Concussion Education
What is a Concussion
A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.
Medical providers may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, the effects of a concussion can be serious.
Concussion Signs and Symptoms:
Athletes who show or report one or more of the signs and symptoms below, or that say they just “don’t feel right” after a bump, blow, or jolt to the head or body, may have a concussion.
| Concussion Signs Observed | Concussion Symptoms Reported |
| Can’t recall events prior to or after the hit or fall | Headache or “pressure” in head |
| Appears dazed or stunned | Nausea or vomiting |
| Forgets an instruction, is confused about a position, or unsure of game, score or opponent | Balance problems or dizziness, or double or blurry vision |
| Moves clumsily | Bothered by light or noise |
| Answers questions slowly | Feeling sluggish, hazy, foggy, or groggy |
| Loses consciousness (even briefly) | Confusion or concentration or memory problems |
| Shows mood, behavior, or personality changes | Just not “feeling right” or “feeling down” |
Signs and symptoms generally show up soon after the injury. However, you may not know how serious the injury is at first and some symptoms may not show up for hours or days. Continue to check for signs of concussion after the injury and a few days after the injury. If an athlete’s concussion signs or symptoms get worse, they should be taken to the emergency department.
Concussion Danger Signs:
In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body. Call 9-1-1 immediately, or take the athlete to the emergency department if they have one or more of the following danger signs:
| Dangerous Signs & Symptoms of a Concussion |
| One pupil larger than the other |
| Drowsiness or inability to wake up |
| A headache that gets worse and does not go away |
| Slurred Speech, weakness, numbness, or decreased coordination |
| Repeated vomiting or nausea, convulsions or seizures (shaking or twitching) |
| Unusual behavior, increased confusion, restlessness, or agitation |
| Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously |
Responding to a Concussion:
The following guidelines are intended to be used by any person or entity that constitutes a “sport organization” under Provincial law. It sets out the minimum requirements for removal from sport and return to sport protocols for athletes who are suspected of having sustained or who have sustained a concussion. Since these policies vary widely across Canada, organizations, athletic trainers and coaches will need to understand their Province specific policies before writing the organization’s concussion policies.
Designated Person(s)
Every sport organization is required to identify a designated person(s) as having specific responsibilities under the removal from sport and return to sport protocols. The responsibilities for the designated person(s) may be shared between one or more individuals
Remove From Sport
Under the removal from sport protocol the designated person(s) is/are responsible for ensuring that:
- An athlete is immediately removed from further training, practice or competition if the athlete has sustained a concussion or is suspected of having sustained a concussion, regardless of whether the concussion was sustained from a sport activity associated with the organization.
- If in the opinion of the designated person(s), there is an emergency and/or any dangerous signs and/or symptoms appear - including those resulting from a suspected concussion, call 911;
- Removal of the athlete from further training, practice or competition; and if the athlete is of minor age, the parent or guardian is informed of the removal.
- The athlete, or the parent or guardian if the athlete is of minor age, is advised that the athlete is required to undergo a medical assessment by a physician or nurse practitioner before the athlete will be permitted to return to training, practice or competition according to the Return-to-Sport protocol for the organization.
- An athlete or, if the athlete is of minor age, the athlete’s parent or guardian receives the Removal-from-Sport and Return-to-Sport protocols for the organization as soon as possible after the athlete’s removal.
- Once removed, the athlete is not permitted to return to training, practice or competition, except in accordance with the organizations Return-to-Sport protocol;
Return to Sport
Under the Return-to-Sport protocol for the organization the designated person(s) is/are responsible for ensuring that:
- An athlete who has sustained a concussion or is suspected of having sustained a concussion does not return to training, practice or competition until permitted to do so in accordance with the organizations Return-to-Sport protocol;
- When an athlete has not been diagnosed with a concussion, the athlete is only permitted to return to training, practice or competition if the athlete or, if the athlete is of minor age, the athlete’s parent or guardian provides confirmation to the designated person(s) about the outcome of the athlete’s medical assessment, specifically that the athlete:
- has undergone a medical assessment by the physician or nurse practitioner and has not been diagnosed as having a concussion, and
- has been medically cleared to return to training, practice or competition by a physician or nurse practitioner.
- When an athlete is diagnosed by a physician or nurse practitioner as having a concussion, the athlete is not permitted to move on to unrestricted training, practice or competition unless the athlete or, if the athlete is of minor age, the athlete’s parent or guardian provides a confirmation of medical clearance by the physician or nurse practitioner to the designated person(s);
- An athlete is not permitted to return to training, practice or competition through the organizations graduated Return-to-Sport steps unless the athlete or, if the athlete is of minor age, the athlete’s parent or guardian has shared the medical advice or recommendations they received, if any, with the designated person(s).
