CONCUSSION AWARENESS, POLICY AND PREVENTION
Martingrove’s policy is that any HIT to the HEAD is an automatic OFF THE FIELD until you receive a doctor’s letter clearing that player (no matter what kind of hit it is). The player must me removed from the field immediately and an accident report must be filled out.
Avoiding injuries is the best way to prevent concussions. Complete each of the SIX topics below to see how safe you keep your athletes.
IV. Activity Selection
V. Rules and Respect
I. Environment: Ensure the environment is safe
“It’s time for practice.”
As a coach, you have a legal obligation to provide a safe environment for athletes at all times.
Assess the safety of the facility itself (e.g., walls, playing area, field, lighting) by:
- Completing a facility safety checklist at the start of the season.
- Conducting a spot check before every practice/game.
- When you arrive at the facility, check the environment for potential hazards.
- Walk around the environment to inspect anything you can’t see from a distance.
- Ensure you have the appropriate equipment
- Instruct athletes about safe behaviour.
Your sport may have specific safety measures that must be followed before and during practices/game. Check with you national and/or provincial/territorial sport organization to see if there are any specific safety measures you should be taking
Ensure you have an Emergency Action Plan (EAP) in place.
II. Equipment: Ensure equipment fits properly and is well maintained
III. Personal Equipment
Wearing equipment that fits properly and is well maintained is an important component of injury prevention. ALWAYS make sure your players are wearing appropriate equipment that fits properly and is in good condition. Enforce the correct wearing of equipment at all practices and competitions. Check with your sport organization for guidelines.
While a helmet cannot prevent a concussion, a properly fitted helmet is one of the best strategies to prevent catastrophic and often irreversible head and brain injuries. And while there’s no evidence that mouth guards prevent concussions, they provide important protection to the teeth.
To understand how helmets work, what helmets standards mean, and how to properly fit a helmet for maximum protection, check out parachute’s helmet FAQ.
Ensuring that team equipment is well maintained is another important element of concussion prevention. What aspects of team equipment do you need to consider in your sport to reduce the risk of concussions?
Do you have to consider any of the following team equipment in your sport when thinking about athlete safety?
- Ball size
- Scrum machines
- Handheld pads
III. Technique: Teach and reinforce correct technique.
Injuries can occur as a result of poor technique. Teach the fundamentals of agility, balance, and coordination to help prevent falls and collisions. Use proper progressions when teaching skills to reduce the chances of injury.
If you coach a contact sport or league, teach and reinforce correct technique for checking or tackling. Check with your sport governing body for educational materials in this area.
If your sport involves skating, focus on the fundamentals of the skill to reduce the chances of collisions and falls. Teach athletes how to fall correctly to minimize the chance of injury.
IV. Activity Selection: Plan safe activities. Agility, balance, and coordination can help prevent falls and collisions, and so can setting drills up properly.
Coach Laura has just introduced her team to the dill of travelling. The athletes worked really hard in today’s practice and are tired. Laura wants to close out the session with an activity that will allow them to keep working on their travelling skills, but also wants to reward them with a fun activity because they’ve worked hard.
Laura decides to do a relay race where athletes travel with the ball/puck/ring to the other side of the gym/rink and touch the wall/boards before the next person on their team goes. As this group is really competitive, Laura builds an element of competition into the activity. To reward the winning team, Laura tells them they won’t have to put the equipment away at the end of the practice. This is an activity they’ve done before, so Laura gets right to it.
There are a number of safety concerns in Scenario #1:
- Athletes have just learned to travel with the ball/puck/ring and fatigue is an issue. Research indicates that the risk of injury increases with the amount of time spent in the game.
- As this is a new skill, athletes probably won’t keep their heads up when travelling and may collide with one another.
- As this is a race, athletes will be travelling at speed, which increases the force of any collision.
- The ball/puck/ring may get loos when passed between athletes, and other athletes may trip on it.
- Athletes may cross paths and collide as they retrieve a loose ball/puck/ring.
- The activity is set up too close to the wall/boards, putting athletes at risk of running/skating/tripping into the wall/boards.
- Laura doesn’t remind them about safety considerations (e.g., what to do if they have to retrieve their ball/puck/ring from another teams’ lane).
- Provide clear instructions to athletes on how to retrieve a loose ball so as to avoid colliding with other athletes, who may have their heads down and not see others crossing their path.
- Set up the activity away from the wall/boards.
- Get athletes to touch their teammate’s hand instead of the wall to reduce the risk of colliding with the wall.
- The combination of athlete fatigue, the element of competition, and travelling being a new skill for the athletes increases the risk of a collision. No single one of these factors is an issue, but the combination increases the risk.
