What Is Concussion?

A concussion is a type of brain injury that occurs when there is a knock to the head or the body that transfers to the brain, causing a temporary neurological impairment. It can result in several physical and mental symptoms.

Researchers at the University of Queensland have reported that “most concussion cases occur in young people aged 5 to 14.” They have also noted that damage to the still-developing areas of the brain could leave students at risk of detrimental long-term consequences.

Identifying Concussion Symptoms

Although concussions can result from relatively minor collisions, concussions are more likely to occur during high-impact activities such as sport. For this reason, schools should always monitor students when they are participating in physical activities and act immediately if they appear to receive any type of head injury.

Some obvious symptoms that a student may be concussed are:

• confusion
• impaired memory
• loss of consciousness
• dazed appearance
• change in behaviour or emotions.

However, symptoms will not always be obvious, and it’s important to recognise less obvious signs such as:

• drowsiness
• balance problems
• sensitivity to light and sound

Severe symptoms that will need immediate medical attention can include:

• repeated vomiting
• seizure or convulsion
• a tingling or burning feeling in limbs
• double vision.

The Australian Institute of Sport (AIS) provides a detailed list of symptoms here. You can also use the Concussion Recognition Tool (designed for non-medical users) to help you recognise concussion.

Concussion is an evolving condition which means that symptoms can change or be delayed, making the condition difficult to detect. It may take up to 48 hours following a collision to exclude a diagnosis of concussion.

What Should You Do if You Know or Suspect That a Student Has Concussion?

As soon as you notice any concussion symptoms, you should remove the student from the sports activity and apply standard first aid procedures. For any critical symptoms, you should immediately refer the student to an emergency department, otherwise, the student should be referred to a medical practitioner as soon as practicable. The student’s parents should also be notified.

Staff should ensure that students:

• remain in the company of a responsible adult for at least three hours
• receive immediate treatment if symptoms worsen
• where relevant, not be allowed to drive until cleared by a medical practitioner.

The Guidelines also recommend that students should not use any medications that have not been prescribed by their healthcare practitioner. The AIS website mentions that athletes with suspected or confirmed concussion should check their medications with their doctor and specifically avoid drugs such as aspirin, anti-inflammatories, sleeping tables and sedating pain medications. Unfortunately, because the Guidelines and the AIS website express different recommendations, it is not clear what a student should do if they have been prescribed one of these drugs. Accordingly, it is imperative that students exhibiting concussion symptoms receive medical attention as soon as possible.

If you have identified any concussion symptoms in the student, you should also make note of the following to assist the health practitioner treating the student:

• when the injury took place
• how the injury occurred
• where on the body the student was hit
• what occurred next in relation to their symptoms
• any other important information.

This will guarantee that the treating health practitioner will have the most accurate information possible so that the practitioner can properly treat the student. If you suspect that a student has a concussion, you should also report this internally to the person in charge of coordinating the management of concussion at your school. The AIS recommends appointing a “concussion officer” for this purpose. It should be noted that the role of the concussion officer will most likely include working with the student’s parents/carers to ensure that the student returns to school under appropriate medical guidance from a doctor, physiotherapist, specialist and/or another practitioner with appropriate training and experience in concussion assessment and management.

Returning to School

Following the initial response above, students should undertake a period of cognitive and physical rest for around 24 to 48 hours. This means, for instance, that the student should not engage in activities that require concentration such as reading or using screens. After this time has passed, the student can generally commence their return to daily activities and begin both a gradual return to learning activities and sport. The Guidelines, however, recommend that returning to learning activities take priority over a return to sport.

When the student is ready to go back to school, they should be given a reduced workload or frequent breaks so that their concussion symptoms don’t increase. The NSW Department of Education provides examples of what this may look like. For instance, the student may only come to school three half-days a week and work their way up from there.

After their initial period of cognitive and physical rest, the student can usually also commence low-intensity exercise, provided that resuming these activities does not make their symptoms worse. Much like cognitive activity, physical activity should be gradual. For more details on returning to school sport, you should consult the Graded Return to Sport Framework for Community and Youth in the Guidelines. The student should not return to sport until they have made a complete return to learning activities and have been cleared by a medical practitioner.

It is important that you regularly monitor the student’s symptoms as they return to school. While mild and brief (terms that are both defined in the Guidelines) exacerbation of symptoms may be manageable while the students is at school, the student should resume resting and seek medical advice as appropriate if their symptoms are above these thresholds. In any case, the student’s progress should be discussed with parents/carers.

Multiple Concussions

The Guidelines state that athletes who suffer from multiple concussions within a short period of time (for example, two concussions in three months, or three concussions in a year) should usually follow a more conservative return to sport protocol. Schools should be mindful of this as they work with parent/carers to ensure that the student returns to sport safely.

While the Guidelines note that the timeframe for returning to sport following multiple concussions will vary according to factors such as the severity of the most recent injury, the number of previous concussions and the general medical history of the athlete, they do recommend that the starting point for returning to sport after suffering a second concussion within three months would be 28 days symptom-free before returning to contact training and a minimum of six weeks from the time of the most recent concussion until return to competitive contact sport.

What Should Schools Do?

There is no definite way to guarantee that a concussion won’t occur during sport activities. However, there are several things that you can do to manage concussion to avoid further risk of harm to students. This includes:

• ensuring that you have the proper policies and procedures in place to manage concussion
• training staff in these policies and procedures, especially in recognising and treating concussion (schools should make their staff aware of how to access the Concussion Recognition Tool to help with this)
• appointing a concussion officer to coordinate the management of concussion at your school
• if it is suspected that a student has sustained a concussion in sport, not taking any chances and immediately pulling the student out of the game
• immediately referring students with critical symptoms to the emergency department, or where non-critical signs or symptoms are observed, a medical practitioner as soon as practicable
• collaborating with parents/carers to follow the guidance in the Guidelines and to ensure that their child returns to school and to sport safely under appropriate medical guidance
• providing students who return to school with a modified learning program
• prioritising a return to learning activities over a return to sport
• ensuring that students resume resting and seek medical advice if their symptoms worsen
• encouraging students to wear helmets, mouth guards or other protective equipment (even though these may not prevent a concussion, they can prevent other types of head injuries such as skull fractures)
• for students who suffer from multiple concussions, following a more conservative return to sport. In situations where more than two concussions have occurred within a 12-month period, the Guidelines suggest that consideration should be given to sitting out a season.