Concussion Protocol

P

pewpew

SILVER ELITE
G03 game today. This is all second-hand info from my wife. MF from our team rips a shot to clear the ball. Player from the other team trying to block the shot takes the ball on the side of the head at VERY CLOSE range according to my wife. Girl goes down immediately and doesn't get up. Play continues. Our coach yells at the ref to halt the game and CR stops play. Our coach/their coach/refs are all around the player. Player remains on the ground for a few minutes. Appears to be KO'd. Finally gets up and instead of walking her directly off the field they take the long route behind the goal to get her off the field sooner to resume play quicker I presume. (My wife tells me she knows if I was there I would've walked onto the field to try and assist..performed an assessment and most likely would've called 911 due to the mechanism of injury. 20+yrs in public safety in case you're wondering.)
The player is sitting on her team's bench and obviously altered by the way she is holding herself..or rather the lack thereof. Not sure how much time left in the second half. She says she sees someone on their phone and figures they're dialing 911. 10+mins pass. No FD arrives. After the game my DD's team shakes hands and they walk over to the bench to check on her as well and my kid tells me later that this girls looks altered. She's had her own concussion so she's speaking from experience.
I use a little google-fu and find the team's info. I decide to call their Team Mgr. and give my .02 Maybe it was none of my business. Who knows. But based on what my wife is telling me and her telling me what she knows I would've done if I was there this girl needs ALS. No answer. Left a v-mail suggesting they need to call 911 to be safe. Game ends. She calls me back. Still no FD response. I decide to call the coach and leave him a message too. No answer. I leave a message. Getting ready for work. I see a missed call by the number I called. I call back asking if this is the coach for HUA FC (not their real name). He says yes and starts by saying he doesn't appreciate my attititude on the v-mail..I stop him right there and tell him I don't really care if he appreciates it or not. Why hasn't anyone called 911?! I explain what my wife has told me and my experience. We go back n forth and I finally tell him we aren't getting anywhere. And I'm gonna just let it go. He says she thinks she probably has a concussion. YOU THINK?!?! Parents were there too. They said they would take her and go get checked out he said. I told him good luck and I hope the kid ends up ok.
Who is responsible at the time of the incident to make the decision to call 911. The ref. The coach. The parent. The bystander assisting who is trained. I'm tempted to email CalSouth regarding the ref and even that club DOC about their coach. Is this going too far??
My wife says I probably wouldn't have even let her up off the field. Another parent from our team sent me a text saying it looked really bad out there and the girl appeared to be in bad shape.
So much for looking out for the safety and best interest of the players...
 
You did and are doing the right thing. It sounds like MANY adults at the game all failed. You can contact the gaming circuit and Cal South and let them investigate it from there. I am not sure how much they care though. There is only so much YOU can do though. Thanks for being that parent that cares though. I would want the same for my kid.
 
Why didn't you or your wife call 911 while the girl was still at the field? Both of you believed that she needed to be assessed profesionally while the game was still going on. With your professional background and your wife's belief that 911 should have been called immediately, you both still didn't call. Why would a civilian do any better?

If you are/were fd, you should know better than anyone what happens when people think someone else called 911.

Hopefully she's ok.
 
IMO it should be the team manager ( with direction from the coach) or the kid’s parent who calls. The referees shouldn’t be carrying their phones on them during the game as most phones don’t fit in the short pockets of the new uniforms, so it would be hard for them to make the phone call. But they can inform the coach to make that phone call.
I had that situation at last year’s CSL League Cup when my son ( GK) and a forward decided to play chicken during a break away and neither on flinched. It was a pretty ugly collision right before the half. There was no medical tent there so they said the 2 opinions were to call 911 or transport him ourselves which we did. But I was the one that had to make that decision as the coach wanted to put him back out into the game.
 
Since you mentioned Cal South I assume the player is in one of there leagues:

They have a whole section and resources on the topic
https://www.calsouth.com/en/playersafety/

#1 responsibility is with the parent(s) and they were required to read and understand Cal South Concussion Information Fact Sheet for Parents
https://media.calsouth.com/data/Dow...sionParentFactSheet5.25.17V4.ENG.pdf?rev=26CB

#2 responsibility is the coach(s) who also have to follow the concussion protocol

If the parent(s) are not in attendance they can delegate to a team manager or some other adult(s) but I'm not sure a team manger is accountable otherwise unless they also have to sign or go through some sort of manager training for concussions protocols for team members that I'm not aware of.

