Concussions

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Regions have many responsibilities: strengthen sport, extend opportunities to participate, and instill the values of fair play, respect and hard work. Creating conditions that promote the performance and well being of athletes is a fundamental component of these goals, which require effective policies and monitoring, as well as the collaboration and collective energy of our entire sport community.

Nationwide data continues to show that many catastrophic head injuries are a direct result of injured athletes returning to play too soon, not having fully recovered from the first head injury. Additionally, the Centers for Disease Control reports that approximately 3 million sports and recreational concussion occur every year.

California has modified existing school concussion law to apply the requirements to all youth sports organizations in which athletes participate. These changes affect all youth sports and head injury policies – particularly how coaches must respond to player injuries.

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The law requires:

A coach, volunteer and/or referee must receive annual training to learn how to recognize the symptoms of a concussion and how to seek proper medical treatment for a person suspected of having a concussion.
Each coach must complete and submit the Concussion in Youth Sports acknowledgement form via their online registration.
Each youth athlete, and their parent, must complete and submit a Concussion in Youth Sports Acknowledgement form, via the online registration, acknowledging the risk of head injury prior to tryouts, practice, or competition.
A youth athlete who exhibits any signs, symptoms, or behaviors consistent with a concussion following an observed or suspected blow to the head must be removed from training and/or play for the entire remainder of the day – “when in doubt, sit them out.”
Coaches must notify the parents or guardians of athletes 17 or younger who have been removed from athletic activities due to suspected concussions.
A youth athlete who has been removed from training and/or play due to a suspected concussion must receive a written clearance to return to the athletic activity from a licensed health care provider, prior to returning to training and/or play.
If the athlete is diagnosed with a concussion, they must go through a graduated return to play protocol of no less than seven days under the supervision of a licensed health care provider.

State law requires coaches take steps to protect athletes when the athlete exhibits any signs, symptoms or behaviors associated with a concussion. Parents may strongly disagree with a coach’s decision to pull an athlete due to a suspected concussion. However, failure to remove an athlete suspected of having suffered a concussion from play can subject you, as the coach, to civil and criminal liability.

What each coach, administrator, referee, and volunteer needs to do:

Review the Concussion in Youth Sports Information sheet.
Watch one concussion training video and complete the short quiz that follows.
Submit your certificate showing completion of the concussion training video and quiz.

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[sf_button colour=”accent” type=”standard” size=”large” link=”https://nfhslearn.com/courses/61151/concussion-in-sports”_blank” icon=”” dropshadow=”no” extraclass=””]NFHS Online Training Video[/sf_button]

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[sf_button colour=”accent” type=”standard” size=”large” link=”https://www.cdc.gov/headsup/youthsports/training/index.html” target=”_blank” icon=”” dropshadow=”no” extraclass=””]CDC Online Training[/sf_button]

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[sf_button colour=”accent” type=”standard” size=”large” link=”http://ncva.com/downloads/Concussion%20Recognition%20Tool%20CRT5.pdf” target=”_blank” icon=”” dropshadow=”no” extraclass=””]Concussion Recognition Tool[/sf_button]

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[sf_button colour=”accent” type=”standard” size=”large” link=”http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=124235.&lawCode=HSC” target=”_blank” icon=”” dropshadow=”no” extraclass=””]California state law AB 25 / Education Code 49475[/sf_button]

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Facts:

A concussion is a brain injury.
All concussions are serious.
Concussions can occur without loss of consciousness.
Concussions can occur in any sport.
Recognition and proper management of concussions when they first occur can help prevent further injury or even death.

What is a concussion?

A concussion is an injury to the brain that causes stretching and tearing of brain cells, damaging the cells and creating chemical changes in the brain. These chemical changes result in physical, emotional, and cognitive symptoms. Once these changes occur, the brain is vulnerable to further injury and sensitive to any increased stress until it fully recovers.

A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Even a “ding,” “getting your bell rung,” or what appears to be a mild jolt or blow to the head or body may cause the brain to shift or rotate suddenly within the skull. Concussions can also result from a fall or from players colliding with each other or with obstacles even if they do not directly hit their head.

The potential for concussion is greatest in athletic environments where collisions are common. Concussions can occur, however, in any organized or unorganized sport or recreational activity; as many as 3.8 million sports and recreation related concussions occur in the United States each year.

Recognizing a Possible Concussion

Loss of consciousness is not required to have a concussion; less than 10% of athletes with a concussion are “knocked out.” To help recognize a concussion, you should watch for the following two things among your athletes:

A forceful blow to the head or body that results in rapid movement of the head.
Any change in the athlete’s behavior, thinking, or physical functioning.

