Combat Concussion

 

Whilst working as a medic covering a Taekwondo tournament in December 2017 I dealt with an incident of concussion. The competitor returned this year and I caught up with her to find out what happened after the event. I was not expecting the story that followed.

Carla, a black belt in Taekwondo, was competing in a sparring contest. She was wearing the appropriate safety equipment including head guard and gloves.

I became concerned about the competitor after she received a blow to her head. She became unsteady on her feet and so the bout was stopped. I removed her from the ring, and she began to complain of nausea and photosensitivity. We moved to a quieter area as the noise levels were beginning to become a problem for her. Following a full assessment my immediate impression was that she was concussed and should not continue in the tournament. 

The assessment revealed that it was difficult for her to answer certain questions. She answered Maddocks questions with no problems, it was when I began filling in her details on my treatment record that she struggled. She was unable to recall her phone number and revealed that she hadn’t been able to remember things for a few days after hitting her head on a concrete archway in a friend’s house.

She began to drop her level of consciousness and I became increasingly concerned, especially as this was her second head injury in the space of a week. Although haemodynamically stable I felt her dropping level of consciousness, nausea and photosensitivity meant I needed to refer Carla to a Doctor as a matter of urgency. I was concerned that this could be a serious head injury, possibly an intracranial bleed. I called 999 and unusually a doctor, nurse and paramedic were on the ambulance that was sent. 

A concussion was diagnosed by the doctor, with the advice to see her own GP on her return to Devon. She left Cardiff that evening with somebody keeping a close eye on her during the long car journey home.

I contacted her in the days following and she said she was feeling tired but generally better. When I caught up with her she told me of her difficult year since.

It was a few weeks after the initial diagnosis of concussion that her symptoms began to worsen. Whilst attending another Taekwondo tournament, as an observer, her friends became concerned when she became vacant and began slurring her words. They quickly took her to hospital.

Numerous scans were performed and thankfully there was no evidence of a life threatening bleed. Following a detailed examination of Carla and her ongoing symptoms a diagnosis of post-concussion syndrome was made. She continued to experience impaired vision finding herself unable to focus for any length of time. 

The extreme tiredness that she encountered restricted her everyday life including her ability to return to work. Concentrating for any length of time lead to exhaustion, even the simplest tasks became difficult. The making of simple decisions such as what to eat for tea were now a challenge. Reading and listening to music became impossible. It took four months before she was back at work as a classroom assistant. This was facilitated by her occupational health department who developed an activity/sleep schedule to aid her rehabilitation. 

Her mental health suffered, experiencing emotional discomfort the year since her injury. Thankfully she has been supported through this with counselling sessions and is now taking medication to ease her depression.

Although some symptoms remain, especially travel sickness and tiredness, things are improving and for the first time in over a year she has returned to exercise. Her involvement with Taekwondo continues, and whilst she has been advised not to spar again, working as an instructor Carla continues to inspire young people to take up the sport. 

When teaching on our First Aid for Sports and Exercise (FASE) and Sports Trauma Management Courses, we stress the importance of recognition and correct management of concussion.

Keeping up to date on any change in guidelines and published research allows us to keep our information current. Hearing directly from someone who has experienced a serious concussion has helped us to understand it’s long-term effects and the impact it can have. 

Kind thanks to Carla Dunne for allowing us to share her story.  

Hi guys, we'd just like to provide you with some links regarding current guidelines 2017.

Firstly this is the new SCAT5 assessment tool 2017; 

http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf

Here is the child SCAT5 assessment tool 2017;

http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097492childscat5.full.pdf

Also here is the consensus statement on concussion in sport from the Berlin conference november 2016;

http://bjsm.bmj.com/content/early/2017/04/26/bjsports-2017-097699

We have updated our Sports trauma management course to comply with the latest guidelines. 

There has also been updates from the British Thoracic Society

Here are the all guidelines;

https://www.brit-thoracic.org.uk/standards-of-care/guidelines/

Here are the guidelines for emergency oxygen use in ambulances, community and pre‐hospital settings;

https://www.brit-thoracic.org.uk/document-library/clinical-information/oxygen/2017-emergency-oxygen-guideline/web-appendix-5-summary-for-ambulance-and-prehospital-settings/

We hope this has been useful for you and we're happy to answer any questions you may have regarding these guidelines.

All Lubas course's are up to date with all current guidelines at the time of the course. 

Hi guys, we'd just like to provide you with some links regarding current guidelines 2017.

Firstly this is the new SCAT5 assessment tool 2017; 

http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf

Here is the child SCAT5 assessment tool 2017;

http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097492childscat5.full.pdf

Also here is the consensus statement on concussion in sport from the Berlin conference november 2016

http://bjsm.bmj.com/content/early/2017/04/26/bjsports-2017-097699

We have updated our Sports trauma management course to comply with the latest guidelines. 