- Move athletes closer together so they don’t have as far to run/skate in each leg of the relay and therefore won’t reach such high speeds. Higher speeds lead to harder collisions.
Coach Rick arrives at practice to find that he has to share the facility with another team. His team is struggling in their games, and Rick’s assistant called him to say he was going to be late and may not be able to make it at all because of an emergency at work.
The main weaknesses of Rick’s team are that they don’t jump on the ball/ring aggressively enough on offence and they give their opponent too much time and space on defence. Rick wants his team to play more aggressively and so decides to run a loose ball drill. To get all the athletes involved, he sets up two stations and plans to rotate after 15 minutes. The loose ball drill is at station 1. At station 2, Rick wants the team to work on fast, crisp passes, as passing accuracy was poor last game.
Station 1: Loose Ball Drill
1. Athletes are in two lines opposite each other and facing away from each other.
2. The athletes in each line are numbered from 1.
3. The coach throws a ball/puck/ring into the middle and calls a number. The two athletes with that number turn and race to get the ball/puck/ring.
4. The player who gets the ball/puck/ring is on offence and tries to get the ball/puck/ring back to his or her line. The other player is on defence.
5. The coach can call more than one number at a time.
Station 2: Passing Drill
1. Set up 5 cones in the shape of a star, 10 metres apart from each other.
2. Put one athlete at each cone, and have the rest line up at the starting point (A).
3. The first athlete at the starting point passes the ball to athlete B and follows his/her pass to that cone.
4. Athlete B passes the ball diagonally to athlete C and follows his/her pass to that cone.
5. Athlete C passes the ball to athlete D and follows his/her pass to that cone.
6. Athlete D passes the ball diagonally to athlete E and follows his/her pass to that cone.
7. Athlete E returns to the starting point with the ball.
Scenario #2, Question #1
There are a number of safety concerns in Scenario #2:
- There are two stations and only one coach. In addition, coach Rick is involved in the running of the loose ball drill.
- The limited practice space and multiple stations offer numerous opportunities for collisions and tripping over loose balls/puck/rings.
- With the loose ball drill, the main safety concern is athletes colliding with one another. Athletes are moving at full speed toward one another and a moving ball/puck/ring. There is a chance that athletes of different sizes and strengths will fight for the same ball/puck/ring.
- With the passing drill, the main concerns are athletes colliding with one another and getting hit by balls. Everyone is moving and several balls are in play.
Scenario #2, Question #2
How would you manage these concerns?
1. There are two stations and only one coach. In addition, coach Rick is involved in the running of the loose ball drill.
2. The limited practice space and multiple stations offer numerous opportunities for collisions and tripping over loose balls/puck/rings.
3. With the loose ball drill, the main safety concern is athletes colliding with one another. Athletes are moving at full speed toward one another and a moving ball/puck/ring. There is a chance that athletes of different sizes and strengths will fight for the same ball/puck/ring.
4. With the passing drill, the main concerns are athletes colliding with one another and getting hit by balls. Everyone is moving and several balls are in play.
1. As the assistant coach is absent and gym/rink space is limited, run only one drill at a time.
Loose Ball Drill
1. Ensure athletes of similar size are partnered against each other.
2. Discuss safety issues before running the drill.
1. Run the drill without any balls/puck/rings first so athletes understand the rotations. As athletes become comfortable with the rotation, add one ball/puck ring. Once athletes understand the drill better, add more balls/pucks/rings.
2. To increase awareness, get athletes to call the name of the person they are passing to.
3. Instruct athletes to keep their heads up and to be aware of their fellow players.
4. Make sure there are no loose balls/pucks/rings that athletes might trip over.
5. Provide clear instructions.
Set up drills with injury prevention in mind. Always consider the following:
- Differences in athletes’ size and strength
- Athletes’ fatigue
- Athletes’ skill level
- Timing between athletes starting the drill
- Athletes crossing paths
- Managing pace
- Placement of equipment
- Proximity to other stations, walls, etc.
- Use/positioning of safety equipment (e.g., mats)
- Managing loose balls/pucks/ring after an athlete’s turn
- Coach position
- Reduction or elimination of contact during practice.
V. Rules and Respect
The game is all tied up with a few seconds on the clock, Mark has a break away and there is only one player between him and the goal and Lucas trips him to prevent the goal and gets called for a tripping penalty. Lucas tell his coach “that was a good penalty I prevented Mark scoring on us”.
Take a minute to reflect on how you would respond in this situation
How do you respond to your athlete?
- Agree with the penalty; your team would have lost for sure if your player hadn’t tripped Mark.
- Tell the athlete there are no “good” penalties and that it’s important to respect both the rules of the game and the other players.
