Simplifying Concussion : Removal from Play

Wednesday, December 23, 2015 9:40 AM | OATA Admin (Administrator)

So we've read about the RECOGNITION of concussion, but what about what to do next? Players may be so symptomatic that referral to the emergency room becomes obvious, or symptoms might be so mild that parents are not sure if they should even go to the doctor.

Over the years, I have worked with many contact sports, and have cared for thousands of athletes! Because of this I am able to make quick decisions, and give parents concise information with little to no grey areas. My experience has helped me to come up with a list of simple rules to follow when dealing with a concussion. This "choose your own adventure" type list depends greatly on your current level of training, and I urge any individual who is not comfortable with making a decision to refer an injured player to a qualified medical practitioner (such as an Athletic Therapist!).

Removal from the Playing Surface

Often a player will go down on the playing surface following a mechanism of injury, and stay down. If an AT is on duty, they are able to quickly rule out severe injuries (spinal cord injuries, fractures, cranial nerve disruption, skull fractures etc.) however this responsibility often comes down to a volunteer trainer, coach, or parent when AT's are not on staff.

There are many things that I am not able to teach through a blog post, or even give advice on, so I would encourage anyone in this position of responsibility to take an advanced course such as First Responder through the Red Cross to help to make the tough decisions about when removal from the playing surface is safe, and when an ambulance should be called and spinal precautions taken.

These ARE some things that I can share that would indicate that I need to stabilize the player and immediately call 911: (bear in mind that this list is not complete by any means)

  • The player is unwilling to move
  • There is deficiency is movement or sensation in the fingers or toes
  • Any deformity to the head, face, or neck (fractures or 'dents')
  • The players is bleeding or leaking fluid from the ears
  • ANY loss of consciousness, even if just for 2 seconds
  • Bruising behind the ears (known as battles sign) indicating a skull fracture

Again, I would urge anyone who is unsure if a player is able to leave the playing surface or not, to stabilize and call for assistance!

Sideline Assessment

There are several high-tech and well respected computer based programs that are used to identify and assess concussions. The most well-known example is the ImPACT test. These tests are very useful, however they are expensive and inaccessible to many athletes, especially in youth or recreation sports.

Studies have shown that in youth and recreation sport, the Sport Concussion Assessment Tool, or SCAT3 is extremely useful at identifying concussion, and can be used at any time with just paper and a pen! There are two versions of the SCAT3, designed for athletes above age 12, or 12 and under.

Anyone who is responsible for athletes should be familiar with the SCAT3, and have a few copies on hand in case of injury. This tool can also be used by trained professionals to complete baseline testing, so that onsite trainers have something to compare to in case of injury (Alana Gulka Athletic Therapy offers this service!).

Immediately following injury, the most important part of the SCAT3 is the symptom score. If an athlete reports ANY symptoms (even just one!), and sustained a mechanism of injury, they should be removed from play, and referred to a medical professional (Certified Athletic Therapist, or a Sports Medicine Physician). No athlete should return to play during the same day!

The SCAT3 has very clear instructions about how to report findings and has a handy letter to send home with parents and players to bring to the doctor or Athletic Therapist.

SCAT 3 Child-SCAT3

What then?

If you have removed a player from the playing surface safely, recorded their signs, symptoms, and noted their mechanism of injury, and referred them for follow up, then you have done your part to keep the player safe!

It is also important to educate players and/or parents on the importance of managing their concussion, and the dangers of second impact syndrome.

Watch for the next blog post, outlining ways to help rehabilitate a concussion, and what resources and treatment methods are available.

Be sure to check back for our next post about how to REHABILITATE a concussion in the clinic.

by: Alana Gulka CAT(C), BAHSc-AT, BSc
Certified Athletic Therapist
First Responder



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