Roles and responsibility of health professionals
Sport concussion is a common injury among children and youth. As a health professional, the most important key to managing any condition is to know exactly what you are dealing with. Healthcare professionals that may be involved in the care of injured athletes include physicians, nurses, certified athletic therapists and trainers. When it comes to concussion management, having access to the right healthcare professionals is important. This might not always be the case, especially for those that live in remote geographical communities. While the materials presented in this section may be targeted towards physicians, it is recognized that other healthcare professionals may be using these tools, and might be more involved in the management and treatment of concussion. The tools provided in this section can be used to inform the knowledge of all healthcare professionals.
The Consensus Statement on Concussion in Sport: 4th International Conference on Concussion in Sport Held in Zurich, November 2012 was developed for use by physicians, therapists, certified athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite or professional level. This consensus document is not intended as a standard of care and is only a guide.
When it comes to concussion management, some colleges have provided specific guidelines to be followed. An example is the position statement from the College of Family Physicians of Canada.
A family physician is often the first medical professional seen by an athlete who has been hurt during play, practice, and/or competition and is thus the first point of contact for proper management, advice, and education regarding that athlete’s return to play. Family physicians also play a role in public education and awareness and can influence sport policy at all levels. It is essential therefore those family physicians are familiar with the contents of the most up-to-date concussion guidelines in order to provide the best care for their patients. Contact your affiliated college to determine if there is a position statement or specified guideline to be followed.
Best Practices for your Practice
Educational documents have been created to inform healthcare professionals and provide guidance when it comes to managing this injury. Some examples of tools that provide assessment and management/treatment guidance include:
This tool represents a standardized method of evaluating injured athletes for concussion and can be used in athletes aged from 13 years and older
This tool represents a standardized method of evaluating injured athletes for concussion and can be used in athletes aged 5 to 12 years old.
The Concussion Guidelines for Physicians document provides information on what is a concussion, causes, signs and symptoms; that sustains concussions; concussion and children; and the role of loss of consciousness. It guides the physician on how to diagnose concussion and conduct an assessment, manage injuries in the sporting environment and providing clearance, the role of imaging, and the importance of prevention.
NEW! Concussion Clinical Toolkit for Health Practitioners
The new Concussion Awareness Training Toolkit – CATT – is ready to be launched both in British Columbia and across the Country. Funded by the BC Children’s Hospital Foundation and Child Health BC, CATT has been developed by a team of injury prevention researchers and emergency department doctors and has been extensively reviewed both provincially and nationally.
Based upon established international principles, the aim of CATT is to standardize concussion recognition, diagnosis, treatment and manage-ment. CATT features a learner-directed online training module supplemented with diagnostic tools (SCAT 2) and links to clinical resources, patient handouts, journal articles, related websites and concussion videos.
CATT is undergoing a two-pronged evaluation. Part 1 of the evaluation is looking at changes in knowledge, attitudes and practices among physicians and nurses following completion of the CATT tutorial and access to the tools and links. Part 2 looks at changes in family experiences when attending the emergency department at the British Columbia Children’s Hospital with a head injured child.
CATT is FREE and is now available online at www.cattonline.com.
CATT qualifies for MainPro M2 credits for clinicians.
Additional resources to have in hand include:
ThinkFirst Concussion Questionnaire - An in-depth questionnaire designed to assess concussion history. Knowing what questions to expect from the patient and having a set of specific questions to ask the patient can assist with the assessment process.
The Mayo Clinic has some examples of questions that a physician can expect from a patient, and that a patient can expect to be asked by their physician. Video from Peterborough that shows a patient/physician dialogue
Centres for Disease Control and Prevention (CDC) offers Heads Up - Facts for Physicians about Mild Traumatic Brain Injury (mTBI) to provide physicians with a more individualized assessment of mTBI and to help guide the management and recovery of patients with mTBI as well as the Acute Concussion Evaluation (ACE) for physicians and clinicians.
Sports-Related Concussion: When Medicine and Sports Meet Head On
Charles Tator, CM, MD, PhD, FRCSC
Michael Clarfield, MD, CCFP, DIP, Sport Medicine
John Axler, MD, FCFP, CCFP
Managing return to play and school
Assisting the patient in returning to play and school is an important part in the management of concussion. Providing the patient with management guidelines, which can be relayed, to the coach or teacher, can be helpful with return to life. Here are some tools that can assist with this process:
• Developed in alignment with PPM158 in Ontario, this tool includes Guidlines for Return to Learn and Return to Physical Activity, which follow the six step guidelines.
Concussion Awareness in Sports by Elaine Keunen RN, BHScN,CCNC(c)
Equipment, Ethics and Ongoing Education
Managing concussion goes beyond creating a return to play and return to school plan. Injury prevention is an important component of not only managing concussion, but also helping to prevent it. As a medical practitioner, it is important to emphasize the importance of:
1. Protective Equipment
• Reinforce wearing the right gear for the right sport, and the importance of having equipment that fits well and is in good condition.
• Helmets prevent skull fractures, brain contusions and lacerations, and blood clots in and around the brain. Helmets do not prevent concussion. There is no such thing as a concussion proof helmet.
• There is no scientific evidence that mouth guards prevent concussions, but they do prevent dental fractures and jaw fractures.
2. Rules and Respect
• Play fair, within the rules, and within your abilities.
• Have respect for your own brain and the brains of your opponents.
Ensuring you have the right knowledge about concussion, and keeping your knowledge current and accurate is very important. Ways to remain current include:
1. Attending conferences, seminars and workshops
2. Taking courses
3. Contacting your college to determine opportunities available for enhancing concussion knowledge
4. Familiarize yourself with your profession’s position statement on concussion:
The College of Family Physicians of Canada
The Canadian Academy of Sport Medicine
Canadian Medical Association Policy on Head Injury and Sport
Canadian Paediatric Society on the Evaluation and management of children and adolescents with sports-related concussion
National Athletic Trainers Association (USA)
Concussion education presentations have been developed for health professionals to provide accurate information and enhance knowledge about concussion. To access these presentations please contact: firstname.lastname@example.org.
Finding a concussion professional
As a healthcare professional, if you feel it is in the best interest of the patient to refer or recommend him/her to a physician with specialized knowledge in concussion and you need to find a physician, contact the Canadian Academy of Sport and Exercise Medicine (CASEM) to find a Sport Medicine physician near you. Sport Medicine Physicians are doctors who are trained in concussion recognition, treatment and management.