the health center, documentation from outside health care providers) that must be fulfilled to maintain the permit during the academic year. Failure to fulfill these requirements will result in the permit being revoked and the refrigerator removed.
• If the school physician authorizes the refrigerator permit, the student will be given a paper certificate that must be displayed on their refrigerator at all times.
• If the school physician authorizes the refrigerator permit, a fee of $50 will be charged to the student’s account for the year.
• Refrigerator must be no larger than 2.7 cubic feet Please address any further questions to the Deerfield Academy Health and Wellness Center at (413) 774-1600.

Please refer to our Notice of Privacy Practices.