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Injury management

Concussion

Concussion must be taken extremely seriously to safeguard the short and long-term welfare of players. Although commonly caused by a blow to the head, it can come from a blow to the body where the force of the collision is transmitted up to the brain. It is not always associated with loss of consciousness.

Concussion has many different symptoms or signs and many of these can be found in the World Rugby Concussion Guidelines at playerwlfare.worldrugby.org/concussion.

Common symptoms include poor concentration, memory loss and balance difficulties. The Pocket Concussion Recognition Tool (shown below) may help with the recognition of concussion.

If an athlete has a suspected concussion, he/she should be removed from the field of play and not allowed to return.

If a concussed player continues to play, they will put themselves at risk of greater injury and they will also let the team down because they will have difficulty processing the game happening around them.

Young players are more susceptible to rare and dangerous neurological complications, including death, caused by a second impact in an already concussed or not fully recovered individual.

Anyone removed due to suspected concussion should be assessed by a health care professional. They should not be allowed to drive a motor vehicle. Return to play should follow a graduated approach as described in the World Rugby Concussion Guidelines.



Pocket CONCUSSION RECOGNITION TOOL™

To help identify concussion in children, youth and adults


RECOGNIZE & REMOVE

Concussion should be suspected if one or more of the following visible clues,signs, symptoms or errors in memory questions are present.


1. Visible clues of suspected concussion

Any one or more of the following visual clues can indicate a possible concussion:

Loss of consciousness or responsiveness
Lying motionless on ground / Slow to get up
Unsteady on feet / Balance problems or falling over / Incoordination
Grabbing / Clutching of head
Dazed, blank or vacant look
Confused / Not aware of plays or events


2. Signs and symptoms of suspected concussion

Presence of any one or more of the following signs & symptoms may suggest a concussion:

  • Loss of consciousness
  • Seizure or convulsion
  • Balance problems
  • Nausea or vomiting
  • Drowsiness
  • More emotional
  • Irritability
  • Sadness
  • Fatigue or low energy
  • Nervous or anxious
  • “Don’t feel right”
  • Difficulty concentrating
  • Headache
  • Dizziness
  • Confusion
  • Feeling slowed down
  • “Pressure in head”
  • Blurred vision
  • Sensitivity to light
  • Amnesia
  • Feeling like “in a fog“
  • Neck pain
  • Sensitivity to noise
  • Difficulty remembering

3. Memory function

Failure to answer any of these questions correctly may suggest a concussion.

“What venue are we at today?”
“Which half is it now?”
“Who scored last in this game?”
“What team did you play last week / game?”
“Did your team win the last game?”


Any athlete with a suspected concussion should be IMMEDIATELY REMOVED FROM PLAY, and should not be returned to activity until they are assessed medically. Athletes with a suspected concussion should not be left alone and should not drive a motor vehicle.

It is recommended that, in all cases of suspected concussion, the player is referred to a medical professional for diagnosis and guidance as well as return to play decisions, even if the symptoms resolve.


RED FLAGS

If ANY of the following are reported then the player should be safely and immediately removed from the field. If no qualified medical professional is available, consider transporting by ambulance for urgent medical assessment:

- Athlete complains of neck pain
- Increasing confusion or irritability
- Repeated vomiting
- Seizure or convulsion
- Weakness or tingling / burning in arms or legs
- Deteriorating conscious state
- Severe or increasing headache
- Unusual behaviour change
- Double vision

Remember:
  • In all cases, the basic principles of first aid (danger, response, airway, breathing, circulation) should be followed.
  • Do not attempt to move the player (other than required for airway support) unless trained to so do.
  • Do not remove helmet (if present) unless trained to do so.

from McCrory et. al, Consensus Statement on Concussion in Sport. Br J Sports Med 47 (5), 2013

© 2013 Concussion in Sport Group

Download the Pocket Concussion Recognition Tool as an Adobe PDF file