Coaches, Teachers and First Aiders can play a vital role in diagnosing concussion.

Coaches, teachers and first aiders can play a vital role in picking up signs and symptoms of concussion and probably have the most important role in the prevention and management of concussion. 

Research has shown that young players in particular rely on their coach to provide information on concussion and are influenced most in their behaviour towards concussion by their coach.

All coaches, teachers and first aiders should be able to recognise suspected concussion and are in the best position to remove the player from play.

If a coach, first aider or teacher recognises a sign or symptom of concussion they should:

• Safely remove the individual from the field of play and ensure that they do not return to play in that game even if they say that their symptoms have resolved. IF IN DOUBT, SIT THEM OUT!
• Observe the player or assign a responsible adult to monitor the individual once the player is removed.
• If player is under 18 years old, contact parent/guardian to inform them of the possible concussion.
• Arrange for the player to get home safely.
• Arrange for a responsible adult to supervise the player over the next 24-48 hours.
• Ensure any relevant injury report form is completed and stored by the club/school/organisation.
• Follow a graduated return to activity (education and/or work) and sport programme with an emphasis on initial relative rest and returning to education/work before returning to training for sport.

Coaches and teachers should: 

• Be able to recognise signs and symptoms of concussion;
• Recognise Red Flag symptoms which require immediate medical attention;
• Coach a safe and effective tackle technique to reduce the risk of concussions occurring;
• Reduce any unnecessary contact training or in matches (in Primary RL);
• Encourage a supportive environment in respect of concussion and its management, and use their influence to have a positive impact on players and parents attitudes to concussion;
• Encourage disclosure of symptoms following head impacts or during Graduated Return
• Put no pressure on players to return sooner than they should, following a concussion;
• Encourage all players to play by the rules and respect the referees.

First Aiders should:

• Be able to recognise signs and symptoms of concussion;
• Recognise Red Flag symptoms which require immediate medical attention;
• Encourage a supportive environment in respect of concussion and its management, and signpost any concerns to appropriate Healthcare Professionals (such as GP, A & E)
• Encourage disclosure of symptoms following head impacts or during Graduated Return
• Place no pressure on players to return sooner than they should, following a concussion;
• Report concussions to the RFL and/or relevant League;
• Encourage all players to play by the rules and respect the referees.

Match Officials have an important role in the prevention and management of concussion.

Through the correct and consistent application of the laws of the game and concussion protocols, they are able to influence players and their coaches' behaviour towards concussion.

In the Community Game, if a Match Official suspects concussion, they must ask for the player to be removed from play right away. The player must not return to the field (even if the player, coach, first aider or parent advise they are now OK). The Match Official has the right to stop the game if a player does not leave the field or tries to return. Match Officials may ask coaches or first aiders the reason why a player is being removed for the purposes of reporting and also to ensure the appropriate steps are taken following player removal. IF IN DOUBT – SIT THEM OUT.

Continuing to play increases Players risk of more severe, longer-lasting concussion symptoms and can be fatal, as well as increasing their risk of other injury.

Remember, RESPECT!

It’s important for parents to understand the risks of concussion and managing it appropriately.

Making sure your child knows what the symptoms can feel like, and to tell you if they arise, and for you as parent are aware of what the symptoms may look like can help in your child’s recovery from concussion.

Parents should:

• Be aware of signs and symptoms of concussion
• Make sure you have all the information on the incident
• Not leave your child alone for the first 24 hours following the incident
• Have your child assessed by an appropriate healthcare professional within 24 hours of accessing the NHS by calling 111
• Monitor your child for worsening symptoms of concussion for at least 24 – 48 hours
• Encourage initial rest/sleep as needed
• Limit smartphone use and computer screentime for the first 24 – 48 hours
• Inform all other sports clubs of the suspected concussion and graduated return, and also school, college, work to ensure support is given
• Support your child through the stages of the Graduated return – with the focus on returning to normal life activity as a priority – then sport
• Encourage reporting of symptoms and act on them if worsening
• Do not put pressure on your child to return to sport too soon or stay on the field
• Respect the referees decisions on enforcing the law and supporting concussion management
• Respect coaches and first aiders when players are removed from the field with suspected concussion

Due to Rugby League being a collision sport concussion can't be eradicated completely, but we can all take steps to reduce the risks of them occurring.

Concussions can occur whilst playing all sports, in school playgrounds and in every day life – accidents – trips, falls and car accidents are some examples.