There has also been updates from the British Thoracic Society

Here are the all guidelines;

https://www.brit-thoracic.org.uk/standards-of-care/guidelines/

Here are the guidelines for emergency oxygen use in ambulances, community and pre‐hospital settings;

https://www.brit-thoracic.org.uk/document-library/clinical-information/oxygen/2017-emergency-oxygen-guideline/web-appendix-5-summary-for-ambulance-and-prehospital-settings/

We hope this has been useful for you and we're happy to answer any questions you may have regarding these guidelines.

All Lubas course's are up to date with all current guidelines at the time of the course. 

Chorley FC Supporters Trust fund lifesaving equipment

A big thank you to Danny Fishwick of Chorley FC for our most recent guest blog. Danny has attended a number of Lubas Medical courses and we felt Chorley's story of local supporters pulling together for the good of the club was too good to ignore! A great example of player safety being the number 1 priority throughout all levels of sport.

 

Danny explains the story in his own words. Enjoy!

 

I’m Danny Fishwick, the Sports Rehabilitator at Chorley Football Club. I have a degree in Sports Rehabilitation which I graduated from in 2010. Working in football I also have pitchside first aid and sports trauma management qualifications.

My role at Chorley Football Club is to lead the medical department for the first team through to the under 18s teams. I am the point of contact for all the players when it comes to injury diagnosis, treatment and rehabilitation and refer them on as and when required. Throughout my training I was involved in non-league football working voluntarily with Stalybridge Celtic, Ashton United and Northwich Victoria. I was given the opportunity to go to Huddersfield Town on placement at university and luckily I ended up staying there for the best part of three years. I worked with their first team and academy as well as working with Altrincham FC in the Conference North. Before joining Chorley I spent a year in Australia working with a semi-pro team called Armadale and also with Perth Glory who are the professional soccer team in Western Australia.


Chorley play in the National League North (formerly the Conference North) and were very close to reaching the National League last year in the play-off final – we were extremely unlucky on the day losing 3-2 to Guiseley, this would have been back-to-back promotions following us winning the Northern Premier League the season before. Our manager is Matt Jansen, who played in the Premier League with Blackburn Rovers. It is a sleeping giant of a club and everything is in place for us to keep building and progressing as far as humanly possible – with the main aim being the Football League.


We are lucky at Chorley as we have a good backroom team and good set of people behind the scenes. We have first aiders that would help me in a traumatic incident and stewards who are also stretcher bearers so everything is in place if traumatic injuries occur. The physios of each team are also very helpful in these situations. Traumatic injuries need to be managed efficiently and confidently – obviously with crowds of 1000-2000 every week we are being watched very closely to ensure we are following protocol fully and properly. As long as everything is done properly and the player is as comfortable as possible before the EMS arrives, we have done our job in a pre-hospital setting.


One of the courses which I really wanted to add to my toolbox was the use of Oxygen and Entonox. This is used in professional sport but not so much at semi-professional level. I wanted to get this introduced to the club, and have a few medical personnel from different clubs in our league attend so it becomes more regular at our level of football. This is life saving equipment and if one life is saved by using it over the space of 10 years then it is worth it. Due to a lot of the oxygen courses being held down south, I enquired about the possibility of hosting this at Chorley FC during the summer. This was arranged through Lubas Medical who came to our club and put on the course. We had medical staff attending from AFC Fylde, Curzon Ashton and Airbus UK just to name a few.


Being trained up is one thing, but purchasing the equipment is another at this level of football. I have been quite lucky with being supported fully when I want to introduce new ideas to the club. At this level of football however the funds aren’t there to be spent in large sums, especially in the summer / pre-season when there are no crowd incomes from games coming into the club. To purchase the oxygen I was lucky enough to have the full backing of the Chorley FC Supporters Trust, who sponsored and purchased it for the club.

Chorley Supporters Trust Board Member James Wilson, who arranged the LifeLine Pro Oxygen kit sponsorship, said:


"I help out as a steward at Chorley FC on matchdays. When the club suggested buying a Lifeline oxygen kit I immediately thought of the Trust. Safety in the football ground is of paramount importance, both on and off the pitch. The Trust are constantly working with Chorley FC to improve the matchday experience so this sponsorship deal was a natural fit for us."


I am tremendously grateful for this support and it proves that clubs at lower levels have a great camaradarie with everyone pulling together to reach the same goal. The staff, players, Trust and the fans all work together for the good of the club, we all want to be in the Football League and with this foundation the sky is the limit. This is what happens in non-league football as the money isn’t always there so everyone pulls together to run the club – which is what makes it so enjoyable to be involved in.

 

Fantastic work from Danny, Chorley FC and the trust.

For more information on the club:

www.chorleyfc.com

@chorleyfc

Follow Danny Fishwick:

@danny_boy23

 

Sports Trauma Management: Concussion

 

What is concussion?

 

A concussion is an injury to the brain that results in temporary loss of normal brain function. It usually is caused by a blow to the head. In many cases, there are no external signs of head trauma. Many people assume that concussions involve a loss of consciousness, but that is not true. In many cases, a person with a concussion never loses consciousness.


