When It Comes to Concussion - Use Your Head!

Concussion is a temporary impairment of brain function usually caused by a blow that has shaken the brain within the skull. Failure to assess, evaluate and manage a player with a concussion can have serious adverse consequences, particularly allowing a player with concussion to continue to play, or to return too early to training or playing. 

There is a need for medical assessment in cases and before return to play, this is stated below and in the IRB Regulations (www.irb.com/lawregulations)

The RFU have therefore produced a series of resources to help with the recognition and management of concussion:

• A wallet-sized Pitch Side Concussion Assistant has been sent out with previous issues of Touchline. If you would like more for your club please contact health@rfu.com.
• Training is available for coaches and volunteers through the 1 day RFU Sports First Aid Course (many standard courses do not contain this information). Ask your local RDO about courses in your area, or visit the first aid section of www.rfu.com/health
• Concussion guidance is also included in the RFU's "Start Rugby" Coach resource pack, available from www.communityrugbyshop.com

In addition, here is a poster to help highlight the signs and symptoms of concussion and the procedures to follow in the event of a suspected injury. More information is also available below.   

If the player has any of these symptoms, they should not return to play:

• headache, feeling dazed or "in a fog”
• balance problems, dizziness
• hearing problems/ringing in ears
• vision problems
• nausea or vomiting
• confusion
• drowsiness
• feeling slowed down, low energy
• more emotional/irritable than usual
• difficulty concentrating and/or remembering
• “don''t feel right”

If the player has any of these signs, they should not return to play

• loss of consciousness or unresponsiveness (even temporarily)
• seizure/convulsion (uncontrolled jerking of arms and legs)
• balance problems, unsteadiness, clumsiness, slurred speech
• appears dazed, stunned or confused
• poor memory (of score, moves, opposition, events)
• odd behaviour
• significantly impaired playing ability

If concussion is suspected, ask these questions

1. Which ground are we at?
2. Which team are we playing today?
3. Which half is it?
4. Who are you marking? (if appropriate)
5. Which team scored last?
6. Which team did we play last week?
7. Did we win last week?

An incorrect answer should be considered abnormal and the player should not return to play. The return to play guidelines should then be followed. Following a suspected concussion, the player should be seen by a doctor

Post-head injury and return to play guidance

Following a head injury or concussion, further serious problems can arise over the first 24 hours.

• the player should not be left alone and should be monitored regularly.
• players must always consult their doctor following a suspected concussion.
• symptoms may worsen with exertion.
• a player who has been concussed MUST NOT play for a minimum of three weeks (unless over 19 and cleared to do so by an approved doctor competent in managing concussion.
• AND should not return to play or training until symptom free.
• AND should only return to play or training with medical clearance.

This applies to all club/school sides a player belongs to and it is his or her/parents responsibility to advise other clubs/schools of the concussion.

 “When in doubt, sit them out”

CONCUSSION ADVICE

Drowsiness

After a knock to the head, It is then quite common for the person (especially children) to want to sleep for a short while. This is normal.

However, it will appear to be a normal ''peaceful" sleep, and they wake up after a nap. If they want to sleep, let them.  

Drowsiness means they cannot be roused. If you have a concern, wake them up after an hour or so. They may be grumpy about being woken up, but that is reassuring. You can then let them go back off to sleep again. You can do this a few times during the night if there is particular concern.

When asleep, check to see that he or she appears to be breathing normally and is sleeping in a normal position.

Headache

It is normal after a knock to the head to have a mild headache. Sometimes there is also tenderness over bruising or mild swelling of the scalp. Some paracetamol will help (such as Calpol or Disprol for children). Do not take tablets containing aspirin.

It is a headache that becomes worse and worse which is of more concern.

DON’T HESITATE. IF IN DOUBT, CONSULT YOUR DOCTOR OR NHS DIRECT 0845 46 47