[jeremy341a]

A player gets hit in the head and goes down. After a few minutes he is helped to his bench. Later in the game the player is subbed back in. As an official in the state of Missouri how should this be handled. Below is the information the state released regarding concussions.

Recognition and evaluation of the athlete with a concussion
1. Recognition of the signs and symptoms of a concussion is important. Every member of the team-athlete,
teammates, coaches, parents or guardians, officials, athletic trainers, and team physicians have a duty to report
a suspected concussion. Not all school districts have medical personnel available to cover every practice and
competition; therefore, the coach is the person in the best position to protect the player and must be aware that
not all student athletes will be forthcoming about their injury.
2. An official shall not be responsible for making the diagnosis of a concussion. The official can assist coaches and
medical staff by recognizing signs and symptoms of a concussion and informing the coach and medical staff of
their concerns.
3. The coach, ATC, or physician on site should evaluate the athlete in a systemic fashion :
a. Assess for airway, breathing, and circulation (basic CPR assessment)
b. Assess for concussion
i. Any unconscious athlete should be assumed to have a severe head and/or neck injury and should have
their cervical spine immobilized until a determination can be made that the cervical spine has not been
injured. If no medical professional can make the assessment, the athlete should be transported to an
appropriate emergency care facility.
ii. A conscious athlete with no neck pain can be further evaluated on the sideline.
4. An athlete experiencing ANY of the signs/symptoms of a concussion should be immediately removed from play.
Signs/Symptoms of a concussion include :
PHYSICAL COGNITIVE EMOTIONAL
Headache Feeling mentally “foggy” Irritability
Nausea/Vomiting Feeling slowed down Sadness
Dazed/Stunned Difficulty concentrating More emotional
Balance problems Difficulty remembering Nervousness
Visual problems Forgetful of recent information
Fatigue Confused about recent events
Sensitivity to light Answers questions slowly
Sensitivity to noise Repeats questions
5. Evaluation
a. Following any first aid management, the medical team, or coach in the absence of medical personnel,
should assess the athlete to determine the presence or absence of a concussion. The SCAT (Sideline
Concussion Assessment Tool) and SCAT2 are effective assessment tools that are readily available and can
assist with the assessment
b. The athlete should be monitored for worsening or change in signs and symptoms over the next 24 hours.
Instructions should be given to the parent or guardian as to signs and symptoms that may require further or
more emergent evaluation.
6. Management of a concussion and return to play
a. An athlete determined to have a concussion or have concussion-like symptoms will be removed from
practice or competition and is not allowed to return to practice or competition that same day.
b. If an athlete displays concussion-like signs or symptoms, the athlete should be assumed to have a
concussion until further medical evaluation can occur. “WHEN IN DOUBT, SIT THEM OUT!”
c. Written clearance from a physician (MD or DO), Advanced Nurse Practitioner in written collaborative
practice with a physician, Certified Physician Assistant in written collaborative practice with a physician, or
Certified Athletic Trainer in written supervision of a physician, must be provided prior to return to play.
d. Following a concussion, the athlete should have both physical and cognitive rest until symptoms have
resolved.
e. An athlete must be asymptomatic at rest and with exertion prior to return to play
f. A graduated return to play protocol has been outlined by the Third International Concussion in Sport Group
Statement (2008, Zurich), is recommended by the NFHS (nfhs.org), and may be used to guide return to play
following medical clearance.