1. Referees and Concussions
What you need to know
Andrew Batista MS ATC CES

2. What is our roles in concussions?
-Protect the kid
*In compliance with the NFHS Concussion Rule found in each NFHS sport rule book---“Any player who exhibits signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion or balance problems) shall be immediately removed from the game and shall not return to play until cleared by an appropriate health-care professional.” 1
*As of July 1, 2010, Oklahoma Statute of Title 70 further states that after the player has been removed from participation the player “may not participate until the athlete is evaluated by a licensed health care provider trained in the evaluation and management of concussion and receives written clearance to return to participation from that health care provider.” 1
*The NFHS rule does not require written clearance but Oklahoma Law does require written clearance.
The official is NOT responsible for the “written clearance” that must be done to re-enter the contest. The decision for the athlete to re-enter the contest and the “written clearance” to document return to play is the responsibility of the acting head coach. 1

3. TAKE HOME Better safe than sorry. Document, Document, Document
Who what when and why
Who got hurt? number name etc (testing kids reaction)
Who is returning them and what is their credentials and the coach that decided to use him/her?
What happened during the play?
When did you send them out and when were they cleared to return?
Why did you suspect a concussion?
If in doubt, the more opinions the better.

4. What is a concussion? Brain Bruise Direct and indirect
Soft tissue that allows you to move, think, feel, communicate
Can be cumulative
Direct and indirect
Blow to the head
Contrecoup- where the brain hits the far part of the skull (Whiplash)
Science has moved away from grading concussions
Symptoms can be delayed

5. Complications
Post Concussion syndrome- symptoms last for hours, days, weeks or months after initial injury
Chronic Traumatic Encephalopathy
Cell death
Only after death
Long term
Second impact Syndrome
Short term bruise before prior bruise healed fully
Intracranial hematomas
Talk and die

6. Signs and symptoms Physical How do we assess this as a lay person?
Vision, headache, balance, orientation, PEARL, Ringing in the ears, Sensitivity to light and sound, vomiting, LOC, gait abnormalities and fatigue
How do we assess this as a lay person?
Look and listen
DIFFERENCES!

7. Signs and Symptoms Cognitive ENGAGE! Confusion Delayed responses
Concentration problem
Amnesia
Retrograde
Anterograde
ENGAGE!

8. Signs and Symptoms Emotional Sleep Engage and Interact Irritability
Uncharacteristic behavior
Anxious
Sadness
Sleep
Drowsiness
Trouble falling asleep
More sleep than usual
Engage and Interact

9. THERE IS NO SUCH THING AS “bell-rung”

10. OTHER TAKE HOMES -Neck injury? -One deficit is enough
-When in doubt, rule out
-Assess as if it was your family member because people can die
-Games matter, Lives matter more
-Communicate- coaches and crew should be on same page.
-Visor clarity
-Mouth guards don’t help
-spearing and helmet to helmet

11. References
OSSAA Concussion Guidelines (November 2015 update)
Concussion in sport. American Medical Society for Sports Medicine position statement. Br J Sports Med 47; 15-26
Concepts of Athletic Training 7th edition. Ronald Pfeiffer et al pg Jones and Bartlett learning. 2015
Acknowledgement:
Kyle Brostrand M.S., A.T.C.
Assistant Athletic Trainer - Men's Soccer
Coordinator of Concussion Management & Research
Rutgers University Sports Medicine