diff --git a/_policy/appendices/CRT5.pdf b/_policy/appendices/CRT5.pdf new file mode 100755 index 0000000..645392b Binary files /dev/null and b/_policy/appendices/CRT5.pdf differ diff --git a/_policy/appendices/Concussion Referral and Return form.pdf b/_policy/appendices/Concussion Referral and Return form.pdf new file mode 100644 index 0000000..31132de Binary files /dev/null and b/_policy/appendices/Concussion Referral and Return form.pdf differ diff --git a/_policy/appendices/Graduated Return to Play Protocol.pdf b/_policy/appendices/Graduated Return to Play Protocol.pdf new file mode 100644 index 0000000..18217ec Binary files /dev/null and b/_policy/appendices/Graduated Return to Play Protocol.pdf differ diff --git a/_policy/appendices/SCAT5.pdf b/_policy/appendices/SCAT5.pdf new file mode 100755 index 0000000..c05188c Binary files /dev/null and b/_policy/appendices/SCAT5.pdf differ diff --git a/_policy/concussion.md b/_policy/concussion.md index 5c9690f..524d13e 100644 --- a/_policy/concussion.md +++ b/_policy/concussion.md @@ -1,9 +1,8 @@ --- 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:secretary-general@internationaltouch.org + +[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