A concussion is a type of mild traumatic brain injury, which happens when a blow to the head or an injury makes the head move back and forth with a lot of force. This causes chemical changes to the brain and can cause damage to brain cells. Though most children and teenagers who suffer from a concussion will recover fully within 4 weeks, a small percentage will go on to have more chronic symptoms. It’s important to recognize concussion symptoms and signs so that the child can be removed from sport and have time to rest. It’s also critical to recognize the rare but life-threatening concussion symptoms that overlap with spinal injury that warrant emergency medical attention.
The CRT5 is the most recent revision of the sport concussion tool, which is designed to help parents, teachers, coaches and health-care providers recognize concussion symptoms and signs. A concussion can be caused by a direct blow to the head but can also occur from a whiplash type injury with no direct blow to the head. The basic principles of first aid should be followed first after an injury – check the airway, breathing and circulation. Once this has been completed the following 4 steps should be followed which are the basis of the CRT5.
1. Identify potential life threatening situations:
Red Flags are signs and symptoms of a much more serious underlying problem. If you notice any red flags it’s important to call 911. Only remove the player from the field or remove helmets or other equipment if trained to do so. Red flags include:
- Neck pain or tenderness
- Severe or increasing headache
- Deteriorating state of consciousness
- Double vision, blurred vision, loss of vision
- Seizures, convulsions or fits
- Vomiting or repeated vomiting
- Weakness, tingling, burning in arms or legs
- Complete loss of consciousness
- Restlessness or agitation
Once red flags are ruled out it’s important to identify if a concussion has occurred.
2. Identify signs and symptoms of a concussion:
Visible clues that indicate a concussion include:
- Laying motionless
- Poor balance
- Slow to get up
- Blank or vacant stare
- Facial injury after head trauma.
Clues the patient tells you that indicate a concussion include:
- Blurred vision
- Sensitivity to light or sound
- Irritable, sad nervous
- Poor concentration
- Poor memory
- Disturbance of balance
- Disturbed sleep.
3. Test the players memory by asking questions such as:
- What venue are we at?
- Which half is it now?
- Who scored in the last game?
- What team did we play last week?
- Did we win the last game?
Incorrect answers on any of the above should indicate a potential concussion.
Once you have completed the CRT5 and you suspect that a player has a concussion follow the steps below:
- The player should immediately discontinue sport and rest from all sport, exercise and activity for 24-48 hours.
- The player should not be left alone for 1-2 hours.
- The player should not drink alcohol or take medication that may make them feel drowsy.
- The player should not be sent home alone.
- The player should not drive a vehicle until cleared by a health care professional.
- The player should seek further medical attention as soon as possible.
- The player should rest from school or work for 24-48 hours. This may involve complete rest or modification of the above: i.e. reduced working hours, working in quiet environment, working from home, limiting screen time.