Referees and Concussions What you need to know Andrew Batista MS ATC CES

What is our roles in concussions? -Protect the kid *In compliance with the NFHS Concussion Rule found in each NFHS sport rule book---“Any player who exhibits signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion or balance problems) shall be immediately removed from the game and shall not return to play until cleared by an appropriate health-care professional.” 1 *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.” 1 *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. 1

TAKE HOME Better safe than sorry. Document, Document, Document Who what when and why Who got hurt? number name etc (testing kids reaction) Who is returning them and what is their credentials and the coach that decided to use him/her? What happened during the play? When did you send them out and when were they cleared to return? Why did you suspect a concussion? If in doubt, the more opinions the better.

What is a concussion? Brain Bruise Direct and indirect Soft tissue that allows you to move, think, feel, communicate Can be cumulative Direct and indirect Blow to the head Contrecoup- where the brain hits the far part of the skull (Whiplash) Science has moved away from grading concussions Symptoms can be delayed

Complications Post Concussion syndrome- symptoms last for hours, days, weeks or months after initial injury Chronic Traumatic Encephalopathy Cell death Only after death Long term Second impact Syndrome Short term bruise before prior bruise healed fully Intracranial hematomas Talk and die

Signs and symptoms Physical How do we assess this as a lay person? Vision, headache, balance, orientation, PEARL, Ringing in the ears, Sensitivity to light and sound, vomiting, LOC, gait abnormalities and fatigue How do we assess this as a lay person? Look and listen DIFFERENCES!

Signs and Symptoms Cognitive ENGAGE! Confusion Delayed responses Concentration problem Amnesia Retrograde Anterograde ENGAGE!

Signs and Symptoms Emotional Sleep Engage and Interact Irritability Uncharacteristic behavior Anxious Sadness Sleep Drowsiness Trouble falling asleep More sleep than usual Engage and Interact

THERE IS NO SUCH THING AS “bell-rung”

OTHER TAKE HOMES -Neck injury? -One deficit is enough -When in doubt, rule out -Assess as if it was your family member because people can die -Games matter, Lives matter more -Communicate- coaches and crew should be on same page. -Visor clarity -Mouth guards don’t help -spearing and helmet to helmet

References OSSAA Concussion Guidelines (November 2015 update) Concussion in sport. American Medical Society for Sports Medicine position statement. Br J Sports Med 47; 15-26 Concepts of Athletic Training 7th edition. Ronald Pfeiffer et al pg 140-150 Jones and Bartlett learning. 2015 Acknowledgement: Kyle Brostrand M.S., A.T.C. Assistant Athletic Trainer - Men's Soccer Coordinator of Concussion Management & Research Rutgers University Sports Medicine