ACC tackles concussion
ACC, the Rugby Union and Sports Medicine New Zealand have combined to produce a sideline concussion management guide
that will be distributed free to sports coaches this season.
The Sideline Concussion Check is the size of credit card and outlines signs, symptoms and tests for concussion.
If any of 12 orientation, concentration and memory questions is answered incorrectly, concussion becomes a distinct
possibility that requires further medical evaluation before the player returns to the game.
ACC Programme Manager Simon Gianotti says injury to the brain is different from bruises or cuts or broken limbs because
you cannot see the extent of the damage.
"Often, there's a false belief that everything is fine when it is not," he says.
Concussion occurs when there is a sudden, violent movement to the head such as in a tackle or a collision between
players. The resulting force causes the brain to bounce inside the head and collide with the skull walls.
There is increasing evidence that concussion is going undiagnosed and unreported with players risking long-term brain
damage because they are not getting proper treatment.
Most of the time, concussion is only suspected when the player is obviously disoriented or has been knocked out cold.
Other times, it gets diagnosed only when a player receives medical treatment for another injury.
Mr Gianotti says that is worrying because if there is a second concussion before the player has fully recovered from the
first, permanent brain damage can result.
"Many of the brain cells that would recover if the brain was allowed to heal die if the brain is further injured while
in this vulnerable state," he says.
The International Rugby Board guidelines stipulate that a player with concussion stand down from play for a minimum of
three weeks and not return to play or training until symptom-free and with a medical clearance.
ACC's Sideline Concussion Check follows a formula developed by the University of Pittsburgh that involves a series of
questions that test short-term memory.
“The questions are not an IQ test,” says Mr Gianotti.
Among the correct questions to ask: "Which ground are we at?", "Which team are we playing?" and "Which team did we play
Immediate memory loss, a good indicator of concussion, is also checked for through questions about the side that scored
most recently and what happened immediately before, and after the impact or collision.
Concentration is checked by asking the player to repeat the days of the week backwards and repeating numbers backwards.
The Sideline Concussion Check also has an insert detailing the procedures that should be followed in the two days
following a suspected trauma to the brain or concussion.
For instance, you should be taken to hospital if you have a headache that gets worse, you start vomiting, can't
recognise people or places, pass out, behave unusually, have seizures, or you are very irritable, unsteady on your feet,
or slur speech. Someone should also wake you and check on you every two hours in the first night's sleep after the
These inserts can be given to the player and/or player support network and can be re-ordered when they run out. The
insert provides advice on what pain relief to take and discusses what to avoid, for instance, alcohol and driving.
“The inserts are also available in Maori, Samoan and Tongan. English is not the first language for everyone. The
information on the insert is so important that we wanted to ensure that it could reach a wider audience.
It is important to realise that concussion symptoms may not appear immediately," Mr Gianotti says.
"When concussion occurs, the blood flow to the brain decreases, but it can take a few minutes for the electro-chemical
balance within the brain to reflect the impact of the concussion.
"You can appear perfectly lucid immediately after the event, but may show signs of confusion a few minutes later."
The Sideline Concussion Check is free and available to all coaches regardless of sport. Free additional copies of the
insert card and the Sideline Concussion Check can be obtained on 0800 THINKSAFE (0800 844 657), quoting ACC1409 for the
Sideline Concussion Check and ACC1284 for the insert cards.