Merge pull request #18 from goodtune/concussion-policy

Approved by the FIT Board in October meeting.

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_policy/concussion.md

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 title: Concussion Policy
-layout: default
 
-approval_authority: 
-responsible_officer: 
+approval_authority: President
+responsible_officer: Event Commission Chair
 first_approved: 
 last_amended: 
 effective_date: 
@@ -12,8 +11,327 @@ review_date:
 
 # FIT Concussion Policy
 
-This policy is under review by the FIT Board -- the current version of this policy is available on
-the [Resources](https://www.internationaltouch.org/resources/) section of the [FIT website].
+## Purpose of policy
 
+The purpose of this policy is to provide event managers, stakeholders and participants with a
+uniform process for recognising and managing concussions sustained in Federation Events.
 
-[FIT website]: https://www.internationaltouch.org/
+## Policy scope and application
+
+This policy applies to all Federation Events and to all participants of Member countries competing
+at any Federation Event. Member countries are encouraged to apply this policy to all events that are
+not afforded Federation Event status.
+
+Copies of the Policy and supporting document can be obtained from the Federation website.
+
+## Definitions
+
+Concussion
+:   is a brain injury that involves a disturbance in brain function rather than a structural injury
+    to the brain. It is caused by direct or indirect force to the head, face, neck or elsewhere with
+    the force transmitted to the head. A player does not have to be knocked unconscious to have a
+    concussion. Loss of consciousness is seen in only 10-15% of cases of concussion.
+
+Concussion Recognition Tool 5™ (CRT5)
+:   is a pocket-sized checklist that helps stakeholders to recognise the signs and symptoms of
+    concussion and determine the need to remove a player from the field (Appendix 1).
+
+Graduated Return to Play (GRP)
+:   refers to the process of recovery and then return to sport following a concussion. This involves
+    a graduated stepwise rehabilitation strategy as outlined in Table 1 (Appendix 4). This table
+    has been modified.
+
+FIT Concussion Referral and Return Form
+:   The FIT Concussion Referral and Return Form consist of three sections, each of which must be
+    completed for players suspected of sustaining a concussion (Appendix 2).
+
+Sport Concussion Assessment Tool 5 (SCAT5)
+:   is a standardised tool for evaluating concussions designed for use by **physicians and licensed
+    healthcare professionals**. The SCAT5 can be administered in 10-20 minutes (Appendix 3).
+
+## Regulatory background and acknowledgements
+
+The advice in this document reflects current best practice for the management of concussion in sport
+and draws upon information provided in a number of existing documents, including:
+
+-   The consensus statement on concussion in sport (McCrory et. al, 2017).
+-   Concussion in Sport Policy (Sports Medicine Australia, 2018).
+-   Rugby Australia Concussion Guidance (Rugby Australia, 2018).
+-   Management of Concussion in Rugby League (National Rugby League, 2017).
+
+## Policy statement
+
+FIT is committed to providing and encouraging a safe, fair and inclusive environment for everyone
+involved in the organisation and within all levels of our sport delivery. This policy is intended to
+set out minimum guidelines around recognising and managing concussion and is not intended to serve
+as medical document. At all times, stakeholders (players/athletes, coaches, officials,
+administrators, parents/guardians (of child participants), first aid attendants, medical staff,
+spectators) need to act in the best interest of player safety and welfare and this requirement
+overrides all other considerations.
+
+It is a requirement that all players who suffer a concussion seek the highest level of medical care
+reasonably available to ensure concussion is managed appropriately.
+
+An individual may report a possible violation of the Concussion Policy either verbally, in writing
+or by email. The report should provide full details of the alleged violation to the extent known by
+the individual. The report may be made anonymously. An individual may make a report to the relevant
+official at the level of sport delivery that the breach occurred.
+
+## FIT Concussion policy
+
+The management of concussion should involve the following steps, with each step followed before
+moving onto the next step
+
+On the day of the injury:
+
+1.  Recognise
+2.  Remove
+3.  Record
+4.  Refer
+
+On the days following the injury:
+
+1.  Rest
+2.  Recover
+3.  Reconsider & record
+4.  Return
+
+### Recognise
+
+Only medical professionals can definitively diagnose a concussion, however recognising the potential
