Appendix C Concussions

A concussion is a brain injury that may be caused by a blow to the head, face, neck or elsewhere on the body with an "impulsive" force transmitted to the head. Concussions can occur without loss of consciousness or other obvious signs. Signs and symptoms may present immediately or evolve over minutes or hours. A repeat concussion that occurs before the brain recovers from the previous one (hours, days or weeks) can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in brain swelling, permanent brain damage and even death.

Game officials are often in the best position to observe players after they have had a blow to the head or body, and may be the first to notice the behaviours that indicate a concussion may be present. While the following is primarily focused on players, any participant can suffer a concussion and must be removed from the field of play.

Clear indicators of concussion include when a player:

• appears dazed or stunned; has a blank or glassy-eyed stare
• appears confused or incoherent
• cannot remember things that happened (amnesia)
• seems slow to answer questions or follow directions, or is easily distracted
• shakes head, grabs or clutches head
• stumbles, has to be physically supported by teammates or loses balance
• moves clumsily or awkwardly
• shows behaviour or personality changes (e.g. becomes more emotional or irritable)

Other signs include:

• seizure or convulsion
• loss of consciousness
• disoriented; not aware of where they are
• lying motionless on the ground or very slow to get up off the ground
• blood or clear fluid leaking from the nose or ears

A player may be suspected of having sustained a concussion if they report one or more of the following symptoms:

• headache
• dizziness
• feeling dazed
• loss or blurring of vision, double vision, or seeing stars or flashing lights
• being more emotional or irritable than normal
• ringing in the ears or sudden deafness
• sleepiness or fatigue
• stomach ache or pain, nausea or vomiting
• poor coordination
• slurred speech
• poor concentration

IF A CONCUSSION IS SUSPECTED:

1. Remove the participant from play. Look for the signs and symptoms of concussion if the participant has experienced a blow to the head. Do not allow the participant to just "shake it off". Each individual will respond to concussions differently.
2. Ensure that the participant is evaluated right away by an appropriate healthcare practitioner. Do not try to judge the severity of the injury yourself. Call an injury timeout to ensure that the participant is evaluated by one of the medical personnel present.
3. Allow the participant to return to play only with permission from medical personnel. Allow medical staff to rely on their clinical skills and protocols in evaluating the participant to establish the appropriate management.
4. Unless a healthcare practitioner has evaluated the participant and has cleared them from concussion, they may not return to play on the same day. Participating without being cleared is flagrant unsportsmanlike conduct, requiring disqualification.
5. Further recovery should follow the concussion management protocol set out by your national federation.

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