Whether you are new to coaching, or have been coaching sports for 20 years or more, the concussion headlines and media coverage over the past five years are certainly of interest to you. The New Jersey Concussion Law that was passed in December 2010 requires all New Jersey school districts to develop a policy for how to manage concussions in their schools. The Law is primarily focused on interscholastic sports; however, there are certain mandates that apply to community-based sports activities as well.

Interscholastic Sports

New Jersey has excellent representation of athletic trainers in high schools; a definite advantage for high school coaches. But athletic trainers are not present at every practice and game for every sport throughout the school year. You know your athletes’ skills and behaviors at practice and in competition better than anyone. It is at least as critical that you are able to recognize the signs and symptoms of a concussion as it is to win a game. No one wants to be the coach of the athlete who should have been pulled from competition because of a concussion but wasn’t – with tragic consequences.

What is your school district’s policy on concussion?

Coaches for interscholastic sports are on the front lines of concussion management. You are there at every practice and at every game. You have most likely taken a course about concussion as the New Jersey Law mandates. Are you comfortable with your knowledge of concussion?

The Law and Model Policy

The New Jersey Concussion Law requires that if a student athlete sustains or is even suspected of having sustained a concussion while playing in a game or practice, the athlete must be immediately removed from play and should not return to sports activity for the remainder of the day. Following removal from play, the athlete must be evaluated by a healthcare provider if available at the school or an urgent referral should be arranged. Immediate removal from play is important, even if the athlete feels better on the sideline, because symptoms may often not fully manifest until hours or days after the incident.

The Model Policy contains the following protocol to follow when a concussion is suspected in interscholastic sports:
Immediate removal from practice or competition. 911 should be called if there is a deterioration of symptoms, loss of consciousness, or direct neck pain associated with the injury.
Student-athlete should be evaluated by the school’s licensed healthcare provider who is trained in the evaluation and management of concussion.
School personnel (Athletic Director, Building Administrator, Certified Athletic Trainer (ATC), School Nurse, Coach, etc.) next contacts parent/guardian and informs that a concussion is suspected.
School provides student-athlete with district board of education approved suggestions for management/medical checklist to give to the parent/guardian, and physician or other licensed healthcare professional trained in the evaluation and management of concussion.
The student-athlete must receive written clearance from a physician, trained in the evaluation and management of concussions that states the student-athlete is asymptomatic at rest and may begin the district’s graduated return-to-play protocol. Medical clearance that is inconsistent with district, charter, and non-public school policy may not be accepted and such matters will be referred to the school/team physician.
On-Field and Sideline Evaluations

Scenario:
You can see the tackle coming but just in the split second before the hit your vision is blocked by another player. Your student is down on the field. What should you do?

The on-field evaluation for concussion is the same as it is for any other injury:

Check for basic life support – Airway, Breathing, Circulation (ABC’s) – learn more about ABC’s
Determine if loss of consciousness or a cervical spine injury may have occurred
Determine to move to the sideline or call for emergency services
A concussion could be suspected because of the force of impact, because of where a student is hit, because a helmet became loose, or because of the student’s reaction to the hit; he didn’t get up immediately. Remember that you don’t need to be hit in the head to sustain a concussion; a hit to the body can transmit force to the head and cause a concussion.

It’s important to:

Talk to the other students who observed the hit to get the details of the event. If you didn’t see the hit this information could be important for medical professionals to know. Even if you did see the hit it’s important to talk to the other students because they might be aware of some other detail that you don’t know about. For example: teammates might know about a fall or car crash that happened the day before or on the weekend.
Do not remove a helmet on the playing field. Removing a student’s helmet off on the field could compromise treatment of a neck or spine injury.
Look for signs of a concussion. Regardless of whether or not the student is reporting symptoms it is important that you know the following signs.
These are things you and other students on the field can observe:
Confusion/disoriented to time and place: Does the student appear to know where he is? Is he making sense when he speaks?
Dizzy or lightheaded/loss of balance: Once the student is upright is his gait normal for him? Does he seem to be leaning or losing his balance?
Foggy: Is the student repeatedly asking the same questions?
Glassy-eyed: Is the student focusing on you as you interact with him? Do his eyes look normal?
Slurred speech: Is there any indication that the student is having difficulty speaking?
Loss of consciousness: Does anyone on the field know if the student lost consciousness event for a few seconds?
Once you have determined that it is safe to move the student to the sideline it is important to:
Take off the helmet. Because the student could become disoriented from a concussion it is easy for a student to assume that if his helmet is on it is ok to go back onto the field.
Monitor every five or ten minutes for signs that the student is feeling worse or has more obvious signs of concussion. Is the student better or worse?
Use a sideline evaluation tool like the SCAT3. The SCAT3 is designed to be used by medical professionals; however,
there is a space on the form to record basic information about the student and the event. This information is important for clinicians to have when further evaluation is conducted.
There is also a place to track symptoms the student is experiencing; even if a medical professional is not available it is helpful to record early symptoms to provide this information to clinicians when further evaluation is conducted.
a. Orientation: There are two sections of the SCAT3 that provide information about how well oriented the student is to the immediate situation.
Below is a list of questions from the Maddox Questions and the Orientation sections of the SCAT 3 that can provide clinicians with important information:
What month is it?
What is the date today?
What is the day of the week?
What year is it?
What time is it right now? (within 1 hour)
At what venue are we at today?
Which half is it now?
Who scored last in this match?
What team did you play last week / game? Did your team win the last game?
A Coaches role continues after the game

Scenario
You are walking down the hall in school and notice Kira, one of your star basketball players. She seems to be a bit distant and is not walking in her usual confident stride. You ask her if everything is ok and walk her to the nurse’s office. Once there Kira explains that she was feeling a bit dizzy but she’s beginning to feel better. The next day you learn that Kira was in a car crash on the week-end and her doctor diagnosed a concussion. Had you not intervened and been aware of the signs of a concussion Kira could have participated in the next basketball practice or competition with tragic results.

Coaches of student athletes are important members of the team involved in a student’s recovery from concussion regardless of where it originated. In order to provide proper management all members need to be on the same page regarding recovery and return to play.

Other members of the team could include:
Coach
Licensed Athletic Trainer
School Nurse
Family Members
Physician knowledgeable in the diagnosis and treatment of concussion
Teachers/Guidance Counselors
Cognitive Therapist
Physical Therapist
Neuropsychologist
NOTE: A Child Study Team Case Manager or Section 504 Coordinator if your student athlete had a pre-existing learning disability. It is important to note that a pre-existing learning disability (ADHD, Asperger’s Syndrome, Dyslexia, etc.) could exacerbate concussion symptoms and concussion symptoms could exacerbate their learning disability symptoms. It is important to involve the Case Manager or 504 Coordinator during recovery time.