Concussion Management in Sports First Aid

The 4th International Conference on Concussion in Sport, held in Zurich in November 2012 and a consensus statement on concussion in sport was produced and published by the British Journal of Sports Medicine. Visit the Resources page on our website to download copies of these consensus statements.  As you can see the topic of concussion in sport is very well discussed and researched. The guidelines from most sporting bodies are based on the Zurich consensus statement and React First has adapted the relevant parts of the statement to teach on their pitchside sports and fitness first aid courses.

Whilst Rugby is by no means the only contact sport where players are at risk of concussion the RFU (Rugby Football Union) have run the extensive Headcase campaign and provide many resources for players, coaches and officials on their website which are well worth reading even if you are not involved in rugby (http://www.rfu.com/headcase).  The International Rugby Board (IRB) player welfare website also has an excellent online training module about concussion which I’d advise everyone to do. You simply need to register on their website to access this resource: http://www.irbplayerwelfare.com/
 
The general rule across all sports is ‘If in doubt, take the player out’ but the considerable pressure on players, coaches and managers, especially when being taken off for concussion might mean  missing future matches. This raises deep concerns about all players’ welfare which must be addressed by each sporting organisation and which is the main message of the brain injury association,  Headway (https://www.headway.org.uk/home.aspx). It was unanimously agreed in the Zurich statement, supported by FIFA, ‘that no RTP (return to play) on the day of a concussive injury should occur’. It also stated that ‘All athletes, regardless of the level of participation, should be managed using the same treatment and RTP paradigm.’
 
Whilst the Zurich statement does not specifically link multiple concussions with the increased likelihood of dementia in the long term, they do site the dangers of exposing yourself to the risk of a second injury while still recovering from the first.  In their concussion training on their website the RFU state: “We have concerns that repeat concussion could shorten a Player’s career and may have some potential to result in permanent neurological impairment.”

CONCUSSION MUST BE TAKEN EXTREMELY SERIOUSLY. IF YOU SUSPECT A PLAYER IS SUFFERING FROM CONCUSSION THEY MUST BE REMOVED FROM PLAY IMMEDIATELY AND ASSESSED BY A MEDICAL PRACTITIONER.

If concussion is diagnosed then a graduated return to play programme must be followed under the guidance of the player’s health practitioner or medical professional.

The Role of a Pitchside First Aider

As a pitchside first aider, you are not considered to be a health practitioner or medical professional when it comes to diagnosing concussion, unless you also hold another qualification such as being a doctor. The following is a recap of what a pitchside sports first aider can reasonably be expected to know about concussion and to do when attending to a player involved in a potential concussion generating impact.

What is Concussion? 

The definition of concussion from the Zurich consensus statement, 2012 is:

Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilised in defining the nature of a concussive head injury include:

  1. Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head.
  2. Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hours.
  3. Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
  4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness.
  5. Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged.

[ref: Consensus statement, Zurich 2012]

In summary:
Concussion is a complex process caused by trauma that transmits force to the brain either directly or indirectly and results in temporary impairment of brain function. Its development and resolution are rapid and spontaneous. A Player can sustain a concussion without losing consciousness. Concussion is associated with a graded set of clinical signs and symptoms that resolve sequentially. Concussion reflects a functional rather than structural injury and standard neuro-imaging is typically normal.
[ref: http://www.irbplayerwelfare.com/ - Concussion Management]


How to Recognise Concussion

Remember that a player doesn't have to be knocked out (lose consciousness) to experience a concussion. As a first aider you will be called upon to do and on-pitch or sideline assessment of a player who has been involved in an incident with concussion producing forces. If you suspect that a player has concussion the player must be removed from the field of play and must not play any further part in the game. Continuing to play after sustaining a concussion may result in a more serious brain injury or a prolonged recovery period.

Use the Pocket CRT – Concussion Recognition Tool. 

/live/Pocket CRT - small.jpg

As a first aider you cannot diagnose concussion however it is also worthwhile to be familiar with the SCAT3 and child SCAT3, concussion assessment tools which are designed for use by medical practitioners to diagnose concussion.
 

Download printable PDF versions of these concussion assessment and  management tools here:
Pocket CRT
SCAT3
Child SCAT3 

Signs and Symptoms of Concussion

Full details of the signs and symptoms of concussion are here.

What to do if you Suspect Concussion

Any athlete with a suspected concussion should be IMMEDIATELY REMOVED FROM PLAY, and should not be returned to activity until they are assessed medically. Athletes with a suspected concussion should not be left alone and should not drive a motor vehicle.

It is recommended that, in all cases of suspected concussion, the player is referred to a medical professional for diagnosis and guidance as well as return to play decisions, even if the symptoms resolve.