- When an athlete is diagnosed by a physician or nurse practitioner as having a concussion, the athlete or, if the athlete is of minor age, the athlete’s parent/guardian has been informed of the importance of disclosing the diagnosis to any other sport organization with which the athlete is registered or school that the athlete attends.
The designated person(s) may rely on the information received from an athlete or, if the athlete is of minor age, from the athlete’s parent or guardian in carrying out their responsibilities under the organizations Return-to-Sport protocol.
Graduated Return to Sport Steps
- The designated person(s) ensures that an athlete who has sustained a concussion or is suspected of having sustained a concussion does not return to training, practice or competition until the athlete or, if the athlete is of minor age, the athlete’s parent or guardian provides confirmation to the designated person(s) that the athlete:
- Has undergone a medical assessment by a physician or nurse practitioner and has not been diagnosed as having a concussion, and
- Has been medically cleared to return to training, practice or competition by the physician or nurse practitioner
- If an athlete has been diagnosed by a physician or nurse practitioner as having a concussion the athletes must proceed through the graduated return to sport steps once being cleared to do so.
- The graduated return-to-sport steps may include the following activities. It is typically recommended that an athlete with concussion rest for 24 to 48 hours before beginning step 1.
|
| Activities | Goal of Step | Duration |
| STEP 1: Symptom-limiting activities | Daily activities that don’t make symptoms worse, such as moving around the home and simple chores | Gradual reintroduction of daily school, and work activities | At least 24 hours |
| STEP 2: Light aerobic activity | Light activities such as walking or stationary bicycle at slow to medium pace for 10 to 15 minutes | Increase heart rate | At least 24 hours |
| STEP 3: Sport-specific exercise | Individual physical activity such as running or skating
No contact or head impact activities | Add movement | At least 24 hours |
| STEP 4: Non-contact training, practice drills | Harder training drills
Add resistance training (if appropriate) | Exercise, coordination and increased thinking | At least 24 hours |
| STEP 5: Unrestricted Training & Practice | Unrestricted training and practice- with contact where applicable | Restore confidence and assess functional skills | At least 24 hours
Obtain clearance from physician or nurse practitioner before unrestricted training, practice or competition |
| STEP 6: Return-to-Sport | Unrestricted competition |
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An athlete should only move to the next step if they do not have any recurring or new symptoms at the current step. If symptoms return the athlete should stop those activities and contact the medical professional involved in managing the return to play. When no symptoms are present, they may start the progression again at the previous step.
- An athlete or the athlete’s parent or guardian must share the medical advice or recommendations they receive with the designated person(s) before being permitted to return to the training, practice or competition through the graduated return to sport steps, if any
- The designated person(s) must inform the athlete or if the athlete is of minor age, the athlete’s parent or guardian of the importance of disclosing the diagnosis to any other sport organization with which the athlete is registered or school that the athlete attends.
- The athlete, or the athlete’s parent or guardian must provide the designated person(s) a confirmation of medical clearance by a physician or nurse practitioner before the athlete is permitted to move on to unrestricted training, practice or competition.
- The sport organization must make and keep a record of the athlete’s progression through the graduated return-to-sport steps until the athlete, or the athlete’s parent or guardian, has provided a confirmation of medical clearance by a physician or nurse practitioner to the designated person(s).
Creating a Safe Sport Culture:
As a youth sport organization or coach, you can create and enforce a safe sport culture that can lower an athlete’s chance of getting a concussion and create an environment that allows them to feel comfortable in reporting symptoms of a concussion.
Enforce the Rules:
Enforce the rules of the sport for fair play, safety and sportsmanship. Ensure that athletes always avoid unsafe actions. Explain to athletes that good sportsmanship is always expected both on and off the field.
Talk about Concussion Reporting:
Talk with athletes about the importance of reporting a concussion. Athletes may not report a concussion because they don’t think symptoms are severe enough or fear losing a position on the team, letting teammates down or looking weak. Positive messaging and praise from a coach will help make athletes comfortable with the concussion reporting system in place.
Create a Concussion Action Plan
Create an action plan that includes information and education on ways to lower the chances of concussion and the steps that will be enforced to safely return the athlete to play.
Adopt Concussion Code of Conduct
Establish a concussion code of conduct that sets out rules of behavior to support concussion prevention. See Athlete Safety Library for Sample Code of Conduct Templates for Coaches and Athletes.
IMPORTANT: This is a draft document intended for use in formulating a plan for adoption by a facility or youth sport organization. Medical and legal counsel for the facility or sport organization should review this Plan before implementation. It is the responsibility of the facility or sport organization to ensure that the Concussion Plan as adopted is consistent with Provincial law.
References:
- Rowan’s Law Ontario Canada - Ontario.ca/concussions
- Concussion Awareness Training Tool - cattonline.com/overview-what-is-a-concussion/
- Concussion in Youth Sport Safety Act - Bill M 206-2011
