Coaches - the first line of defense

Every school district and private youth sports organization should have a sideline protocol for dealing with head injuries, and all sideline personnel should practice the procedure. You don't want to have to think about what to do when facing a situation where time may not be on your side.

What to do if you SUSPECT an athlete may have suffered a concussion...

1) Remove the athlete from play immediately, and KEEP THEM OUT

Know the signs and symptoms. Concussions are as unique as the athletes who experience them. Some athletes may have headaches, some may be dizzy, many will report they are "fine" because their symptoms haven't fully developed. Do not leave the athlete alone at any time, and watch for signs that symptoms are worsening.

2) Determine if emergency medical help is needed

An athletic trainer or other medical professional may assess the athlete using the Sideline Concussion Assessment Tool or SCAT 2 or pocket SCAT 2 and determine if emergency medical assistance is required. If medical help is not available, have an adult stay with the athlete and re-assess them every 5-10 minutes for several hours after the injury, being careful to look for signs of deterioration. If the athlete is deteriorating or exhibits any of the following signs/symptoms, call 911 immediately:

•headaches that worsen

•seizures

•neck pain

•very drowsy, can't be awakened

•repeated vomiting

•increasing confusion or irritability

•weakness, numbness in arms and legs

•unable to recognize people/places, less responsive than usual

Source: Children's National Medical Center, Washington DC

3) Contact parent/guardian

Notify the athlete's parents/guardian that their child has suffered a possible concussion as soon as possible. Make sure they know the signs/symptoms, and that their onset may be hours or days after the injury occurred. If parents are not present, assign an adult to stay with the athlete for observation, and evaluate them every 10 minutes for several hours.

4) Return-to-Play

Only allow the athlete to return to play after they have obtained written authorization from a qualified medical professional and ensure that they are 100% symptom-free at rest and during exertion (see gradual return-to-play below) before allowing them to resume practice or play.

Verify that the athlete is 100% symptom-free before allowing them to participate in any activity. Coaches are sometimes the last to know. Ask parents/teammates if they're aware of any lingering symptoms such as a headache.

Institute a gradual return-to-play procedure after the athlete is medically cleared, and make sure they are symptom-free during exertion. If symptoms return during exercise, their brain may not be fully healed.

5) Additional Considerations

Education is key. Most concussed athletes go home from the game or practice, so educating parents is crucial. Many school districts require parents and athletes to take an online concussion course prior to the athletes' participation in sports.

School districts need to establish an emergency plan, particularly for those times when medical professionals are not present, for instance, at practices. Who will make the determination to call 911, how will emergency crews be summoned, who will stay with the athlete and provide care while EMTs are enroute, who will contact the parents, travel with the athlete to the hospital, etc. This plan is also important in the event of multiple emergencies that may occur simultanously.

Questions/comments? contact Jean Rickerson at This e-mail address is being protected from spambots. You need JavaScript enabled to view it.