A referee's concussion job is narrow: if a player shows signs, symptoms or behaviors consistent with a concussion, the official stops play and removes the player. Under the NFHS concussion rule, officials don't diagnose, don't run the sideline evaluation and don't need paperwork to let a player back in; that responsibility belongs to a health care professional and the people running the game. In New York schools, state regulation (8 NYCRR 136.5) requires immediate removal, presumes injury when in doubt, and bars a return until the student has been symptom free for at least 24 hours and has written, signed clearance from a licensed physician. Community leagues and tournaments on Long Island should write their own policy before opening day: who takes over when a referee removes a player, whether same-day return is ever allowed, and how the incident gets recorded.
What the referee actually does when a player may be concussed
Most of the confusion on Long Island sidelines comes from people expecting the referee to make a medical call. The rules don't ask for that. The NFHS concussion rule, which the New York State Public High School Athletic Association circulated to schools and officials' associations when it took effect for the 2010–11 school year, says: "Any athlete who exhibits signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headaches, 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."
The NYSPHSAA memo then splits the job in two. For the sport official: remove the athlete from the contest. The memo says the official "is NOT responsible for the sideline evaluation or the management of the athlete once they have been removed from the game," and "does not have to receive any paper work clearing the player to return to the game." For the school official: get the athlete assessed by an appropriate health care professional, and if one suspects a concussion, the player may not return. If no appropriate professional is available, the memo says the athlete may not return either.
That division is useful outside school sports too. Referees watch for the signs and take the player out. Somebody on the league side has to be ready to take over the moment that happens. When that person isn't defined, the referee ends up fielding questions from a coach who wants the player back in and a parent who wants answers, and neither is the official's call to make.
School games vs. community leagues: which rules apply?
New York's concussion regulation is written for schools. 8 NYCRR 136.5 applies to school districts, charter schools and nonpublic schools, and sets the minimum standards for pupils hurt during school-sponsored or related activities. It says:
- A school must require the immediate removal from athletic activities of any pupil who has sustained, or is believed to have sustained, a concussion.
- If there is any doubt, the pupil is presumed injured until proven otherwise.
- The pupil can't resume athletic activity until symptom free for at least 24 hours and evaluated by, with written and signed authorization from, a licensed physician. In public schools, extra-class athletics also need clearance from the director of school health services.
- Coaches, PE teachers, nurses and certified athletic trainers working with school athletes must complete an approved concussion course every two years.
A Saturday rec soccer game, a CYO basketball league, a PAL program, a travel tournament at a private complex or an adult league isn't a school activity, so that regulation doesn't govern it. Those programs follow whatever their governing body, sanctioning organization, insurer or facility requires, plus their own league rules. That is exactly why a league should put its concussion policy in writing. When a school district rents its field to your league, or your tournament uses school facilities, ask the district what it expects from outside users as well.
Signs officials are trained to watch for
The NYSPHSAA memo includes a list of observable signs for officials and school staff. In plain terms, the groups are:
- Problems with brain function: a dazed look or vacant stare, confusion about what's happening, not remembering the play, the score or the period, or reporting headache, nausea, blurred vision, ringing ears or feeling foggy.
- Slowed responses: slow or slurred answers, slow movements or reactions.
- Unusual behavior: combative, very silly or out-of-character reactions, asking the same question again and again, restlessness.
- Balance and coordination: dizziness, clumsy movement, trouble walking a straight line.
Officials see a player for seconds at a time from 20 or 40 yards away. Coaches, trainers and parents often notice changes first. A good league policy lets anyone flag a concern to the referee at a stoppage, and makes clear the referee can stop play for an injury without waiting for a coach to ask.
Tell Us Your Concussion Policy When You Book
Booking officials for a league night or tournament on Long Island? Include your league's concussion policy and the name of your on-site contact in the request, so the crew knows who takes over when a player is removed.