+signs and symptoms of a suspected concussion is relatively simple. It is the responsibility of
+**all** Touch stakeholders, including players, parents, coaches, officials, teachers and trainers to
+recognise and remove players exhibiting the signs and symptoms of a potential concussion. This is
+particularly important to ensure appropriate management and to prevent further injury. Symptoms can
+come on at any time, but usually within 24-48 hours after a collision. If recognised and
+appropriately managed, most people (70-80%) will recover from their symptoms within 2 to 4 weeks of
+their injury; however, the rate of recovery varies from person to person.
+
+Children and adolescents are more susceptible to concussion, typically take longer to recover and
+are more susceptible to rare and dangerous neurological complications, including death caused by a
+single or second impact. Concussion that is ignored or not recognised can be fatal, therefore:
+
+-   All potential concussions should be taken seriously.
+-   Children and adolescents must be treated more conservatively than adults.
+-   All players with potential head injury or concussion must be removed from the field immediately.
+-   Return to play or training on the same day is not permitted for any potential head injury or
+    concussion.
+
+Prior to commencement of the event, Event Managers will ensure that an official from each team and
+every referee is supplied with a copy of the pocket Concussion Recognition Tool 5™ (CRT5). This tool
+helps stakeholders recognise the signs and symptoms of concussion and determine the need to remove a
+player from the field (Appendix 1).
+
+Each team should also be provided with copies of the FIT Concussion Referral and Return Form
+(Appendix 2). The FIT Concussion Referral and Return Form consist of three sections, each of which
+must be completed.
+
+The use of this tool should be discussed at all pre-event briefings, preferably by the Event Medical
+Officer. Referees and team officials (coaches, managers, trainers) should familiarise themselves
+with this tool prior to the tournament commencing. Any questions in regards to the use of the CRT
+should be directed towards the designated medical officer in the first instance or Event officials
+if/when the Event Medical Officer is not available.
+
+**Note:** Although tools like the CRT5 can help to recognise concussion, they are not a replacement
+for a comprehensive medical assessment.
+
+### Remove
+
+Initial management must adhere to first aid rules, including airway, breathing, circulation and
+spinal immobilisation.
+
+Players with a suspected concussion should be immediately removed from the field of play.
+
+In most circumstances a suspected concussion will occur following a knock to the head or a
+significant collision. In these cases, it is the responsibility of the referee to immediately stop
+play and ensure that the player is safely removed from the field of play. The player's number should
+be noted on the scorecard and they should not be allowed to return to the field of play until
+medically assessed.
+
+In some cases, a player may be interchanged without the knowledge of the referee or may develop
+symptoms and signs sometime after a collision. In these cases, it is the responsibility of team
+officials to use the CRT5 to assess for signs and symptoms of concussion. If a concussion is
+suspected or if there is any doubt, it is the responsibility of a team official to notify match
+officials that a player has been removed. This can be achieved by informing the referee nearest to
+their substitute box that a player has been removed due to a suspected concussion. This referee
+should stop play at the next break in play and record the number of the player on the scorecard.
+
+Players with a suspected concussion should:
+
+-   Not be left alone (until medically assessed or for at least the first 1–2 hours).
+-   Not be allowed to return to the current game or any other game held on the same day unless
+    cleared by a medical practitioner. Officials should not be influenced by the player, team
+    officials (coach, manager, trainer), parents or other stakeholders suggesting that they should
+    return to play.
+-   Not drink alcohol or use recreational drugs.
+-   Not take certain prescription medications including aspirin, anti-inflammatory medications,
+    sedative medications or strong pain-relieving medications
+-   Not be sent home by themselves.
+-   Not drive a motor vehicle
+-   Be referred to a medical practitioner for completion of an appropriate medical assessment.
+
+**Note:** a player with a headache post-game that did not exhibit any signs or symptoms during the
+game, nor observed to have had a head knock, is not classified as concussed.
+
+### Record
+
+Any player removed from the field of play with a potential concussion should be recorded in the
