Concussion in sport is a topic of increasing concern, and most sports bodies now take it very seriously. Concussion is not something to be ignored or ‘shaken off’ for a quick return to play, and if you are involved in sports first aid in any way you probably already knew this. Unfortunately, the repeated occurrence of incidents such as Hugo Lloris continuing to play while concussed indicates that ignorance of the issues surrounding concussion persists at all levels of sport. With this in mind, we’ve prepared a brief summary of some of the things to bear in mind when dealing with head injuries in sport. Obviously, what follows is not an exhaustive guide to concussion, nor is it a substitute for adequate first aid training.
What is Concussion?
Concussion is the disturbance of mental function that can occur when the head is subject to strong acceleration forces and the brain moves around inside the skull. Often this is the result of a direct blow to the head, but it can also happen as result of other sudden, forceful movements – for instance, a hard impact to the body that causes the head to snap back. Given this, it is a very common injury in contact sports such as Rugby, football, american football and boxing.
People who suffer concussion may exhibit any of a long and varied list of symptoms. Some of the most obvious include a short period unconsciousness, confusion and loss of co-ordination and balance. But not all – or even any – of these will necessarily be present in every case of concussion.
Concussion is considered one of the mildest forms of brain injury; in most cases it is a transient experience and the casualty is back to normal quite quickly. However, it might still take several weeks for them to be considered fully recovered, and in a small number of cases much more serious problems can arise. Repeated concussions – for instance, as suffered by boxers – are linked to severe neurological conditions and permanent loss of mental function. Therefore, any head injury or suspected concussion warrants close and careful attention.
How Do I Recognise Concussion?
According to the British Journal of Sports Medicine, ‘Sport-related concussions can be difficult to diagnose. Concussion produces an evolving constellation of somatic, cognitive and neurobehavioral symptoms…’ (Link Here). Therefore, the diagnosis needs to be made by a doctor. However, there are symptoms you should look out for that make it reasonable for you to suspect concussion. These include:
- Loss of consciousness
- Casualty not fully alert – e.g. does not quickly and clearly respond to simple questions
- Slow movements
- Stumbling or unsteadiness
- Change of personality
- Ringing in the ears
The Sport Concussion Assessment Tool, known as SCAT3, provides a structured guide to assessing players who have suffered a head injury. A shorter Pocket Concussion Recognition Tool is also available. It is a good idea to print copies of these documents and keep them in your first aid kit. But remember, SCAT3 is not a substitute for clinical diagnosis by a doctor.
What Should I Do if I Suspect Concussion?
If a player exhibits any of the warning signs for concussion – or if you have any doubts at all about a player with a head injury – your immediate action should be:
- Withdraw the player from the game
- Do not allow the player to return to the game, even if they appear to recover
- Closely monitor the player’s condition for any changes
- Refer the player to a doctor
It’s important that any player with a suspected concussion is withdrawn from the game, and does not play again that day. For a start, you need to carefully watch someone with concussion for any deterioration or new symptoms, (for instance beginning to vomit, or new bluring of vision,) that could indicate a much more serious problem such as compression – this is an emergency and you need to seek immediate medical attention for the player.
There is also some evidence to suggest that incurring a second head injury on top of an existing concussion can cause rapid brain swelling and death, so a concussed player still needs to sit out the rest of the game even if they appear ‘back to normal’ quite quickly.
In short, the safest course of action is to withdraw the player and have them examined by a doctor. Even for a mild concussion, the player will need to take at least a week to recover before returning to any form of sport.
(You will notice that some sources of information on concussion indicate that medical attention is only necessary if there is a deterioration after the initial incident, whereas SCAT3 recommends that anyone with any level of suspected concussion is seen by a doctor. Bear in mind that SCAT3 is currently the most up-to-date advice for concussion in sport.)