On Field Management & Immediate Treatment For Concussion

Every time a player sustains a head injury during a game, they could be at risk of a more serious brain injury. If concussion is not correctly diagnosed and treated then more serious complications can occur, even days or weeks after injury. Here we explain what to do if a head injury is sustained or suspected during a match or competition.

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On field management of Concussion

It is not always possible to carry out a full assessment at the time of injury. The player may be confused and difficult to examine.

Any player that has suffered a suspected blow to the head must be treated as if they have a concussion until proven otherwise.

This means stopping physical activity immediately and, if safe to do so, removing them immediately from the field of play. A more serious structural brain injury may be suspected if:

  • There has been a high-speed impact or trauma to the head or if the head makes contact with a hard surface or body part such as the knee.
  • Symptoms worsen over a short period of time, e.g. nausea or headaches.
  • The patient lost consciousness immediately after the impact (however short the time was), or they have fallen unconscious since.
  • The patient has a seizure or fit.
  • Bleeding or fluid leaking from the nose or ear which could be evidence of a skull fracture and needs immediate assessment by a qualified healthcare professional.
  • The focal neurological deficit is detected by the doctor when examining the patient. This means that the brain is not functioning normally and this may affect sensation or muscular movements anywhere in the body. It can also refer to memory loss and emotional changes.

If a player is suspected of having a concussion then they should be fully assessed by a doctor as soon as possible and if they lost consciousness at any stage, then they must be taken to the hospital so the athlete can be assessed fully. The doctor may decide (but not in all cases) to organise a brain scan to see if there has been any bleeding within the skull or brain and therefore if there has been any injury to the brain.


Immediate first aid for Concussion

The priorities when approaching an injury are based on the principles of DR ABC but this assessment should only be carried out by a person who has completed an Emergency Aid training course.  
DR ABC stands for:

  • D for danger. Ensure the player and any staff assisting are not in further danger for example from any gameplay still occurring.
  • R for a response. Is the player responding? Can they talk? Are they conscious?
  • A is for Airway. Remove any objects such as mouth guards from the mouth and ensure the airway is clear and in the optimized position.
  • B is for breathing. Ensure the patient is able to breathe sufficiently.
  • C is for Circulation.  This can be assessed by feeling for a pulse, however, If the patient is not breathing normally or not at all, then CPR must start immediately.

Once the above stages have been assessed, then the next priority is to remove the player from the field, but first checking for any neck or spinal cord injury. This may appear as tenderness in the neck, deformity, change in sensation in the arms or legs or if the patient complains of neck pain. If this is suspected then they should not be moved until they have been immobilized in a brace. If the patient loses consciousness at any stage during or after the impact, then a neck injury should always be suspected until it can be discounted.

If you are interested in attending a basic first aid training course, many organisations such as St John’s Ambulance, the RFU or the FA organise a number of courses every month in your local area (see websites for details).

Examination

If there is a doctor present pitch side and there is no neck injury suspected, then a full neurological examination will be carried out, usually back in the changing rooms where it is quiet. It is possible the patient may be disorientated, uncooperative or convulsing (fits). If a suitably qualified person is not present, then the patient should always be taken to the hospital or an ambulance called.  It is vital to establish an accurate diagnosis, as the consequences of missing concussion or associated brain injury could be fatal (see SIS).

Doctors will use the SCAT5 assessment tool or concussion and once a concussion has been fully assessed, then the patient will be continually monitored right up until full recovery (see treatment and return to play).

This article has been written with reference to the bibliography.