Introduction

The recognition of concussion in sport has come to the forefront of injury in sport. More and more scientific and public press attention is paid to this injury, and our knowledge of the causation, effects and outcomes of concussion injury is expanding daily. Skate Canada and its medical team recognize the importance and need for athletes, parents, coaches and other team members to rapidly and appropriately RECOGNIZE and RESPOND to a concussion injury. The following policy has been drafted to address this, and is based on the ongoing work being done by the Concussion in Sport Group and their latest Consensus Statement on Concussion in Sport: the 5^th International Conference on Concussion in Sport held in Berlin, October 2016. These recommendations can be found in the British Journal of Sports Medicine at:  http://dx.doi.org/10.1136/bjsports-2017-097699

Updates to this policy will occur when the next Consensus Statement is reviewed and released, typically in four year’s time.

Definition

1. Concussion is defined as a disturbance in brain function caused by a direct or indirect force to the head.
2. Concussion may be caused either by:
   • a direct blow to the head, face, neck
   • indirectly, through an awkward landing or impact elsewhere on the body, with an impulsive force transmitted to the head.

Concussion injury results in a number of signs and symptoms. Loss of consciousness does not need to occur.

No two concussions are alike; each concussion can result in differing constellations of symptoms.

Although the majority of concussion cases tend to resolve within a few weeks with proper medical attention, it is important to note that in a small percentage of cases, post-concussive symptoms may be prolonged.  Concussion symptoms that extend longer than one month may be due to injury involving other areas such as the neck.  Careful medical monitoring is essential and the concussion management may require additional therapy intervention.

Concussion Symptoms

• Loss of consciousness
• Seizure or convulsion
• Amnesia
• Headache
• Pressure in head
• Neck Pain
• Dizziness
• Blurred vision
• Balance Problems
• Sensitivity to light
• Sensitivity to noise
• Feeling slowed down
• Feeling like “in a fog”
• “Don’t feel right”
• Difficulty concentrating
• Difficulty remembering
• Fatigue or low energy
• Confusion
• Drowsiness
• Trouble falling asleep
• More emotional
• Irritability
• Sadness
• Nervous or Anxious

Please note that children under the age of 12 may present with different concussion symptoms than those listed above.  Children may also require additional healing time, as their brains are still developing.

Sustaining a secondary concussion when not fully recovered from an initial concussion injury can be devastating/life-threatening.  This is referred to as “second impact syndrome.”

What to do if you RECOGNIZE/suspect someone has a concussion:

1. The skater must be safely REMOVED from the ice and evaluated onsite with standard emergency management principles, including consideration of cervical spine injury.
2. The skater must seek medical attention expediently and be assessed by a qualified medical professional (physician, physical therapist, athletic therapist) with experience in the assessment and management of concussion injury. If no healthcare provider is available on site (including international events) and the skater is exhibiting one or more of the symptoms listed under Concussion Symptoms above (must be assessed by the coach and/or team leader), the skater must be transferred to an Emergency Department or Urgent Care assessment center.
3. The skater should not be left alone following a concussion injury and should be monitored for deterioration over the initial few hours following the injury.
4. A skater diagnosed with a concussion will not be allowed to return to skate on the same day as the concussion injury. It must be recognized that the appearance of symptoms of concussion may be delayed several hours following a concussive episode. If the injured person is under the age of eighteen (18), the parents/guardian will be contacted immediately.
5. A skater must receive medical clearance by a concussion-trained health care professional before resuming on- or off-ice training.

Skate Canada recognizes the following to be example of acceptable health care professionals: sport and exercise medicine physician, sport physiotherapist, athletic therapist, family physician. 

Please refer to the resource list available through Skate Canada for a qualified medical professional near you.