Safety First: Head Injury Checklistby: Melinda Flegel
© August/September 2014
If an athlete has suffered a blow to the head or a whipping of the head and neck, immediately evaluate for symptoms and signs of injury.
Causes of Head Injury
• Direct blow to the head
• Sudden, forceful jarring or whipping of the head
Ask if Experiencing Symptoms
• Ringing in the ears
• Blurred or double vision
Check for Signs
• Inability to multitask (unable to do several athletic skills at once or do a skill correctly when distracted)
• Short-term memory loss
• Emotional changes such as a short temper or depression
• Unresponsiveness to touch or voice (call out the athlete’s name and tap on the shoulder)
• Irregular breathing
• Bleeding or a wound at the point of the blow
• Blood or fluid leaking from the mouth, nose, or ears
• Arm or leg weakness or numbness
• Neck pain with a decrease in motion
• Bump or deformity at the point of the blow
• Abnormalities in pupils (unequal in size or failure to constrict to light)
If an athlete exhibits any of the previously listed signs or symptoms, pull the athlete out of activity. Symptoms such as headache or ringing in the ears may be the early signs of a more serious injury. In these cases, do the following:
1. Continue to monitor the athlete and alert emergency medical services if signs and symptoms worsen.
2. Immediately contact the parent or guardian and have them take the athlete to a physician.
3. Give the parent or guardian a checklist of signs and symptoms to monitor.
For injuries with more severe signs such as confusion, unsteadiness, vomiting, convulsions, increasing headaches, increasing irritability, unusual behavior, arm or leg weakness or numbness, neck pain with a decrease in motion, pupil abnormalities, or unconsciousness, do the following:
1. Immediately call emergency medical services.
2. Stabilize the head and neck until EMS takes over. Leave an athlete’s helmet on when stabilizing the head and neck. You don’t want to jar the head or neck unnecessarily. This is especially true if the athlete is also wearing shoulder pads.
3. Monitor the athlete for breathing difficulty and perform CPR if necessary.
4. Control any profuse bleeding but avoid applying excess pressure over a head wound.
5. Monitor for shock and treat as needed.
6. Immobilize any fractures or unstable injuries as long as it does not jostle the athlete, which may worsen his or her condition.
When can an athlete return to a sport after a brain injury? In most cases, this decision has already been decided for you. Check your state law or the regulations of the National Federation of State High School Associations (NFHS) to ensure that your athletes are receiving mandated care and supervision. The NFHS prohibits athletes from returning to activity until examined and released by a physician. Many states are enacting laws with similar or stricter guidelines. Check your state for specific laws regarding brain injuries in athletes.
• Educate yourself, your athletes, and their parents or guardians about concussions. Visit the CDC website at www.cdc.gov.
• During preseason physicals, screen for any history of head, spine, or nerve injuries. Have these athletes cleared by a physician, preferably a neurologist, before allowing them to participate.
• Use preseason brain testing. Numerous software programs or testing contractors can assess each athlete’s normal brain function, including memory, cognitive functioning, motor (muscle and balance) control, and other functions before the beginning of a sport season. This information is then used as a baseline from which an athlete’s brain function can be compared when an injury is suspected or has
Doctors and athletic trainers can monitor this information while the athlete recovers and determine when an athlete is ready to progressively return to activity. These tests can also be used to monitor the athlete for any signs of decreasing brain function as he or she progresses back into full participation. A decrease in function signals that the athlete is not ready to proceed further and may need to actually decrease activity. This type of testing can be an important tool for you, your athletes, and their physicians in helping to more objectively determine the severity of a brain injury, the level of recovery, and the athlete’s readiness to return to activity.
• Incorporate neck strengthening exercises into your preseason and in-season conditioning programs. These can be done simply by providing resistance to the head with a hand against all of its normal movements.
For helmets, ensure the following:
• Helmets are regularly checked for damage and replaced if necessary.
• Older helmets are regularly replaced.
• Helmets are properly fitted to each athlete.
• Athletes are instructed in effectively securing helmets in place. A well-fitted helmet isn’t effective if chin straps are not snapped and snug.
• Athletes are repeatedly reminded not to use the top of the helmet as a point of contact when tackling or checking another player or lowering the head just before contacting another athlete. Enforce this rule as necessary by sidelining offending athletes and reinforcing proper technique.
For coaches, the most important things you can do to help protect your players is to monitor athletes for signs or symptoms of head injury and educate athletes about the signs and symptoms of head injuries. Encourage athletes to report signs of suspected brain injury in teammates. Consider providing some sort of recognition to these athletes in order to encourage reporting.
Editor’s Note: The preceding is an excerpt from Sport First Aid, Fifth Edition (Human Kinetics, 2013), written by Melinda Flegel. Sport First Aid is the textbook for the Sport First Aid course, available through the Human Kinetics Coach Education Program and used by the majority of state high school associations, athletic directors associations, and school districts for certifying high school coaches. The Sport First Aid text and course are available at www.HumanKineticsCoachEducationCenter.com. (All content provided by Human Kinetics).