All coaches, managers and parents involved in sport are encouraged to become familiar with the following:

Basic Facts

Concussion is a mild brain injury. Contrary to popular belief, you don't actually have to get a blow directly to the head itself – impact anywhere on your body that causes your head to shake violently can lead to concussion
You don't have to be knocked out to get concussion. In fact, only 20 per cent of concussions will be preceded by a loss of consciousness
Any symptoms that might indicate concussion should lead to a player being immediately removed from the field. Symptoms can occur immediately after the injury, or up to several weeks later
If in doubt, it is better to be conservative and treat as concussion, as athletes of less than 18 years of age are at high risk for complications, including death from head injury and a prolonged return to play if recurrent concussions take place over a short period
The first 24 hours after the event are crucial. This is the time when serious complications are more likely to occur, so it is really important the player is not left alone and has someone who can monitor how he is doing – if symptoms start to worsen in any way, he needs to be reassessed by a doctor urgently.
Recovery includes rest and sleep (as much as required); avoiding anything stimulating for the brain (screens, loud music, noisy environments); alcohol and drugs; staying off work and school until allowed back

Other high risk factors for complications/prolonged return to play are:
1. Previous concussion this season
2. ADHD or Hyperactivity
3. Previous seizures
4. Drug use; Psychotropic drugs; Weed/Party Pills

Procedures

Follow this protocol if Concussion is confirmed by a positive concussion test.

Signs that a player has suffered a concussion injury include:

1. Loss of consciousness
2. Confusion/disorientation/inability to recall blow to head/loss of memory
3. Dizziness/poor co-ordination/poor balance/blurred or double vision
4. Headache
5. Light sensitivity
6. Nausea/Vomiting

Note: Player needs only one of these signs to warrant a concussion check in Emergency Unit at Hospital.

Initial treatment of Concussion includes:

1. Visit to Emergency Unit (not after hours GP) to exclude serious head injury/might need CT scan

2. Sent home with family member who will watch athlete carefully over next 24 hours for signs of drowsiness, vomiting, confusion and slurred speech

3. Brain rest for next week includes avoiding text messaging and computer games, limit television and computer use, decrease school work (class teacher to be informed)

4. Consider more time at school for assignments; no tests until recovered at least for 2 weeks; increased breaks between classes; may need a note taker

5. Monitor for two to three months after concussion for scholastic difficulties (Teacher-in-charge of Rugby to inform form teacher)

6. Physical rest until cleared to progress by protocol to follow. Avoid especially weight lifting, aerobic exercise, sexual activity and even household chores

7. Wear sunglasses for light sensitivity and ear plugs if sound sensitive

8. Simple painkillers for headaches – Paracetamol

Developing signs

Tiredness – this can be pronounced, with some people reporting a need to sleep far longer than they normally would
Irritability or "fragility" – this can include feeling like you might burst into tears or lose your temper more easily than normal
Heightened sensitivity to noise and light
Tinnitus, or "ringing" in your ears

Graduated return to playing sport

Once rested and no headache, neck pain, dizziness, nausea, noise and light sensitivity, then commence graduated return to play – note that a mandatory three week stand down is minimum allowable time to return to play.

A player may take longer to be fit enough to return to play safely, and rushing him back to play will only increase risk of complications especially recurrent concussion and even death.

Step 1: No activity: complete physical and cognitive rest.

Step 2: After asymptomatic at rest and seen by GP who needs to give club written clearance to commence return-to-play protocol: athlete needs to complete a full day at school, interact with peers, watch sports training without re-emergence of symptoms

Step 3: Light aerobic exercise, includes walking, swimming, stationary cycle – intensity <70% maximum heart rate (no weight training) with no symptoms; next day advance to step 4.

Step 4: Heavier aerobic exercise – running but no head impact activities – intensity <85% maximum heart rate with no symptoms; next day advance to step 5.

Step 5: Rugby Specific exercise but non-contact drills includes passing, kicking drills. Can commence light weight training. Progress to step 6 if no symptoms.

Step 6 – Full contact practice – full practice participation.

Note: if during any step concussion symptoms reoccur, the athlete will return to the previous level of activity.

Progression through steps typically involves multiple days on each level ie. It is unusual for a player to progress through a level in a single day.

The minimum return to play period is three weeks – any sooner puts player at risk of recurrent concussions.

Concussion experts suggest three concussions in one season should result in termination of season for that player. It is important, therefore, to manage concussion appropriately on first concussion.

“When in doubt, sit him out!”

In this issue

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