+allotted space on the referee's scorecard.  When the scorecard is returned to the Event Manager, the
+referees should communicate that a player has been removed in line with the FIT Concussion Policy.
+Event Managers should also review all scorecards to check whether any player has been removed due to
+a suspected concussion.
+
+The Event Manager should ensure the details of this player are centrally recorded so that this
+player cannot return to the field of play until medically assessed.
+
+It is the responsibility of the team officials to complete Section 1 of the FIT Concussion Referral
+and Return Form and to hand this form to the Event Medical Officer; this formally starts the
+referral process.
+
+### Refer
+
+All players with a suspected concussion need a medical assessment by a medical practitioner.
+
+Where feasible, Team Officials should contact Tournament Control/Event Administration to notify them
+of the need for a concussion assessment by the Event Medical Officer. The Event Manager will notify
+the Medical Officer Prompt notification will allow for completion of an immediate/on field
+assessment as soon as possible. The Medical Officer is advised to use part 1 of the SCAT5 as part of
+their assessment.
+
+**Note: If there are serious concerns about the player or red flags, then the player must be
+referred to an Emergency Department as soon as possible or call an ambulance.**
+
+After completing Section 1 of the FIT Concussion Referral and Return Form, Team Officials should
+forward this form promptly to the Event Medical Officer. It is then the medical officer's
+responsibility to complete an assessment and sign Section 3 of the FIT Concussion Referral and
+Return Form.
+
+On rare occasions an Event Medical Officer will not be present or not feel confident in completing
+the FIT Concussion Referral and Return Form. In these cases, the from should be provided to a local
+general practice or a doctor in a hospital emergency department. Ideally, the medical doctor who
+reviews the player should have experience in the assessment and management of sports concussion.
+
+In line with the Berlin Consensus statement of concussion in sport, the medical assessment should
+include "*a comprehensive history and detailed neurological examination including: a) thorough
+assessment of mental status, cognitive functioning, sleep/wake disturbance, ocular function,
+vestibular function, gait and balance: b) Determination of the clinical status of the patient,
+including whether there has been improvement or deterioration since the time of injury. This may
+involve seeking additional information from parents, coaches, teammates and eyewitnesses to the
+injury. c) Determination of the need for emergent neuroimaging to exclude a more severe brain injury
+(e.g., structural abnormality)."*
+
+Once the medical officer has signed Section 3 of the FIT Concussion Referral and Return Form, the
+form should be returned to the Event Manager. The Event Manager should ensure that the decision
+around medical clearance has been recorded centrally.
+
+A player deemed not to have sustained a concussion may return to the field of play.
+
+**Any players diagnosed with concussion will not be able to play again in that touch tournament.**
+This is because best evidence indicates that it takes a minimum of 1 week to proceed through the
+Graduated Return to Play (GRP) protocols. Players diagnosed by a medical practitioner as having
+sustained a concussion should follow the GRP as outlined in Steps 5 to 8.
+
+The Event Manager should also ensure that the athlete and team officials are provided with a copy of
+the FIT Concussion Referral and Return Form and the Graduated Return to Play table (Appendix 4).
+This will assist the athlete in recovering from their concussion with the assistance off their
+member nation and local medical support.
+
+### Rest
+
+**While these steps may begin during the FIT Event, they are likely to continue in the weeks after
+the Event concludes. Therefore, it is the responsibility of Team Officials and Member Associations
+to ensure that the player receives the appropriate medical clearance.**
+
+Most people will recover from a concussion within 10 to 14 days; however, rest is crucial to recover
+from a concussion. Complete physical and cognitive rest is recommended immediately following a
+concussion (24–48 hours). The time required for complete rest will vary from player to player and
+the decision to increase activity is based on the absence of signs and symptoms.
+
+Rest means not undertaking any activity that provokes symptoms and may include the following:
+
+-   Resting quietly at home
+-   Missing a day or two from study or work.
+-   Going for a gentle walk outside / around the block
+-   Limiting any tasks that require prolonged focus, memory or concentration
