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Concussion Policy & Resources

Recognition of a Concussion

A concussion is a traumatic brain injury that interferes with normal brain function. Medically, a concussion is a complex, pathophysiological event to the brain that is induced by trauma.

These are some common signs and symptoms that are indicative of a probable concussion. Other causes for symptoms should also be considered.

  • Signs (observed by others)
    • Athlete appears dazed or stunned
    • Confusion (about assignment, plays, etc.)
    • Forgets plays
    • Unsure about game, score, opponent
    • Moves clumsily (altered coordination)
    • Balance problems
    • Personality change
    • Responds slowly to questions
    • Forgets events before or after hit
    • Loss of conscious (any duration)
  • Symptoms (reported by athlete)
    • Headache
    • Fatigue
    • Nausea or vomiting
    • Double vision, blurry vision
    • Sensitive to light or noise
    • Feels sluggish
    • Feels “foggy”
    • Problems concentrating or remembering

General cognitive status can be determined by simple sideline cognitive testing.

  • Cognitive impairment (altered or diminished cognitive function)
    • Athletic trainers- Utilize the Scat5 (Sports Concussion Assessment Tool), BESS (Balance Error Scoring System), or sideline ImPACT.
    • Coaches- Contact your athletic trainer.
  • Neuropsychological testing is utilized to help determine recovery after concussion.
    • All athletes participating in LA Fire events are recommended to have a baseline ImPACT test on file.
  • All athletes are recommended to view a video presentation entitled “Heads Up: Concussion in High School Sports” prior to taking the baseline test.
    • Athletes in collision and contact sports (as defined by the American Academy of Pediatrics classifications) are required to take a “new” baseline test prior to participation every two (2) years.

Management & Referral Guidelines

Suggested guidelines for management of sports-related concussions:

  • Any athlete with a witnessed loss of conscious (LOC) of any duration should be stabilized and transported to the nearest emergency department via emergency vehicle.
  • Any athlete who has symptoms of a concussion, and who is not stable (i.e. condition is changing or deteriorating), is to be transported immediately to the nearest emergency department via emergency vehicle.
  • An athlete who exhibits ANY of the following symptoms should be transported immediately to the nearest emergency department via emergency vehicle:
    • Deterioration of neurological function
    • Decreasing level of consciousness
    • Decrease or irregularity in respirations
    • Decrease or irregularity in pulse
    • Unequal, dilated, or unreactive pupils
    • Any signs or symptoms of associated injuries, spine or skull fracture, or bleeding
    • Mental status changes: lethargy, difficulty maintaining arousal, confusion or agitation
    • Seizure activity
    • Cranial nerve deficits
  • An athlete who is symptomatic but stable may be transported by his/her guardians. The guardians should be advised to contact a physician specializing in concussion treatment and management or seek care at the nearest emergency department on the day of the injury.

ALWAYS give guardians the option of going to the emergency department even if you do not feel it is necessary.

Return to Play (RTP) Procedures after Concussion

Returning to participate on the same day of injury

  • An athlete who exhibits signs or symptoms of concussion or has abnormal cognitive testing should not be permitted to return to play on the day of the injury. Any athlete who denies symptoms but has abnormal sideline cognitive testing should be held out of activity.
  • “When in doubt, hold them out.”

Return to play after concussion

  • The athlete must meet all of the following criteria in order to progress to activity:
    • Asymptomatic at rest and with exertion (including mental exertion in school) AND:
    • Within normal range of baseline on post-concussion ImPACT testing AND:
    • Have written clearance from primary care physician or specialist (athlete must be cleared for progression to activity by a physician other than an Emergency Room physician).
  • Once the above criteria are met, the athlete will be progressed back to full activity following a stepwise process (as recommended by both the Prague and NATA Statements), preferably under the supervision of the LA Fire Sports Medicine Team.
  • Progression is individualized and will be determined on a case by case basis. Factors that may affect the rate of progression include: previous history of concussion, duration and type of symptoms, age of the athlete, and sport/activity in which the athlete participates. An athlete with a prior history of concussion, one who has had an extended duration of symptoms, or one who is participating in a collision or contact sport should be progressed more slowly.
  • Stepwise progression as described in the Prague Statement:
    • No activity – do not progress to step 2 until asymptomatic
    • Light aerobic exercise – walking, stationary bike
    • Sport-specific training (e.g., skating in hockey, running in soccer)
    • Non-contact training drills
    • Full-contact training after medical clearance
    • Game play
      • Note: If the athlete experiences post-concussion symptoms during any phase, the athlete should drop back to the previous asymptomatic level and resume the progression after 24 hours.
  • Ochsner Sports Medicine Institute, its athletic trainers, coaches, parents, and athlete will discuss appropriate activities for the day. The athlete will be given verbal and written instructions regarding permitted activities. Ideally the athletic trainer and athlete will each sign these instructions or shall confirm receipt of an email message.
  • The athlete should see the athletic trainer daily for re-assessment and instructions until he or she, has progressed to unrestricted activity, and been given a written report to that effect, from the athletic trainer.