1. Trained Personnel
2. Appropriate Equipment
3. Emergency back-up plan to care for critically injured athlete

1.   Lack of motion of extremities could indicate possible cervical spine injury
2. Incoherent speech suggests a significant concussion
3. Athlete's helmet should not be removed initially unless cervical spine injury is ruled out 

• Make sure athlete is breathing spontaneously, has a pulse and unobstructed airway.
• If adequate airway, respiration, and pulse, begin initial assessment of the level of consciousness.  Athlete should lie down for this assessment.
• If athlete is unconscious -- one assumes athlete has an associated cervical spine injury until proven otherwise.  In this case, the neck should be stabilized and cardiopulmonary resuscitation should be initiated.  A standardized method of assessing the level of consciousness is established by using the  Glasgow Coma Scale.
• Medical personnel should quickly determine if further evaluation on sidelines is needed or if emergent care and hospital transport is necessary.

 
1. Once athlete is brought to the sidelines, a thorough evaluation should be completed to define the level of injury.  Coaches and staff should review symptoms, complete a careful neurologic evaluation, and assess the athlete using neuropsychologic testing.

2. Review of Symptoms -- Question athlete about symptoms such as dizziness, light-headedness, vertigo (i.e., dizziness), blurred or double vision, tinnitus (i.e., ringing in the ears), headache, nausea, and  vomiting.  For a list of more possible symptoms, click here.
        Many of these symptoms may be present initially after an acute head injury. However, headaches, nausea, and vomiting may not become evident until several minutes after the trauma.  Vomiting is very common, but suggests a significant injury with elevated intracranial pressure and should be a cause for concern.

3. Neurologic Evaluation -- This provides information on brain structures and includes neurodiagnostic procedures such as computed tomography (CT Scan) and magnetic resonance imaging (MRI).  This is used more often for more severe head injuries.  It is costly and not portable like the following assessment measure.

4. Neuropsychologic Testing -- This type of testing provides information on the athlete's functional status.  An example of this is the Standardized Assessment of Concussion (SAC).  This is a standardized means of objectively measuring and documenting the presence and severity of neurocognitive impairment associated with concussion.  It evaluates orientation, memory, concentration, and delayed recall abilities of athletes on the sideline.  This assessment is quick and immediately provides information to athletic trainers, coaches and other medical personnel to aide in the clinical decision making of athletes.  The content and length of the SAC was designed for quick and easy assessment by those with little expertise in psychometric testing.  However, this measure is not intended to substitute for formal neurologic or neuropsychological evaluation of the athlete.  Two approaches to using the SAC have been taken in the examination of athletes.

1.  To compare injured player's score to his or her pre-injury score.  Evaluate each athlete at the beginning of the season to provide a basis of comparison in the event of a concussion.  Another evaluation should be completed 24 hours after suspected concussion and again 5 days later.

2.  Use population-based normative data to compare injured athletes score to see if it is abnormal and indicative of concussion.

For more information about the SAC, contact: 
Dr. Micheal McCrea 
by email:  micheal.mccrea@phci.org or 
by phone:  1-262-544-2156

 
1. The initial evaluation of the athlete begins on the playing field.  The evaluation should continue until the symptoms have completely evolved. 

2. When formal neuropsychologic evaluations are performed, they should take place within 24 hours of suspected concussion, whenever possible.  Those athletes who have suffered very mild concussions may appear symptom free, but a neuropsychologic evaluation may reveal subtle aspects of cognitive functioning even if the player denies persistent difficulties.

3. If the athlete displays deficits on neuropsychologic testing, a follow-up evaluation should be completed within 48 hours.  Every 5 days is a practical follow-up interval.