As the leader of a group of young people, the coach assumes a significant responsibility for helping to insure their health and well-being. A great deal of emphasis must be placed on training and conditioning, first aid, injury prevention and management, proper use of equipment, and maintenance of safe playing areas.
Below is a summary of some major points to consider in the care and prevention of athlete injuries and is not intended to be all inclusive.
There are three categories of heat illness, and the student-athlete may not sustain all
three in order.
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Definition of Concussion, Concussion Facts
A concussion is an injury to the brain as a result of a force or jolt
applied directly or indirectly to the head, which produces a range of
possible symptoms and may or may not involve a loss of consciousness.
80-90% of concussions occur without loss of consciousness. Recognition
and proper management of concussions when they first occur can help
prevent further injury, prolonged recovery, or even death (secondary
impact syndrome). Concussions are also called mild traumatic brain
injuries (MTBI). Concussions can occur in any sport, including:
Baseball, Basketball, Cheerleading, Equestrian, Field Hockey, Football,
Gymnastics, Ice Hockey, Lacrosse, Rugby, Soccer, Softball, Volleyball,
and Wrestling. The potential for concussions is greatest in athletic
environments where collisions or significant falls are common.
Environmental factors also can cause injury. For example, a player may
collide with an unpadded goalpost or trip on an uneven playing surface.
Sometimes people do not recognize that a bump, blow, or jolt to the head
can cause a concussion. As a result, student-athletes may receive no medical
care at the time of the injury, but they may later report symptoms such
as headache and dizziness. These symptoms can be a sign of a concussion
and must be carefully evaluated.
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Signs and Symptoms of Concussion
Concussion results in a range of physical, cognitive, emotional and
sleep-related symptoms. Duration of symptoms can vary from person to
person and may last for as short as several minutes and last as long as
several days, weeks, months or even longer in some cases. Knowledge of
the full range of signs (what you can see) and symptoms (what the
student-athlete reports) are important. One or more of these signs and
symptoms following a blow or jolt to the head may indicate that a
concussion has occurred. Concussions can also occur with no obvious
signs or symptoms right away. Any of the symptoms listed in the table
below should be taken seriously. Student-athletes, who experience any of these
signs or symptoms after a bump, blow, or jolt to the head should be kept
from practice or game play until cleared by a qualified health care
professional.
Signs Observed by Coaching Staff Symptoms Reported by Student-athlete
- Appears dazed or stunned; Headache
- Is confused about assignment; Nausea
- Forgets plays; Balance problems or dizziness
- Is unsure of game, score, or opponent; Double or fuzzy vision
- Moves clumsily; Sensitivity to light or noise
- Answers questions slowly; Feeling sluggish
- Loses consciousness; Feeling foggy or groggy
- Shows behavior or personality changes; Concentration or memory
problems
- Can't recall events prior to hit; Confusion
- Can't recall events after hit
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Return to Play after a Concussion
The student-athlete should never return to play competitive sports activities (practice or games) while experiencing any lingering or persisting symptoms of a concussion, no matter how slight. The student-athlete must be completely symptom free at rest and with physical exertion (e.g. sprints, non-contact aerobic activity) and cognitive exertion (e.g. studying, schoolwork) prior to return to sports activities. Given the potential of the student-athlete with a concussion to minimize symptoms to expedite their return to play, objective data in the form of formal neuropsychological testing and balance testing may be used as a criterion for safe return to play. Student-athletes cannot return to play until written clearance is provided by a qualified health care professional (e.g., physician or certified athletic trainer). As with any injury, return to play following a concussion should occur gradually and systematically. It is Maryland law (13A.06.08.06) that athletes who have suffered a concussion must complete the 6 step Return to Play Protocol once they have been released by a doctor and prior to fully returning to practices and games. The return to play protocol requires gradually increasing exertion and close monitoring of their response to treatment. Student athletes should be monitored for symptoms and cognitive function carefully during each stage of increased exertion.
Progression is allowed to the next level of exertion if the student-athlete is asymptomatic at the current level. A specific return-to-play (RTP) protocol outlining gradual increase in activity has been established by the Concussion in Sport Group.
Premature return to play from a concussion can have serious consequences including a significantly higher risk for re-injury, prolonged recovery, and an increased risk for a catastrophic outcome, second impact syndrome, which results in death. Prevent these poor outcomes by delaying the athlete's return to the activity until the player receives appropriate medical evaluation and approval for return to play.
Please refer to the resources on concussions from cdc.gov/HEADSUP. These resources are for coaches, athletes, and parents.
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On-Field / Sideline Assessment & Action
If student-athlete exhibits any sign of concussion or reports any
symptom, they are to be removed from practice or play. When in doubt,
keep the player out of play and seek an evaluation from a qualified
health care professional trained in concussion assessment and
management. The coach is not to try to judge the severity of the injury.
Health care professionals have a number of different methods that they
can use to assess the severity of concussion.
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Managing Concussion with no Loss of Consciousness
First aid:
- Remove student-athlete from activity until a qualified health care
professional can evaluate them (i.e. physician, certified athletic
trainer, and neuropsychologist).
- Monitor student-athlete for sign and symptoms every 5 minutes.
- Contact the parent/guardian.
- If signs/symptoms worsen, activate the emergency medical system,
call 911.
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Managing Concussion with Loss of Consciousness
Signs: Student-athlete does not respond to external stimuli
(i.e., voice or touch).
First aid:
- Activate emergency medical system and call 911 immediately.
- Contact parent/guardian.
- Monitor student-athlete's vital signs and keep head and spine immobilized
and wait for emergency personnel.
- If and when student-athlete regains consciousness, monitor for
signs/symptoms every 5 minutes and maintain head and spine
immobilization.
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Coach Report of Concussion to Athletic Trainer
Any coach who suspects a student-athlete has suffered a concussion, must notify the parent and provide the Acute Concussion Evaluation (ACE) form. This form will be completed by the student-athletes physician and returned to the school nurse.
A concussion that is identified by a coach must be reported to the school nurse and Athletic Director for appropriate follow-up with the student and primary care professional.
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Communication with Parent/Guardians
On the day of the injury, inform the student-athlete's parents/guardians about
the known or possible concussion and give them the fact sheet on
concussion. Make sure they know that the student-athlete should be seen by a
qualified health care professional.