Any case lets all hope the players get checked out correctly, is eventually ok and the parents follows the protocol rest of the way.

Good for you to bring this up and trying to help out.
 
I work in the medical field and have dealt with numerous mild TBI to serious TBI cases. I also have to go through soccer Head Injury training several times each year.

Referee would be the one to tell the coach that the player is done playing for the day, is required to annotate the head injury on the game report and submit a supplemental report. A referee should never say that a player has a concussion, but should say there was a head injury and exactly how it occurred.

Coach can also indicate to the referee that the player is done for the day due to a head injury (Referee is still responsible to report it). Coach is also responsible for assessing the player and notifying the club that the referee indicated a head injury, so the club can work with the league and parents to start the concussion process. The coach should also talk with the parents and manager to determine what the parents want to do.

Parents, if they believe the player may have a concussion they can take the player to the ER. They are responsible for working with the league and club during the concussion process.

Spectators should stay off the field unless the referee asks them to come on. Let the process work.

Just because a parent yells that they are a doctor, paramedic, nurse, etc. doesn’t mean that they are or are needed on the field. If the injury is bad enough that the player cannot be moved and 911 needs to be called, I will talk to the coach to bring the parents on and if the coach has a spectator that that works in the medical field bring them on. I will rarely bring someone on from the other team since it can cause problems if there was a foul involved.

As a referee I have seen a fairly good number of head injuries. I have only seen two head injuries where 911 needed to be called and all of the others the parents transported to the ER or a doctor. In one the keeper got knocked out when he hit the post and was out for about 5 minutes with blood coming out his ear. The other one involved a girl that took a hard kicked ball to the eye and the eye filled with blood, so the parent called 911.

I understand you wanted to help, but you were not at the field to hear what the referees, coach, manager and parents discussed. Maybe the parents did not want to call 911 and planned to take the player to the ER after the game. I can understand why the coach did not appreciate you involving yourself into a situation that has a process that must be followed. Unless the coach is a complete moron and has been living under a rock for the past five years, they know there is a required process for head injuries.
 
I talked to our coach this morning and told him what I'd done so that he was aware of it. He smiled/laughed and said right after the game the other coach played him my v-mail and asked "Is this one of your dads?" He said yes. "He's been in with the FD for a long time. He's helped a few of our own and other team's players in the past when they needed help." The other coach.."oh." Our coach said the girl was out cold on the field. He wanted to call 911 but the dad came onto the field and said no..she'll be ok. Our coach said he thought the dad was a bit spun out and unsure of what to do so dad said let's just get her off the field. Our coach said to move the girl to our bench at least since it was really close by but they opted to walk her all the way around to their bench with the help of 2 people assisting her because she couldn't really walk under her own power. Spoke with another dad from our team that was right there and said the blow to the head from the ball was hard..but her fall to the ground and her head hitting the grass seemed worse since she did nothing to protect herself as I'm guessing she was already dazed from the blow from the soccer ball.

In response to those asking why neither my wife nor myself called 911... I was hard asleep when she called. Finished a 36 Sat morning followed by a full day of stuff around the house including watching games and coaching one game. She took our G03 to her game while I stayed home and slept. When she called and told me what was going on..I rolled over..found the team info..called the Team Mgr and left a v-mail and went back to sleep. When my wife called back a second time to tell me there still wasn't a FD response and that the game had just ended I sat up and called their coach. Left the v-mail. I missed his call to me. Called him back. We hashed it out as previously stated...including him saying the family was taking her to the ER. Nothing left for me to do at that point. My wife and I are both kicking ourselves in the ass for not doing anything. I was in a slight fog. By the time I woke myself up and spoke with the coach it was too late for a FD response.

