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Crucial Concussion Evaluation Info for Coaches
by Dev Mishra, October 3rd, 2012 12:28PM
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TAGS:  youth boys, youth girls


By Dev K. Mishra, M.D.

How should a coach evaluate a young athlete for a possible concussion?

The key word in that first sentence is “possible,” meaning that a coach who is not medically trained should not make the definitive diagnosis of a concussion. Your job is to assess the athlete and determine whether you suspect a concussion, remove that athlete from play, and send the athlete for evaluation by a medical professional trained in sports concussion management.

I highly recommend the Pocket SCAT2 concussion assessment tool, which you can download HERE, under the heading "Assessment Tools."

If your athlete has taken contact and has any one of the features noted on the card you should suspect a concussion and remove the athlete from play:

* Loss of consciousness
* Seizure or convulsion
* Amnesia
* Headache
* “Pressure in head”
* Neck Pain
* Nausea or vomiting
* Dizziness
* Blurred vision
* Balance problems
* Sensitivity to light
* Sensitivity to noise
* Feeling slowed down
* Feeling like “in a fog“
* “Don’t feel right”
* Difficulty concentrating
* Difficulty remembering
* Fatigue or low energy
* Confusion
* Drowsiness
* More emotional
* Irritability
* Sadness
* Nervous or anxious

The downloads available at the Sports Concussion Library offer more detailed information, and should be studied by coaches.

If the athlete is unconscious, do not move, shake, or attempt to rouse the athlete. Call for emergency medical transportation immediately. Stay with the athlete until help arrives. If the athlete is unconscious it is a medical emergency.

As our knowledge about concussion has improved it’s clear to us that the definition of concussion needs to change. Long gone are the days when an athlete needed to be knocked unconscious or close to unconscious before it was deemed a concussion.

We know now that even a headache that happens after contact to the player’s head, player’s body, or by the ground to the player’s body can be an early indicator of a concussion. Essentially, the definition of concussion is quite a bit broader than it once was.

What that means for the coach is that there are going to be a lot more suspected concussions. It means that you’ll likely deal with situations where you’ll ask yourself questions such as “it’s just a headache, do I really have to hold this player out after something like that?”

My advice to you: yes, you need to hold that player out of practice or competition and the player should seek medical attention urgently.

Use your best judgment and be overly cautious.

The final phrasing on the SCAT2 card says what you need very clearly:

“Any athlete with a suspected concussion should be IMMEDIATELY REMOVED FROM PLAY, urgently assessed medically, should not be left alone and should not drive a motor vehicle.”

(Dr. Dev K. Mishra is the creator of the injury management program for coaches. He is an orthopedic surgeon in private practice in Burlingame, Calif. He is a member of the team physician pool with the U.S. Soccer Federation and has served as team physician at the University of California, Berkeley. This article first appeared on

1 comment
  1. Steve Bender
    commented on: October 3, 2012 at 7:49 p.m.
    TERRIBLE Idea!!!! The SCAT 2 assessment tool is designed for medical professionals and athletic trainers. It is not something that coaches who are not trained and licensed with their state medical board should be using. There is a PAR assessment tool available in the app store and google play that is designed for coaches to use. It collects specifics on the injury and then asks for a yes no answer on each of the 14 signs and 14 symptoms that are listed in the CDC informaiton made available through their website and links from the US Youth Soccer site. Whether coaches use the app or the paper version, the result is the same: If a player has sustained a bump or blow to the head or body and exhibits one or more of the signs OR reports one or more of the symptoms, the responsible coach removes the player from the activity and refers him or her to a health care provider experienced in evaluating for concussion. Once removed, this player should not return until an experienced health care provider has cleared the player and the player has gone through a stepwise progressive return to play working up from rest to aerobic activity, to increasing activity, full practice and full game play, with at least 24 symptom free hours inbetween each step. For the 30 plus states that have passed the Zachary Lystedt law version applicable to youth sports as well as schools, coaches in those states should already know this. For the rest, including my own, it is time to take action and protect our players from themselves and their ill-informed coaches, parents, and soccer leaders. The CDC website

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