The formal medical definition of concussion is: 'a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma'. (American Association of Neurological Surgeons, AANS).

 


The key words here are 'Brain Injury' as in its simplest form, that is what a concussion is. A concussion could precipitate following a direct impact to the head i.e. blunt force trauma. Or it could occur due to rapid acceleration / deceleration forces. This insult to the brain can cause momentary interruption to cerebral activity.


Concussion is not the only medical condition which can result from a head injury, an intracranial haemorrhage is another possible complication. There are many different types of intracranial haemorrhage, all of which can lead to an increase in intra cranial pressure, and eventually prove fatal.

Initial symptoms associated with a bleed within the cranium may involve lucid intervals, loss of consciousness and headache. All of which are also symptoms which may be present during a concussion. This therefore stresses the importance of a continual player assessment, following a head injury. With a concussion it is usual for the symptoms to dissipate after a period of time, whereas with an intracranial haemorrhage the patient will more likely deteriorate. 


Types of intracranial bleed/haemorrhage


Signs and Symptoms of concussion


Symptoms which may occur after the incident may include:-


•    Headache                   
•    Short term memory loss
•    Nausea and/or vomiting
•    Dazed or vacant expression
•    Unconsciousness
•    Irritability
•    Visual disturbances
•    Balance problems
•    Inability to follow commands
•    Drowsiness
•    Seizures or fits


If the player is showing any of these signs and/or symptoms following a head injury they should be removed from play immediately and assessed further. The assessment should be carried out  by a doctor using an appropriate tool such as the Sports Concussion Assessment Tool (SCAT3 and Child SCAT).

Concussion can be slow to develop, or the individual may suffer a delayed onset concussion. In this instance the competitor may be relatively symptom free to begin with, and then progress to display signs and symptoms of concussion as time passes. It is therefore important to continually assess a player who has received a blow to the head. Following removal from play the individual should be repeatedly assessed for signs of improvement or deterioration and acted on accordingly.

Base line checks should be taken, recorded and then repeated every 5 minutes i.e. pulse, blood pressure, oxygen saturation, respiratory rate, GCS, short term memory test (Maddocks questions) etc. It is always best to air on the side of caution, especially with younger athletes. If there are any signs of deterioration, transport to hospital for further assessment is required.

When can a player return to play?


The only person who can medically clear a player to continue in their given sport, at this present time, is a doctor. Many clubs and sporting bodies have their own protocols for dealing with head injuries and concussion, but there is no clear answer as to whether a player should continue or not. Individuals who cover sport should be competent, and have a level of knowledge which is relevant to the care which they are expected to supply. This is harder to enforce within the lower leagues and especially so at youth level.

Anyone who offers medical support for a sporting team or sports competitors shouldhave appropriate training in the management of traumatic sports injuries. By having this training they can safely acknowledge their capabilities and seek further assistance as and when required. As always your clinical judgement is what guides you when assessing an injured player, and assessment tools such as SCAT3 and child SCAT help to assist your decisions. The graduated return to play guidelines may also help with assessment of a sports competitor following a concussion before allowing them to return to their sport.

Concussion issues continue in high profile sport!


It’s rare for a month of sport to go by lately without hearing some mention of concussion. At the start of 2015 we had a brilliant 6 Nations tournament that was over-shadowed in the first weekend by the George North concussion issue. This was just one of three concussions in two months for North, and he was rightfully rested from his club duties. George North says he is now through his concussion problems and has been cleared to resume full training.

http://www.bbc.co.uk/sport/0/rugby-union/32960716
 

 


Later in the same tournament we saw England’s Mike Brown receive a nasty concussion after colliding with Andrea Masi. Brown was rested for the next game against Ireland but returned for the last two games against Scotland and France. After which he complained of “not feeling right”. Being a more severe concussion Brown was still experiencing symptoms 12 weeks post incident, and missed the rest of the Harlequins season while he underwent further assessment.

http://www.telegraph.co.uk/sport/rugbyunion/club/11587955/Mike-Browns-concussion-is-assessed-by-head-injury-specialists.html

 


 
Concussion is not just isolated to rugby. There have recently been a number of high profile head injuries within other sports. Most notably in April 2015 we saw Chelsea’s Oscar collide with Arsenal’s David Ospina. Early signs showed Oscar was dazed and displaying unnatural positioning of his arms known as fencing. Surprisingly though, he

returned to play, only to be substituted later in the game before eventually requiring hospitalization for further assessment. Despite Premier league protocols, Oscar was back on the substitution bench for Chelsea three days later.


http://www.standard.co.uk/sport/chelseas-response-to-oscar-head-injury-completely-unacceptable-says-fa-concussion-panel-10222116.html

     


On our Lubas Medical Sports Trauma Management courses we provide information on recognising, treating and the appropriate management of concussion in sport. We also teach participants how to manage a number of other conditions and injuries that can occur in sport. We ensure that every course we provide is specific to your chosen profession and helps you to provide the gold standard of care to the athletes and individuals you cover. 

Post by Month