Concussions Awareness and Treatment

Summary: This page contains important information on Concussions; Acute Head Injuries, warning signs, care, and treatment. , You will find important information on helmet use, fitting, limitations, and emerging helmet technology. These topics are vital for skiing families. 

Introduction

Understanding what to do if you or a loved one ever experience a concussions is good knowledge to keep handy. My decision to create a webpage came about when I was working on the SRT Online Concussion Policy Form. If your home is half as busy as mine, chances are you skim-read several if not all of the forms we must sign in order to join SRT and WIJARA, including the Concussion Policy Form. Yet based on my own experience from years of racing and coaching, I believe that this topic deserves it's own page. And, I sincerely hope that when you have time you take a few minutes to sit down and read up on concussions.
-- Coach Mya

In 2009, Michael Schumacher, was seriously injured when he lost control skiing, crashed, and suffered a nearly fatal head injury while skiing in the Alps. Michael's head injury served as a wake up call for skiers globally that our heads are precious and deserve protecting.

Educating the SRT ski racing community on concussions goes lock-step with the team's philosophy of providing comprehensive information and education to athletes and family members participating in skiing.

Part two of this series provides crucial information on skiing helmets, providing a comprehensive resource, covering everything from how to fit helmets properly to their use in skiing, their effectiveness, their limitations, and the latest technology advancements in helmet design and construction.

So this page, is the first of two pages, with this page expanding on what covered in the concussion form, plus additional information on post injury care.

Understanding Concussions, Head and Upper Neck Injuries, and Monitoring

In the last two decades new research has shed light on head injuries and concussions in sports. In skiing use of helmets has reduced the number of head injuries reported by ski areas. One high-profile skiing accident, the death of Nicole Richardson, illustrated the importance of care & treatment for head injuries in the 72 hours after the accident. The tragic incident must serve as a reminder to us all -- athletes, coaches, parents, and guardians -- that we must pay attention and monitor a concussed athlete, parent, or coach in the aftermath of a incident in order to prevent a seemingly minor bell ringing turning into a nightmare scenario.  

The sources that I used for this page came from multiple prominent research institutions actively engaged in the study, care, and treatment of head injuries. Two points that I cannot emphasize enough, engraved in every source, points to the important of (A) prevention and (B) monitoring the first 72 hours, post incident, for clues that the head injury has manifested into a dangerous, life threatening situation.

About The Acute Symptoms Phase

Called "The Acute Symptoms Phase", the 72 hours post incident, is the window of time where symptoms indicative of a serious head injury manifest. The acute symptomatic phase is defined as the time from injury, through maximum symptoms, to the beginning of when the symptoms resolve. Typically, this phase lasts less than three days. Within the acute symptoms phase it's important that the patient is diagnosed then monitored. It's up to first responders, most likely coaches and ski patrol, check for the clues that indicate a head injury has occurred. If they find that a head or upper neck injury has occurred the athlete will be removed from practice, either sent to ski patrol or to the lodge. If during a race day or weekend, an athlete experiences a head injury the athlete should be removed from any further skiing or racing for the day by the parents, guardians, or coaches. 

Secondary Impact Syndrome (Why Athletes Must Sit Out Practice or Competition)

Rare but possible, Secondary Impact Syndrome, (SIS), happens if an athlete experiences two head injuries back to back. Tho rare, SIS occurs when an initial concussion is ignored and an athlete continues to participate in practice or compete. If a second blow to the head, even minor, is experienced while symptoms of the initial injury are still present, the second blow becomes the catalyst for a life threatening injury to the brain. Tho uncertain to the exact mechanism, it's believed that when the brain swells rapidly after the initial injury, upon the second impact, the swelled brain, already squeezed or weakened, suffers a catastrophic internal failure. SIS usually results in near instant death, those who do not die are typically left seriously disabled for life.

Acute Symptomatic Phase Diagnosis

Even minor blows to the head can cause a concussion. We use to define concussions interns of severity. This is no longer the case, if a blow to the head occurs, you should automatically assume a concussion has occurred. If a person experiences a momentary change to their vision, such as a "flash" or complains of pain then you must assume a concussion has occurred. If a person experiences a loss of consciousness, even briefly, this is an automatic red flag warning that a concussion has occurred. If you observe any of the other following "Red Flag Symptoms" during this phase, you should assume a concussion has occurred and should go to the emergency room.

