Concussions; “Remove, Refer, Rest, Return”

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What is a concussion?

Concussions are the result of a temporary disturbance in brain function due to trauma. They can be caused by a direct (e.g. falling and hitting your head) or indirect (e.g. whiplash) force to the head and/or neck. They can, but more often occurs without loss of consciousness.

What are the signs and symptoms?

Things you can recognise in others:

  • Slow response or vacant
  • Slurred speech
  • Loss of memory
  • Distracted, disorientated, uncoordinated or unsteadiness
  • Emotionally confused

Things to ask for:

  • Headache
  • “Pressure in head”
  • Neck pain
  • Feeling sick
  • Dizziness or blurred vision
  • Sensitivity to light or noise
  • Feeling “slowed down”, “in a fog”, “don’t feel right”
  • Difficulty concentrating and remembering
  • Low energy or fatigue
  • Drowsiness
  • Difficulty falling asleep
  • Feeling emotional, irritable, sad, nervous or anxious

Emergency signs and symptoms:

  • Suspected spinal injury
  • Convulsions/seizures
  • Drowsiness or cannot be woken up
  • Worsening headache
  • Vomiting repeatedly
  • Weakness in arms or legs
  • Unequal pupil size
  • Slurred speech

In a case of emergency, call an ambulance or present to A+E

How do I manage a concussion?

  • Come down from the ski field
  • Requires mental and physical rest
  • No alcohol
  • Avoid driving or unsupervised medication
  • Requires monitoring for 24-48 hours
  • Medical clearance to return

Take home messages:

  • Most concussions occur without loss of consciousness from a direct or non-direct force to the head.
  • Early detection is one of the most useful things you can do. Immediate removal from activity after a suspected concussion will improve your recovery time frame.
  • No two concussions will present the same. There is a spectrum of severities and a variety of signs and symptoms to look out for.
  • Loss of consciousness or the initial severity of symptoms is not necessarily a prediction of the severity of the injury or length of recovery.
  • Management is complete mental and physical rest. (i.e. no exercise – even light exercise), no TV, reading, etc. Be as lazy as you can!
  • Return to physical activity should follow medical clearance followed by a supervised symptom based program with stages of exercise progression.

Remember the 4 R’s

  • Remove from activity
  • Refer for medical assessment
  • Rest physically and mentally
  • Return to activity following medical clearance

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