The syndrome of concussion is very common in sport. It is a transient condition with full recovery anticipated. However, it is often difficult to differentiate from more serious, life threatening injuries.

Cause

- Blow to the head or face
- The head coming to a sudden stop or being propelled forward suddenly resulting in sudden acceleration/deceleration eg. Landing on the back after a fall from a height.

Recognition

- Mechanism of injury
- Loss of consciousness (Can last from seconds to minutes)
- Confusion or agitation
- Memory loss & impaired information processing.
- Blurred vision
- Headache
- Loss of balance, “dizziness”
- Nausea

It is often difficult to assess if an athlete has lost consciousness following a blow to the head. The Sports Trainer is encouraged to act conservatively and if unsure, manage the athlete as if the have lost consciousness.

Management

Suspect the athlete has concussion if there is:

- Obvious loss of consciousness
- Altered mental state
- Unable to answer simple questions eg. Who are we playing?

If there are no symptoms or signs of concussion or other head injury and the athlete feels fully recovered from the incident, he/she may be considered for return to play.

If these symptoms are present:

- If athlete is unconscious, apply DRABC
- Assume cervical spine injury till proven otherwise by appropriate protocol
- Appropriately immobilise the athlete
- Once DRABC is stable, remove the athlete from play
- Transport to hospital for urgent medical referral

All suspected head injuries require urgent medical assessment

If there is any memory loss, then the athlete has lost consciousness and requires management. The severity of the brain injury is related to the duration of the period of memory loss and the length of the period of loss of consciousness.

Management of an athlete who has lost consciousness

In the care of any unconscious athlete the priorities remain those of DRABC. However, in the event that an athlete has lost consciousness as a result of trauma (i.e a fall or contact with an object or another person) the potential for spinal injury requires some consideration and modification of the practical application of DRABC. However, the principles of DRABC remain the same.

D – Control the dangers at the scene. This includes warning those caring for the athlete against unnecessary movement of the athlete that could lead to damage to the spinal cord. Send someone to call for an ambulance.
R – Check for response, again avoiding any unnecessary movement that could lead to damage of the spinal cord.
A – (with control of neck movement) – Do not roll the athlete into the coma position unless there is bleeding from the mouth or nose or the athlete appears to be vomiting. Open the airway by chin pull or jaw thrust. Only use hyperextension of the neck if opening of the airway cannot be achieved by trying the other 2 techniques and the athlete is showing signs of deterioration due to a compromised airway.
B – Check for breathing in the usual way. If the athlete is not breathing, logroll the athlete into the supine position (i.e on the back) and commence EAR.
C – Check for circulation in the usual way. If the athlete has no palpable pulse, logroll the athlete into the supine position (i.e on the back) and commence ECC.
- Immobilise the head and neck in a stable position to prevent a change in the relationship between the position of the head relative to the body. This may be achieved by gently but firmly holding the head in the position you found it between the flat of your two hands. Only apply a rigid cervical collar if you have been trained to do so. Inexperienced and unqualified personnel are likely to promote excessive movement of the neck and may actually cause injury to the spinal cord rather than prevent it.
- In the event that there is a valid reason for moving the athlete from the field, transfer should only occur is the ABC’s are secure and the neck and spine can be protected from movement of the head relevant to the trunk. If the athlete must be moved, this should be achieved by a coordinated team approach with a team leader (Sports Trainer or most experienced/qualified person) to lead the action of the team. In the past the Jordan Frame was the equipment of choice. Recent research has shown that more spinal movement than previously thought may occur during transfer on a Jordan Frame. The scoop stretcher is used by and endorsed by the professional Ambulance Services in Australia. If the ABC’s become “at risk” during transport, stop, lower the stretcher/board to the ground and correct the problem before proceeding with transport.

If the athlete regains consciousness before the ambulance arrives:

- Keep the athlete quiet.
- Ask if neck pain is present. If neck pain is present, treat as a potential spinal injury.
- If suspicious of neck injury or there is any doubt, do not move athlete and call an ambulance.
- If not suspicious of neck injury, the athlete does not have to lie still.
- Refer the athlete to a hospital for further assessment and management.

The athletes requires urgent transfer for medical opinion, if there is any:

- Loss of Consciousness
- Amnesia
- Confusion

Remember, a blow to the head can cause bleeding into the brain, or direct brain damage. Therefore, it is important that a doctor assesses all head injuries. Any unconscious athlete with an injury above the level of the collarbone should be treated as if he/she has an unstable cervical injury till proven otherwise by a doctor.

Compression

A blow to the head can bruise the brain tissue, resulting in:

- Swelling
- Tissue damage
- Bleeding

The amount of swelling and bleeding depends upon the severity of the blow. This swelling may not occur immediately, but may develop over the following few hours. Therefore all head injuries must be referred to a doctor for further assessment.

Signs of bleeding into the brain

If the following symptoms are noticed 4-6 hours following a blow to the head the athlete must be referred to a doctor immediately:

- Tiredness & Drowsiness
- Listlessness
- Headache
- Nausea and possible vomiting
- Lack of Co-ordination
- Loss of balance
- Dizziness
- Possible blurred vision or visual disturbance.

Management

Any athlete who has lost consciousness should be referred to a doctor for further assessment and management.
If following an incident, an athlete starts to develop these symptoms then they should be referred to a doctor for further assessment and management.

Serious Head Injury

Trauma to the head may cause bleeding into or around the brain. This causes increased pressure inside the skull, which may require surgical drainage. It may take hours for signs and symptoms of swelling to become apparent.

Future management

Athletes who have lost consciousness should:

- Receive a medical clearance before resuming training and competition.
- Once medical clearance has been received, the athlete should follow a plan of graduated return to general exercise, then non-contact drills and then contact drill. Should symptoms of headache, recur at any stage, the athlete should be referred back to a doctor for reassessment.
- Pass a skills test before returning to full training and competition
- Should the athlete develop headache, lethargy or nausea with any of these activities, the activity should cease and the athlete should be referred back for further medical opinion.

The athlete’s skill and coordination will be the last function to regain normal levels of skill following an episode of concession.