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Signs Observed by Coach

Appears dazed or stunned
Is confused about assignment or position
Forgets sports plays
Is unsure of game, score, or opponent
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows behavior or personality changes
Can’t recall event prior to hit or fall
Can’t recall events after hit or fall

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Symptoms Reported by Athlete

Headache or “pressure” in head
Nausea or vomiting
Balance problems or dizziness
Double or blurry vision
Sensitivity to light
Sensitivity to noise
Feeling sluggish, hazy, foggy or groggy
Concentration or memory problems
Confusion
Does not “feel right”

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Athletes who experience any of these signs, symptoms or behaviors following an observed or suspected blow to the head or body must not be allowed to participate in any athletic event or training for the remainder of that day. That athlete cannot be allowed to participate in any future athletic event or training until the athlete both (i) no longer exhibits signs, symptoms, or behaviors consistent with a concussion; and (ii) receives written clearance from a licensed health care provider. Signs and symptoms of concussion can last from several minutes, to days, weeks, months, or even longer in some cases.

Remember, you can’t see a concussion and some athletes may not experience and/or report symptoms until hours or days after the injury. If your athlete exhibits any signs, symptoms or behaviors following an observed or suspected blow to the head or body, you must keep the athlete out of the game or practice for the remainder of the day and cannot allow that athlete to again participate in games or practices until the athlete has been medically cleared.

Failure to comply with these requirements can lead to civil or even criminal liability for a coach if their athlete is injured due to continuing to play after receiving a suspected concussion.

Prevention and Preparation

As a coach, you can play a key role in preventing concussions and responding to them properly when they occur. Here are some steps you can take to ensure the best outcome for your athlete and the team:

Educate athletes and parents about concussions. Talk with athletes and their parents about the dangers and potential long-term consequences of concussion. Explain concerns about concussions and your expectations of safe play to athletes, parents and assistant coaches.
Insist that safety comes first.
- Teach athletes safe playing techniques and encourage them to follow the rules of play.
- Encourage athletes to practice good sportsmanship at all times.
- Make sure athletes wear the right protective equipment for their activity. Protective equipment should fit properly, be well maintained and worn consistently and correctly.
- Review the athlete fact sheet with your team to help them recognize the signs and symptoms of a concussion.
Teach athletes and parents that it’s not smart to play with a concussion. Sometimes players and parents wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don’t let athletes persuade you that they’re “just fine” after they have sustained a bump or blow to the head. Ask if players have ever had a concussion.
Understand that, as the coach, you can be held civilly or criminally liable if you allow a player with a concussion or suspected concussion to continue to play. When in doubt, sit them out.
Prevent long-term problems. A repeat concussion that occurs before the brain recovers from the first concussion – usually within a short period of time (hours, days, or weeks) – can slow recovery or increase the likelihood of having long-term cognitive problems. In rare cases, repeat concussions can result in brain swelling, permanent brain damage and even death. This is a more serious condition called second impact syndrome. Avoidance of second impacts is why it is critical to keep athletes with known or suspected concussions from play or practice until they have been evaluated and received a medical release form from a licensed health care provider. Remind your athletes: “It’s better to miss one game than the whole season.”

ACTION PLAN

What must a coach do when a concussion is suspected?

Immediately remove the athlete from play. Look for the signs, symptoms and behaviors of a concussion if you observe or suspect that the athlete has experienced a bump or blow to the head or body. Athletes who experience any signs, symptoms or behaviors consistent with a concussion must not be allowed to return to play or practice for the remainder of the day. When in doubt, sit them out.
Ensure that the athlete is evaluated right away by an appropriate health care professional. Do not try to judge the severity of the injury yourself. Licensed health care providers have a number of methods that they can use to assess the severity of concussions. As a coach, recording the following information can help licensed health care providers in assessing the athlete after the injury:
- Cause of the injury and force of the hit or blow to the head or body.
- Any loss of consciousness (passed out/knocked out) and if so, for how long.
- Any memory loss immediately following the injury.
- Any seizures immediately following the injury.
- Any symptoms observed or reported by the athlete or the athlete’s parents/guardians, including headache, dizziness, nausea, vomiting, sensitivity to light or noise, slurred or slow speech, etc.
- Number of previous known concussions.
Inform the athlete’s parents or guardians about the possible concussion and give them the fact sheet on concussions – make sure they know the athlete should be seen by a licensed health care provider experienced in evaluating for concussions and brain injuries.
Allow the athlete to return to practice or play when all concussion symptoms have been resolved, at least one day has elapsed since the injury, and written clearance has been obtained from a licensed health care provider. A repeat concussion that occurs before the brain recovers from the first concussion can slow recovery or increase the likelihood of having long-term cognitive problems. Prevent common long-term cognitive problems and avoid second impact syndrome by keeping the athlete away from practice or play until the athlete receives the appropriate evaluation and approval for return to activity.

Who can issue Written Clearance?

To allow an athlete to return to practice or play, the written clearance must be issued by a licensed health care provider who is trained in the evaluation and management of concussions and is acting within the scope of his or her practice.

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CDC: Information for parents regarding concussions in youth sports.

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