Request Officials →The handoff: what has to happen after the whistle
The minutes right after a removal are where policies break down. Decide these in advance and print them on the field sheet:
| Question | What to decide before the season |
|---|---|
| Who takes over from the referee? | Name a person for each field or session. At a school event this is school health personnel. At a community event it might be an athletic trainer you've hired, an EMT on site, or a league official. |
| Can the player return the same day? | The NFHS and NYSPHSAA recommend that a player who suffers a concussion should not return to play the day of the injury. Many community leagues simply adopt "removed means done for the day." |
| What if no health care professional is there? | Under the NYSPHSAA protocol for school games, the athlete may not return if an appropriate professional isn't available. A community league that has no medical coverage should follow the same rule. |
| Who tells the parent? | The coach or league contact, not the referee. Give parents written information and tell them the player needs medical clearance before the next practice or game. |
| How is it recorded? | Note it on the game report: time, what was observed, who took over. Referees can describe what they saw; they don't record diagnoses. |
| What does clearance look like? | Write down what document your league accepts before a player returns, and who collects it. Coaches should not accept a verbal "he's fine." |
If you're putting together the rest of your league paperwork, our guide to starting a sports league on Long Island covers field permits and insurance certificates, and our lightning and heat safety policy guide covers the other safety stoppages officials make.
Train the adults, not just the officials
A referee may be the one who removes the player, but coaches are the ones who see the athlete before and after the game. CDC's HEADS UP program offers free online concussion training for youth sports coaches through CDC TRAIN, with a certificate for those who pass the post-test. School coaches in New York already need an approved course every two years under 8 NYCRR 136.5. Community leagues can ask their volunteer coaches to complete a free course before the season and keep the certificates on file. It costs nothing and gives every coach the same vocabulary as the officials.
At the pre-game meeting, referees and coaches can spend 30 seconds on it: who the on-site contact is, where they'll be, and that a removed player won't come back without clearance. That conversation settles the issue before anyone is emotional about it.
Return to play is a medical decision with a written plan
Officials have no role in return to play, but leagues do, because the coach decides who's on the roster next week. The NYSPHSAA memo included a recommended graduated protocol for school officials: no exertional activity until medically cleared and symptom free for 24 hours, then light activity, sport-specific aerobic work, non-contact drills and full-contact practice, with the athlete moving back a step if symptoms return. Treat that as an illustration of how cautious the progression is, not as instructions for a specific child. The player's own clinician sets the plan. Your league's job is to require the clearance document your policy names and to make sure coaches follow it.
This guide is general information for league organizers, not medical advice. A player with worsening symptoms, repeated vomiting, a seizure, or a loss of consciousness needs emergency care: call 911.
Tournaments and multi-field events need a plan per field
Weekend tournaments are where coverage gaps show up. Six fields running at once and one athletic trainer means the trainer is a five-minute walk from most injuries. Before the event:
- Put a named contact and a phone number on every field's scorecard or tablet.
- Tell the referee crews, at check-in, how to summon that contact.
- Decide whether a player removed in pool play can return later in the tournament without written clearance. (Most organizers say no.)
- Give the tournament desk a log for removals so coaches of the next game know.
- Make sure your schedule has room for injury stoppages without forcing referees to rush.
If you're staffing a big event, our tournament referees guide covers crew sizes and scheduling across multiple fields.
Need Officials Who Follow Your Safety Rules?
League games, tournaments and last-minute fill-ins across Nassau and Suffolk. Send the date, sport, level and your league's safety policies, and we'll staff the games.
Request Officials →Frequently Asked Questions
Yes. Under the NFHS concussion rule, any athlete who shows signs, symptoms or behaviors consistent with a concussion is to be immediately removed from the contest. The NYSPHSAA memo on the rule says the sport official's job is to remove the athlete; officials don't diagnose a concussion.
No. The NYSPHSAA memo says officials aren't responsible for the sideline evaluation or for managing the athlete after removal, and don't need to receive clearance paperwork. An appropriate health care professional decides, and if none is available at a school contest, the athlete may not return.
8 NYCRR 136.5 requires schools to remove a pupil believed to have a concussion immediately, presumes injury when in doubt, and bars return to athletics until the pupil has been symptom free for at least 24 hours and has written, signed authorization from a licensed physician. Public schools also need clearance from the director of school health services for extra-class athletics.
8 NYCRR 136.5 applies to school districts, charter schools and nonpublic schools. Community rec, travel, CYO, PAL and adult leagues follow their governing body, insurer and facility rules plus their own league policy, which is why leagues should put a concussion policy in writing.
The NFHS and NYSPHSAA recommend that an athlete who suffers a concussion not return to play on the day of the injury. Many community leagues and tournaments adopt a simple rule: a player removed for a suspected concussion is done for the day and needs written clearance before playing again.
Sources (checked October 30, 2026): NYSPHSAA memo to member schools and sport official organizations, "NFHS Concussion Rule" (rev. Aug. 19, 2010); 8 NYCRR 136.5, Concussion management and awareness (Cornell LII); CDC HEADS UP online training courses. This page is general information for league organizers and is not medical or legal advice.