Concussions : Responding to a Head Injury

Nearly half of all injuries in high school sports occur during practice when no athletic trainer or emergency medical personnel are present. In these instances, coaches are the first responders. As a coach, are you prepared to take action in a medical emergency? Sport First Aid-5th Edition, a book written by Melinda Flegel and published by Human Kinetics, provides high school and club coaches with action steps for the care and prevention of more than 110 sport-related injuries and illnesses. This section of the book details how coaches should respond to the occurrence of a head injury when there is no athletic trainer or medical staff around.

If an athlete has suffered a blow to the head or a whipping of the head and neck, immediately evaluate for symptoms and signs of injury.
Causes

Direct blow to the head
Sudden, forceful jarring or whipping of the head
Ask if Experiencing Symptoms

Headache
Dizziness
Ringing in the ears
Grogginess
Nausea
Blurred or double vision
Check for Signs

Confusion
Unsteadiness
Inability to multitask (unable to do several athletic skills at once or do a skill correctly when distracted)
Short-term memory loss
Emotional changes such as a short temper or depression
Unresponsiveness to touch or voice (call out the athlete’s name and tap on the shoulder)
Irregular breathing
Bleeding or a wound at the point of the blow
Blood or fluid leaking from the mouth, nose, or ears
Arm or leg weakness or numbness
Neck pain with a decrease in motion
Bump or deformity at the point of the blow
Convulsions
Abnormalities in pupils (unequal in size or failure to constrict to light)
Vomiting
First Aid

If an athlete exhibits any of the previously listed signs or symptoms, pull the athlete out of activity. Symptoms such as headache or ringing in the ears may be the early signs of a more serious injury. In these cases, do the following:

Continue to monitor the athlete and alert emergency medical services if signs and symptoms worsen.
Immediately contact the parent or guardian and have them take the athlete to a physician.
Give the parent or guardian a checklist of signs and symptoms to monitor.
For injuries with more severe signs such as confusion, unsteadiness, vomiting, convulsions, increasing headaches, increasing irritability, unusual behavior, arm or leg weakness or numbness, neck pain with a decrease in motion, pupil abnormalities, or unconsciousness, do the following:

Immediately call emergency medical services.
Stabilize the head and neck until EMS takes over. Leave an athlete’s helmet on when stabilizing the head and neck. You don’t want to jar the head or neck unnecessarily. This is especially true if the athlete is also wearing shoulder pads.
Monitor the athlete for breathing difficulty and perform CPR if necessary.
Control any profuse bleeding but avoid applying excess pressure over a head wound.
Monitor for shock and treat as needed.
Immobilize any fractures or unstable injuries as long as it does not jostle the athlete, which may worsen his or her condition.
Playing Status

When can an athlete return to a sport after a brain injury? In most cases, this decision has already been decided for you. Check your state law or the regulations of the National Federation of State High School Associations (NFHS) to ensure that your athletes are receiving mandated care and supervision. The NFHS prohibits athletes from returning to activity until examined and released by a physician. Many states are enacting laws with similar or stricter guidelines. Check your state for specific laws regarding brain injuries in athletes.
Prevention

Educate yourself, your athletes, and their parents or guardians about concussions. Visit the CDC website atwww.cdc.gov.
During preseason physicals, screen for any history of head, spine, or nerve injuries. Have these athletes cleared by a physician, preferably a neurologist, before allowing them to participate.
Use preseason brain testing. Numerous software programs or testing contractors can assess each athlete’s normal brain function, including memory, cognitive functioning, motor (muscle and balance) control, and other functions before the beginning of a sport season. This information is then used as a baseline from which an athlete’s brain function can be compared when an injury is suspected or has occurred. Doctors and athletic trainers can monitor this information while the athlete recovers and determine when an athlete is ready to progressively return to activity. These tests can also be used to monitor the athlete for any signs of decreasing brain function as he or she progresses back into full participation. A decrease in function signals that the athlete is not ready to proceed further and may need to actually decrease activity. This type of testing can be an important tool for you, your athletes, and their physicians in helping to more objectively determine the seve


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