As a coach, you are expected to follow the code of ethics. The code reflects core coaching values and sets out the behaviour expected of coaches. It provides a reference for what constitutes both “the good and right thing to do”
The 5 core ethical principles of the code of ethics are:
- Physical safety and health of athletes
- Coaching responsibly
- Integrity in relations with others
- Honouring sport
When the rules of the game, sportsmanlike behaviour, and fair play are overlooked the chance of injury increases. Rules exist for athletes’ protection. Educate athletes about the rules, and play by them yourself.
Serve as a role model to others in the sport, and encourage sportsmanlike behaviour and adherence to the rules, even when they don’t work in your favour.
Show respect for athletes as people. If an athlete is suspected of having a concussion, respect the seriousness of the injury and remove the athlete from play-even if he/she is a star player and crucial to the success of the team. Educate others on the team about concussion, and highlight the importance of everyone following appropriate Return to Play Guidelines.
VI. Education: Education is the cornerstone of prevention
Coach, parent, and athlete education is the foundation of concussion prevention. Recognizing the injury is of primary importance, since appropriate management can begin only when concussions are recognized.
As a coach, you are in an excellent position to help athletes and parents stay informed about how to recognize, manage, and reduce the risk of concussion. Before the season begins, make sure athletes and parents know:
- What a concussion is
- How serious concussions can be and what the possible long-term consequences are
- How to prevent concussions
- How to recognize the signs and symptoms of concussions
- What team policy is for athletes suspected of having a concussion
- What team policy is about return to play
Section 2 – Suspect and Act
Suspecting a concussion and acting appropriately
A concussion is a serious brain injury. Most athletes who sustain a concussion recover with appropriate management by the coach and physician.
You will work on two scenarios in this section of Making Head Way in Sport. You must successfully complete BOTH to pass this section.
In each scenario, you play the coach and decide how to act. Even though the scenarios may not be about your sport, you will benefit from completing them. As you work through a scenario, reflect on the similarities with your sport and think about how you can transfer what you learn to your own coaching.
How healthy can you keep your athlete?
Two girls are running for the ball and collide together. Coach looks over and sees that one of the girls is slowly getting up, but the other girl is still on the ground and looks to be unconscious. She has been out for about 20 seconds; she’s just coming around now.
What to do?
a) Call 911 or
b) move the athlete onto her side in case she starts vomiting?
Key Learning Point:
If an athlete loses consciousness or you are worried about a more severe injury or neck injury, call 911 and implement your Emergency Action Plan (EAP)
When to seek medical care immediately:
- Concussion symptoms worsen; for example, headaches get worse or don’t go away
- You observe these physical symptoms:
- Neck pain
- Extreme drowsiness (can’t be wakened)
- Problems walking or with balance
- Repeated vomiting
- Slurred speech
- Difficulty with vision
- Tingling/numbness in arm/legs
- These emotional symptoms occur:
- Excessive emotional reactions
- Significant irritability
- These cognitive symptoms are present:
- Inability to recognize people or places
- Sustained or increasing confusion
- Less responsiveness than usual
Key Learning Point:
Do not move the athlete if you suspect a neck injury. A neck injury should be suspected if an athlete is unconscious or is unable to answer questions.
Do you have a headache? Do you feel any pain? Where am I? What happened? Well one minute I was attacking and the next think I knew someone collided with me from behind. I turned to look at the other player and she was out cold. I hope she’s ok; she doesn’t look good. Did you black out too?
What are you thinking?
a) You’re glad that your athlete did not suffer a concussion too or
b) you’re worried that your athlete may have a concussion?
Key Learning Point:
Athletes may have a concussion even if they do not lose consciousness. Most concussions do not involve a loss of consciousness.
Loss of consciousness is only one sign of concussion and occurs in less than 10% of concussions.
Common signs and symptoms of concussion:
There are different types of signs and symptoms of signs and symptoms of concussion: physical, cognitive, and emotional/behavioural. The presence of any of the following signs (something observed by another person) and symptoms (something reported by the individual) may suggest a concussion. The signs may not always be obvious, so it’s important to be vigilant.
- Loss of consciousness
- Seizure or convulsion
- Slurred speech
- Poor coordination or balance
- Vacant look
- Slowed reaction time
- Difficulty concentrating/easily distracted
- Does not know time, date, place, etc.
- Strange or inappropriate emotions
- “pressure in head”
- Neck pain
- Blurred vision
- Balance problems
- Sensitivity to light or noise
- Fatigue or low energy
- Feeling slowed down
- Feeling as if “in a fog”
- Difficulty concentrating
- Difficulty remembering
- More emotional than usual
- Nervous or anxious
The signs and symptoms of concussion are listed in the pocket concussion recognition tool for easy reference. Keep it handy as a quick reference for the signs and symptoms of concussion.
Wow I can’t believe she had to be taken off by an ambulance, I hope she’s ok.
