Concussion: Protecting Athletes and the Educational Institution

By Donna A. Lopiano, Ph.D., President, Sports Management Resources

During football season, it’s not unusual to read about a teenage football player collapsing several weeks after suffering a concussion.  Afterwards we may learn that he returned to competition claiming no symptoms, when in actuality, he continued to experience headaches but told no one because he was afraid of missing playing time.  Or, the athletic director may walk into the principal’s office with an advertisement for a coach-administered computer-based program promoting neuro-cognitive testing of athletes, telling the administrator how important it is to have baseline data before returning a player to competition after a head injury.   How should the manager of an educational institution deal with the potentially life-threatening consequences of head injury?

Here are several steps to take to make sure that your coaches and staff are prepared to respond to concussions:

  1. At the beginning of every season, the school’s team physician should present an in-service program for coaches and athletics event staff on recognizing the observable behaviors and student-reported symptoms that are signs of concussion.   Most important, the team physician is responsible for sending a clear message, “When in doubt, sit the athlete out!”  Such in-service programs recognize the fact that a certified athletic trainer or team physician is not in attendance at every practice and emphasizes the school policy directing staff to err on the side of student safety.
  2. On the issue of whether a school should have a protocol for neuro-cognitive evaluation, the answer is “yes”.  However, such a testing program should be administered by a certified athletic trainer, a physician or other qualified personnel and never by a coach.  The coach will always been in a conflict of interest position and should not be put in a position to be involved in the decision to return an athlete to play after a concussion, which may very well rely on comparisons to such baseline data.  While the coach plays an important role in recognizing behavioral symptoms or listening to an athlete describe his or her symptoms, assessments of physical condition and decisions to return from injury rightfully belong to trained certified personnel.
  3. The decision to return to competition should not be solely dependent on athlete-reported symptoms because the athlete also has a conflict of interest.  Research demonstrates that athletes underreport their conditions due to a desire to return to competition. (Van Campen, et. al,2006) While athlete reporting plays a role, ultimately neuro-cognitive testing must guide any such decision.
  4. Following a concussion, the athlete should be referred to a physician for medical evaluation, on the same day as the injury if there was loss of consciousness, amnesia lasting longer than 15 minutes, vomiting, motor, sensory or balance deficits or symptoms that worsen.  Immediate transport to the hospital emergency room should occur in the case of pulse or respiration irregularity or decreases, unequal, dilated or un-reactive pupils, lethargy, confusion, seizures and other symptoms.  All of these operating rules should be covered in the physician education program at the beginning of the season and be given to coaches and staff in writing.  There are clear protocols for responses to concussion that must be communicated to coaches and staff.
  5. The school should have conservative policies in place to deal with athletes who suffer repeated concussions, from removal for the rest of the game to disqualification from participation for the rest of the season to complete disqualification from participation in contact sports.  These policies should be established in consultation with a physician and be based on continuation of symptoms, repeated concussions and other physician determined factors.
  6. Policies should exist which require a physician or certified trainer to give oral and written instructions to parents regarding home care following an athlete suffering a concussion, especially with regard to ingesting alcohol, drugs or other substances affecting cognitive functioning.

One of the best resources for the athletics director and school administrator is the National Athletic Trainers’ Association Position Statement on the Management of Sport-Related Concussion.

In summary, responsible handling of concussions means: 

  • assessment of neurocognitive baseline data by qualified personnel;
  • adequate preparation of on-the-field staff in symptom recognition and conditions for emergency treatment versus physician referral;
  • oral and written communication with parents and caregivers regarding home care of the athlete following a concussion; and
  • conservative return to play decisions only after qualified medical personnel are sure the athlete is symptom-free.  

Resources:

Guskiewicz, K.M., S.L. Bruce, R.C. Cantu, M.S. Ferrara, J.P. Kelly, M. McCrea, M. Putukian, T.C. Valovich McLeod.  (2004)  National Athletic Trainers’ Association Position Statement: Management of Sport-Related Concussion
 Journal of Athletic Training, 2004; 39(3):280-297.  http://www.csmfoundation.org/NATA_Position_Statement.pdf

Van Kampen, D.A., M.R. Lovell, J.E. Pardina, M.W. Collins, and F.H. Fu. (2006) The "Value Added" of Neurocognitive Testing After Sports-Related Concussion. The American Journal of Sports Medicine 34:1630-1635 (2006)