@Surfref You always give good info on here. However I must disagree with you on this one. You're saying to let the process work. But in this instance the process failed. By myself included. 3rd party informants not at the scene call 911 all the time to request a 911 response. There is nothing wrong with getting units rolling. It's better to either cancel them on the way if updated info is received or even once they get there and assess and decide everything is ok. Then you factor in the delayed response time of calling 911 and the chance that you aren't getting the jurisdictional units who might be on another run. Instead you are getting the 2nd or 3rd-in units who are coming from a further distance and have extended the time even longer to get the patient help. Don't get me wrong. I'm not saying I'm going to call the local FD every time I get a text or a phone call of someone needing help. But with credible info why wouldn't you elect to be proactive. I won't make the same mistake again. I think we can all learn from this incident.

UPDATE: In the time it's taken me to finish this post our coach sent me a text. He sent a text earlier today to the other coach asking about his player. She did suffer a TBI and will be ok but will be out for an unspecified amount of time...........
 
Is the CIF concussion protocol different from the Cal-South one?
To summarize what I belive the Cal-South one to be:
1. Player gets hurt in the head. Player comes out of the game. Player does not return to game (Ref is supposed to make note on the game card and take the player card?)
2. Player must be seen by a doctor prior to returning to practice or games.
3. If player sees a doctor and the doctor says "no concussion", the doc signs a note and the player can return. (Coach or parents may elect to sit her out more time).
4. If a player sees a doctor and doctor says "yes concussion", the player may not return until the doctor clears her. Which means at least 1 week of no symptoms (headache, dizzyness, light sensitivity, able to read, etc) and then a doctors note stating that she is cleared to resume all activities.

I heard recently that high school requires additional fitness testing to clear a player. Anyone have the details?
 
timbuck said:
Is the CIF concussion protocol different from the Cal-South one?
To summarize what I belive the Cal-South one to be:
1. Player gets hurt in the head. Player comes out of the game. Player does not return to game (Ref is supposed to make note on the game card and take the player card?)
2. Player must be seen by a doctor prior to returning to practice or games.
3. If player sees a doctor and the doctor says "no concussion", the doc signs a note and the player can return. (Coach or parents may elect to sit her out more time).
4. If a player sees a doctor and doctor says "yes concussion", the player may not return until the doctor clears her. Which means at least 1 week of no symptoms (headache, dizzyness, light sensitivity, able to read, etc) and then a doctors note stating that she is cleared to resume all activities.

I heard recently that high school requires additional fitness testing to clear a player. Anyone have the details?
Click to expand...

Try this https://www.calsouth.com/en/playersafety/
 
timbuck said:
Is the CIF concussion protocol different from the Cal-South one?
To summarize what I belive the Cal-South one to be:
1. Player gets hurt in the head. Player comes out of the game. Player does not return to game (Ref is supposed to make note on the game card and take the player card?)
2. Player must be seen by a doctor prior to returning to practice or games.
3. If player sees a doctor and the doctor says "no concussion", the doc signs a note and the player can return. (Coach or parents may elect to sit her out more time).
4. If a player sees a doctor and doctor says "yes concussion", the player may not return until the doctor clears her. Which means at least 1 week of no symptoms (headache, dizzyness, light sensitivity, able to read, etc) and then a doctors note stating that she is cleared to resume all activities.

I heard recently that high school requires additional fitness testing to clear a player. Anyone have the details?
Click to expand...

Basically the same protocol for club. As a referee we can get in trouble for not reporting. High School does make it easier and has a more streamlined system. I never get an argument from HS coaches if I tell them their player is suspected of having a head injury and they are done for the day. But, when I say the same thing to club coaches I get pushback about 50% of the time from the coach and parents. I have never had a HS coach try to put a player with a suspected head injury back in the game, but have had numerous club coaches attempt to put the player back in.
 
What about this part on the cal-south form?

“If the licensed health care provider determines that the athlete sustained a concussion or other head injury, the athlete shall also complete a graduated return-to-play protocol of no less than seven days in duration under the supervision of a licensed health care provider.”

What are the specifics of the graduated return to play protocol?
 