+-   Avoiding excessive TV, use of mobile devices, gaming, computers and phones as these can
+    aggravate symptoms.
+
+After this brief period of rest, athletes are encouraged to become gradually and progressively more
+active as long as they do not experience any symptoms (i.e. activity level should not bring on or
+worsen their symptoms). Athletes should avoid vigorous exertion while they are recovering.
+
+### Recover - Graduated return to play
+
+Managing concussion is a shared responsibility between the player, Team Officials and medical
+practitioner. Open communication is essential and information should be shared. A player who has
+suffered a concussion should return to sport gradually. They should increase their exercise
+progressively, as long as they remain symptom-free, following the stages outlined in Table 1
+(Appendix 4). Each stage of progression should take at least 24 hours so that athletes would take a
+minimum of 1 week to proceed through the full rehabilitation protocol; if any symptoms worsen during
+activity, the athlete should go back to the previous stage. In athletes who experience prolonged
+symptoms and resultant inactivity, each step may take longer than 24hours.
+
+**Note:** The time frame for returning to play may vary with player age, history, level of sport,
+etc., and management must be individualised. As children and adolescents often take longer to
+recover from a concussion than adults, it is suggested the graduated return to play protocol should
+be extended such that a child does not return to contact/collision activities less than 14 days from
+the resolution of all symptoms.
+
+### Reconsider and record
+
+Prior to returning to the field of play, a participant that sustained a concussion at a FIT event
+should seek medical clearance. Given the nature of FIT events, it will not be possible for the Event
+Medical Officer to provide this clearance. Therefore, the athlete is advised to contact their
+general practitioner on returning home and organise to have medical clearance. Again, once the FIT Event concludes, it is the responsibility of Team Officials and Member Associations to ensure that
+the player receives the appropriate medical clearance. FIT advises the athlete and Member
+Association to provide the local medical officer with a copy of the complete FIT Concussion Referral
+and Return Form as this will provide them with a background of the injury.
+
+**Note: It is not ideal to seek medical clearance from inexperienced medical doctors who do not know
+the medical history of the player (e.g., junior hospital emergency room doctors).**
+
+### Return to Play
+
+A player should only return to play when they have fully recovered from concussion. This means the
+player must:
+
+-   Not have any signs or symptoms of concussion at rest or in normal daily activities (school,
+    study, or work).
+-   Have followed the mandatory required rest time away from cognitive and physical activity.
+-   Have successfully completed the GRP without any symptoms or signs of concussion (during or after
+    training).
+-   Have received medical clearance to play.
+
+## Contact
+
+Enquiries in relation to this policy should be directed to the [FIT Secretary General].
+
+## Related policies and documents
+
+Refer to the following related policies and documents:
+
+-   McCrory P., Meeuwisse W., Dvorak J. et al. (2017).
+    [Consensus Statement on Concussion in Sport - The 5th International Conference on concussion in
+    sport held in Berlin, October 2016](http://dx.doi.org/10.1136/bjsports-2017-097699).
+    *British Journal of Sports Medicine, 0, 1-10.*
+-   National Rugby League (2017). [Management of Concussion in Rugby League].
+-   Rugby Australia (2018). [Rugby Australia Concussion Guidance].
+-   Sports Medicine Australia, 2018. [Concussion in Sport Policy, Version 1].
+
+## Appendices
+
+-   [Appendix 1: Concussion Recognition Tool]
+-   [Appendix 2: FIT Concussion Referral and Return Form]
+-   [Appendix 3: SCAT5]
+-   [Appendix 4: Graduated Return to Play Protocol]
+
+[FIT Secretary General]: mailto:[email protected]
+
+[Management of Concussion in Rugby League]: https://playnrl.com/media/2372/the-management-of-concussion-in-rugby-league-8217.pdf
+[Rugby Australia Concussion Guidance]: http://www.rugbyaustralia.com.au/Portals/33/Running%252520Rugby/Safe%252520Practices/Concussion%252520Guidance%2525202018.pdf
+[Concussion in Sport Policy, Version 1]: http://sma.org.au/resources-advice/concussion/
+
+[Appendix 1: Concussion Recognition Tool]: ../appendices/CRT5.pdf
+[Appendix 2: FIT Concussion Referral and Return Form]: ../appendices/Concussion%20Referral%20and%20Return%20form.pdf
+[Appendix 3: SCAT5]: ../appendices/SCAT5.pdf
+[Appendix 4: Graduated Return to Play Protocol]: ../appendices/Graduated%20Return%20to%20Play%20Protocol.pdf