Ya me too, I guess I was lucky she ends up going to the hospital and I feel fine I hope she’s ok.
What do you do?
a) Liz, your athlete, looks to be her normal self so you gather athletes into a huddle to refocus the team or
b) ask the assistant coach to take charge of the team so you can follow-up with Liz, your injured athlete or
c) Tell Liz to sit out as you’re worried about her after the collision and you need to give your full attention to the rest of the team
Key Learning Point:
Concussion is a serious brain injury and must be managed appropriately. If you do not act when you suspect a concussion has occurred, you are putting your athlete at RISK.
What happened did you hit your head?
No but I feel hard.
How do you feel?
I’m fine, can I get back in the game? We need to win this one to get through to the next round!
Do you have a headache?
No I’m fine! I don’t know why your worried? Can I go back in now? Don’t you want to win this game too?
What do you do?
a) Let Liz go back in the game or
b) Ask more about how Liz is feeling.
Key Learning Point:
Following a collision that concerns you, look for signs and symptoms of concussion, as well as changes in the athlete’s behavioural, cognitive, and emotional state. Don’t let the athlete back in the game until you have checked for signs and symptoms. If the athlete shows any signs, however brief, he/she should be removed from play, even if recovery seems complete. If in doubt, sit them out!
Your role as a coach is to recognize signs and symptoms of concussion, presume that there is a concussion, and take the appropriate action – NOT to diagnose a concussion.
Use the pocket concussion recognition tool as a resource to remind you of the signs and symptoms of concussion. As well as asking athletes whether they have any symptoms, it’s also important to keep a lookout for any changes in their behaviour. Are they dropping more passes than usual? Do they stay in rather than go out with the team for dinner? Do they seem to be their usual self?
Of course, the game is important but your health is more important, concussion is different than other injuries; you can’t just suck it up and play it through this is a brain injury and you need your brain for the rest of your life. Let’s make sure you don’t have any signs of concussion before we put you back in the game. Do you feel dizzy, pressure on your head? Do you feel sick, any problems with your balance? Can you see ok, or is your vision blurry?
No, I’m feeling good!
Ok it seems that you’re ok to get back into the game, but if you start to feel any of this symptoms you have to tell me right away! Remember a concussion is a brain injury and we need to take care of your brain! (I must talk to her parents after the game to tell them what happened).
Saturday comes around (two days later) and we are at practice and Liz is extra slow today. Coach askes Liz “what’s wrong” nothing I just have a lot on my mind with exams and everything and I have a little bit of a headache I just need some time to study and I’ll be ok.
What do you do?
a) Let Liz go home and study to help reduce the stress around her exams or
b) Tell Liz to let you know if her headache gets any worse or
c) Remind Liz of the importance of treating her teammates with respect.
Key Learning Point:
The signs and symptoms of concussion may not appear immediately. For example, one study showed that in 12% of individuals, symptoms of concussion appeared later in the day and in 8% of cases symptoms appeared the next day (Duhaime et al., 2012). It is therefore important to keep monitoring athletes in the days following a collision. Look for changes in behaviour and emotion; these could be signs of concussion. Use the pocket concussion recognition tool as a resource to remind you of the signs and symptoms of concussion.
Key Learning Point:
Educate athletes about the severity of concussions and the importance of communicating any signs or symptoms to the coach or trainer. 50% of athletes fail to recognize their symptoms or deny the presence of symptoms (McCrea et al., 2004)
Key Learning Point:
An athlete may have suffered a concussion even if there are no visible signs of concussion (they may not have appeared yet) and the athlete does not report any symptoms (the athlete denies or does not recognize them). It is therefore important to remove the athlete from play following a collision that could lead to a concussion for close observation to ensure signs and symptoms do not appear.
Am I liable if I let an athlete back in the game following a major collision, even if he/she is not showing any signs and symptoms of concussion?
Nations of liability always turn on the specific circumstances of a case (i.e., the actual facts of a specific situation). However, if there is a team protocol for significant body contact, then it must be followed. We know that the signs and symptoms of concussion do not always present immediately. As a coach, you should know the difference between a minor collision and a major collision and should act on that difference. At a minimum, you should check for signs and symptoms and act appropriately. Allocation of liability considers your knowledge and experience as a coach. You are expected to have the degree of knowledge and skill appropriate to the level at which you are coaching and to exhibit the same dame standard of skill as another coach with the same knowledge and skill in a similar situation. Most sport organizations now have or should have, a concussion policy, as do their leagues. The bar has been raised with regard to concussions and coaches are expected to act accordingly.
Hilary A. Findlay, Ph.D., L.L.B.
Co-Founder, Sport Law & Strategy Group
Associate Professor, Department of Sport
Management, Brock University