Surfref said:
Basically the same protocol for club. As a referee we can get in trouble for not reporting. High School does make it easier and has a more streamlined system. I never get an argument from HS coaches if I tell them their player is suspected of having a head injury and they are done for the day. But, when I say the same thing to club coaches I get pushback about 50% of the time from the coach and parents. I have never had a HS coach try to put a player with a suspected head injury back in the game, but have had numerous club coaches attempt to put the player back in.
Click to expand...

I'm suspecting it is due to shorter rosters on club teams compared to HS teams
 
timbuck said:
What about this part on the cal-south form?

“If the licensed health care provider determines that the athlete sustained a concussion or other head injury, the athlete shall also complete a graduated return-to-play protocol of no less than seven days in duration under the supervision of a licensed health care provider.”

What are the specifics of the graduated return to play protocol?
Click to expand...

http://www.cifstate.org/sports-medicine/concussions/index
 
pewpew said:
I talked to our coach this morning and told him what I'd done so that he was aware of it. He smiled/laughed and said right after the game the other coach played him my v-mail and asked "Is this one of your dads?" He said yes. "He's been in with the FD for a long time. He's helped a few of our own and other team's players in the past when they needed help." The other coach.."oh." Our coach said the girl was out cold on the field. He wanted to call 911 but the dad came onto the field and said no..she'll be ok. Our coach said he thought the dad was a bit spun out and unsure of what to do so dad said let's just get her off the field. Our coach said to move the girl to our bench at least since it was really close by but they opted to walk her all the way around to their bench with the help of 2 people assisting her because she couldn't really walk under her own power. Spoke with another dad from our team that was right there and said the blow to the head from the ball was hard..but her fall to the ground and her head hitting the grass seemed worse since she did nothing to protect herself as I'm guessing she was already dazed from the blow from the soccer ball.

In response to those asking why neither my wife nor myself called 911... I was hard asleep when she called. Finished a 36 Sat morning followed by a full day of stuff around the house including watching games and coaching one game. She took our G03 to her game while I stayed home and slept. When she called and told me what was going on..I rolled over..found the team info..called the Team Mgr and left a v-mail and went back to sleep. When my wife called back a second time to tell me there still wasn't a FD response and that the game had just ended I sat up and called their coach. Left the v-mail. I missed his call to me. Called him back. We hashed it out as previously stated...including him saying the family was taking her to the ER. Nothing left for me to do at that point. My wife and I are both kicking ourselves in the ass for not doing anything. I was in a slight fog. By the time I woke myself up and spoke with the coach it was too late for a FD response.

@Surfref You always give good info on here. However I must disagree with you on this one. You're saying to let the process work. But in this instance the process failed. By myself included. 3rd party informants not at the scene call 911 all the time to request a 911 response. There is nothing wrong with getting units rolling. It's better to either cancel them on the way if updated info is received or even once they get there and assess and decide everything is ok. Then you factor in the delayed response time of calling 911 and the chance that you aren't getting the jurisdictional units who might be on another run. Instead you are getting the 2nd or 3rd-in units who are coming from a further distance and have extended the time even longer to get the patient help. Don't get me wrong. I'm not saying I'm going to call the local FD every time I get a text or a phone call of someone needing help. But with credible info why wouldn't you elect to be proactive. I won't make the same mistake again. I think we can all learn from this incident.

UPDATE: In the time it's taken me to finish this post our coach sent me a text. He sent a text earlier today to the other coach asking about his player. She did suffer a TBI and will be ok but will be out for an unspecified amount of time...........
Click to expand...

I agree with you that a possible TBI should be seen by an MD as quickly as possible. I wouldn't say that the process failed, I would say the parents failed in your situation. The problem I have had over the years is that when I have suggested that 911 be called for a head injury the parents always say no that they will transport because they do not want to pay for the ambulance. Most parents are under the impression that if the FD responds it means their kid has to be transported by ambulance which is not true. Ultimately it is the parents decision and they sometimes make really dumb choices. I had a HS age player with a lower tib-fib break (dangling ankle type) and the parents refused to have the kid transported via ambulance. The FD stabilized the leg and helped load the kid into the parents SUV and the parents transported him.
 
timbuck said:
Is the CIF concussion protocol different from the Cal-South one?
To summarize what I belive the Cal-South one to be:
1. Player gets hurt in the head. Player comes out of the game. Player does not return to game (Ref is supposed to make note on the game card and take the player card?)
2. Player must be seen by a doctor prior to returning to practice or games.
3. If player sees a doctor and the doctor says "no concussion", the doc signs a note and the player can return. (Coach or parents may elect to sit her out more time).
4. If a player sees a doctor and doctor says "yes concussion", the player may not return until the doctor clears her. Which means at least 1 week of no symptoms (headache, dizzyness, light sensitivity, able to read, etc) and then a doctors note stating that she is cleared to resume all activities.