Red Flag Signs of an Acute Head Injury

Below the Red Flag warning signs are segmented based on when the symptoms are most likely to arise post injury. That is to say, what are the initial signs of an acute head injury in the immediate aftermath vs. What symptoms are most likely to manifest after several hours have passed post injury.

• Clues & Symptoms Detected at the Site of an Accident.

  • Unconscious or Lost consciousness (even briefly).
  • Patient complains of headache or acute pain. (Exclaims "I hit my head hard!").
  • Experiences a "flash" in vision during crash, or patient complains of "seeing stars".
  • Painful with or without touch, (all over? or just at the impact sight?).
  • Helmet has visible external damage.
  • Sensitivity to light or noise, wants to keep eyes closed.
  • Ringing in the ears and head.
  • Repetitive comments or questions.
  • Can't recall or answer basic questions, ( Where they are? The day of the week? Their name, age, grade, or school they attend? etc.).
  • The head or neck is painful to move or rise.
  • Dizziness or problems with balance.
  • Weakness, tingling, or burning in arms or legs.
  • Dilated pupils or unevenly dilated pupils

• Post incident, symptoms that develop in the minutes and hours after

  • Headache or Pressure in the head building
  • Severe or increasing headache
  • Severe neck pain
  • Increasingly restless, agitated, or combative
  • Increasingly tired or wants to sleep
  • Vision issues, such as persistent blurry, double, or loss of vision in one or both eyes
  • Dilated pupils or unevenly dilated pupils
  • Confusion, lack of memory
  • Nausea, feeling sick

• Symptoms that typically are experienced beyond 2 hours, tho they may occur earlier

  • Repetitive vomiting
  • Seizure or convulsion
  • Feeling off, not feeling right, feeling down
  • Nausea
  • Dizziness or Problems with Balance
  • Problems with Concentration or Memory
  • Increasing confusion or inability to stay awake

• Additional Signs that may be Observed by Parents or Guardians

  • Appears dazed or stunned
  • Is confused
  • Forgets instruction
  • Moves clumsily
  • Answers questions slowly
  • Shows mood, behavior or personality changes
  • Can't recall events prior to fall or hit
  • Can't recall events after hit or fall

Remember, if you see any of these symptoms seek medical attention, go to the emergency room or urgent care.

READ THIS INFORMATiON ABOUT CONCUSSIONS, HEAD INJURIES, AND RISK

• Concussions / Head injuries may result in disability or death in extreme situations.
• Seek medical evaluation and attention if your child experiences any of the signs above.
• Second impact syndrome, or SIS, happens when the brain swells rapidly shortly after a person suffers a second concussion before symptoms from an earlier concussion have subsided. This event is rare, but when it does happen, it is most often fatal. The few who do not die from such an event are usually left severely disabled for life!
• Helmets do not help if a skier hits a solid object at speeds greater than 12 mph! Hitting immovable objects such as a tree, exposed rock, lift tower, wooden pole, or other ski area equipment is extremely likely to result in serious injury, perminent disablity, or DEATH! 
• Helmets help only to a point. Skiing in terrain parks, skiing off of the edge of marked trails, and/or skiing out of control increases the risk of serious concussion, head, or bodily injury.
• IT IS UP TO PARENTS / GUARDIANS TO DISCUSS THESE TOPICS WITH THEIR CHILD!
• IT IS UP TO PARENTS / GUARDIANS TO ACCEPT THE RISKS ASSOCIATED WITH SKIING!

Care & Monitoring: Post Injury Concussion Treatment 

• First off, if you're concerned, seek medical attention. Don't assume that symptoms will get better.
• It is CRUCIAL to monitor the patient for the symptoms listed above in the immediate aftermath of the event that led to the head injury..
• Resting both physically and mentally helps.
• Icing helps keep swelling down Icing in rotations of 15 - 20 minutes every two to three hours.
• Check the patient's symptoms throughout the first 72 hours at least every 2 to 4 hours.
• Avoid any practices or physical exercise.
• Keep noise low and movement to a minimum
• Avoid mental stress like homework, testing, or reading

After you are done reading this page, read about Helmets, Use, & Limitations under Team Resources.

Thank you for reading -- the more members we can educate regarding concussions and care the better off we'll all be for it.

-- Coach Mya