The following article was written by Robin Bowman. Robin is a certified athletic trainer and risk manager with nearly 20 years experience in recreational and varsity athletics.
Concussions are arguably the biggest hot-button issue in sports today. As more research comes out on the complex and sometimes long-lasting effects of even a single concussion, those involved with sports and recreation at all levels are left with some difficult questions. Should children be participating in contact and collision sports? If so, at what age is it appropriate to begin? What should athletes, parents, coaches, officials, and administrators know about concussions? Who is responsible for recognizing and responding to a suspected concussion? How can we balance all the benefits of athletic participation with the very real risks?
Risk managers are tasked with weighing these questions and developing sensible concussion plans. These plans should include strategies for minimizing the number of concussions; a concussion education plan for athletes, coaches and parents; and a well-defined protocol to be followed whenever a concussion is suspected.
The New Standard of Care
Gone are the days of brushing off concussions as “getting your bell rung” and returning to play the same day as the injury. As Maya Angelou said, “I did then what I knew how to do. Now that I know better, I do better.” As a society, we now know better, and those working in and around athletics are held to a higher standard of care than they once were. The expectation is that every team and every league have a plan in place for concussion education, recognition and response.
Concussions Can be Managed
While we still have much to learn, we know that concussions are serious injuries that can have long-lasting effects. While we can’t eliminate the injuries altogether, we can take measures to reduce the incidence and ensure all potential concussions are taken seriously and athletes are offered appropriate care.
In an ideal world, there would be an athletic trainer/athletic therapist on the sideline of every practice and competition to look after the wellbeing of the athletes, but this isn’t realistic for many youth sports leagues. Even without an AT on the sideline, every team should have access to someone trained in concussion recognition and response.
Concussions Must be Managed
Effective concussion management is going to take a change in the culture. Risk managers, athletic administrators, and coaches play a vital role in setting the tone for a team, an athletic department, or a league. Those in these roles share responsibility for making sure athletes look at concussions with proper perspective and help them understand the rest of their career and rest of their life is more important than any one game or any one season.
We need to replace any thoughts an athlete may have of playing through a concussion as a sign of “toughness” with an understanding of the seriousness and potentially life-altering effects of the injury. Hiding a concussion and playing through isn’t tough, it’s just a bad idea.
We need to instill in athletes the responsibility to care for oneself, one’s teammates, and one’s opponents. Sportsmanship and fair play are more than just positive character traits, they help reduce unnecessary injuries.
Risk managers have a duty to ensure there is a plan in place to educate athletes, coaches, and administrators on how to recognize concussions, and what to do when an athlete is suspected of having a concussion. When dealing with youth leagues, it is also important to educate the parents. Create a shared understanding that athlete safety is paramount and everyone associated with the league is expected to take concussion seriously and work together to care for the athletes.
The physical nature of sports means that concussions are going to happen from time to time. This is a risk inherent with athletic participation. There are ways to minimize the incidence of concussions, though.
Provide safe playing facilities and equipment. Conduct a safety audit of all facilities used for practice and competition. Are there obstacles in the way? Is there equipment lying around that could cause a tripping hazard? Are there walls or posts that need to be padded? Are playing surfaces well-maintained and free of holes? (Even a poorly maintained grass field can increase the chance of concussion by being too hard or causing athletes to fall.) What can be done to make the athletic facilities safer? Is the equipment being used in good repair, and do athletes have the appropriate and properly fitted safety equipment? Prioritize and address any issues uncovered in your safety audits.
Train athletes to use proper technique. From the earliest stages of sports participation, athletes should be trained to use good form and proper technique that does not put themselves or others at unnecessary risk of injury.
Insist on good sportsmanship. This is part of changing the culture of sports, but good sportsmanship is non-negotiable. Create a culture in which foul play is discouraged. (While a hockey player may get a concussion from falling on the ice, there is no excuse for getting one from engaging in a fight.) Have zero tolerance for dirty play.
Consider low- or no-contact versions of sports. For example, a league could play flag- or two-hand-touch football instead of tackle football. Limiting contact in practice is another option for lowering the risk of concussion. Even some NCAA Division I football programs have moved to eliminating tackling in practices.
While it’s unlikely we’ll completely eliminate concussions anytime soon, we can have an impact by proactively managing the risks we have control over.
Have a Plan
Since it is impossible to prevent all concussions, you must have a plan in place for how you will respond when an athlete is concussed. Don’t wait until an injury happens to think about how you’ll handle it. Have a well-thought-out plan in place long before a competitive season starts, and communicate this plan to everyone involved with the team, athletic department, or league. A plan can only work if people are aware of it. Make sure everyone knows what their role is in preventing, recognizing, and responding to concussions.
Maintain Proper Documentation
It’s hard to overstate the importance of thorough documentation. Risk managers should ensure that every team keeps thorough and up-to-date documentation of:
- Facility and equipment inspections
- Pre-participation physical exams
- Concussion policies and protocols
- Proof of concussion training
- Waivers and releases
- Injury reports with follow-up/progress notes
- Proof of medical clearance to return to activity following a concussion
In the event of legal action, the judge will want to see both documentation of the organization’s concussion policies and protocols and proof that they were followed.
Putting it All Together
Concussions aren’t going away anytime soon, but neither are athletics. A risk manager should provide leadership on concussion education, prevention, and response efforts for their team or league. There are many proactive steps than can be taken to minimize risk, but it takes consistent effort and a team approach to make real change.
Br J Sports Med 2017 51: 838-847 originally published online April 26, 2017