I heard recently that high school requires additional fitness testing to clear a player. Anyone have the details?
Click to expand...
And do clubs actually ask to see the MD note allowing the player to play? Our coach could care less....
 
They should. Or I think they could be held liable if another head injury occurs prior to the doctor clearance.
 
I had a ref tag my older daughter with a possible concussion during a game and she wasn't allowed back in. I was irritated she was irritated and we had to get her cleared by a doctor before she could come back to practice or games. Her club had set up baseline testing to be done at the banner concussion center at the start of the season and i was able to get her in the following day to get cleared. Even though she said she felt fine and knew she didnt have a concussion her baseline test proved otherwise. She failed miserably and took 2 weeks till she finally passed it. I was a horrible parent thinking that a ref would want my daughter out of a game for know good reason.
Speed said:
And do clubs actually ask to see the MD note allowing the player to play? Our coach could care less....
Click to expand...
In Arizona if you get a head injury during the game the ref pulls the players card and the state association will not release it till you bring in a doctors note.
 
Just A Dad said:
I had a ref tag my older daughter with a possible concussion during a game and she wasn't allowed back in. I was irritated she was irritated and we had to get her cleared by a doctor before she could come back to practice or games. Her club had set up baseline testing to be done at the banner concussion center at the start of the season and i was able to get her in the following day to get cleared. Even though she said she felt fine and knew she didnt have a concussion her baseline test proved otherwise. She failed miserably and took 2 weeks till she finally passed it. I was a horrible parent thinking that a ref would want my daughter out of a game for know good reason.

In Arizona if you get a head injury during the game the ref pulls the players card and the state association will not release it till you bring in a doctors note.
Click to expand...

The club is supposed to pull the card and
Speed said:
And do clubs actually ask to see the MD note allowing the player to play? Our coach could care less....
Click to expand...

The coach had better care. This is not something that is mandated by Cal South, but is California law. The club is supposed to pull the player card and notify the league and Cal South. Leagues and Cal South track that the player is properly cleared and follows the process to ease back into playing. During State/National Cup and a lot of tournament the card gets pulled at the field and turned over to Cal South until the player is cleared.
 
Just A Dad said:
I had a ref tag my older daughter with a possible concussion during a game and she wasn't allowed back in. I was irritated she was irritated and we had to get her cleared by a doctor before she could come back to practice or games. Her club had set up baseline testing to be done at the banner concussion center at the start of the season and i was able to get her in the following day to get cleared. Even though she said she felt fine and knew she didnt have a concussion her baseline test proved otherwise. She failed miserably and took 2 weeks till she finally passed it. I was a horrible parent thinking that a ref would want my daughter out of a game for know good reason.

In Arizona if you get a head injury during the game the ref pulls the players card and the state association will not release it till you bring in a doctors note.
Click to expand...

My daughter's concussion while in college was similar. She initially did not have a headache but was a little unsteady and wanted to go back into the game. After the game the trainers took her to do her test to compare to her baseline test and it showed she was impaired. Over the next couple hours in the ER her symptoms (sensitivity to light and sound, headache, nausea, sleepiness, unsteady standing). It took her 6 weeks to get cleared and two weeks before she could attend classes again. The thing that really pissed me off and her after she saw the video, was the referee didn't seem to care that she got leveled, flew 3 yards through the air and bounced her head off the turf, he just slowly walked the 40 yards to her, called no foul and did not issue a card. We ran into him on the field about 8 months after the incident and I was surprised that my daughter unloaded on him. I think she felt justified in telling another referee they were a useless old man and should not be refereeing any one (throw in a few words of profanity). He just looked dejected as I pulled her away.
 
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