Understanding the NCAA Concussion Protocol: What Athletes and Coaches Need to Know

On-Field and Sideline Evaluation

When a concussion is suspected during play, immediate evaluation is essential. The protocol emphasizes a multi-modal screen that should be completed within 10–15 minutes, encompassing red flag symptoms, cervical spine clearance, symptom severity scoring, cognitive performance, and balance control.

This rapid yet thorough screening determines whether an athlete should be removed from play for further evaluation. In practice, many athletic trainers and team physicians rely on mobile tools that capture real-time data for objective analysis and documentation. Sway's On-Field Assessment Survey fits well into this approach, enabling consistent application of sideline evaluations​.

Emergency Action Plan (EAP)

Every program must have a clearly documented Concussion Emergency Action Plan. This includes designated contacts, EMS procedures, and facility-specific logistics. Ensuring all staff are trained and that protocols are rehearsed annually can be the difference between rapid intervention and preventable complications during a high-stress event.

The EAP must be readily accessible and integrated into the athletic department’s broader emergency response strategies. Compliance with this requirement is often reviewed during NCAA site visits or audits.

Subacute Management and Monitoring

Following the initial 72 hours post-injury, a structured subacute protocol guides return-to-learn and RTP progression. This includes:

• Serial symptom tracking
• Graded cognitive and physical exertion
• Sleep and mood screenings
• Assessment of vestibulo-ocular function (modified VOMS)
• Orthostatic vitals and tandem gait testing

Research conducted as part of the NCAA–DoD CARE initiative emphasizes the importance of personalized management strategies. One recent study found that sex-specific factors influence time to recovery, including symptom profiles and initial cognitive scores (source). Female athletes, for instance, often report more intense symptoms and may experience longer recovery periods, necessitating individualized care plans.

Clinically, this reinforces the need to avoid rigid timelines. Protocol adherence should be guided by objective criteria and functional thresholds—not arbitrary days on a calendar. Tracking systems embedded in platforms like Sway can support athletic trainers in executing serial evaluations while minimizing administrative burden.

Return-to-Play: A Graduated Approach

Return-to-play remains the most sensitive and scrutinized phase of concussion care. According to the Amsterdam Consensus Statement, RTP must follow a stepwise progression:

1. Symptom-limited activity
2. Light aerobic exercise
3. Sport-specific drills (non-contact)
4. Non-contact training with cognitive load
5. Full contact practice (cleared by physician)
6. Return to competition

Each phase should span at least 24 hours, and athletes must remain symptom-free at each stage before progressing. If symptoms return, they must revert to the previous stage.

What’s often overlooked is the cognitive exertion associated with return-to-learn. NCAA guidelines suggest these be synchronized—an athlete struggling with classwork or exams is not yet ready to rejoin competitive play. This dual burden is particularly relevant in college settings, where academic pressure can hinder or prolong recovery.

Long-Term Innovation: What’s Ahead?

The NCAA has demonstrated interest in expanding treatment options for athletes with persistent symptoms. A 2024 randomized trial, partially supported by NCAA funding, explored neuromodulation strategies for prolonged post-concussion issues (source). While not yet standard protocol, it reflects a future-focused shift toward individualized, tech-enabled recovery modalities—particularly for athletes facing multiple or delayed recoveries.

These innovations point toward a larger movement: concussion care is moving beyond acute symptom tracking and toward long-term brain health monitoring, supported by digital tools, AI-assisted interpretation, and cross-disciplinary management.

Real-World Implementation: Key Takeaways for Athletic Staff

Despite having robust guidelines, institutional execution often depends on available resources, staff training, and administrative alignment. This is where technology, staffing strategy, and education intersect.

For high school and college athletic trainers managing large caseloads, tools that reduce documentation burden and standardize assessments are critical. Platforms like Sway, which align with the NCAA checklist, offer user-friendly integrations that complement busy sideline and clinical workflows​.

Athletic directors play a pivotal role in supporting these efforts. Budget decisions, resource allocation, and staffing influence every aspect of concussion protocol compliance. Demonstrating a program’s alignment with NCAA requirements and athlete safety priorities can also strengthen a department’s institutional standing and public trust.

Protecting Athletes, Elevating Standards

Understanding the NCAA Concussion Protocol isn’t about checking boxes—it’s about ensuring student-athletes have the safest environment possible for competition and recovery. Athletic trainers are the frontline decision-makers, but true success depends on collaboration across departments.

Evidence-backed tools, consistent evaluations, and person-centered care are the foundation of effective concussion management. As research evolves and technologies advance, so too must our strategies for implementation. 

Standardization doesn’t limit care—it elevates it.

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