Concussion question?

[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.

[Rufus]

Not to be unresponsive, but you should check with your local association board to find out (1) what instruction they've received from the state scholastic governing board and, as a result, (2) how they're going to treat such cases during games.

I know that's how it was handled here in Georgia so I'm thinking it's already been addressed and you just need to approach your association to clarify in Missouri.

[maven]

I don't mean to be rude, but didn't you answer your own question? Follow the procedure dictated by the state (my state's is almost identical), especially #6.

Or is your real question about the state procedure?

[OKREF]

Here if we have the symptoms we make them leave. They may not return unless cleared by a licensed medical staff. If they return we do not question anything. We are to assume they have been cleared.

[JRutledge]

I am not understanding the question either if you mentioned the policy. My state we have a state law where players cannot be cleared except from a Doctor or a Certified Athletic Trainer. After we send them out, the law takes over as to who that person is or the school's responsibility for who those people are to clear a player. And when they tell us they can come back in, they better have done their duty. We also file a "Special Report" for every incident and then the school has to answer to the IHSA with what they did. We are out of the mix after that point. This might not be your state's policy, but follow the policy and I cannot see how you can go wrong.

Peace

[MD Longhorn]

What is the policy when sdfisodifjisofis?

Before answering, let me post the policy when sdfisodifjisofis.
Ok.. now, what was my question?

[OKREF]

Looks like 6- C is your answer. Don't really understand why you would even be asking this.

[BayStateRef]

I think the OP points to several larger issues involving concussion and concussion-like symptoms.

The key to this question is actually in your state rule 6A,

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.

Did you determine the player had "concussion-like symptoms." If so, they may not return that day. End of discussion. No written approval from doctors, etc. can overcome this first standard.

If you did not make that determination (based on everything earlier in the state policy and other concussion training you may have), did the training staff? If so, the same rule applies. There is no exception.

My state has the same requirements: if a player exhibits signs of a concussion, they may not return to play or practice that day. No exceptions.

As officials, we are required in Massachusetts to take a course on concussion recognition annually. We have independent judgment and authority to determine whether a player has concussion-like symptoms. If we make that decision, the player cannot return to play that day, no matter what.

I would much prefer to defer to the judgment of athletic trainers and health professionals, since my knowledge is limited to the on-line courses and related material I read.

[rockyroad]

I actually understand the question...most of the "policy" the OP provided is really directed at the schools and the coaching/athletic staff. Most do the State policies I have seen look very similar. Very few say anything about our responsibilities and what we should do...our job is mostly outlined in the rule book and mechanics manual.

If we see signs or symptoms, we send the player off and notify the coach. If/when the coach sends the player back into the game, it is their responsibility to have had the player checked out and cleared. The liability is theirs. If we see more signs or symptoms, then we send the player back out of the game.

[jeremy341a]

Originally Posted by rockyroad

I actually understand the question...most of the "policy" the OP provided is really directed at the schools and the coaching/athletic staff. Most do the State policies I have seen look very similar. Very few say anything about our responsibilities and what we should do...our job is mostly outlined in the rule book and mechanics manual.

If we see signs or symptoms, we send the player off and notify the coach. If/when the coach sends the player back into the game, it is their responsibility to have had the player checked out and cleared. The liability is theirs. If we see more signs or symptoms, then we send the player back out of the game.

This is it. This is why I was asking because early in the policy it basically states the it is not up to the official to decide. I was wondering if you guys thought that #6 was referring to the schools/coaches responsibility. That is the way I took it.

I should have asked more clearly. As an official if you see a player have concussion symptoms and then later return to the game then this is nothing the official should be concerned with correct? All liability is on the coach and/or school?

[OKREF]

Originally Posted by jeremy341a

This is it. This is why I was asking because early in the policy it basically states the it is not up to the official to decide. I was wondering if you guys thought that #6 was referring to the schools/coaches responsibility. That is the way I took it.

I should have asked more clearly. As an official if you see a player have concussion symptoms and then later return to the game then this is nothing the official should be concerned with correct? All liability is on the coach and/or school?

yes

[maven]

I see now: 6c states that "written clearance must be provided," without stating to whom it must be provided.

I recommend asking the state to clarify this particular issue for officials.

[OKREF]

Originally Posted by maven

I see now: 6c states that "written clearance must be provided," without stating to whom it must be provided.

I recommend asking the state to clarify this particular issue for officials.

This is the rule for our state.. The legislation passed a concussion law.


• As of July 1, 2010, Oklahoma Statute 24-155 of Title 70 further states that after the player has been removed from participation the player “may not participate until the athlete is evaluated by a licensed health care provider trained in the evaluation and management of concussion and receives written clearance to return to participation from that health care provider.”
• The NFHS rule does not require written clearance but Oklahoma Law does require written clearance.
The official is NOT responsible for the “written clearance” that must be done to re-enter the contest. The decision for the athlete to re-enter the contest and the “written clearance” to document return to play is the responsibility of the acting head coach.