Ideally, we all want to prevent concussions occurring in the first place and there are some measures that can be taken during rugby training and games that have the potential to reduce the number of concussions that we see.

Recommendations include:

1. Ensure the playing or training area is safe and all posts and barriers on or close to the pitch are protected with appropriate padding.
2. Ensure correct techniques are coached and performed consistently by all players. If the head of the tackler hits the ball carrier there is a significant risk of concussion and/or neck injury. You should therefore ensure that you are able to perform correct tackle technique consistently.
3. Playing by the Laws of the game – no strikes to the head, no high tackles, tackles in the air or dangerous throws.
4. In Primary Rugby League adhering to the recommendation of no tackle to age.

What is concussion?

• Concussion is a traumatic brain injury resulting in a disturbance of brain function. It affects the way a person thinks, feels and remembers things.
• Loss of consciousness (being ‘knocked out’) occurs in less than 10% of concussions and is not required to diagnose concussion. However, anyone who loses consciousness because of a head injury has had a concussion.
• Anyone with suspected concussion should be immediately removed from the field of play and assessed by an appropriate Healthcare Professional or access the NHS by calling 111 within 24 hours of the injury.

Generally, a short period of relative rest (24-48 hours) followed by a gradual stepwise return to normal life and then subsequently Rugby League or any sport is the foundation of concussion management.

In the first 24 – 48 hours

All those suspected of sustaining a concussion should be assessed by a Healthcare Professional (doctor) or by accessing the NHS by calling 111 within 24 hours of the injury.

No-one should return to competition or within 24 hours of a suspected concussion. Anyone with a suspected concussion should NOT:

• Drive a motor vehicle (e.g. car or motorcycle)
• Ride a bicycle
• Operate machinery
• Drink alcohol within 24 hours of a suspected concussion
• Commercial drivers (HGV etc.) should seek review by an appropriate Healthcare Professional before driving
• Be left alone/unsupervised

Within the first 24-48 hours you can perform mental activities like reading, and activities of daily living as well as walking, if you feel able. 

If symptoms worsen, or any red flag symptoms occur you should seek immediate medical care by calling 999 as a matter of urgency.

Next steps to return to normal life

The graduated return to activity (education/work) and sport programme can be self managed, however the following should always be remembered:

• This varies from person to person and is not a ‘one size fits all’ process. Most symptoms of a concussion resolve by two to four weeks, but some can take longer. Everyone is unique in their recovery duration which is why completion of a graduated return to activity (education/work) and sport programme is important to reduce the risks of a slow recovery, further brain injury, and longer-term problems. Children and adolescents may take longer to recover than adults.
• After the initial 48 hour rest period, a staged return to normal life (education/work) and sport at a rate that does not make existing symptoms worsen, more than mildly, or produce new symptoms is the main aim. This is before return to sport is contemplated. 
• It is OK for players who are following a Graduated Return to return to school or work activities, and subsequently school or work part-time (e.g. half-days or with scheduled breaks), even if symptoms are still present, provided that symptoms are not severe or significantly worsened.
• Participating in light physical activity is beneficial and has been shown to have a positive effect on recovery after the initial period of relative rest. The focus should be on returning to normal daily activities of education and work in advance of unrestricted sporting activities, such as playing in a match or a full contact training session.

Finally, a return to sport

• The final stage of return to school or work activity is when the individual is back to full mental activity, as it was prior to the injury occurring. This should occur before return to unrestricted sport is even thought about.
• Similar to the return to education/work progression, the return to sport progression can occur at a rate that does not, more than mildly, exacerbate existing symptoms or produce new symptoms. It is acceptable to begin light aerobic activity (e.g. walking, light jogging, riding a stationary bike etc.), even if symptoms are still present, provided they are stable and are not getting worse and the activity is stopped for more than mild symptom exacerbation. Symptom exacerbations are typically brief (several minutes to a few hours) and the activity can be resumed once the symptom exacerbation has subsided.
• Although severe or prolonged symptoms (over 28 days) should be under the supervision of an appropriate Healthcare Professional and management will depend on the severity of symptoms and the types of symptoms and difficulties that are present. If symptoms persist for more than 28 days, individuals need to be assessed by an appropriate Healthcare Professional – typically their GP.
• Progression through the stages are dependent upon the activity not more than mildly exacerbating symptoms. Medical advice from the NHS via 111 should be sought if symptoms deteriorate or do not improve by 14 days after the injury.

You can access an online module regarding concussion via Our Learning Zone. Access here.