Concussion Protocol in Youth and Professional Sports

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As we all have become more educated on concussions, youth and professional sports have become increasingly strict with guidelines to be removed from play if there is a suspected concussion, and when it is an appropriate and safe time to return to play.


In a previous post, I talked about Rowan's Law, which is a policy outlined in Ontario where coaches must be educated on how to provide immediate care for concussions, assess symptoms, and it prevents athletes from returning to play too early.

On this post, I am going to outline the specifics I found regarding concussion protocol in professional sports and youth sport.


NFL Concussion Protocol
"The NFL's concussion protocol is once again under fire after Cam Newton 
got repeatedly pummeled and went unchecked" (2016) Business Insider.


Below is a brief summary of the NFL Concussion protocol.

"No-Go" Signs and Symptoms: If a player demonstrates/reports any symptoms of a concussion they are to be immediately brought the the locker room and is not allowed to return to the game or practice within the game day.
The player must have experienced:
  • Loss of Consciousness
  • Confusion
  • Amnesia

NFL Sideline Concussion Assessment (Sideline Survey): If the player demonstrates or explains any symptoms of a concussion, or if the trainer, physician, spotter, coach, teammate, game official or Unaffiliated Neurotrauma Consultant expresses concern of a concussion, the athlete is to be removed to the sideline or stabilized on the field if necessary. The athlete then must complete the NFL Sideline Concussion Assessment.
The NFL Sideline Concussion Assessment Includes:
  • Review of "No-Go" criteria (if present, athlete is to go to the locker room)
  • Inquiry about the event
  • Review of concussion signs & symptoms 
  • Video review of injury
  • Focused Neurological Exam
    • Cervical Spine Examination (Range of motion/pain)
    • Speech Evaluation 
    • Gait Observation
    • Pupillary Exam

Below is the Concussion Game Day Checklist that is meant to be used by the NFL and its medical teams if a concussion is suspected.

https://www.playsmartplaysafe.com/focus-on-safety/protecting-players/nfl-head-neck-spine-committees-protocols-regarding-diagnosis-management-concussion/


NHL Concussion Policy 



1. Education: Educate players, coaches, medical stuff, etc. before or during training camp via a video and educational brochure to educate about what concussion are and their signs and symptoms.

2. Baseline Testing: The testing is to be performed during training camp.

Testing Options:

  • X2 SCAT3: to be done annually by athletic trainers, team physicians and neuropsychologists. Also administered if concussion is suspected or diagnosed.
  • ImPACT: administered every other year if they have not suffered a concussion in the previous season and if the have valid ImPACT test data from 3 consecutive yearly English Language tests. Other athletes complete this test annually. 
  • Paper and Pencil Testing: A player who was diagnosed with a concussion in the previous season is to be re-evaluated by a neuropsychologist at the beginning of the season. 
3. Removal From Play for Acute Evaluation: Mandatory removal as soon as a concussion is suspected and/or any symptoms are present
  • Symptoms: Headache, Dizziness, balance/coordination problem, nausea, amnesia, acute cognitive delay, cognitive slowness, light/sound sensitivity, disorientation, visual disturbance, tinnitus
  • Signs: Motionless on the ice, balance problems, vacant look, slow to get up, grabbing head
The remaining steps the concussion protocol include In-play identification of possible concussion, Acute Evaluation, Management of the Concussion, Post Concussion Neuropsychological Evaluation, and Return to play.

Return to play states that a player who suffered a concussion is not allowed to return to play in that game or any event on the same day. They are able to return once there is complete recovery of concussion related symptoms, no emergence of the symptoms, and a player has been evaluated by a physician.

https://nhl.bamcontent.com/images/assets/binary/282574512/binary-file/file.pdf


Soccer Canada Concussion Guidelines (Youth Soccer)



1. Removal From Play: If a concussion is suspected the athlete is to be removed from play in a safe manner. 911 should be called if there is a suspected neck injury or if any of the following symptoms are present:

  • Severe neck pain
  • Deteriorating consciousness
  • Increasing confusion
  • Severe or increasing headache
  • Repeated vomiting
  • Unusual behaviour change
  • Seizure
  • Double vision
  • Weakness/tingling in arms or legs

2. Refer to Medical Professional & Report: Head injuries need to be diagnosed by a physician even if the symptoms seem to resolve. 

Parents and coaches need to report any signs or symptoms they experience with the child to each other and the medical professionals. 


3. Rest and Recover: Follow Medical Professionals orders in relation to the rest and recovery time period and steps to ensure full recovery. 
Often it is recommended to avoid any screens (eye strain), or anything that is cognitively demanding for at least the first couple days following a diagnosed concussion.

4. Return to play: Athletes must meet the following to be allowed back into play:
  • Symptom-free for 10 days or more
  • Be off any medical treatments that hide symptoms (ie. sleeping medication)
  • Provide written consent by a medical professional 
  • Completed a graduated return to play protocol without recurrence of symptoms.





Does the Concussion Protocol Mean Anything Though?

It seems that youth sports and professional sports have this topic under control... you would think right???

Well, unfortunately it seems too often that professional athletes are either coming back to play within the same game or in the following game, which we know creates more danger for secondary impact syndrome. The lasting question is that when reading the policies and guidelines that are outlined by professional sports, and actually see what happens when an athlete experiences a concussion, are the professional sport organizations actually acknowledging the danger of head trauma, or are they continuing to just try to run a business regardless of the health of their athletes? Where are their priorities?

 Only a few weeks ago the NFL Concussion Protocol experienced criticism again from an incident involving Cam Newton of the Seattle Seahawks. Continue on to the linked article to learn more about Cam Newton's hit and how the NFL responded to it. 













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