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Written on 12th May 2023 by Kim Milan

The government has published new guidance on how to manage concussion injuries in sport, If In Doubt, Sit Them Out, UK Concussion Guidelines for Non-Elite (Grassroots) Sport.

The guidance was developed in partnership with medical professionals and sports governing bodies and follows concussion awareness campaigns by brain injury charities, including Headway and UKABIF.

The guidance is aimed at coaches, teachers, volunteers and supporters, and parents and carers of players of grassroots (non-professional) sports, and provides information on how to recognise and safely manage concussion from the time of injury through to a return to education, work and sport. The guidance emphasises that it must never be used to replace or delay seeking professional medical advice or treatment for concussion injury.

The overriding principle and key message contained in the guidance is that anyone who is suspected to have a concussion must be removed from play, for their own safety and to avoid making their concussion brain injury worse.

What is concussion?

A concussion is a traumatic brain injury. It can be caused by something hitting the head directly or by severe, rapid head movement related to something else, such as a whiplash injury. Concussion affects the injured person’s brain function, such as their memory or the way they feel or think.

We tend to assume that concussion is related to being ‘knocked out’ but only 10% of concussion accidents involve loss of consciousness for the injured person. A diagnosis of concussion does not depend on the injury leading to a loss of consciousness, but any loss of consciousness from a head injury always means concussion.

Concussion on the sports field is often assumed to be an insignificant or minor injury but, as the guidance makes clear,  that assumption is wrong and risks causing further, avoidable, serious harm to the injured player. All concussion injuries are serious, with an increased risk of lasting or fatal brain injury if the player does not receive correct care when the concussion accident occurs. The guidance emphasises, repeatedly, that anyone with suspected concussion should be immediately removed from the field of play and assessed by an appropriate healthcare professional (if available onsite) or by calling NHS 111 within 24 hours of the injury. If players with concussion receive appropriate care and their concussion is properly managed, most people make a full recovery from concussion over time.

Concussion injuries can happen to people of any age, but children and teenagers are more likely to suffer concussion injuries and may need longer to recover. If they return to school, college or sporting activities too soon this can exacerbate their symptoms and delay their recovery. It can also increase their risk of more serious neurological and potentially fatal consequences from a second concussion injury or accident before they have fully recovered from their previous injury.

What are the signs and symptoms of concussion?

An impact or knock to a player’s head may not always be obvious in the excitement or competitive atmosphere of a fast moving game. The player may not display obvious signs of concussion, or the invisible head injury may be overlooked if the player suffers more obvious physical injuries. Conversely, concussion can also be difficult to differentiate from other severe injuries, such as brain haemorrhage (bleeding within the brain).

The effects of concussion injury can be physical, causing headaches, dizziness and visual disturbance. Concussion can also affect the injured person’s mood, mental processing or ability to think clearly, and their sleep. Concussion head injury symptoms may appear immediately or within minutes of the injury but it can also take 24-48 hours for the after-effects of the concussion injury to appear.

What are the risks of playing on after sports concussion injury?

The guidance emphasises that players, coaches, teachers, referees, and even spectators and families, have a responsibility to watch out for individuals with suspected concussion and ensure that they are protected from more serious injury by immediately removing them from play.

Playing on after a concussion injury can increase the injury to the brain, delay recovery, and cause more severe or (in rare cases) fatal injury if the player then suffers a further head injury leading to  ‘second impact syndrome’. Playing sport after a recent concussion injury also increases the risk of other sport-related injuries, such as musculoskeletal or fracture injuries.

What are the guidelines for managing sports concussion?

The key principle and message of the new If In Doubt, Sit Them Out guidelines is that coaches, match officials, team managers, administrators, as well as teammates, parents and carers must do their best to ensure that any player with a suspected concussion is removed from play immediately and as safely as possible. If a neck or spinal injury is also suspected, the player should only be moved by appropriately trained healthcare professionals.

Following any suspected concussion, the injured (concussed) person should be assessed by an appropriate healthcare professional (if available onsite) or via NHS 111 within 24 hours of the injury. The player must not return to school, work or sporting activity that day and until a healthcare professional has ruled out concussion,  or until they have completed a graduated (stage by stage) return to activity programme which prioritises a gradual, manageable return to education or work before returning to sporting activity and training. The aim of the staged programme is to rehabilitate the injured person whilst allowing their brain time to recover from the concussion injury.

In addition, the guidance recommends that the concussed person rests and sleeps as much as possible and avoids smartphone, screen and computer use for the first 24-48 hours, to help with their recovery.  Walking and easy activities of daily living are allowed, but they should not be left alone, consume alcohol or drive a motor vehicle for at least the first 24 hours after the injury and longer if they continue to experience symptoms. People who drive for work, such as HGV drivers, should be reviewed by an appropriate healthcare professional before returning to driving.

Nobody should return to sporting competition within 21 days from their concussion injury. Anyone who is still experiencing concussion symptoms after 28 days should see their GP, who might refer them for specialist review.

Players who display visible signs of head injury must be assessed by a healthcare professional or via NHS 111 within 24 hours of their injury, and before returning to education, work or sporting activity. Visible signs may include one or more of the following:

  • loss of consciousness or responsiveness;
  • lying motionless on the ground or being slow to get up;
  • balance and coordination difficulties, such as falling over or being unsteady on their feet;
  • appearing dazed, blank, vacant or confused or slow to answer questions;
  • clutching their head;
  • having a seizure, fit or convulsion;
  • lying rigid or motionless from muscle spasm (tonic posturing);
  • vomiting;
  • being more emotional or irritable than usual.

In addition to those listed above, other signs and symptoms of possible concussion include drowsiness or fatigue, headache, visual problems, sensitivity to light or sound, or not feeling right.

The player should receive urgent medical assessment from an appropriately trained, onsite healthcare professional or be taken by emergency ambulance transfer to a hospital accident and emergency (A&E) department if they have any of the following red flag symptoms of head injury:

  • deteriorating level of consciousness or increasing drowsiness;
  • amnesia (no memory) of events before or after the injury;
  • increasing confusion or irritability;
  • unusual changes in behaviour;
  • new neurological difficulties, such as with understanding, speaking, reading or writing, double vision, weakness or loss of balance or sensation;
  • seizure/convulsion, limb twitching, lying rigid or motionless due to muscle spasm;
  • severe or increasing headaches;
  • repeated vomiting;
  • severe neck pain;
  • suspected skill fracture.

Emergency treatment, as above, should also be given to anyone with suspected concussion who also has a previous history of brain surgery or a bleeding disorder, takes blood-thinning (anticoagulant) medication or is intoxicated with alcohol or drugs.

Most symptoms of concussion resolve within two to four weeks with correct post-accident care, but even apparently minor trauma to the head can also leave the injured person with long-term effects from their brain injury. Training and engaging in sport has countless health and wellbeing benefits but when accidents occur it is vital that those who are responsible for the game also take responsibility for ensuring the players’ safety. If someone suffers avoidable serious injury as a result of negligent school, club or sports event management, they may be entitled to compensation.

If you or your child have suffered serious injury as a result of someone else’s negligence, you can talk to one of our experienced solicitors, free and confidentially. For advice about making a claim and obtaining rehabilitation, contact our team.